Sarah Wiehe
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Engaging the Community to Inform Patient-Centered Outcomes Research
Despite well-known associations between where a person lives and his/her health, few patient-centered approaches have been used to develop and implement place-based health interventions. For the first time in the United States, Avondale Meadows, a Purpose Built Community in Indianapolis, is incorporating health as part of its community development strategy.
Avondale Meadows is an 800-unit, mixed income housing development with a key emphasis on housing, education, and health. Now, nearly all units leased and health-related amenities, including a Health and Wellness Center, are about to be implemented. Dr. Wiehe, with a team of academic and community partners, have engaged all stakeholders, including current and future residents, to discuss how to improve the community’s health. Through mixed-methods and participatory design, the team has elicited and engaged residents to develop health-promoting interventions in their community. These ideas were presented back to the larger community for validation and further resident engagement. Now, as the community members are incorporated into the ‘research team,’ they will work together to translate their ideas into action.
Dr. Wiehe’s work to engage the community in ways to improve their health is another example of how IUPUI’s faculty members are TRANSLATING their RESEARCH INTO PRACTICE.
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Item Acceptance of HIV Testing for Children Ages 18 Months to 13 Years Identified Through Voluntary, Home-Based HIV Counseling and Testing in Western Kenya(2010-10) Vreeman, Rachel C.; Nyandiko, Winstone M.; Braitstein, Paula; Were, Martin C.; Ayaya, Samwel O.; Ndege, Samson K.; Wiehe, Sarah E.Background Home-based, voluntary counseling and testing (HCT) presents a novel approach to early diagnosis. We sought to describe uptake of pediatric HIV testing, associated factors, and HIV prevalence among children offered HCT in Kenya. Methods The USAID-AMPATH Partnership conducted HCT in western Kenya in 2008. Children 18 months to 13 years were offered HCT if their mother was known to be dead, her living status was unknown, mother was HIV-infected or of unknown HIV status. This retrospective analysis describes the cohort of children encountered and tested. Results HCT was offered to 2,289 children and accepted for 1,294 (57%). Children were more likely to be tested if more information was available about a suspected or confirmed maternal HIV-infection (for HIV-infected, living mothers OR=3.20, 95% CI: 1.64–6.23), if parents were not in household (OR=1.50, 95% CI: 1.40–1.63), if they were grandchildren of head of household (OR=4.02, 95% CI: 3.06–5.28), or if their father was not in household (OR=1.41, 95% CI: 1.24–1.56). Of the eligible children tested, 60 (4.6%) were HIV-infected. Conclusions HCT provides an opportunity to identify HIV among high-risk children; however, acceptance of HCT for children was limited. Further investigation is needed to identify and overcome barriers to testing uptake.Item Adolescent Burmese Refugees Perspectives on Determinants of Health(Springer, 2018-04) Dixit, Avika; Miner, Emily M.; Wiehe, Sarah E.; McHenry, Megan S.; Pediatrics, School of MedicineOver 70,000 Burmese refugees have resettled in the United States in the past decade. While Burmese adolescents quickly acculturate into American society, their perspectives on health are not well-known. The purpose of this study was to identify adolescent Burmese refugee perspectives on determinants of health and health-related experiences after resettlement. In this qualitative study, Burmese adolescents took photographs depicting health-related experiences that were used as elicitation tools during focus groups. These discussions were recorded, transcribed, and analyzed for themes. Participants described positive determinants of health, including family and church. Rampant tobacco use was identified by the participants as a determinant of poor health within the Burmese community. Notably, the participants were proud to serve as liaisons within their community, despite the stressful nature of this role. Our results highlight the need to screen this population for anxiety, secondary to serving as a liaison for their community, as well as tobacco use.Item Adolescent Health-Risk Behavior and Community Disorder(2013-11) Wiehe, Sarah E.; Kwan, Mei-Po; Wilson, Jeffrey S.; Fortenberry, J. DennisBackground Various forms of community disorder are associated with health outcomes but little is known about how dynamic context where an adolescent spends time relates to her health-related behaviors. Objective Assess whether exposure to contexts associated with crime (as a marker of community disorder) correlates with self-reported health-related behaviors among adolescent girls. Methods Girls (N = 52), aged 14–17, were recruited from a single geographic urban area and monitored for 1 week using a GPS-enabled cell phone. Adolescents completed an audio computer-assisted self-administered interview survey on substance use (cigarette, alcohol, or marijuana use) and sexual intercourse in the last 30 days. In addition to recorded home and school address, phones transmitted location data every 5 minutes (path points). Using ArcGIS, we defined community disorder as aggregated point-level Unified Crime Report data within a 200-meter Euclidian buffer from home, school and each path point. Using Stata, we analyzed how exposures to areas of higher crime prevalence differed among girls who reported each behavior or not. Results Participants lived and spent time in areas with variable crime prevalence within 200 meters of their home, school and path points. Significant differences in exposure occurred based on home location among girls who reported any substance use or not (p 0.04) and sexual intercourse or not (p 0.01). Differences in exposure by school and path points were only significant among girls reporting any substance use or not (p 0.03 and 0.02, respectively). Exposure also varied by school/non-school day as well as time of day. Conclusions Adolescent travel patterns are not random. Furthermore, the crime context where an adolescent spends time relates to her health-related behavior. These data may guide policy relating to crime control and inform time- and space-specific interventions to improve adolescent health.Item Area-level incarceration and STI risk among a cohort of justice-involved adolescents and adults(2014-11) Wiehe, Sarah E.; Rosenman, Marc; Scanlon, Michael L.; Fortenberry, J. Dennis; Aalsma, Matthew C.Background: Living in areas of high incarceration is associated with increased risk of STI; however, STI risk with respect to both this area-level exposure and an individual’s involvement with the justice system is not known. Objective: Among individuals before and after arrest or incarceration, assess the association between area-level incarceration rates and risk of chlamydia, gonorrhea, or syphilis. Methods: Retrospective cohort study of individuals living in Marion County (Indianapolis), Indiana who were arrested or in jail, prison, juvenile detention, or juvenile prison between 2005-2008 (N=97,765). Area-level incarceration exposure was defined by the proportion of person-days incarcerated among the total population*365 within a census block group. A 1-year period was assessed before and after a randomly-selected arrest/incarceration per person. Multivariable logistic regression, controlling for age, race, STI history, and year, was performed to assess chlamydia, gonorrhea, or syphilis risk by quartile area-level incarceration exposure, adjusting for individual clustering and stratifying by gender. Results: Area-level incarceration was associated with increased odds of each STI, with a dose response relationship particularly among those with an arrest or jail stay. Women with a history of arrest or jail/prison stay and living in high incarceration areas had higher odds of STI, compared to men with comparable incarceration history and living in similar areas.Item Assessing Individuals’ Exposure to Environmental Conditions Using Residence-Based Measures, Activity Location-Based Measures, and Activity Path-Based Measures(Wolters Kluwer, 2019-03) Morrison, Christopher N.; Byrnes, Hilary F.; Miller, Brenda A.; Kaner, Emily; Wiehe, Sarah E.; Ponicki, William R.; Wiebe, Douglas J.; Pediatrics, School of MedicineBackground: Many approaches are available to researchers who wish to measure individuals' exposure to environmental conditions. Different approaches may yield different estimates of associations with health outcomes. Taking adolescents' exposure to alcohol outlets as an example, we aimed to (1) compare exposure measures and (2) assess whether exposure measures were differentially associated with alcohol consumption. Methods: We tracked 231 adolescents 14-16 years of age from the San Francisco Bay Area for 4 weeks in 2015/2016 using global positioning systems (GPS). Participants were texted ecologic momentary assessment surveys six times per week, including assessment of alcohol consumption. We used GPS data to calculate exposure to alcohol outlets using three approach types: residence-based (e.g., within the home census tract), activity location-based (e.g., within buffer distances of frequently attended places), and activity path-based (e.g., average outlets per hour within buffer distances of GPS route lines). Spearman correlations compared exposure measures, and separate Tobit models assessed associations with the proportion of ecologic momentary assessment responses positive for alcohol consumption. Results: Measures were mostly strongly correlated within approach types (ρ ≥ 0.7), but weakly (ρ < 0.3) to moderately (0.3 ≤ ρ < 0.7) correlated between approach types. Associations with alcohol consumption were mostly inconsistent within and between approach types. Some of the residence-based measures (e.g., census tract: β = 8.3, 95% CI = 2.8, 13.8), none of the activity location-based approaches, and most of the activity path-based approaches (e.g., outlet-hours per hour, 100 m buffer: β = 8.3, 95% CI = 3.3, 13.3) were associated with alcohol consumption. Conclusions: Methodologic decisions regarding measurement of exposure to environmental conditions may affect study results.Item Assessing Needs and Experiences of Preparing for Medical Emergencies Among Children with Cancer and Their Caregivers(Wolters Kluwer, 2020-11) Mueller, Emily L.; Cochrane, Anneli R.; Moore, Courtney M.; Jenkins, Kelli B.; Bauer, Nerissa S.; Wiehe, Sarah E.; Pediatrics, School of MedicineBackground: Caregivers of children with cancer can experience stress when seeking care in the emergency department (ED). We sought to assess how caregivers prepare for and manage a medical emergency that arises in the community setting. Methods: A qualitative evaluation of ED visit preparations taken by children with cancer and their caregivers using self-reported interactive toolkits. Eligible participants included children with cancer (age: 11 to 21 y) currently receiving therapy for cancer diagnosis with an ED visit (besides initial diagnosis) within the previous 2 months and caregivers of same. Participants received a paper toolkit, which were structured as experience maps with several generative activities. Toolkits were transcribed, thematically coded, and iteratively analyzed using NVivo 12.0 software. Results: A total of 25 toolkits were received (7 children, 18 caregivers), with about three quarters of participants living >1 hour from the treating institution. Several important common themes and areas for improvement emerged. Themes included struggles with decision-making regarding when and where to seek ED care, preparing to go to the ED, waiting during the ED visit, repetition of information to multiple providers, accessing of ports, and provider-to-provider and provider-to-caregiver/patient communication. Conclusions: The information gained from this study has the potential to inform a tool to support this population in planning for and managing emergent medical issues. This tool has the potential to improve patient and caregiver satisfaction, patient-centered outcomes, and clinical outcomes.Item Association of environmental indicators with teen alcohol use and problem behavior: Teens' observations vs. objectively-measured indicators(Elsevier, 2017-01) Byrnes, Hilary F.; Miller, Brenda A.; Morrison, Christopher N.; Wiebe, Douglas J.; Woychik, Marcie; Wiehe, Sarah E.; Medicine, School of MedicineMost prior studies use objectively measured data (e.g., census-based indicators) to assess contextual risks. However, teens' observations might be more important for their risk behavior. OBJECTIVES: 1) determine relationships between observed and objective indicators of contextual risks 2) determine relations of observed and objective indicators with teen alcohol use and problem behavior. Teens aged 14-16 (N=170) carried GPS-enabled smartphones for one month, with locations documented. Ecological momentary assessment (EMA) measured teens' observations via texts regarding risk behaviors and environmental observations. Objective indicators of alcohol outlets and disorganization were spatially joined to EMAs based on teens' location at the time of the texts. Observed and objective disorganization, and objective indicators of alcohol outlets were related to alcohol use. Observed disorganization was related to problem behavior, while objective indicators were unrelated. Findings suggest the importance of considering teens' observations of contextual risk for understanding influences on risk behavior and suggest future directions for research and prevention strategies.Item Brief report: Using global positioning system (GPS) enabled cell phones to examine adolescent travel patterns and time in proximity to alcohol outlets(Elsevier, 2016-07) Byrnes, Hilary F.; Miller, Brenda A.; Morrison, Christopher N.; Wiebe, Douglas J.; Remer, Lillian G.; Wiehe, Sarah E.; Department of Pediatrics, IU School of MedicineAs adolescents gain freedom to explore new environments unsupervised, more time in proximity to alcohol outlets may increase risks for alcohol and marijuana use. This pilot study: 1) Describes variations in adolescents' proximity to outlets by time of day and day of the week, 2) Examines variations in outlet proximity by drinking and marijuana use status, and 3) Tests feasibility of obtaining real-time data to study adolescent proximity to outlets. U.S. adolescents (N = 18) aged 16–17 (50% female) carried GPS-enabled smartphones for one week with their locations tracked. The geographic areas where adolescents spend time, activity spaces, were created by connecting GPS points sequentially and adding spatial buffers around routes. Proximity to outlets was greater during after school and evening hours. Drinkers and marijuana users were in proximity to outlets 1½ to 2 times more than non-users. Findings provide information about where adolescents spend time and times of greatest risk, informing prevention efforts.Item Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment(Office of the Vice Chancellor for Research, 2012-04-13) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah; Zollinger, TerryUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program.Item Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment(Office of the Vice Chancellor for Research, 2013-04-05) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah E.; Zollinger, TerrellUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program.