For the December E4A Methods Blog post we crowdsourced innovative and/or transformative studies published in 2022 (with a couple from 2021 that we thought were worth highlighting). When soliciting recommendations, we defined innovative studies as those that employed new or novel approaches or methods or applied them in new ways. We defined transformative studies as those that have informed or have the potential to inform real-world decision-making to advance health and racial equity, as well as those studies that could lead to changes to enhance equity through the research process.
We didn’t provide any topical bounds and studies focused on a number of issues - from measuring structural racism to strategies for identifying misinformation. Additionally, several studies are featured where the research team used new data sources or existing data sources in new ways. Take a peek at the round-up of research highlighted through our crowdsourcing effort.
We’d love to hear if you have any thoughts about the articles below or if there are other studies you think should have been featured.
Measuring Racism & Community Power
Improving The Measurement Of Structural Racism To Achieve Antiracist Health Policy
Hardeman RR, Homan PA, Chantarat T, Davis BA, & Brown TH. Health Affairs. 2022;41(2).
Hardeman and team propose novel ways to measure structural racism and advance antiracist health policy research. The ability to measure changes in structural racism in response to policies and other interventions could change how we evaluate interventions and which ones are implemented.
Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities
Graetz N, Boen CE, Esposito MH. Journal of Health & Social Behavior. 2022;63(2):232-249.
The research team employed a counterfactual approach to examine race as a variable that is part of a social process rather than an individual characteristic. They did this to examine racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health to better understand how racist systems interact to impact health over time. The authors discuss the benefits and limitations of this approach.
Antiracism and Community-Based Participatory Research: Synergies, Challenges, and Opportunities
Fleming et al. American Journal of Public Health. 2022: Epub ahead of print.
The authors propose that the principles of antiracism and Community-Based Participatory Research (CBPR) align and that together they can be used to disrupt structural racism. They make recommendations for the use of antiracist-CBPR, provide examples, and discuss the challenges that those looking to use such an approach face.
Building Community Power To Dismantle Policy-Based Structural Inequity In Population Health
Iton A, Ross RK, Tamber PS. Health Affairs. 2022;41(12).
The authors highlight that despite mixed findings in the empirical literature, community centered efforts are often successful in yielding change. Studies about community organizing, collective action, movement building, and other related efforts are inherently complex. While there aren’t great methods and measures for assessing their impact on outcomes, centering and serving the community in research can unleash collective power and action.
Reproductive Rights
Self-Managed Abortion in the US
Grossman D, Verma N. JAMA. 2022;328(17):1693-4.
With a growing number of states banning or limiting abortion, there is the potential for more pregnant people to self-induce or self-manage abortion. The authors highlight interventions within the healthcare setting that can be used to protect health and minimize legal risk.
Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic
Upadhyay UD, Koenig LR, Meckstroth KR. JAMA Network Open. 2021 Aug 2;4(8):e2122320.
During a period of the COVID-19 pandemic, the Food and Drug Administration briefly paused certain requirements around the prescription and use of mifepristone for medication abortions. Clinicians were able to prescribe mifepristone during tele-health visits and the pills could then be dispensed from mail-order pharmacies, negating the need for any in-person visits in most cases. Even though the sample size was relatively small, this study suggests that this approach to medication abortion works and is safe.
Data Sources in the Fight for Health Equity
Risks and Opportunities to Ensure Equity in the Application of Big Data Research in Public Health
Wesson P, Hswen Y, Valdes G, Stojanovski K, Handley MA. Annual Review of Public Health. 2022;43(1):59-78.
While the use of Big Data has the potential to advance public health and provide important answers to questions around health and equity, there is also the potential to perpetuate harms introduced by biases in the original data sources (e.g., absence of data). The authors highlight strategies for incorporating equity and justice frameworks into the work being done with big data in an effort to reduce harm perpetuation.
Spatial Data and Data Linkages
A Population-Based Cohort Study of Traffic Congestion and Infant Growth Using Connected Vehicle Data
Willis MD, et al. Science Advances. 2022;8(43):eabp8281.
While there is mounting evidence that vehicle-related air pollution negatively impacts reproductive and infant health outcomes, the authors of this study were the first to examine the specific impact of traffic congestion on these outcomes. Traditionally, studies have focused primarily on proximity to highways and other transportation infrastructure. What’s notable about this is that traffic congestion can be impacted by both infrastructure and policy levers.&
Data Obtained Through the Freedom of Information Act
Influenza, Varicella, and Mumps Outbreaks in US Migrant Detention Centers
Lo NC, et al. JAMA. 2021;325(2):180-2.
Upon evaluating 2019 data from 22 US Immigration and Customs Enforcement (ICE) detention centers, the study team found that there were recurrent outbreaks of three vaccine-preventable diseases: influenza, varicella, and mumps. Prevalence of these outbreaks suggest policy changes that are needed to reduce disease risk: vaccination protocols and access to healthcare.
Adult Hospitalizations from Immigration Detention in Louisiana and Texas, 2015–2018
Nwadiuko J, et al. PLOS Global Public Health. 2022;2(8):e0000432.
Authors analyzed data from a variety of sources, including US Immigration and Customs Enforcement (ICE) data obtained via a Freedom of Information Act request, to evaluate hospitalizations by individuals detained in ICE facilities. The analysis showed that individuals hospitalized after being detained in ICE facilities were more likely to have indicators of severe disease (e.g., ICU admission, specific procedures, etc.) than other individuals hospitalized in the US. Most common reasons for hospitalization included infectious and psychiatric illness. Findings suggest that potential levers to reduce severe illness in individuals detained by ICE include changes to and better enforcement of ICE policies, better assessment of an individual’s risk of physical and mental health, and increased access to ICE health data for regular monitoring and evaluation.
Demographic Disparities in the Federal Drug Approval Process for Allergic Rhinitis Medications
Liebowitz A, Spielman DB, Schlosser RJ, Stewart MG, Gudis DA. The Laryngoscope. 2022; Epub ahead of print.
While the demographic prevalence of allergic rhinitis is very similar to the racial, ethnic, and sex demographics of the US population, data obtained from a Freedom of Information act revealed that participants in the trials conducted to approve 22 drugs to treat the condition are not. Trials included overrepresentation of white participants and underrepresentation of Black, Asian, Pacific Island, Native American, and Hispanic participants. Underrepresentation of minoritized groups has long been and continues to be an issue in clinical and drug trials. Continuing to examine the data and make public the results may aid in needed adjustments to the way clinical trials are done as well as the FDA review processes and policies.
CalOSHA Data
A Descriptive Analysis of 2020 California Occupational Safety and Health Administration COVID-19-Related Complaints
Thomas, et al. SSM-Population Health. 2022;17:101016.
The research team used data from the California Occupational Safety and Health Administration (Cal/OHSA) to evaluate the relationship between industry-specific complaints and industry-specific mortality rates during 2020. They found that the industry with the highest COVID-19 mortality rates, Agriculture, had the fewest number of complaints per 100k workers. On the flip side, the industry with the second lowest COVID-19 mortality rate, Health Care, had the largest number of complaints per 100k workers. There could be a number of causes of this discrepancy, such as poor enforcement in certain sectors and lack of employee awareness or empowerment in some industries to submit complaints. What is clear is that changes need to be made to the way complaints are submitted, evaluated, and handled. Proactive measures on the part of Cal/OSHA are also warranted.
COVID-19
Pandemic Response in Specific Settings
Lifting Universal Masking in Schools — Covid-19 Incidence Among Students and Staff
Cowger, et al. New England Journal of Medicine. 2022; 387:1935-1946.
Taking advantage of staggered lifting of masking requirements in Massachusetts, schools allowed the study team to assess the impact of universal masking on the incidence of COVID-19 in schools. Results show that lifting the masking policies led to increased COVID-19 cases in the associated schools. The authors highlight that universal masking is an effective intervention to keep schools open and reduce health inequities.
Examining COVID-19 Mortality Rates by Race and Ethnicity Among Incarcerated People in 11 US State Prisons (March–October 2021)
Li MY, et al. SSM-Population Health. 2022:101299.
Using data from 11 state Departments of Corrections, the authors determined that when compared to whites, COVID-19 mortality rates were higher for Black, Hispanic, and other non-white individuals that were incarcerated in state prisons. Additionally, age at time of death was significantly lower for Black individuals than white individuals. Aside from the need for carceral reform, the authors highlight the need for collection of and access to more comprehensive data on those involved in the carceral system to better understand racial/ethnic disparities in health and incarceration.
Resident Mortality And Worker Infection Rates From COVID-19 Lower In Union Than Nonunion US Nursing Homes, 2020–21
Dean A, McCallum J, Kimmel SD, Venkataramani AS. Health Affairs. 2022;41(5):751-9.
Quantitatively rigorous research focusing on how labor conditions influence the health of workers and the health of those who depend on them, as many of the most vulnerable individuals in our society are deeply dependent on low-wage workers for care.
COVID-19 and Analysis of Big Data from Social Media
Association of “#covid19” Versus “#chinesevirus” with Anti-Asian Sentiments on Twitter: March 9–23, 2020
Hswen Y, Xu X, Hing A, Hawkins JB, Brownstein JS, Gee GC. American Journal of Public Health. 2021;111(5):956-64.
The authors of this paper have made a clear connection between the words used by an influencer on social media, in this case the use of “Chinese virus”, with a marked increase in tweets expressing anti-Asian sentiment. These findings demonstrate the impacts social media can have on real world interactions and sentiments, as well as highlighting the potential for intervention on social media.
Spatial Distribution of Hateful Tweets Against Asians and Asian Americans During the COVID-19 Pandemic, November 2019 to May 2020
Hohl A, Choi M, Yellow Horse AJ, Medina RM, Wan N, Wen M. American Journal of Public Health. 2022;112(4):646-9.
The authors of this study connected what’s happening in the real world with what we see on social media, using geocoding data associated with tweets expressing anti-Asian sentiment during the first few months of the COVID-19 pandemic. Using the space-time scan statistic to analyze tweets, they identified clusters of anti-Asian hate within the contiguous U.S.
Causal Inference
Invited Commentary: Conducting and Emulating Trials to Study Effects of Social Interventions
Rojas-Saunero LP, Labrecque JA, Swanson SA. American Journal of Epidemiology. 2022;191(8): 1453–1456.
When studying the social determinants of health, establishing causal effect can be extremely challenging due to the number of potential drivers of health and inability to track a single cause with an effect. The authors of the piece discuss some of the ways to establish causality when studying the social determinants of health.
Countering Misinformation
Technique-Based Inoculation Against Real-World Misinformation
Roozenbeek J, Traberg CS, & van der Linden S. Royal Society Open Science. 2022;9(5).
The authors evaluated how an intervention, playing the online game Bad News, can aid not only in inoculating individuals against specific pieces of misinformation, but the techniques used to develop misinformation. Countering misinformation has become increasingly important as the avenues for delivering it to the public have grown.