dissertation grants public health

HEALTH POLICY RESEARCH SCHOLARS DISSERTATION GRANT AWARDEES

All scholars in Health Policy Research Scholars (HPRS) are eligible to apply for the HPRS Dissertation Grant, a competitive award of up to $10,000 dollars. The one-time grant supports scholar dissertation research activities for projects that have specific health policy implications and advance a Culture of Health. Applications are reviewed and awarded quarterly.

Who is Health Policy Research Scholars for?

Applicants must be:.

• Full-time doctoral students who are entering the second year of their programs in fall 2022 and do not expect to graduate before spring/summer 2025 .
• From historically marginalized backgrounds and/or populations underrepresented in specific doctoral disciplines.
• Pursuing a research-focused discipline that can advance a Culture of Health.
• Interested in health policy and interdisciplinary approaches.

What do scholars receive?

• Annual award funding of up to $30,000 for up to four years or until they complete their doctoral program (whichever is sooner).
• Mentoring and training in health policy and leadership.
• Professional ties to public health and policy leaders and innovators from diverse fields.
• Opportunity to compete for an additional dissertationgrant of up to $10,000.
• Membership in a network of scholars and alumni for research and advocacy collaborations.
• Ashley Cooper : Socioecological Factors Associated with Weight Status in College Educated Black Women
• Leo Davis : The Role of Fatherhood Interventions in Sustaining Well-being, Mental Health, Child Attachment, and Parenting Relationships for Fathers Impacted by the Criminal Justice System
• Manuel Galvan : Understanding the Distribution of Anti-Black Discrimination: A Study of Hiring, Housing, Judicial Decisions, and Policy Beliefs
• Bryant Jackson-Green : Regulation by Litigation in Correctional Health Services: A Mixed-Methods Policy Implementation Study
• Shana McClain : Epistemic Injustice and Silencing of Violence Against Black Women and Girls: Testing Cultural Betrayal Trauma Theory
• Erika Mey : Understanding the Health of Cambodians (in Cambodia and America) and the Overall Refugee Community in America
• Katherine A. Pérez-Quiñones : The Right to Stay: local perspectives on the politics of disaster, mitigation planning, and habitat conservation in Espinar, Puerto Rico
• Sevly Snguon : Guaranteed income as an economic intervention to mitigate the impact of structural racism on health
• Wes Wislar : Doing Disabled Gender and Sexuality: An Examination of Experiences in the Medical Establishment, the Family, and Schools
• Cheryl Aguilar : What about the Parents? Exploring the Impact of Immigration Separation and Reunification on the Wellbeing and Sense of Self of Central American Parents
• Khadijah Ameen : Moving towards community power in academic health – community research partnerships involving Black communities
• Emmanuella Asabor : Segregation and the Infectious Disease Illness Experience: The cases of HIV and COVID-19 in South Africa and the United States 
• Brianna Baker : A Mother’s Message: A Family Systems Investigation of Black Women and Girls’ Mental Well-Being, Hope, and Healing
• Denae Bradley : Intimate Spaces in Carceral Places: An Examination of Black Doula Care with Incarcerated Pregnant People
• Sarah El-Azab : A Critical Analysis of Organizational Practices Underlying Interoperability of Race and Ethnicity Data
• Jamilah George : Psychedelic Just(US): The Role of Racial Trauma, Pain Interference, Stigma, and the Justice System on Psychedelic Acceptability among Black Americans
• José Manuel González Vera : Cultural Adaptation of the ACT Guide for Undocumented Community Members
• Alec Hall : The Muunganiko Curriculum: A Piloted Tier 2 Intervention that Integrates Restorative Justice and Youth Participatory Action Research
• Ciara Horne : Methods for Quantifying Inequitable Social Impacts of Dam Failures on Marginalized Communities
• Natasha Lee-Johnson : Black Maternal Resilience: A Mixed Method Study on Perceived Risk of Adverse Pregnancy Outcomes and Decision-Making
• Jessica Levasseur : Exploring the Utility of Silicone Wristbands for Monitoring Exposure to Environmental Phenols With a Focus on Parabens
• Cashell Lewis : Unmasking the Social Determinants of Health: Criminal Legal System Involvement and Suicidal Behavior Among Black Men Among Black Men
• David Mai : Harnessing Regnase-1 and Roquin-1 activity to modulate T cell function
• Adrian Manriquez : The Exploration of Latino BIP Participants’ Experiences of Oppression and Expressions of Critical Consciousness
• Aliyah Middleton : Legal Child Traffickers: Local Businesses and Organizations in Domestic Minor Sex Trafficking 
• Lupita Quintana : Developing and evaluating a surveillance system model to facilitate the prevention of pesticide related illness in the State of Illinois
• Sally Ryman : Health Care Experiences of Trans Students Attending Historically Black Colleges and Universities
• Pyar Seth : The Spectral Defect: Rethinking the Drug War through Medicine
• Jenna Sung : Reaching the families Single Session Interventions are best positioned to help: Empowering Economically Insecure Parents to Manage Child Anxiety
• Shannon Whittaker : Gentrification, displacement and health equity: Moving from risks to solutions
• Gabriel Lorenzo Aguilar : The Case for Humanitarian Technical Communication: Theory, Method, and Praxis
• Gabriella Alvarez : Neuroinflammatory Mechanisms Linking Chronic Stress to Motivational Deficits: A Neuropharmacological Approach
• Sofia Cárdenas : Fathers’ Sleep Quality, White Matter Microstructure, and Neural Activation During the Transition to Parenthood
• Christopher Chiu : Sexual Racism and Health among Asian American Sexual Minority Men
• Hayden Dawes : Liberating Ourselves with #RadicalPermission: A Mixed-Methods Intervention Study of People in Digital Community
• Monica De La Cruz : Beyond Sticks and Stones: Exploring Discourses of Poverty
• Daniel Do : COVID-19, Racism, and Mental Health Services
• Morgan Farnworth : Governing the Overdose Crisis: A Multilevel Analysis of Problems, Policy, and Public Capacity
• Jordyn Gunville : Maternal Health Outcomes and Access to Prenatal Care Among American Indians: A Mixed Methods Dissertation
• Alein Haro-Ramos : Immigration and Racial Hierarchies: Structural sources of mental health disparities and digital innovations for mental health among U.S. Latinxs
• Ariel Hart : Beyond the Obstetric Carceral Sphere?: Examining Midwifery Epistemology and Praxis in a Black-led Birth Center
• James Huỳ nh : How Kinship and Coalition Networks Shape Distress, Anxiety, and Well-Being Among People Involved in LGBTQ+ Vietnamese American Issues in Orange County, CA
• Grace Ibitamuno : Investigating the Health and Wellness of Children with Autism Spectrum Disorder and their Families
• Asia Ivey : Black Educators Matter: An Examination of Equity Leadership and Policy Implications for Critical Professional Development
• Gabriel Johnson : Hegemonic Masculinity in Black men ≠ Black Masculinity: An Attempt to Avert the Dominant Gaze, and Its Effects on the Mental Health of Young BlaQ Men
• Natalie Larez : A Pilot Study: Youth Participatory Engagement and Action in Mental Health
• Deniss Martinez : Knowledge and Power Sharing in Indigenous Natural Resource Collaborations in California
• Destiny Printz : Melanated and Mindful: Feasibility of a Brief Parental Stress Intervention for Black and Hispanic Mothers of Toddlers
• Michael Rosario :  [Coming Soon]
• Shlon Smith : Access Defined: Towards a Better Understanding of Black Youth’s Access and Utilization of School Mental Health Services
• Kate Somerville : Exploring the Role of School Policy in Healing, Wellbeing, and Mental Health: Centering Student Perspectives on School-Based Approaches to Trauma
• Mahader Tamene : Assessing the Impact of Structural Racism on the Mental Health of Birthing People
• Mudia Uzzi : Structural Drivers of Violent Crime in Baltimore City: An Investigation of Historical and Contemporary Practices and Patterns of Structural Racism
• Mi’Chael Wright : Not on [         ]’s Internet: Black Girl’s Identity and Their Dichotomous Online Experiences
• Keona Wynne : Probing Psychotraumatology Frameworks and Models: An Investigation into the Explanatory Power of Psychotraumatology for Health Equity
• Andrew Arriaga : It’s the Law?: A Study of Policy, Minority Stress, and Gay Men’s Barriers to Parenthood in the United States
• Matthew Bakko : Disentangling Punishment and Care: Organizing Institutional Change in Municipal Community Safety
• Shanaé Burch : In Pursuit of Healthful Narratives: Black Women and/or Gender-Expansive Citizens Creating and Performing Art and Cultural Work in Service of “Good Health”
• Alberto Cifuentes : A Convergent Mixed Methods Study of the Impact of Stigma on the Sexual Health and Substance Use Outcomes of Internet-based Cisgender Male Sex Workers Who Have Sex with Men
• Katherine Gutierrez : Three Essays on Policy, Equity, and Economics
• Mónica Gutierrez : Does Power Impact an Individual’s Ability to Maintain Place, Space, and Identity? A Community Study
• Ans Irfan : Advancing Culture of Health & Health Systems Strengthening through Climate Adaptive Social Entrepreneurship: Social Impact Case Study for Climate Competent Care
• M. Nicole Kunkel : The Effects of Perinatal PCBs and Sociosexual Stress on the Hypothalamus and Behavior of Female Rats
• TyKera Marrow : Just Be A Man About It: A Sequential Explanatory Examination of Men’s Health and Healthcare Utilization
• Tiana Moore : Residential Mobility and Historical Discriminatory Housing Policy’s Influence on Contemporary Child Health and Cognition
• Ezinne Nwankwo : Matters of Place and Health: Ethnic Enclaves, Immigration Enforcement, and Preterm Births Among Latina Mothers in the U.S.
• Samantha Perez : A Novel Cancer-Specific Plectin Targeting Monoclonal Antibody Promotes an Antitumor Immune Response in PDAC Models
• Jocelyn Poe : On Trauma Imaginaries & Community Health
• Jake Ryann Sumibcay : Examining Structural Racism as a Fundamental Cause of Health Inequities Among the Native Hawaiian and Pacific Islanders in the United States and the Indigenous Māori and Pacific Peoples in Aotearoa New Zealand: An Exploratory Comparative Case Study Analysis
• Hawi Teizazu : Maternal Mortality in the Spotlight: An Analysis of Maternal Health Research, News Media Coverage, and Public Opinion Related to Maternal Mortality and Maternal Health Policies in the United States
• Noah Triplett : Applying Human-Centered Design to Maximize Acceptability, Feasibility, and Usability of Mobile Technology Supervision in Kenya: A Mixed Methods Pilot Study
• Kevin Wiley Jr. : Data Quality and Care Coordination in Type 2 Diabetes Management
• Natasha Williams : Mental Health Among Black Lesbian, Gay, and Bisexual People: Examining Patterns of Risk, Treatment Utilization, and Mental Health Management Strategies
• Chioma Woko : The Effect of Source Credibility on Promising Message Themes: A Message Pretesting Study to Address COVID-19 Vaccine Hesitancy among Black Americans
• Angela Adler :  Brain Injury and Romantic Partnership: Relationship Quality and Stigma
• Deanna Barath : Hospital Cross-Sector Partnerships to Improve Health Outcomes
• Rebekah Cross : Gentrification, Residential Mobility and Preterm Birth among Black Women: A Mixed-Methods Study of Racial Resegregation in Northern California
• Yaminette Diaz-Linhart : Does Worker Voice Impact Worker Well-being in Health Care and Social Services?
• Tran Doan :  A Cost-Effectiveness Analysis of Universal Routine Depression Screening of U.S. Adolescents in Primary Care
• Josefina Flores Morales : Three Essays on the Health of Immigrants and Undocumented Adults and Elders
• Terrell Frazier : Innovation at the Intersection: Specifying the Dynamics of Tactical Innovation within Heterogenous Activist Networks
• Regina Fuller : The (Un)Making of Comprehensive Sexuality Education Policy in Ghana
• Cristina Gomez-Vidal : The Legal Reproduction of Maternal and Infant Health Inequities in Unincorporated Communities
• Ashley Gripper : We Don’t Farm because it’s Trendy: An Environmental Justice Approach to Understanding the Connections Between Urban Agriculture and Health in Philadelphia
• Raven Hardy : Mechanism of Brain Circuitry Underlying Cognitive Decline in Sickle Cell Disease (SCD)
• Demar Lewis : Black Ideologies on Community Safety in the 21st Century
• Kathleen McCarty : Sport Opportunities for Collegiate Students with Disabilities: A Mixed Methods Review of Current Program Offerings, Barriers, and Facilitators
• Laurent Reyes : A Phenomenological Study Exploring Experiences of Civic Participation among Older African Americans and Latinx Immigrants using an Intersectional Life-Course Perspective
• Kristi Roybal : Exploring the Relationship between Historical Redlining and Place-Based Reproductive Health Inequities: A Qualitative GIS Approach
• Leslie Salas-Hernández : Understanding Police-Public Contact: The Role of Police Violence and a Police Training Intervention
• Samantha Scott : How Deep is your Kaumaha? Unfolding the Experiences of Historical and Intergenerational Trauma among Wāhine
• Dislorei (Desi) Small-Rodriguez : Remaking Collective Identities: Data Sovereignty, Citizenship, and Indigenous Nations
• Jennifer Whittaker : Understanding the Role of Place in Health and Wellbeing for Rural Families: A Photovoice Project by Moms
• Bukola Bakare : Corporate Social Responsibility and Traffic Congestion: A Mixed Methods Study
• Samuel Baxter : Examining Racial Differences in Cardiovascular Health among Young Men: The role of Residential Segregation
• Jasmine Blanks Jones : Performance as Public Work: Youth as Civic Actors for Policy and Practice in Liberia
• Erica Browne : Moving Further Upstream to Promote Racial Equity: A Mixed Method Analysis of Private Nonprofit Hospital Community Benefit
• Brittney Butler : Examination of Exposures to Anti-Black Racism Over the Lifecourse and their Association with Pregnancy Induced Hypertensive Disorders Among Black Women
• Alane Celeste-Villalvir : Finding the Missing Millions: An Exploration of Challenges and Facilitators to Hepatitis C (HCV) Screening Among Individuals Experiencing Homelessness
• Angeliz Encarnación Burgos : Urban Development under Conditions of Colonialism: A Critical Urban History of Santurce, Puerto Rico
• Mario Alberto Espinoza-Kulick : La Gente Unida: Latinx Immigrant and Indigenous Health and Advocacy on California’s Central Coast
• Jenny Guadamuz : Immigration Status, Cardiovascular Risk Factors, and Medication Use in the United States
• Ana Herrera : The Association between Tobacco Retail Outlet Density and Advertising with Neighborhood Socio-demographic Characteristics around Colleges in Texas
• Amy Jones : The New Affirmative Action: The Experience of Students of Color in Diversity-Focused Collegiate Incorporation Programs
• Matthew Lee : Advancing Understandings of Policy Implementation and Sustainability to Address Health Equity: A Mixed Methods Case Study of Tobacco Control in New York City
• Jennifer McGee-Avila : Multilevel Points of Intervention to Improve Cervical Cancer Screening Among Women Living with HIV: A Mixed Methods Approach to Addressing Health Inequities
• Marcela Nava : The Political Economy of Immigrant Health: An Interdisciplinary Exploration of Social Capital and the Immigrant Paradox
• Adrian Neely : School Connectedness and African American Students: An Examination with Implications for Policy and Teacher Education
• Marie Plaisime : Perceptions of Racial Bias & Interracial Anxiety Among Medical Students: A Mixed Methods Study
• Arrianna Planey : A Multi-Scale Spatial & Political Economic Analysis of Health Policy, Provider Location Decisions, and Access to Audiology Services
• Jennifer Richmond : Reducing Racial Disparities in Health Services Use: Exploring the Role of Racial Equity Training for Nurse Navigators and Improved Measurement of Trust in Health Care
• Kristefer Stojanovski : Systems Science Approaches to Visualize, Model, and Explore Stigma’s Role in Socially Patterning HIV Risk Among Gay, Bisexual, and Other Men Who Have Sex With Men (GBMSM) in Europe
• Dana Williamson : Understanding Capacity-building Efforts to Address Environmental Justice Concerns
• Henry Willis : Developing a Culturally-Adapted Mobile Mental Health Intervention: A Multi-Study, Mixed Methods Approach
• Andrew Anderson : Exploring Mental Health Disparities among Accountable Care Organizations
• Sondra Calhoun Lavigne : Antimicrobial Use and Resistance: Intersections of Companion Animal and Public Health
• Michelle Doose : Examining the Multilevel Influences on Diabetes and Hypertension Clinical Care Management among Breast Cancer Patients
• Paul Shafer : Effect of the Affordable Care Act on Utilization of Emergency and Primary Care
• Patrice Williams : “They Over-Promised and Under-Delivered”: A Mixed Methods Study on the Effects of Residential Displacement Pressure on Black Residents in Southwest Atlanta

The Program at a Glance

Doctoral students from a variety of disciplines—such as urban planning, political science, economics, anthropology, education, social work, geography, and sociology—who are committed to using policy change to advance population health and health equity.

• Full-time doctoral students who are starting the second year of their programs in fall 2023 and do not expect to graduate before spring/summer 2026.

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Other Training-Related Programs

Dissertation award, program purpose.

Although not technically fellowships, these grants support dissertation research costs of students in accredited research doctoral programs in the United States (including Puerto Rico and other U.S. territories or possessions).

Eligibility

Career level.

U.S. citizen or permanent resident, enrolled in a research doctoral degree program.

Graduate/Clinical Doctorate

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U.S. domestic institutions

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Stipend levels & info.

• NIH Policies for NRSA Stipends, Compensation and Other Income
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Policy Notices

• NOT-OD-24-129: Updates to NIH Institutional Training Grant Applications for Due Dates on or After January 25, 2025
• NOT-OD-24-116: Childcare Costs for Ruth L. Kirschstein National Research Service Award (NRSA) Individual Fellows and Institutional Research Training Awards
• NOT-OD-24-107: Implementation of Revisions to the NIH and AHRQ Fellowship Application and Review Process
• NOT-OD-24-084: Overview of Grant Application and Review Changes for Due Dates on or after January 25, 2025
• NOT-OD-23-111: Reminder – NIH Policies for NRSA Stipends, Compensation and Other Income
• NOT-OD-23-076: Ruth L. Kirschstein National Research Service Award (NRSA) Stipends, Tuition/Fees and Other Budgetary Levels Effective for Fiscal Year 2023

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Center for Qualitative Studies in Health and Medicine

• Our Research
• Qualitative Courses
• Dissertation Enhancement Awards

Dissertation Awards

The Center for Qualitative Studies in Health and Medicine (CQSHM) Dissertation Enhancement Award supports dissertation projects that use ethnographic or other qualitative methodologies and approaches.

The award is one way the CQSHM promotes innovative and high-quality qualitative work at the Johns Hopkins Bloomberg School of Public Health. The award recognizes that conducting research using these methodologies involves a considerable time investment. The award is designed to enhance students’ ability to conduct rigorous research and is a supplement to any current sources of support.

In this round, the Center will award approximately 2 research grants of $2,000 each for studies conducted in 2023-2024.

Eligibility

All doctoral (PhD, ScD, or DrPH) candidates who have successfully completed their school-wide oral exams before June 21, 2024 are eligible to apply for the awards. To be competitive, students should have taken at least one (and preferably more) qualitative research courses at Johns Hopkins and be planning or conducting dissertation research that relies on extensive use of qualitative methods. Students whose dissertation research is primarily quantitative will not be considered for this award. Mixed methods studies must contain a considerable component of qualitative research, and the funds requested should align with this aspect of the work.

Use of Award Funds

Funds may be used to cover the costs of fieldwork, equipment, participant reimbursements, and most other research-related expenses. Awards will be made as a payment to the student awardee; it is not possible for awards to be made on a cost-reimbursement basis. There may be tax implications of receipt of such an award, and if it is not possible/advantageous for a student to accept such a payment, this may be a reason not to apply for this award.

Grant Recipient Requirements

In accepting an award, the student agrees to:

• Present the research to CQSHM faculty affiliates and other interested members of the University community prior to their dissertation defense;
• Acknowledge CQSHM support in their dissertation and in publications resulting from the work;
• Send the CQSHM copies of any papers or publications resulting from the supported work; and
• Provide a brief summary of how the funds were used at the end of the award period.

Application Process

To be considered for an award, please submit the following materials to  Susan Hannum , PhD, CQSHM Center Coordinator. 

• The research proposed or under way. Include a clear description of your research questions and methods.
• A statement about how the award would enhance your ability to carry out the project.
• A description of any methodological innovation involved in your dissertation research.
• A detailed budget of how funds will be used to support the dissertation research.

All applicants should also provide a complete JHSPH transcript (unofficial is acceptable) and a letter of recommendation from their advisor. The letter should comment on the overall dissertation project and attest to the centrality of qualitative approaches to it. Applications are due by July 8, 2024.

Review Process

Proposals will be reviewed by an interdisciplinary committee of CQSHM faculty affiliates. Applications will be judged on the following criteria:

• The overall quality of the proposed project, including innovation and creativity in the study questions and design, and rigorous application of qualitative or ethnographic methods.
• The ability of the student to carry out high quality research, to be assessed on the basis of the student’s training (including coursework), experience, academic performance, and the feasibility of the proposed project.
• Evidence that the funds would enhance the student’s work.

Unfortunately, CQSHM cannot provide feedback on individual proposals.

Dissertation Grant Awardees

Anna Batchelder, School of Nursing: Community Building in Group Antenatal Care in Blantyre, Malawi

Sara Soloman, Health Policy and Management: A Community-Engaged, Equity-Centered Adaptation of the Cure Violence Model in Southwest Philadelphia

Victoria Green, Mental Health: Characterizing the impact of Maryland psychiatric rehabilitation program environments on community integration among adults with serious mental illness: A multi-site case study approach 

Arman Majidulla, International Health:  What about the community? Examining cleaner cookstove research in the Peruvian Andes 

Molly Sauer, International Health:  Exploring Maternal Immunization Decision-making, Demand, and Readiness in Advance of Future Vaccines in Pregnancy

Tara Maudrie, International Health:  Nourishment through Cultural Values: Developing a Culturally Driven Approach to Nutrition for Urban American Indian/Alaska Native Communities 

Rachel Topazian, Health Policy and Management:  Data privacy perspectives in the fire service 

Ashley Truong, Mental Health:  Exploring experiences of drug use among people experiencing unsheltered homelessness in Baltimore City: An interpretative phenomenological analysis 

Deja Knight, International Health:  Investigating structural, community, relationship, and individual correlates to PrEP awareness, interest, and preferences among Black cisgender women in Baltimore, Maryland 

Emily Hoppe, School of Nursing:  Parents’ Adverse and Positive Childhood Experiences and Their Parenting Practices in the Context of Neighborhood Safety 

Kathryn Spielman, International Health:  Breastfeeding support and maternal breastfeeding decision-making and practices in Yucatan, Mexico 

Abigail Winiker, Health, Behavior and Society:  Multi-Level Sources of Coping and Resilience Among People Who Inject Drugs (PWID) in Baltimore, MD: A Qualitative Study and Framework Development

Carolyn Ellison, Health, Behavior and Society:  Exploring Supplemental Nutrition Assistance Program (SNAP) Participation Stigma in the Context of the COVID-19 Pandemic

Dominique Guillaume, School of Nursing:  Evaluating the influence of risk perception and cultural worldviews on HPV vaccination intention among Haitian immigrant women living with HIV 

Evan Eschlimab, Health, Behavior and Society:  Investigating Redditors’ perceptions and experiences of structural stigma toward people who use opioids: A qualitative social media analysis 

Kathleen Ridgeway, International Health:  Emotion regulation, ART adherence, and virologic status among adolescents and young adults living with HIV in Zambia 

Erin Cooney, International Health:  Pre-exposure prophylaxis engagement among transgender women in the United States 

Abigail Baum, Health Policy and Management:  Citizen Participation in Determining Public Safety Policy: Understanding the degree and effect of participatory governance in recent police reform efforts

Greg Rosen, International Health: Longitudinal viral load trajectories and dynamics among people living with HIV in Rakai, Uganda: A Mixed Methods Study

Debbie Wilson, School of Nursing:  Enhancing caregivers and children's well-being through an evidence-based and culturally informed prevention intervention

Kaitlyn Harper, International Health:  Diet quality and food-related behaviors in US adolescents experiencing food insecurity during the COVID-19 pandemic 

Laura Kroart, Health, Behavior and Society: Examining context of opioid use experiences, impact of services, and overdose risk among rural women on the Eastern Shore of Maryland    

Kaitlyn Atkins, International Health:  Intersectional Stigma and Pre-Exposure Prophylaxis Continuation among Key Populations in Namibia

Holly Nishimura, International Health: Transactional sex and HIV incidence among men in Rakai, Ugand a

Amelia Noor-Oshiro, Health, Behavior and Society:  Intersectional Stigma, Belongingness, and Suicide: A Novel Approach for Minority Mental Health

John Mark Wiginton, Health, Behavior and Society: Posttraumatic Stress and HIV Risk among Black Gay, Bisexual, and Other Men Who have Sex with Men

Kirsty Sievwright, International Health: Examining family and household factors related to HIV self-management among adolescents and young adults living with HIV in Ndola, Zambia

Rachel Presskreischer, Health Policay and Management

Sarah LaFave

Beata Debinski, Health, Behavior and Society: Applying Organizational Theory to Assess Intimate Partner Violence Prevention and Response in the Catholic Church: A Case Study of the Archdiocese of Chicago Domestic Violence Outreach Ministry

Michael DiStefano, Health Policy and Management

Yoona Kim, International Health

Samantha Tsang, Health, Behavior and Society

Elizabeth Thomas, International Health: Piloting sustainable and scalable strategies to separate young children from poultry and poultry feces

Soim park, International Health: Experiences of Social Support and Mental Health among Adult North Korean Refugees

Tahilin Karver, Health, Behavior and Society: Exploring the role of quality of care and peer navigation on HIV treatment and care outcomes among vulnerable women in the Dominican Republic 

Yasmin Ogale, International Health: Improving and Expanding STI Diagnosis in a Low-resource Setting: Understanding Treatment Seeking Behavior and the Acceptability of Self-collected Samples for STI Testing Among Adults in Rakai, Uganda

Divya Mishra, International Health

Sarah Elaraby, International Health: Ecocultural Perspectives on Problematic Child Behavior: An Exploratory Qualitative Study in the Context of Urban Poverty in Egypt

Tuo-Yne Tseng, Health, Behavior and Society 

Katherine Merrill, International Health: Violence victimization and HIV care and treatment practices among HIV-positive youth in Ndola, Zambia

Katie Heley, Health Policy and Management: Smokeless tobacco use, problematic opioid use, and serious mental illness and violence

Natalia Varallyay, International Health

Yonaira Rivera, Health, Behavior and Society: I dentifying ways to effectively reach and educate Latinos on how cancer prevention and screening can reduce cancer health disparities

Erin Hunter, International Health: Bangladeshi schoolgirls’ self-efficacy in effectively managing menstrual hygiene    

Jimmy Le, Epidemiology: A Patient-Centered Approach for Identifying Outcomes for Glaucoma Trials 

Laura Beres, International Health: Patterns and Factors Influencing Return to Care among Patients Living with HIV in Zambia  

Lauren Czaplicki, Health, Behavior and Society: A case study of the development and implementation of a menthol cigarette ban in retail stores within 500 feet of secondary schools

Ann Herbet, Population, Family and Reproductive Health: The Growing Girls Project

Anna Leddy, Health, Behavior and Society: Gender-based violence (GBV) and HIV risk among female sex workers (FSW) in Iringa, Tanzania 

Danielle Edwards, Health Policy and Management: Factors Affecting Menu Development and the Effectiveness and Ethical Considerations of ‘Nudge’ Techniques Designed to Encouraging Meatless Eating in Rural Restaurants.  

Philip McNab, Health, Behavior and Society

Rachel Fabi, Health Policy and Management

Jessica Rothstein, International Health

2015 - 2016

Azal Ahmadi, International Health: Migration and HIV medication adherence among HIV-positive female sex workers in Senegal

Bob Vollinger, Health, Behavior and Society: Assessing Attitudes and Beliefs regarding Developing and Implementing Policy to Reduce Secondhand Smoke in Multi-Unit Housing in Montgomery County, Maryland 

Karina Christiansen, Health Policy and Management: Reframing "Food Deserts": The History of Urban Supermarket Access and Its Public Policy Discourse

Kwame Sakyi, International Health: Experiences in HIV Care in The Postpartum Period in Ghana: The Role of Stigma, Birthweight, and Newborn Care

Leila Jamal, Health Policy and Management: Exploring Parental Involvement in Research for Rare Pediatric Conditions

Meike Schleiff, International Health: A Team-based Assessment of the Appropriateness and Role for Community Health Workers in Rural West Virginia

Radha Rajan, Health, Behavior and Society: Understanding “Engagement” and Factors Influencing Use of the SKATA Mobile Application for Family Planning in Indonesia

Sharon Tsui, International Health

Zoe Hendrickson, Health, Behavior and Society: Exploring the intersection of household gender dynamics, labor migration, and family planning in Nepal      

2013 - 2014

Ginny Fonner, International Health: Triaging and Incentivizing Voluntary Counseling and Testing (VCT) for HIV Prevention in Rural Tanzania: Assessing Participants’ Experience

Molly Simmons, Health Policy and Management

Nasreen Jessani, International Health: Exploring the dual role of academic faculty in bridging the evidence to policy divide in Kenya

Sarah Beckham, Population, Family and Reproductive Health: "Like any other woman"? Pregnancy, motherhood, and HIV among sex workers in southern Tanzania

Simran Sabherwal, Population, Family and Reproductive Health: An Exploration of Son Preference and the Treatment of Daughters among Punjabi Sikhs in Northern California

Elizabeth Rhoades, International Health: The hopi people and drought: observations, adaptations, and stewardship in a sacred land 

CQSHM Mailing List

Please contact  Susan Hannum , the CQSHM center coordinator, to be added to the list. 

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School of Public Health

Small dissertation research grants.

Supports research costs for UIC School of Public Health doctoral students

Deadline for Applications FY24: Rolling until June 15, 2024 (dependent upon availability of funds - see below)

Future Deadlines: Availability of FY25 funds will be announced in July 2024

Grant purpose and eligibility restrictions Heading link Copy link

Purpose: A limited number of small grants are available each year to support research activities for UIC SPH PhD/DrPH students conducting dissertation research projects. Research activities that may be supported include fieldwork, data collection and analysis, laboratory experiments, or participation of human subjects.

Eligibility Restrictions: • All UIC SPH PhD/DrPH candidates with approved dissertation proposals are eligible to apply. • Awards may not exceed 12 months without prior approval from the Associate Dean for Research. • Award limit is $500. • Students may receive this award only one time during their studies. • All awardees must provide the SPH Office of Research with UIC IRB Approval or Determination letter prior to disbursement of funds. • Recipients must provide a brief progress report 6 months after the award start date and a final report no later than 12 months after the award start date. • Recipients should present findings during UIC SPH Research and Scholarship Week.

Available funding FY 2024: 10 awards of up to $500 each Heading link Copy link

Proposal checklist and award decisions heading link copy link.

Grant Proposal Elements: The proposal must contain the following elements: 1. Complete application cover page (in application system) 2. 250 word abstract (will be published on website if awarded) 3. Dissertation proposal approval date 4. Current non-fellowship NIH formatted biosketch. Template and agency instructions can be located at https://grants.nih.gov/grants/forms/biosketch.htm 5. Budget table and narrative (maximum 2 pages) (template provided) 6. Acknowledgements from the Chair of the student’s Dissertation Committee indicating willingness to work with the student in the completion of work (completed in the application system). 7. Timeline for completing the dissertation. 8. IRB approval or determination (if required).

Applications must be submitted in InfoReady and include all sections listed above. Attachments must be in PDF format. If you have any questions regarding submission or program requirements, please email [email protected].

Award Decisions: For each funding cycle, priority will be given to awarding funds to at least one student in each of the four SPH Divisions and the DrPH program. All completed applications that provide a reasonable justification for the requested funds will be considered eligible for funding. If more than one application is received from a given division, the SPH Associate Dean for Research and Division or DrPH Director will confer to rank order applications based on the assessed necessity of the requested funding for the timely completion of the student’s dissertation. Multiple students in each division or the DrPH program may receive funding in a given cycle if available funding permits (e.g., no applications are received from students in one or more of divisions and/or the DrPH program). The Associate Dean for Research also may modify the amount of funding awarded to a student at their discretion (e.g., to accommodate providing funding to more than one student in a division).

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Call for Dissertation Grant Proposals AERA Grants Program Seeks Proposals for Dissertation Grants

Deadline: May 30, 2024

With support from the National Science Foundation, the American Educational Research Association (AERA) Grants Program seeks proposals for Dissertation Grants. The AERA Grants Program provides advanced graduate students with research funding and professional development and training. The program supports highly competitive dissertation research using rigorous quantitative methods to examine large-scale, education-related data. The aim of the program is to advance fundamental knowledge of relevance to STEM education policy, foster significant science using education data, promote equity in STEM, and build research capacity in education and learning. Since 1991, this AERA Program has been vital to both research and training at early career stages.   

The Grants Program encourages the use of major data sets from multiple and diverse sources. It emphasizes the advanced statistical analysis of data sets from the U.S. Department of Education’s National Center for Education Statistics (NCES), the National Science Foundation (NSF), and other federal agencies. The program also supports studies using large-scale international data systems (e.g., PISA, PIRLS, or TIMMS) that benefit from U.S. federal government support. In addition, statewide longitudinal administrative data systems (SLDS) enhanced through federal grants are also eligible for consideration. The inclusion of federal or state administrative information that further expands the analytic capacity of the research is permissible. The thrust of the analysis needs to be generalizable to a national, state, or population or a subgroup within the sample that the dataset represents.

The Grants Program is open to field-initiated research and welcomes proposals that:

• develop or benefit from advanced statistical or innovative quantitative methods or measures;
• analyze more than one large-scale national or international federally funded data set, or more than one statewide longitudinal data system (SLDS) or incorporate other data enhancements;
• integrate, link, or blend multiple large-scale data sources; or
• undertake replication research of major findings or major studies using large-scale, federally supported or enhanced data.

The Grants Program encourages proposals across the life span and contexts of education and learning of relevance to STEM policy and practice. The research may focus on a wide range of topics, including but not limited to such issues as student achievement in STEM, analysis of STEM education policies, contextual factors in education, educational participation and persistence (pre-kindergarten through graduate school), early childhood education and development, postsecondary education, and the STEM workforce and transitions. Studies that examine issues of diversity, equity, and inclusion across STEM topics and/or for specific racial and ethnic groups, social classes, genders, or persons with disabilities are encouraged.

Applicant Eligibility Dissertation Grants are available for advanced doctoral students and are intended to support the student while analyzing data and writing the doctoral dissertation. Proposals are encouraged from the full range of education research fields and other fields and disciplines engaged in education-related research, including economics, political science, psychology, sociology, demography, statistics, public policy, and psychometrics. Applicants for this one-year, non-renewable award should be advanced doctoral students at the dissertation writing stage, usually the last year of study. Applicants may be U.S. citizens or U.S. permanent residents enrolled in a doctoral program. Non­U.S. citizens enrolled in a doctoral program at an U.S. institution are also eligible to apply. Underrepresented racial and ethnic minority researchers as well as women, individuals with disabilities, and veterans are strongly encouraged to apply.

Data Set Eligibility The dissertation research project must include the analysis of large-scale data. The data set can originate from one or multiple sources, including (1) federal data bases, (2) federally supported national studies, (3) international data sets supported by federal funds, or (4) statewide longitudinal administrative data systems (SLDS) enhanced through federal grants. Although the emphasis is on large-scale education data sets and systems, other social science and health-related databases that can advance knowledge about education and learning are eligible for consideration.

Many national data resources, including important longitudinal data sets, have been developed or funded by NCES, NSF, the U.S. Department of Labor, the U.S. Census Bureau, the National Institutes of Health, or other federal agencies. International datasets such as PISA, PIAAC, TIMMS, and others are supported. If international data sets are used, the study must include U.S. education.

NCES has enhanced and improved SLDS through grants to nearly every state, the District of Columbia, Puerto Rico, the Virgin Islands, and America Samoa. This federal investment has produced state-level data from pre-K to grade 12, through higher education, and into the workforce. Many SLDS are available for analysis and can be used to address salient issues in education research or linked with other data sets.

Data Set Access The data set(s) of interest must be available for analysis at the time of application. Use of public or restricted-data files is permissible. Prior to receiving funding, students must provide documentation that they have permission to use the data for the research project. In many cases, graduate students will gain access to restricted files through a faculty member or senior scholar.

Data Sharing All data or data-related products produced under the AERA Grants Program must be shared and made available consonant with ethical standards for the conduct of research. Grantees are expected to place article-related data, [1] codebook or coding procedures, algorithms, code, and so forth in an accessible archive at the time of publication. Also, at a reasonable time after completion of the dissertation research, all data or data-related products must be archived at the AERA-ICPSR Data Sharing Repository supported by NSF and located at the Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan. AERA provides guidance to facilitate the data sharing and archiving process.

Dissertation Grant Award

Award Component 1, $27,500 Stipend . AERA will award each grantee up to a $27,500 stipend to study education, teaching, learning, or other education research topics using one or multiple large-scale databases. The funds can be used for research-related expenses such as tuition, living expenses, travel to secure data enclaves or scholarly conferences, books, computer equipment, and other expenses directly related to conducting this research. As part of the proposal, applicants provide a budget that outlines anticipated research-related expenses. AERA encourages cost sharing from universities in the form of tuition assistance, office space, university fees, and other expenses. In accordance with AERA's agreement with NSF, institutions cannot charge overhead or indirect costs to administer the grant funds. In addition to the funding, grantees will be paired with a Governing Board member who will serve as a resource and provide advice and feedback to grantees and monitor grantees’ progress.

Award Component 2, AERA Research Conference. Grantees will participate in an AERA research conference held in Washington, DC. During this 2-day conference grantees will participate in seminar-type sessions on substantive, methodological, and professional issues. Also, they will have the opportunity to network and interact with the Grants Program Governing Board, senior scholars and researchers, other graduate students who use large-scale datasets in their research, and representatives from key federal agencies such as the National Center for Educational Statistics, the National Science Foundation, and the U.S. Department of Education. The award will cover all travel and lodging expenses for grantees to participate in the conference.

Award Component 3, AERA Annual Meeting Capstone Research Institute. Each spring AERA holds its Annual Meeting which brings together over 15,000 researchers, scholars, and policy leaders to present their research, share knowledge, and build research capacity through over 2,000 substantive sessions. Grantees will take a data analysis or appropriate methods course while attending the AERA Annual Meeting. The grantees will present their research in an invited poster session along with other graduate students who received dissertation support from AERA and other prestigious fellowship programs. Finally, grantees will participate in a Capstone conference directly after the Annual Meeting that will address issues such as building a research agenda, searching for a faculty appointment, and publishing research. Grantees must include travel and lodging expenses to the Annual Meeting in their budget.

Informational Webinar Applicants are encouraged to watch the informational webinar to learn more about the AERA Grants Program and discuss the application process..

Project Dates AERA is flexible on research project start dates, depending on what is best for the applicant. The earliest date a grant may start is approximately three months following the application deadline. Alternatively, an award start date several months or more after that may be requested.

Funding Restrictions Dissertation Grantees may not accept concurrent grant or fellowship awards from another agency, foundation, institution or the like for the same dissertation project that is funded by the AERA Grants Program. If the awardee is offered more than one major grant or fellowship for the same project for the same time period, in order to accept the AERA Grants Program Dissertation Grant, the other award(s) must be declined. Awardees may accept Research Assistant or Teaching Assistant appointments at their doctoral institutions and may have additional employment.

If the applicant is employed by a contractor of NCES, NSF, other federal agency, state agency, or other entity that provides the dataset proposed for the project, the dissertation research must not be considered part of the applicant's work responsibilities. An additional letter from the applicant's employer is required as part of the application submission, stating that the dissertation project is separate from the applicant's job duties. This letter must be sent electronically by the deadline to [email protected] .

Evaluation Criteria Evaluation criteria include the significance of the research question, the conceptual clarity and potential contribution of the proposal, the relevance to an important STEM education policy issue, the strength of the methodological model and proposed statistical analysis, and the applicant’s relevant research and academic experience. Additionally, the review criteria include the following: What is already known on the issue? How might this project inform STEM education policy? How does the methodology relate specifically to the research question? Does the applicant know the data set? Does the analytic plan fit the question and the data? How does this project promote equity in STEM education and learning? Is the applicant qualified to carry out the proposed study? Reviewers will be members of the AERA Grants Program Governing Board. Due to the large volume of applications received, the AERA Grants Program is unable to provide individual feedback on unfunded proposals.

Reporting Requirements Dissertation Grantees will be required to submit a brief (3-6 pages) progress report midway through the grant period. A final report will be submitted at the end of the grant period. The final report consists of an extended dissertation abstract (3-6 pages), a statement of research dissemination and communication activities and plans (1-3 pages), and the complete approved dissertation. It should be submitted electronically to [email protected] . All reporting requirements and deadlines are outlined in the award letter.

Funding Disbursement Funding will be linked to the approval of the progress report and final report. Grantees will receive one-half of the total award at the beginning of the grant period, one-quarter upon approval of the progress report, and one-quarter upon approval of the final report. Grants are awarded through the grantee’s institution. In accordance with AERA's agreement with NSF, institutions cannot charge overhead or indirect costs to administer the grant funds.

Considerations in the Development of the Proposal Applicants are strongly encouraged to read Estimating Causal Effects: Using Experimental and Observational Designs , by Barbara Schneider, Martin Carnoy, Jeremy Kilpatrick, William H. Schmidt, and Richard J. Shavelson prior to submitting a dissertation grant proposal. Selection bias is a recurring issue during the review process and should be addressed in the proposal.

Applicants should choose research topics that can be supported by the samples and variables contained in the proposed data set(s). Applicants should also be familiar with the User Guides and/or Manuals (e.g., use of design weights and design effects) of the specific data sets. Applicants should be familiar with statistical methods and available computer programs that allow for sophisticated analyses of the selected data.

Applicants should explicitly address the curricular content when it applies. Applicants are encouraged to capitalize on the capacity of large-scale data sets to examine diverse populations, including racial, ethnic, social class, and gender groups. Studies are encouraged that promote or inform diversity, equity, and inclusion for underrepresented population as well as across STEM topics. The proposed topic must have education policy relevance, and the models to be tested must include predictor variables that are manipulable (e.g., course work in mathematics, instructional practices used by teachers, parental involvement). Studies focusing on STEM education policy are strongly encouraged. Studies that model achievement test data should clearly define the achievement construct and identify the kinds of items to be used to operationalize the topic of interest. Also, when planning to use existing sub-scales, the applicant should describe why these sub-scales are appropriate and how they will be applied. Existing sub-scales provided by NCES or other agencies may not be appropriate for the proposed construct.

Dissertation Grant Application Guidelines AERA Grants Program

Application Deadline All applications for the AERA Grants Program must be completed using the AERA online application portal by 11:59pm Pacific time on May 30, 2024 . An applicant may submit only one proposal to the AERA Grants Program for review at any one time. Due to the large volume of applications received, the AERA Program is unable to provide individual feedback on unfunded proposals.

Submission Information Please enter the background information requested in the proposal submission portal. This includes the applicant’s contact and background demographic information. Also, enter the proposal title, amount of funding requested, and the start and end dates of the project.

Dataset(s) used: Name data set(s) used (e.g., ECLS­K, ELS:2002, IPEDS, CCD, AddHealth, SLDS-State, PISA, and so forth). Proposals must include the analysis of at least one large-scale federal, international, or state administrative data system.

Dissertation abstract Enter the abstract of your proposed research project (250 words maximum).

Contribution to the field Briefly describe the potential contributions this research will make to the field of education (250 words maximum). You may cut and paste or type into the text box.

• Statement of how this research advances the current state of knowledge in the field, substantively and/or methodologically
• Theoretical or conceptual framework for the research
• Brief review of relevant research/policy literature
• Research questions, hypotheses to be tested
• Description of methodology including the data set(s) and justification for selecting data file to address research question; any additional or supplemental data sample (e.g., groups used, exclusions to sample, and estimated sample sizes); rationale for variables used; and specification and clarification of variables and analytic techniques
• Data analysis plan and/or statistical model or formulas, appropriately defined
• Brief dissemination plan for this research including proposed conferences to present the findings and potential scholarly journals to publish the research  
• Variables list: A categorized list of the variables from the NCES, NSF, or other data set(s) that will be used in this research project. (2 single-spaced pages maximum)  
• References cited (not part of page limit)  
• Budget . Awards for Dissertation Grants are up to $27,500 for 1­year projects. The budget must include funds to attend the AERA Annual Meeting. The funds can be used for research-related expenses such as tuition, living expenses, travel to secure data enclaves or scholarly conferences, books, computer equipment, and other expenses directly related to conducting this research. AERA encourages cost sharing from universities in the form of tuition assistance, office space, university fees, and other expenses. In accordance with AERA's agreement with NSF, institutions cannot charge overhead or indirect costs to administer the grant funds. There is no specific template for the budget. It may be a simple 2­column format or a more complex spreadsheet. (no page limit)  
• Research and academic employment history
• Relevant graduate courses in statistics and methodology
• Relevant publications and presentations
• Relevant professional affiliations and/or memberships

Please combine items 1-5 as one PDF document and upload on online application.

Letter(s) of support: The letter(s) must be sent separately, by the faculty member. One substantive letter of support is required from the applicant's primary faculty dissertation advisor that includes an indication of the applicant's current progress toward the degree and expected date of completion, and of the student's potential for success in his or her anticipated career path.

If the applicant is from a discipline other than education, a second letter of support from a faculty advisor who has an education research background is also required if the primary faculty advisory does not specialize in education research. Although this second letter should focus mainly on the applicant's qualifications, research experience, and potential, it should also include a brief paragraph on the advisor's own education research experience.

Further Questions Contact George L. Wimberly, Co-Principal Investigator, AERA Grants Program ( [email protected]) or 202-238-3200 if you have questions regarding the application or submission process. NOTE: All awards are contingent upon AERA's receiving continued federal funding.

Visit the AERA Grants Program Website at http://www.aera.net/grantsprogram .

[1] Awardees with access to data under restricted access provisions are expected to archive a detailed specification of the data set so that others can request the same data under the same or similar restricted conditions. 

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Grant Resources

• Association of Schools of Public Health. Funding Opportunities Listing of Public Health-related funding opportunities from Federal Government entities and some NGOs.
• Catalog of Federal Domestic Assistance Provides a full listing of all Federal programs available to State and local governments; federally-recognized Indian tribal governments; Territories of the United States; domestic public, quasi- public, and private profit and nonprofit organizations; specialized groups; and individuals.
• CDC Office of Financial Resources Information about applying for CDC grants.
• Challenge.Gov Challenge.Gov is a program that supports federal agencies to mature and scale the use of prize competitions in order to advance their missions by offering advanced infrastructure, empowering members of the Challenge and Prize Community of Practice, hosting interactive learning experiences, and developing practical toolkits. Federal agencies can engage public solvers in challenges and prize competitions to identify innovative solutions to critical issues.
• CRIS Database (USDA Current Research Info System) CRIS is the U.S. Department of Agriculture's (USDA) documentation and reporting system for ongoing and recently completed research projects in agriculture, food and nutrition, and forestry.
• de Beaumont Foundation "The de Beaumont Foundation’s mission is to strengthen and transform public health in the United States. The Foundation improves the effectiveness and capacity of local and state health departments through research, collaboration, and strategic grantmaking."
• Fogarty International Center Dedicated to advancing the mission of the NIH by supporting global health research conducted by U.S. and international investigators and building partnerships between health research institutions in the U.S. and abroad. Publishes a comprehensive listing of international funding opportunities called the Directory of Non-NIH Funding Opportunities.
• Foundation Center An independent nonprofit information clearinghouse that provides resources helpful in the grantseeking process, including numerous online trainings .

• Health Effects Institute Provides high-quality, impartial, and relevant science on the health effects of air pollution. Identifies the highest priority areas for health effects research, then funds and oversees the conduct of research projects.
• Grantmakers in Health Fosters communication and collaboration among grantmakers and others to help strengthen the grantmaking community's knowledge, skills, and effectiveness.
• Grants.gov A website for federal agencies to post discretionary funding opportunities and for grantees to find and apply to them.
• Health Research Alliance HRA is a a collaborative member organization of nonprofit research funders interested in identifying and adopting effective practices in funding health research. The Grants Administration Working Group addresses a wide range of operational issues of concern to funders of health research and training. Past meeting topics have included: Peer review; Grants management and other software platforms; Dealing with overlapping grant support; Pre-award and post-award processes.
• International Development Research Centre IDRC funds research in developing countries to promote growth, reduce poverty, and drive large-scale positive change: "projects that aim to bring employment, food security, health, peace, and prosperity to developing regions of the world."
• International Initiative for Impact Evaluation (3ie): Funding 3ie funds impact evaluations and systematic reviews of social and economic development interventions in low-and middle-income countries. Areas include policy, thematic sectors/sub-sectors, development priorities, replication studies, and more.
• New Investigators Program (NIH) Helpful information on the grant application process designed to assist new researchers. Many NIH institutes and centers give new investigators special consideration in their selection for funding, and in some cases provide five years of support instead of the four that is the NIH average duration for a grant.
• NIH Grants & Funding Information about National Institutes of Health grants and how to apply. Find information on their New and Early Stage Investigators Program, as well as NIH grants for people re-entering the workforce after an interruption for family responsibilities, or those who need to transition into safer, and more supportive research environment ( details ). 2022-2023 NIH Grants Conference recorded sessions are available on many aspects of grantseeking.
• NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) A repository of both intramural and extramural NIH-funded research projects. Access publications and patents resulting from NIH funding. In addition to NIH-funded research, the system provides access to research supported by CDC, AHRQ, HRSA, SAMHSA, and the VA. Includes the Grants Matchmaker : Enter abstracts or other scientific text and Matchmaker will return lists of similar projects from RePORTER or program officials associated with those projects.
• NIH Data Book Summary statistics on extramural grants and contract awards, grant applications, the organizations that NIH supports, the trainees and fellows supported through NIH programs, and the national biomedical workforce. Can help inform your chances at getting an NIH grant.
• National Science Foundation Funds research and education in most fields of science and engineering.
• Nonprofit Learning Lab webinars The Nonprofit Learning Lab is a national nonprofit that trains leaders in the nonprofit sector. Free webinars include How to Find New Funders in Your Backyard in Under 60 Minutes , How to Plan Your 12-Month Grants Calendar in Under 60 Minutes , and many more.
• Patient-Centered Outcomes Research Institute (PCORI) A nonprofit, nongovernmental organization. Congress authorized the establishment of PCORI in 2010 to improve the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policy makers make informed health decisions. They fund comparative clinical effectiveness research, as well as support work that will improve the methods used to conduct such studies.
• Pivot Guide From UC Berkeley's Sponsored Project Office, this guide provides information on Pivot's features as well as search tips.
• Public Health Law Research Funds research that directly tests the effects of law on public health, that illuminates the health law-making process, documents the implementation of law, and explores the mechanisms through which laws influence individuals and environments.
• Robert Wood Johnson Foundation Funds innovative projects that can create meaningful, measurable change such as training and fellowship programs, policy analysis, health services research, and gathering and monitoring of health-related statistics. Pioneering Ideas: Exploring the Future to Build of Culture of Health proposals primed to impact health equity moving forward will be accepted throughout the year on a rolling admission.
• Rural Health Information Hub Provides information on funding for rural health projects.
• UC Berkeley Sponsored Projects Office Reviews and authorizes proposals for submission. Interprets, negotiates, and accepts contracts and grants for sponsored projects funded by federal and state agencies, foundations, and other public and private sources.
• W. K. Kellogg Foundation: Grants Funds research that match its current funding focus. The website also has publications and resources on grantseeking, evaluation, and more.

California-Specific Grant Resources

• California Endowment Awards grants to organizations and institutions that directly benefit the health and well-being of Californians, and those that work to provide and expand access to affordable, quality health care for California's underserved individuals and communities.
• California Grants Portal Use the California Grants Portal (a project by the California State Library) to find all grants and loans offered on a competitive or first-come basis by California state agencies. All new state-administered grant and loan opportunities offered on a competitive or first-come basis will be posted here. Search by applicant type, grant category (topic area), or grant timeline.
• California Health Care Foundation Grants Funds projects that have relevance to California health care and generally have implications beyond a single institution.
• California Wellness Foundation Improves the health of the people of California by making grants for health promotion, wellness education and disease prevention.
• University of California. Office of the President - Research Grants Program Office Comprised of three state-funded research programs that target high-priority health issues in California: HIV/AIDS, breast cancer, and tobacco-related disease. Each program awards grants to California scientists to investigate these diseases.

NIH Data Management and Sharing

Details on the NIH requirements are found on their Data Management and Sharing Policy website , which includes:

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See also the Data Management and Sharing Plan Checklist for Researchers , from the Working Group on NIH DMSP Guidance.

Use the DMPTool to create your data management plan. The DMPTool provides a click-through wizard for creating a DMP that complies with funder requirements, and includes DMP templates. Free to use for UCB researchers.

UC Berkeley Library has prepared Guidance for Data Management and Sharing Costs on NIH Budget Requests (docx).

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White   House Shares Government, Private Sector, Academic, and Non-Profit Actions to Accelerate Progress on Mental Health   Research

The United States is facing an unprecedented mental health crisis impacting Americans of all ages. To tackle this crisis, the Biden-Harris Administration has taken bold steps to transform how mental health is understood, accessed, and treated. Under President Biden’s Unity Agenda, the Biden-Harris Administration released a comprehensive mental health strategy and mental health research priorities . These steps aim to make mental health care more affordable and accessible and improve health outcomes for all Americans.  

As a part of Mental Health Awareness Month, the White House Office of Science and Technology Policy called on government agencies, the private sector, nonprofit organizations, and academia to share the actions they are taking to expand and improve mental health research in the United States. These actions address key research priorities and move us closer to a future where every American has access to the best available care when and where they need it.

Government Actions

• The National Institutes of Health (NIH) Common Fund’s Community Partnerships to Advance Science for Society (ComPASS) Program announced 25 community-led research awards. The ComPASS program provides an unprecedented opportunity for communities to lead innovative intervention projects that study ways to address the underlying structural factors that affect health and health equity. Awards include research focused on addressing stigmatization of behavioral health and services and improving access to behavioral health services in Hispanic, low-income, rural, and LGBTQ+ communities.
• Accelerating Medicines Partnership® Program for Schizophrenia (AMP SCZ) released its first research data set — AMP SCZ 1.0 —through a collaboration of the National Institute of Mental Health (NIMH), the Foundation for NIH, the Food and Drug Administration, and multiple public and private partners. To improve the understanding of schizophrenia and to identify new and better targets for treatment, AMP SCZ established a research network that examines trajectories for people who are at clinical high risk for psychosis. The network also develops psychosis prediction algorithms using biomarkers, clinical data, and existing clinical high risk-related datasets.
• NIMH’s Individually Measured Phenotypes to Advance Computational Translation in Mental Health program is a new initiative focused on using behavioral measures and computational methods to define novel clinical signatures that can be used for individual-level prediction and clinical decision making in treating mental disorders . As one example of research supported through this initiative, researchers at the University of Washington are applying computational modeling strategies to behavioral data collected through a smartphone app, with the goal of predicting and preventing serious negative outcomes for people who experience hallucinations.
• NIMH awarded research grants to develop and test innovative psychosocial interventions to prevent suicide. Researchers at San Diego State, one of the grant recipients, are combining an existing intervention—the Safety Planning Intervention—with patient navigator services, and testing the effectiveness of this novel combined intervention in reducing suicide risk among sexual and gender minority youth and young adults.
• NIMH and the Eunice Kennedy Shriver National Institute of Child Health and Human Development funded 11 new studies focused on understanding bidirectional relationships between social media use and adolescent mental illness, psychiatric symptoms, and risk or resilience for psychopathology . Collectively, this research aims to address important questions about the short-term and long-term interactions between social media behavior and youth mental health, as well as the mechanisms contributing to risk and resilience.

Private Sector, Academic, and Non-Profit Actions

• The University of California, Somos Esenciales, and Zuckerberg San Francisco General Hospital are conducting the Supporting Peer Interactions to Expand Access study, which examines digital mental health solutions in resource-limited settings, emphasizing cultural and linguistic inclusivity. This study examines a cognitive-behavioral therapy intervention for depression or anxiety for Latino patients with limited-English proficiency and tests implementation strategies, including support from community peers, to integrate this intervention into primary care.
• Headspace is launching a participatory research approach to better understand mental health needs. Headspace is partnering with the city of Hartford, Connecticut to provide mental health resources to all Hartford residents including free access to the Headspace app. This public-private partnership is the first of its kind to improve community-wide mental wellness while researching engagement with the Headspace app and the associated mental health outcomes.
• The Association of American Medical Colleges (AAMC) established a Mental and Behavioral Health Awards Program to champion integrated behavioral health (IBH) patient care models. The inaugural funding was awarded to Cincinnati Children’s Hospital Medical Center, Georgetown University Medical Center, Texas A&M School of Medicine, and the University of California Davis School of Medicine for their innovative approaches to IBH team training and patient care, as well as their commitment to accessible and equitable whole person care. AAMC will summarize and disseminate lessons learned from these institutions to advance IBH across the health care delivery system.
• Unity Health Care established the $2.3 million J. Willard and Alice S. Marriott Foundation’s Behavioral Health Development Fund to train the next generation of IBH fellows. This program allows Unity to recruit and train the next generation of mental health providers, with a focus on models of care that expand access, improve outcomes, and drive health equity through IBH. The behavioral health providers work seamlessly with primary care providers to address unmet critical and looming mental health challenges with a culturally congruent approach.
• The American Association of Psychiatric Pharmacists is providing up to $500,000 to study the impact of integrating Board-Certified Psychiatric Pharmacists (BCPPs) into health care teams. BCPPs are advanced practice clinical pharmacists who provide Comprehensive Medication Management within team-based care focusing on medication optimization, evidence-based practices, and patient-centered goals. These research grants fund multiple sites and expand the number and quality of studies involving BCPPs.
• The Healthy Brains Global Initiative (HBGI), the Mental Health Services Oversight and Accountability Commission, and initially three counties in California, are implementing performance-based pilot programs to improve outcomes for people living with serious mental illnesses. These pilots are testing reimbursement for achieving health, housing, and wellbeing outcomes while strengthening the performance management of existing Full Service Partnership (FSP) services. FSP programs intend to be comprehensive services for individuals who are unhoused and who are experiencing severe mental illness.
• The NIH-funded RAND-USC Schaeffer Opioid Policy Tools and Information Center (OPTIC) is building evidence to guide policy responses to the opioid crisis. RAND and the University of Southern California lead OPTIC, a collaboration of eight research institutions, to create national resources to guide policy responses to the opioid crisis. OPTIC develops and disseminates information on policy effectiveness overall and in diverse, structurally disadvantaged communities, improved tools and methods for assessing policy effects, and strategies for addressing the opioid crisis.
• Insight is opening a new medical-psychiatric hospital to serve the community disproportionately burdened by the Flint Water Crisis with a $2.5 million grant from the Michigan Department of Health and Human Services. The hospital and services are being designed to transform how behavioral health is understood, accessed, treated, and integrated with medical and community services. Research at the hospital will focus on advancing equity in access to behavioral health services, developing treatments for serious illnesses, and supporting youth mental health.
• RAND and Active Minds are evaluating how Send Silence Packing®, the country’s largest traveling campus-based mental health literacy and suicide prevention exhibit, affects college students’ knowledge, behaviors, and stigma around mental health. Findings will guide scalability, resource allocation and decision-making on college campuses and efforts to optimize peer-informed actions to support student mental health and well-being.
• The Child Mind Institute (CMI) is leveraging over $150M from partnerships with the Stavros Niarchos Foundation and the State of California to expand mental health care access for youth in marginalized communities worldwide. CMI utilizes evidence-based, culturally adapted educational resources, provider training, and scalable, innovative, open-source digital technologies for mental health assessment and intervention. The Youth Mental Health Academy recruits a diverse workforce by providing educational and internship experiences to 2,500 high school students from under-represented communities. The Healthy Brain Network openly shares diverse brain and behavior data from >7,000 participants for pediatric mental health and learning research.

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June 6, 2024

Initiative announces awardees of spring quarter 2024 Tier 3 pilot research grants

“We are excited to be able to support these innovative, interdisciplinary projects as each seeks to scale its impact,” shared Ali H. Mokdad, the university’s chief strategy officer for population health and professor of health metrics sciences. “The projects collectively will take on some of the most pressing challenges we face to our health and well-being, including climate change, people experiencing homelessness and rural health.”

The purpose of the Tier 3 pilot grant program is to support faculty and PI-eligible staff to create follow-on opportunities for impactful projects that have developed preliminary data or realized proof-of-concept and are seeking to scale their efforts and/or expand the scope of their work. This round of awards represented researchers from eight different UW schools and colleges – Arts & Sciences, Built Environments, Engineering, Environment, Medicine, Public Health, Public Policy & Governance and Social Work – as well as a number of community-based partners.

The five awardees for this cycle are:

Community-driven Enumeration and Needs Assessment of People Experiencing Homelessness: A high-frequency method for enumeration and needs assessment of the unsheltered population of people experiencing homelessness

Investigators Zack W. Almquist, Department of Sociology Amy Hagopian, Department of Health Systems and Population Health Paul Hebert, Department of Health Systems and Population Health and VA Health Services Research and Development Tyler McCormick, Departments of Sociology and Statistics Junhe Yang, Center for Studies in Demography & Ecology and eScience Institute Owen Kajfasz, King County Regional Homelessness Authority Janelle Rothfolk, King County Regional Homelessness Authority Cathea Carey, King County Regional Homelessness Authority

Project abstract The U.S. Department of Housing and Urban Development’s 2023 Annual Homeless Assessment Report estimates 653,100 people were homeless at a point in time that year, a 12% increase from 2022. Each U.S. Continuum of Care–the entity responsible for coordinating homeless services for a region–conducts a “Point-in-Time (PIT) count” to contribute to the national count. The PIT comprises two key elements: (1) the emergency shelter report from administrative records and (2) an unsheltered PIT count conducted by volunteers who make in-person counts of people living in tents, vehicles, etc., on a single night in January.

In 2022 – through a Tier 2 PHI grant – we introduced a novel method for counting unsheltered people experiencing homelessness through a social network (peer-referral) method, respondent-driven sampling (RDS), which allows for creating a population-representative survey for understanding the needs, demographics, and size of the unsheltered population in King County. We followed this with RDS in 2023 and 2024.

We propose to extend this method to allow for quarterly surveying of this vulnerable population. Quarterly surveys will provide an entirely novel seasonal enumeration of the unsheltered population and facilitate the timely collection of new survey instruments relevant to changing conditions in the community. Employing RDS quarterly is novel and will require developing procedures and statistical methods. Further, we plan to open-source the app we developed for conducting the RDS and provide training tools for other continuum of care to take up our method.

Living with Water: Co-developing strategies to protect health while adapting to sea level rise in the Duwamish Valley

Investigators Nicole Errett, Department of Environmental & Occupational Health Sciences Maja Jeranko, Department of Environmental & Occupational Health Sciences BJ Cummings, Department of Environmental & Occupational Health Sciences Katelin Teigen, Department of Environmental & Occupational Health Sciences Juliette Randazza, Department of Environmental & Occupational Health Sciences Paulina López, Duwamish River Community Coalition Robin Schwartz, Duwamish River Community Coalition Celina Balderas Guzman, Department of Landscape Architecture Bethany Gordon, Department of Civil & Environmental Engineering Sameer H. Shah, School of Environmental and Forest Sciences Amir Sheikh, The Burke Museum / Quaternary Research Center

Project abstract Global climate change presents significant threats to coastal and river communities, with flooding events increasing in frequency and severity in recent years. Seattle’s Duwamish Valley (DV) has been particularly affected by sea level rise, exemplified by a devastating flood in December 2022 that severely damaged South Park residents and businesses. In response, the City of Seattle (City) has implemented temporary flood prevention strategies, such as sandbag barriers and stormwater infrastructure enhancements.

While engineered solutions offer some protection, their long-term effectiveness hinges on flood risks remaining below infrastructural protective capacity. Before the flood, our UW team collaborated with the Duwamish River Community Coalition (DRCC), City, and public health agencies to conduct a multilingual door-to-door survey (SASPER) of community residents to assess the local impacts of climate change and collect information about their support for various climate adaptation strategies. The Tier 3 project builds on this work and responds to a community request to develop a comprehensive community-driven flood adaptation vision for South Park.

In partnership with DRCC, we propose to (1) conduct an integrated literature review of strategies for flood adaptation based on a values-focused needs assessment of South Park residents; (2) co-design a flood adaptation vision with residents through community-based workshops/design charrettes; and (3) evaluate our approach to community co-design of flood and sea-level rise adaptation through an equity lens. Leveraging our long-standing partnership with DRCC, we seek to build community capacity for climate resilience planning and support ongoing flood adaptation efforts in the Duwamish Valley.

Sensing the impacts of climate change on frontline workers in Thailand

Investigators Kurtis Heimerl, Paul G. Allen School of Computer Science & Engineering Jason Young, Information School Adisorn Lertsinsrubtavee, Asia Institute of Technology Weenarin Lulitanonda, Thailand Clean Air Network

Project abstract Climate change is reshaping environments around the world, with frontline populations bearing the consequences. In South-East Asia, burns of land have created some of the consistently worst air quality in the world. Major megalopolises like Bangkok, Jakarta, and Singapore commonly have months of AQI ratings above 100. In 2020, we began work with researchers at the Asia Institute of Technology (AIT) to explore the impacts of this crisis on marginalized communities, specifically Thai motorcycle taxi drivers. These taxis, using Uber-like ride-sharing, are often driven by low-income people as a full-time job. Unfortunately, these frontline workers receive extreme pollution exposure. Leveraging mixed methods, our prior studies found that drivers experience significant pollution exposure and despite the risks, drivers felt as though they must work and had limited mitigation strategies available.

We propose to focus on understanding how other frontline workers in developing countries react to pollution, explore mechanisms for improving their outcomes with new sensors and measurements, and expand engage in policy changes. Specifically, we seek funding to (1) conduct a new study with lower-income frontline communities, notably street sweepers and roadside vendors, (2) develop new mobile cognitive tests that are easier for participants to use and explore the effects of pollution on participants through cognitive tests such as PVTs, and (3) collaborate with our local community partner, Thailand Clean Air Network (ThaiCAN), to use our data to support the recent Clean Air Bill as well as raise awareness by spotlighting the effects of poor air quality.

Online Assessment and Monitoring of Memory Health in Rural Communities Through Personalized Computational Modeling

Investigators Andrea Stocco, Department of Psychology Thomas Grabowski, Department of Radiology; Alzheimer’s Disease Research Center Nancy Spurgeon, Central Washington Area Health Education Center

Project abstract The incidence of dementia is as much as 80% higher in rural than in urban areas, but up to 92% of rural cases remain undiagnosed until late stages due to limited access to diagnostic services. This massive diagnostic gap translates into significant health disparities, since the success of treatments often depends on early detection. This project aims to reduce the diagnostic gap through an innovative software for online, repeatable assessment of memory function. The software consists of an eight-minute adaptive memory test whose responses are fed to a computational model of long-term memory. The model’s parameters are fit to the individual’s behavior, providing a multidimensional profile of their visuomotor and memory function.

In partnership with the Central Washington Area Health Education Center (AHEC), we plan to deploy this tool in the rural communities of Douglas and Chelan counties, WA, recruiting up to 500 individuals in a longitudinal memory health monitoring program. Awareness of this program will be spread through a series of public events: lectures, seminars for health professionals, and brain-wellness fairs. A subset of participants whose memory is deteriorating rapidly will be offered the opportunity to enroll in the Alzheimer’s Disease Research Center’s clinical registry to receive professional care and the possibility to enroll in further studies. If successful, this project will address all three pillars of population health: improving human health, increasing the resilience, and reducing the social and economic inequity of rural communities through advanced, online diagnostic monitoring of memory health.

Improving data to understand the well-being of small and excluded populations

Investigators Jennie Romich, School of Social Work Sofia G. Ayala, Center for Studies in Demography & Ecology Santino Camacho, School of Social Work Isaac Sederbaum, Evans School of Public Policy & Governance Scott Allard, Evans School of Public Policy & Governance Max Halvorson, School of Social Work Youngjun Choe, Department of Industrial & Systems Engineering a Arjee Restar, Department of Epidemiology

Project abstract Research data often renders small populations invisible. This project focuses on two populations who are rarely included and identified in sufficient numbers for group analysis in either general population surveys or administrative data, transgender (trans) people and Native Hawaiians and Pacific Islanders (NHPI).

This project will establish community-informed methods and practices for identifying small populations within Washington State administrative data. It will do so by: (1) documenting the presence of transgender people and Native Hawaiian and Pacific Islander (NHPI) peoples within extant data, specifically the Washington Merged Longitudinal Administrative Data; (2) working with leaders from trans and NHPI communities to develop principles for best describing their populations; (3) developing a set of practices and methods for identifying trans and NHPI persons within future administrative data resources within and beyond Washington State.

More information about the Population Health Initiative pilot grant program, tiering and upcoming deadlines can be found by visiting our funding page .

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$1.25M Mellon Foundation Grant Supports Humanities-Oriented Project Focused on Pandemic Backlash and Public Health

A project that uses humanities methods to document and explore pandemic backlash and the experiences of public health officials has received $1.25 million in funding from the Mellon Foundation. The multi-university effort involves historians and public health scholars based at Syracuse University’s Maxwell School of Citizenship and Public Affairs, New York University’s School of Global Public Health and The Ohio State University College of Public Health.

The three-year grant supports the creation of a unique oral history archive and course development focused on the history and ethics of public health pandemic response and faculty and doctoral student training that centers humanities knowledge and methods.

From left: Marian Moser Jones, Amy Fairchild and Cheryl Healton

The educational and research resource will create “new, urgently needed, accessible opportunities for the humanities to speak to public health and broaden access to humanities higher learning opportunities,” says Amy Fairchild , professor at the Maxwell School, who is principal investigator (PI). Co-PIs are Marian Moser Jones , associate professor of health services management and policy at The Ohio State University, and Cheryl Healton , founding dean and professor of public health policy and management at the School of Global Public Health at New York University (NYU).

The research team has already conducted nearly 100 interviews with state and local health officials, delving into their experiences during the COVID-19 pandemic. A planned third phase of the oral history initiative will result in approximately 150 interviews from 40 states and two territories that will become part of a digital archive, “Stewards in the Storm,” housed at Syracuse University’s Qualitative Data Repository .

Widespread public and political backlash against protective health measures in response to the COVID-19 pandemic—and against those who were trying to implement those measures—has had a lasting impact on public health, including ongoing staff shortages and attempts to sharply curtail public health authorities needed to preserve life. In their initial rounds of interviews, the research team found that 36 percent of health officials reported receiving death threats, and 24 percent reported serious threats to their families—with women and people of color more likely to receive such threats.

The third round of interviews is important, Healton says, “because it ensures a resource with a broad, nationally inclusive sample that both researchers and instructors can use to conduct reliable, valid research and to develop strong humanities content in courses that reach both public health and humanities students.”

In addition to expanding the interviews, the researchers also plan to establish a hands-on “Backlash Lab” that will introduce students to the history and ethics of public health, oral history interviewing techniques, qualitative coding strategies and techniques, and quantitative analysis. The lab, anchored at Syracuse, Ohio State and NYU, will also create partnerships with colleges that have historically served Black, Hispanic or first-generation students. Students will code interviews and write case studies to be used in undergraduate and graduate courses as well as professional settings.

Additionally, a survey course, Pandemics: History, Ethics, Politics and Policy, will be developed collaboratively and offered at Syracuse, Ohio State, NYU and Cornell University, with the aim of extending it to other collaborating institutions and other schools and programs in public health. The course aims to cut across public health, public policy and the humanities with a focus on history, medical sociology and communications.

In years two and three of the project, the team will run two workshops for scholars teaching public health and humanities at community and four-year colleges and universities across the country, with a focus on institutions that have public health schools or programs. The workshops will introduce teachers to the techniques of oral history, suggest ways to work with the archive and extend the reach of the new course.

The project capitalizes on synergies between public health and the humanities and addresses common gaps in knowledge about public health history. “As important as easy access to primary documents related to pandemic responses are, we can further illuminate broader historical themes that enrich both the humanities and the field of public health by providing insight into peoples’ lived experiences of pandemics and pandemic response,” Moser Jones says.

“This rich body of narrative history does more than create qualitative data through oral history methods,” Fairchild adds. “Rather, it uses the experience of the pandemic as a lens that can clarify and contextualize the continuing climate of pandemic-associated backlash that has ongoing repercussions for pragmatic efforts to confront population health challenges, from reproductive rights to climate change. It is primarily the foundation for humanistic investigation into the ways in which governmental responses to crises are social products and reflect the societies in which people live and die.”

Wendy S. Loughlin

• Warehouse Display Honors Design Alumnus for Innovative Headwear, Protective Sports Equipment Thursday, June 6, 2024, By News Staff
• School of Education Receives Gift to Fund Indigenous Teacher Preparation Scholarships Thursday, June 6, 2024, By Martin Walls
• Human Dynamics Task Force Members Appointed, Set to Begin Work Thursday, June 6, 2024, By Wendy S. Loughlin
• The Road to Developing Sustainable Infrastructure Thursday, June 6, 2024, By Kwami Maranga
• Nimisha Thakur Receives Newcombe Fellowship for Doctoral Research in India Thursday, June 6, 2024, By Kelly Homan Rodoski

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• Published: 13 July 2022

Factors contributing to the high prevalence of multidrug-resistance/Rifampicin-resistance in patients with tuberculosis: an epidemiological cross sectional and qualitative study from Khabarovsk krai region of Russia

• Ilia Bykov 1 , 2 ,
• Olga Dyachenko 3 ,
• Pavel Ratmanov 2 ,
• Huan Liu 1 ,
• Libo Liang 1 &
• Qunhong Wu 1  

BMC Infectious Diseases volume  22 , Article number:  612 ( 2022 ) Cite this article

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Growing prevalence of multidrug-resistant/Rifampicin-resistant tuberculosis (MDR/RR-TB; resistance to Isoniazid and Rifampicin/Isolated resistance to Rifampicin) is putting in jeopardy the WHO End TB strategy. This study aimed to identify factors contributing to the high prevalence of MDR/RR-TB in Khabarovsk krai region of Russia.

A cross-sectional retrospective study was conducted, analyzing clinical, demographic, and drug susceptibility testing data on 1440 patients. As a source of raw data, the national electronic TB surveillance system was used. Anonymous data was collected on every patient diagnosed with TB in all healthcare facilities of the region from January 2018 to December 2019. Only patients with proven excretion of m. tuberculosis were included in the study. Factors associated with MDR/RR-TB were identified through logistic regression analysis, in conjunction with in-depth interviews with eight patients, five healthcare managers and five doctors.

2661 patients were identified with TB, 1440 were incorporated in the study based on inclusion criteria. Of these, 618 (42.9%) were identified with MDR/RR-TB. Patients with a history of imprisonment were 16.53 times (95% CI 5.37 to 50.88,) more likely to have MDR/RR-TB, whereas re-treatment patients were 2.82 times (95% CI 2.16 to 3.66) more likely to have MDR/RR-TB. Other influencing factors included presence of disability (AOR is 2.32, 95% CI 1.38 to 3.89), cavitary disease (AOR is 1.76, 95% CI 1.37 to 2.25), and retirement status (AOR 0.65, 95% CI 0.43 to 0.98, p = 0.042). Poor patient knowledge and understanding of the disease, progressive weariness of prolonged TB treatment, and inability hospitalize infectious patients without their consent were perceived by the interviewees as major influencing factors.

Conclusions

Incarceration and treatment history, regardless of outcome, were identified as major factors influencing MDR/RR-TB prevalence. It is essential for the TB care system to eliminate legal loopholes, which deprive doctors of means to enforce quarantine procedures and epidemiological surveillance on infected patients, former and current inmates. Increasing people’s awareness of TB, early detection and appropriate treatment of patients with TB are needed for successfully combating MDR/RR-TB.

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Introduction

The continuous increase of multidrug-resistant/Rifampicin-resistant tuberculosis (MDR/RR-TB; resistance to Isoniazid and Rifampicin/Isolated resistance to Rifampicin) throughout the globe is a major public health issue. In 2020, the WHO reported that the global treatment success rate for MDR/RR-TB was only 59%. Treatment of MDR/RR-TB is more toxic to the patient, less effective, and it carries a much higher economic burden on the patients and the healthcare system, jeopardizing TB control efforts in developed and developing countries alike [ 1 , 2 , 3 , 4 ].

Russia carries one of the greatest burdens of MDR/RR-TB in the world. In 2018, MDR/RR-TB accounted for 35% of all new TB cases and 71% of all previously treated TB cases, with an MDR/RR-TB incidence of 27 per 100,000 and second highest in the world MDR/RR-TB prevalence rate [ 5 , 6 ].

Such situation develops despite what seems to be a well-designed TB care system, in which all aspects of TB care in Russia are free of charge to the public. The entire system was designed to provide universal, quality, and specialized care that is centralized in TB-designated facilities (TBDF), as depicted in Fig.  1 . All healthcare facilities and schools are participating in detection of asymptomatic TB by performing a mandatory annual chest x-ray in adults and Tuberculin Skin Testing (TST) in children. If TB is suspected, the healthcare facility is legally obliged to transfer such a patient to the TBDF, so the final diagnosis of suspected TB patients and provision of TB treatment are reserved only for TBDF [ 7 ]. The only exception to this system are penitentiary facilities, which screen, diagnose and treat inmates themselves. Such independence has been already proposed by researchers as a main reason for the high incidence of TB in Russian prisons, but little has been done to improve this situation [ 8 ].

Organization of TB care in Russia. PHF primary healthcare facility, HF healthcare facility, TBDF TB designated facility, DOT directly observed treatment, PCR polymerase chain reaction, TST tuberculin skin test, DST drug susceptibility testing, DST Diaskin skin test, CT computed tomography, MTB mycobacterium tuberculosis

High MDR/RR-TB incidence encourages the government of the Russian Federation and the Russian society of Phthisiatricians Footnote 1 have developed specific policies and guidelines to address the issues [ 9 ]. Joint TB control programs with international partners have been initiated, research funds have been extended, a centralized national electronic database of TB patients created, and new diagnostic techniques and policies implemented. However, the progress has been far from satisfactory, as despite the decrease in total TB incidence, the prevalence of MDR/RR-TB is continuing to rise [ 5 , 6 , 7 , 8 ].

It is crucial to identify the underlying reasons for such high MDR/RR-TB prevalence so that more feasible and cost-effective approaches can be developed to control this trend. International reviews, and some country-level studies, have identified that risk factors for MDR/RR-TB vary depending on country, region, or locality. Among the most prevalent are poor adherence to TB treatment on the part of patients, poor monitoring and management of TB treatment adverse events, poverty, overcrowding, HIV co-infection, diabetes, alcoholism, smoking, cavitary disease and young age [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].

This study was undertaken in Khabarovsk Krai, in the Far East of Russia, where the proportion of MDR-TB among newly diagnosed cases (38%) was estimated to be the third highest in the country, significantly higher than the national average of 29.3% in 2018 [ 19 ]. Unfortunately, there is a notable gap in research into MDR/RR-TB rates between high and low prevalence regions of Russia. Despite some studies carried out in low-prevalence regions, factors influencing MDR/RR-TB in high- prevalence regions have rarely been investigated [ 20 , 21 , 22 ].

Data collection

Khabarovsk Krai is a region in the Far East of the Russian Federation, and it considered one of its high-prevalence TB regions. The TB incidence there is 87.7 per 100,000 in 2019 (almost twice the national average) with a population of only 1.2 million. These figures relegate region to ninth place by total TB incidence out of all 85 regions of Russia [ 19 ].

The mixed epidemiological, cross-sectional, retrospective and a qualitative study was conducted in the central “Tuberculosis Hospital” of Khabarovsk Krai. This institution collects and processes information about all patients with tuberculosis in region and functions as a reference laboratory at the regional level.

The Federal Register of TB patients (FRTP) was used as a source of data, which is a subsystem of the digital Unified State Healthcare Information System (USHIS). FRTP stores data of TB patients in form of electronic medical records, which were accessed by the investigator in April 2021. Anonymous demographic and clinical characteristics of every patient that was diagnosed with TB from January 2018 to December 2019 was collected and summarized into single data set for further analysis. The surveillance covered all healthcare institutions in the region and strictly followed the guidelines developed by the WHO and the International Union against Tuberculosis and Lung Disease [ 23 , 24 ].

Diagnostic methods

In all patients with suspected TB in the region, an acid-fast bacilli sputum smear, culture (with both liquid and solid media), real-time PCR, and Drug Susceptibility Testing (DST) are routinely implemented as initial diagnostic tests.

Various DST techniques were employed to detect MDR/RR-TB in patients. A liquid and solid media sputum culture tested MTB resistance to the following agents: Isoniazid, Rifampicin, Ethambutol, Streptomycin, Linezolid, Capreomycin, Amikacin, Ofloxacin, Levofloxacin, Kanamycin, Ethionamide, Para-aminosalicylic acid and Cycloserine. DST in direct PCR was performed with Allele-specific polymerase chain reaction aimed to identify rpoB, katG, inhA, embB and gyrA genes mutations associated with resistance to Isoniazid, Rifampicin, Ethambutol and fluoroquinolones [ 25 ]. All DST strictly followed the procedures and methods set out by WHO and the International Union against Tuberculosis and Lung Disease [ 24 ].

A new patient was defined as a patient with TB who had never been treated for TB previously, or who had received anti-TB drugs treatment for less than 1 month. A re-treatment patient was defined as a patient who had received anti-TB drug treatment for more than 1 month [ 10 ].

Inclusion/Exclusion criteria

A patient whose sample tests positive for mycobacterium tuberculosis (MTB) in at least one of the four initial diagnostic tests was defined as having active pulmonary TB. Patients whose samples are negative for the MTB in all four initial diagnostic tests were defined as having non-active pulmonary TB. Such patients were excluded from the study. Patients with mono-resistance (resistance to one first-line anti-TB drug only), poly-resistance (resistance to more than one first-line anti-TB drug, other than both isoniazid and rifampicin) and extensive drug resistance (resistance to any fluoroquinolone, and at least one second-line injectable TB medication, in addition to multidrug resistance) were excluded from the study. Patients whose electronic medical records contained incomplete set of data were also excluded from the study.

In-depth interviews

The interviewees were purposely selected based on their roles and experience in TB control. A total of 8 re-treatment and newly diagnosed patients completed the interviews, including one with a history of incarceration. 10 healthcare workers involved with their treatment completed interviews, including 5 physicians and 5 health administrative officials. Patients with TB were asked to answer when, where, and why they had received TB services, how they were treated and what problems they faced. The administrative officials were asked to answer questions about the arrangement of treatment regimens and compliance of providers and patients. The physicians were asked to answer questions about their experiences and problems in treating TB patients. The interviews were digitally recorded, transcribed, and thematically coded. The final sample size was determined by a saturation of information when no new categories emerged .

Quantitative data analysis

Quantitative variables of demographic and clinical characteristics of the patients with MDR/RR-TB were compared with those without MDR/RR-TB. Three regression models were constructed for all cases combined—only new cases and only re-treatment cases, respectively. Tested in the regression analysis were the following independent variables: gender, age, social status, place of residence, living conditions, substances abuse, a history of imprisonment, partial or total permanent inability to work (further—disability), HIV status, a history of treatment with Rifampicin and Isoniazid, TB localization, cavitary disease, and circumstances of TB discovery. For the re-treatment patients, additional variables of previous therapy outcome and length of previous treatment with Rifampicin and Isoniazid were added.

Three separate binary logistic regression models were created. Chi square tests were used for testing the statistical significance of the models as a whole. Fitness of the models to the data were tested with the Hosmer & Lemeshow test. Regression coefficient, Odds ratio with 95% confidence interval (95% CI) for each variable category was calculated and Wald statistics method used to determine their statistical significance [ 26 ]. An analysis was performed using SPSS software V24.0.01.

Qualitative data analysis

The interview data was analyzed thematically, with the coding framework developed inductively from the data. The initial coding used open coding and theoretical coding. The initial codes were then refined to produce a smaller set of themes. The coding framework was subject to continuing revision with each iteration during analysis. Main objectives of the analysis were to receive clinical explanation for the results of quantitative data analysis, identify non-apparent factors influencing MDR/RR-TB incidence, determine features of the TB care system organization and limitations of the study. An analysis was performed using Nvivo software V11.0.

Characteristics of the study population

During the study period, in all healthcare institutions of the region, 2661 patients were diagnosed with TB, of which 1544 patients had an active pulmonary tuberculosis, and 101 patients were excluded from the study due to resistance types other then MDR/RR-TB, three patients were excluded due to an incomplete set of variables leaving 1440 patients for further analysis (Fig.  2 ).

Flow chart of patients enrollment. PCR polymerase chain reaction, DST drug susceptibility testing, MDR/RR-TB multidrug-resistant/Rifampicin-resistant tuberculosis

Participants had a median age of 41 years, and 73.5% of them were male. MDR/RR was detected in 618 participants (42.9%, 95% CI 40.3% to 45.5%). The proportion of participants residing in cities was 69.4%, and 989 of them (68.7%) had no record of employment. By residence type, 61.5% were living in separate apartments and 151 (10.5%) were homeless at the time of TB diagnosis. There were 2.01 times more homeless among re-treatment cases than in newly diagnosed cases (16,5% vs 8.2%). Alcoholism was reported in 3.5% of all cases and in 62.5% of TB was discovered actively with an annual chest x-ray in primary healthcare facilities (PHF). More than half of all cases (55.1%) showed signs of cavitary disease. Disabilities were reported in 6% of the entire sample, while 8.3% were tested positive for HIV. 78 patients (5.4%) were in detention or had an official history of incarceration at the time of diagnosis. Overall, incarcerated patients had a much higher prevalence MDR/RR (93.6%, 95% CI 85.6% to 97.8%) compared to the population without a history of imprisonment (40.0%, 95% CI 37.4% to 42.7%) (p < 0.001).

Out of the 1440 patients, 394 were re-treatment patients, totaling 27.4% of the overall sample. The re-treatment patients had greater prevalence of MDR/RR (64.6%, 95% CI 59.8% to 69.4%) than the new patients (34.8%, 95% CI 31.8% to 37.7%) (p < 0.001) (Table 1 ).

Factors associated with MDR/RR-TB

Data of 1440 patients undergone logistic regression analysis. The strongest associative factors for MDR/RR-TB were a history of imprisonment and history of previous treatment. In these cases, the risk of having MDR/RR-TB was 16.53 (95% CI 5.37 to 50.88, p < 0.001) and 2.82 times higher (95% CI 2.16 to 3.66, p < 0.001) respectively.

Other influencing factors included presence of disability (AOR is 2.32, 95% CI 1.38 to 3.89, p = 0.001), cavitary disease (AOR is 1.76, 95% CI 1.37 to 2.25, p < 0.001), positive HIV status (AOR 1.55, 95% CI 1.01 to 2.39, p = 0.046), age (AOR for being older than 41 years is 1.36, 95% CI 1.06 to 1.76, p = 0.013), place of residence (AOR for residing in the city is 1.44, 95% CI 1.09 to 1.89, p = 0.01). The only variable that showed protective effect against MDR/RR-TB was retirement status (AOR 0.65, 95% CI 0.43 to 0.98, p = 0.042) (Table 2 ).

The multilevel model for the newly diagnosed patients was composed of 1047 cases. Of these, 364 had MDR/RR-TB (34.7%). History of imprisonment was the strongest associative factor, with 11.9 times higher risk of MDR/RR-TB (95% CI 2.94 to 43.78, p < 0.001).

Among remaining factors, three showed association with presence of MDR/RR-TB. Cases with underlying cavitary disease were 1.96 times more likely to have MDR/RR-TB (95% CI 1.46 to 2.63, p < 0.001). Patients living in cities were 1.841 times more likely to have MDR/RR-TB (95% CI 1.25 to 2.44, p = 0.001). Positive HIV status was associated with 1.67 times increase in MDR/RR-TB risk (95% CI 1.01 to 2.77, p = 0.047) (Table 3 ).

393 re-treatment patients were analyzed in the separate multilevel model. Four variables proved to be significant, with a history of incarceration remaining the strongest associative factor. Such patients were 38.5 times more likely to have MDR/RR-TB (95% CI 3.64 to 407.42, p = 0.002). The presence of disability led to a 4.43 times greater likelihood of contracting MDR/RR-TB (95% CI 1.47 to 13.38, p = 0.008). A final two significant variables were official records of employment (AOR 4.32, 95% CI 1.74 to 10.71, p = 0.002) and being discovered actively by PHF (AOR 1.79, 95% CI 1.05 to 3.05, p = 0.03) (Table 3 ).

Interpretation of interviews

Healthcare providers confirmed that former inmates are the most problematic group of TB patients. TB care in penitentiary facilities is provided on site, by the often undertrained medical stuff with insufficient funding and equipment. This medical service is not controlled by the authorities of general TB care system and operates without supervision. Lack of centralized control in tandem with poor nutrition and living conditions, overcrowding, treatment regimen neglect by prisons’ medical staff and inmates, make prisons the clearest breeding ground for drug resistance. After being released, prisoners mostly disappear from epidemiological surveillance and, even if they show up for further treatment, they often fail to adhere to the regimen and follow-up procedures and there are no legal tools for healthcare providers to enforce surveillance on them.

Among interviewees, there was a consensus that the main obstacle toward achieving full patient’s compliance is the length of therapy. Patients become progressively tired as the treatment advances, especially those with drug resistance, whose regimens typically last for 24 months or more.

In these cases, all patients with MDR/RR-TB receive treatment in inpatient conditions for at least twelve months in TBDF. After that period, the patient can be transferred to an outpatient treatment regimen. This option is reserved for patients who have proven themselves trustworthy, showing full compliance during inpatient treatment, and not actively secreting TB mycobacterium so as not to be an ongoing source of infection to others. Patients who do not meet those criteria continue their treatment in inpatient conditions until the end of the course. Such prolonged treatment, combined with insufficient awareness about consequences of intermittent treatment, leads patients to forgo treatment, usually as soon as symptoms disappear.

Outpatients phase of regimens provide many opportunities for the patients to drop out due to various reasons. Local TBDF in collaboration with the Russian Red Cross NGO are trying to address this issue by more thoroughly educating patients about TB treatment, giving out free monthly food packages and reimbursement of travel expenses to fully compliant patients. According to physicians, this has been especially effective in encouraging economically disadvantaged patients to continue their treatment.

Neither patients nor healthcare providers reported adverse effects to be a significant issue in achieving full treatment adherence. During an inpatient stay, patients are closely monitored for occurrence of adverse effects, where they are also given medication for side effects prevention. Physicians stated that they are equipped with all the necessary medications for the effective management of adverse effects.

Monitoring the occurrence of the adverse events among outpatients is carried out through mandatory monthly examination. The only issue here, that during ambulatory phase of the treatment, patients pay out-of-pocket for drugs to combat minor side effects, but in event of adverse effects occurrence during this phase physicians try to hospitalize such patients in TBDF so they could receive free medication and avoid financial burden. Same couldn’t be said about medical service in penitentiary facilities, according to patients, monitoring procedures are next to non-existing and medications for combating adverse events are scarce there. So, it is common for the inmates to discontinue medications as soon as adverse event occurs.

Both physicians and healthcare managers reported that TBDF of the region are sufficiently supplied with quality anti-TB medication and all the necessary diagnostic equipment.

Healthcare providers stated that both outcome and history of previous treatment contributed to the resistance development contrary to our results that mere fact of previous treatment history is increasing risk of resistance presence regardless of its outcome. Same goes for social status and living conditions, which, according to our statistical data, do not influence resistance development, but from a clinical standpoint, socially disadvantaged patients (particularly homeless ones) display a greater tendency to acquire MDR/RR TB. Another substantial problem that was not supported by data but reported by interviewees, is a greater frequency of alcohol and substances abuse. MDR/RR–TB prevalence in those groups is significantly higher than average.

Physicians did not report any association between presence of disability and risk of MDR/RR-TB development but they stated that some patients purposely do not comply with treatment to worsen their condition and acquire disability status for receiving social security benefits.

Besides the TB mycobacterium’s major biological features leading to the prevalence of MDR/RR-TB, such as mutation potential [ 27 ], strains [ 28 ] and draft genome sequences [ 29 ], TB related service patterns, demographics and clinical factors also have a significant impact on the development of MDR/RR-TB. Based on the statistical analysis of 1440 TB patients, we identified several factors influencing incidence of MDR/RR-TB in the Khabarovsk region of Russia. Among them are incarceration and previous anti TB treatment history, cavitary disease, HIV co-infection, age, place of residence, retirement status, presence of disability, circumstance of TB discovery and social status. We also concluded that newly diagnosed patients and retreatment patients tend to have different risk factors for contracting and developing MDR/RR-TB. Qualitative survey showed that organization of the TB care system, features of TB treatment process, healthcare and social security legislation play important role in TB epidemiology and may influence incidence of MDR/RR-TB both directly and indirectly.

Findings of quantitative data analysis were partially supported by interviews with patients, health managers, and physicians. Incarceration history was identified as the strongest risk factor associated with MDR/RR-TB in all studied groups. In this data, a high prevalence of TB and its drug resistant forms can be seen in prisons all around the world, developed and developing countries alike [ 30 , 31 , 32 ].

In 2021, according to Birkbeck University of London, Russia occupied 5th place in the world in terms of total prison population [ 33 ]. Based on literature reports and the interpretation of interviews, we can conclude that persistent unhygienic incarceration conditions and low quality of medical care in penitentiary facilities cause high prevalence of MDR/RR among TB infected inmates [ 7 ]. This creates a substantial pool of hosts, carrying drug resistant TB in the general population. Contrary to all other healthcare facilities in Russia, penitentiary institutions’ medical service operates independently from the general TB care system (Fig.  1 ). Such demarcation deprives inmates of proper care and follow up, which they can receive in TBDF. Either a considerable reduction in the total prison population and/or inclusion of penitentiary facilities in the TB care system may address the problem.

This predicament of prisons is explained by a contradiction of Russian laws in the field of healthcare. No medical procedures can be instituted without a patient's consent, including hospitalization, so some patients simply leave TBDF at will. To ensure epidemiological surveillance, healthcare providers have to file a claim for forced hospitalization to the court, but there are no legal mechanisms to execute positive court decisions without a patient's written consent. Thereby, infectious TB patients can leave TBDF even with a court decision of forced hospitalization. In 2011 it was that 3500 out of 6000 lawsuits were satisfied in favor of forced hospitalization, and it took an average of 3 months to obtain a court decision and up to 30% of patients left TBDF after forced hospitalization [ 34 ].

To ensure proper TB surveillance, measures should be taken to eliminate such a loophole in the legal framework. For reducing the pool of former inmates with MDR/RR-TB, better treatment conditions and epidemiological surveillance in penitentiary facilities must be established. Such intervention of providing TB care for inmates in civil clinics has been implemented in the Tomsk oblast region of Russia from 2000 to 2002 [ 7 ], which consisted of two phases of DOTS-plus individualized MDR-TB treatment regimens. In first “intensive” inpatient phase, patients received a high calories and protein rich diet, a separate and better accommodation, and were closely monitored for occurrence of treatment’s side effects. In the second “continuation” ambulatory phase, a community-based approach was used to provide directly observed therapy in outpatient clinics. For avoiding treatment discontinuation, adverse effects were managed aggressively, alongside with provision of monthly food packages to fully compliant patients and reimbursement of travel expenses.

The results showed significant increase in compliance, reduction in adverse effects, decrease in mortality rate, and increased treatment efficiency among incarcerated patients. Listed interventions, contrary to penitentiary facilities, are common practice in civil TB designated clinics therefore success of this study supports the necessity of centralized TB care for all TB patients [ 8 ].

As it was reported by numerous studies, poor adherence to drug susceptible TB treatment and poor screening for MDR/RR-TB are the major threats to MDR/RR-TB spread. According to the WHO, in 2020 DST underwent 92% and 94% of all newly diagnosed and retreatment TB cases respectively [ 4 ]. Such large-scale testing combined with routine usage of direct PCR DST and culture-based DST methods in all TB suspected patients provide a reliable and effective system of monitoring and detection of MDR/RR-TB. This conclusion is supported by the results of healthcare providers’ interviews.

A much larger concern is the problem of the poor adherence to the TB treatment. Implementation of DOT and DOTS plus were beneficial but didn’t fully address this problem in Russia [ 7 , 34 ]. As was reported, the length of therapy seems to be a major factor affecting a patient’s drop-out rate. Because of Russian legislation, it is challenging to keep patients in hospitals against their will but attempts to overcome this obstacle are present. For example, a special mobile medical team may visit some infected patients daily in their homes to deliver DOT. Those patients are typically not from economically disadvantaged groups, and their living conditions are much better than those of inpatient TB designated facilities, so their compliance is much higher when they stay in conditions that can be compared to home confinement but not in inpatient facility. Another instance is that pediatric TBDF provides compulsory school education to children, so they don’t disrupt their studies during a hospital stay.

A study from Belarus performed in 2009 identified positive association between disability and MDR/RR-TB prevalence [ 35 ]. Concerning another type of social security policies, influence of retirement social status on the risk of MDR/RR-TB development is uncertain as both positive and negative relationships were reported in the literature [ 13 , 36 ]. A study conducted in Ethiopia revealed a tenfold increase in risk of MDR-TB for the military pensioners, explaining it as pensioners receive much fewer social benefits compared to the active military servicemen [ 13 ]. At the same time, researchers from Belarus describe a protective effect similar to results received in our study with a reported AOR of 0.6 [ 36 ]. Such consistency in results may be due to that Russia and Belarus, both being part former Soviet Union members, have similar social security policies regarding retirement benefits and benefits for people with permanent inability to work. There is a need for further investigation of that phenomenon in countries with and without such policies. Such studies may support disability status as a risk factor or reveal its connection to social security policies. It should be mentioned as limitation, that we had no data on whether disability was TB-related or determined by another disease, thus the full statistical meaning of this variable remains uncertain.

Our results concerning association between MDR/RR-TB with younger age, cavitary disease, and positive HIV status correspond with previous studies [ 28 , 37 , 38 ].

Regarding place of residency, city dwellers have better access to healthcare in general and have a far greater capacity to complete annual chest X-rays. Therefore, cities tend to see greater number of people diagnosed with TB than in rural areas. Likewise, the increased population density in cities provides more chances to contract MDR/RR–TB. This can explain an emerging trend observed by physicians—the increase in the prevalence of MDR / RR-TB among newly diagnosed patients.

Our study has several limitations. We failed to explain the significance of official employment status as a risk factor among re-treatment patients and insignificance of social status and living conditions, as these results contradict with previous studies [ 12 , 38 , 39 , 40 ]. Also, our data indicates that outcome of previous treatment does not influence risk of MDR/RR-TB development which contradicts with previous studies and healthcare providers’ interviews [ 38 ]. During patients selection process, gyrB mutation of m.tuberculosis in DST was not tested due to usage of premanufactured reagent in allele-specific PCR [ 25 ], but because of simultaneous use of cultural DST methods we are confident that no patient with fluoroquinolones resistance was enrolled in the study.

It should be stated that data on narcotics and alcohol use disorders was based on official records of seeking medical attention for such conditions. Because significantly few patients in Russia seek medical attention for addiction-related problems [ 41 ] based on this and interviewee reports of high prevalence of these conditions in TB patients and corresponding literature [ 19 ], we acknowledge that our data may not fully represent the overall prevalence of substance abuse in the studied population.

It is worth mentioning that, even so according to the healthcare professionals’ interviews, TBDF is sufficiently supplied with medications of proper quality, our quantitative data didn’t contain information about supply and quality of anti-TB drugs. Another piece of valuable information that has not been represented in the quantitative data set was the occurrence of adverse effects. But based on the in-depth interview results, we can conclude that adverse events don’t affect compliance of patients receiving TB care in TBDF. Contrary to the penitentiary institutions where treatment drop-out due to adverse events occurrence is a major problem [ 31 ].

Incarceration and treatment history, regardless of outcome, seems to be a major factor influencing MDR/RR-TB prevalence in Russia. It is essential for the TB care system to eliminate legal loopholes, which deprive doctors of means to enforce quarantine procedures and epidemiological surveillance on infected patients, former and current inmates, who seem to be the main source of MDR/RR-TB hosts in the general population. The last can be addressed by treating inmates in the facilities of the general TB care system. In the end, we want to say that further attempts to better patients’ education and public awareness about TB, with continuing coordinated and centralized care for patients with TB, in tandem with greater compliance by patients with TB treatment guidelines, are the keys to success in the battle against MDR/RR-TB globally.

Availability of data and materials

The datasets analyzed during the current study are under jurisdiction of corresponding authority body and are not publicly available but are available from the corresponding author on reasonable request due to need of corresponding authority body notification of data sharing with the third party.

Phthisiatrician—a medical specialist trained in the diagnosis and treatment of tuberculosis. In Russia, historically, it stands out as a separate medical specialization.

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Acknowledgements

The authors thank the staff of central “Tuberculosis Hospital” of Khabarovsk Krai for their support, access to the data and help with this study as well as Kremer M. for the proofreading and editing of the paper.

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Ilia Bykov, Huan Liu, Libo Liang & Qunhong Wu

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IB, QW, PR, LL, LH designed and planned this study; IB undertook data collection, performed statistical analysis, conducted interviews and wrote the manuscript draft; OD provided access to the data, follow up the study on data collection and interviews conduction as well as guidance and expert opinion on TB matters; IB, QW, PR, OD, LL, LH revised, proofread and edited the paper. All authors read and approved the final manuscript.

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Bykov, I., Dyachenko, O., Ratmanov, P. et al. Factors contributing to the high prevalence of multidrug-resistance/Rifampicin-resistance in patients with tuberculosis: an epidemiological cross sectional and qualitative study from Khabarovsk krai region of Russia. BMC Infect Dis 22 , 612 (2022). https://doi.org/10.1186/s12879-022-07598-7

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With deadline nearing, Newsom and lawmakers disagree over solutions to California budget crisis

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With a deadline looming, Gov. Gavin Newsom and Democrats in the state Legislature are working to settle their differences over access to public healthcare services, delaying minimum wage increases for workers and pausing tax credits for businesses as they cut their way out of California’s $45-billion budget deficit.

The governor’s proposal takes $12.2 billion from the state’s rainy day reserves to help cover the shortfall over the next two years and reduces funding to address climate change, provide broadband internet and increase subsidized child care, among dozens of other cuts.

Lawmakers responded last week with their own plan, which largely aligns with the governor’s strategy but pushes back on some of his proposals to reduce funding for homelessness and housing. Democrats in the Legislature called for substantially deeper cuts to climate change programs and the state prison system.

Assembly Budget Chair Jesse Gabriel (D-Encino) said the Legislature’s budget pitch restores “many of the most painful cuts to safety net programs, housing and health, including rate increases for health providers” proposed by the governor. Lawmakers have targeted some of Newsom’s marquee programs, such as decreasing grants to curtail homeless encampments and money to support behavioral health.

“These were difficult choices,” Gabriel said in an Assembly budget hearing last week. “But we had to set priorities and create a plan of action because that is what this moment requires.”

California is experiencing a deficit largely because tax revenues came in lower than expected, which Newsom has described as a return to normal after the economic boom brought on by the COVID-19 pandemic and billions of dollars in federal stimulus payments and business loans. Overspending, due to poor revenue forecasts, has also worsened the state’s financial troubles.

Staff members for legislative leaders and the governor have negotiated privately for the last week in hopes of reaching an agreement before the June 15 deadline for the Legislature to pass a state budget.

If lawmakers and the governor fail to reach a budget deal in the coming days, the Senate and Assembly are expected to pass a preliminary budget next week. Lawmakers will then adopt additional bills that reflect an agreement with the governor before the budget takes effect on July 1.

These are a few key differences they are expected to resolve in a final budget agreement:

Medi-Cal reimbursement rate increases

Newsom and lawmakers renewed a tax last June on managed care organizations , known as the MCO tax. The tax applies to health insurance providers that charge fixed monthly payments for services and is based on the number of people enrolled in plans each month.

The tax essentially acts as a mechanism to allow California to collect billions in additional federal funds for Medi-Cal, California’s healthcare system for low-income residents, as Democrats expand eligibility to all income-qualifying immigrants.

The law Democrats approved last year extends the MCO tax through 2027 and dedicates a portion of the revenue to increase payment rates to doctors and other Medi-Cal providers, in some cases, for the first time in two decades.

But Newsom’s budget proposal repurposes the funding, taking $6.7 billion over multiple years that was intended to go toward higher provider rates and using that money instead for general Medi-Cal costs. By tweaking the tax, Newsom’s changes could generate $9.7 billion to support the Medi-Cal program in total, with federal approval.

The governor’s proposal frustrates doctors and other healthcare providers, who have argued for years that the state’s reimbursement rates for serving Medi-Cal patients are too low to sustain a practice. The low reimbursements rates, they say, leave the state system short of providers and California’s most vulnerable populations without access to care. Doctors are leading the charge to pass a measure on the 2024 ballot that would permanently establish an MCO tax and direct a portion of the revenue to higher provider reimbursement rates.

The budget plan offered by Legislative Democrats rejects Newsom’s plan to eliminate more than $2.4 billion in provider rate increases scheduled to take effect Jan. 1, 2025. Lawmakers instead delay most of the rate hikes until 2026.

The California Medical Assn., which is among a coalition opposed to both proposals, said the governor and lawmakers “have a generational opportunity to achieve true equity in health care.”

“Too many families cannot get the care they need because we have refused to appropriately fund Medi-Cal,” said Dustin Corcoran, chief executive of the CMA. “The state has added millions of new patients in Medi-Cal and this funding would ensure we will have the providers to care for them.”

What to know about Gov. Newsom’s plan to offset California’s $45-billion deficit

In his revised budget proposal, Gov. Gavin Newsom lays out his plan to shrink California’s yawning deficit. Here’s what’s in it.

May 10, 2024

Increase minimum wage for healthcare workers — or not

Newsom signed legislation in October that increased the minimum wage for healthcare workers to $25 per hour. Labor unions celebrated their hard-fought wage hike, which will mostly benefit workers who are not directly involved in providing care.

At the time, no one, including the governor, publicly mentioned a major caveat he laid out behind closed doors before he agreed to sign the bill: If state revenues ended up as dire as forecasts predicted, there was “no way in hell” he would allow the law to take effect as planned in June.

Within weeks after signing the law, Newsom began calling for reforms to reduce funding for the wage increase as the budget deficit grew. Negotiations, between the administration, labor unions, and the healthcare industry, have played out privately for months without a resolution.

The governor since has been crystal clear about his concerns over the plan’s price tag, originally pegged at $2 billion from the state general fund, with another $2 billion paid with federal funds, in its first year. Other estimates suggest the administration is overestimating the cost, which could be closer to $300 million.

With negotiations with labor ongoing, Newsom provided no funding for the wage increases in his May budget proposal. Democratic lawmakers, siding with unions, want to spend $100 million for the pay raises in 2024-25, which would increase to $300 million in the third year of implementation.

As deficit estimate hits $68 billion, Newsom seeks ‘major changes’ to healthcare wage law

Gov. Gavin Newsom said his staff has been working with Democrats in the Legislature on the state’s healthcare minimum wage law in light of budget concerns.

Dec. 7, 2023

How hard to hit business

In the early stages of the pandemic, Newsom and lawmakers paused the ability of businesses with income of more than $1 million from deducting net operating losses from their tax bills, and limited business tax credits in the state to $5 million per filer in 2020, 2021 and 2022.

The changes were adopted to temporarily boost state tax revenues during a chaotic time when the pandemic created economic uncertainty across the nation and California projected massive revenue losses.

Newsom restored the deductions and ended the tax limits one year early in 2022 when the state anticipated a massive budget surplus. Now with California facing a deficit, he wants to suspend and cap the tax breaks again for the 2025, 2026 and 2027 tax years, with the ability to restore the credits if revenues turnaround.

Lawmakers agreed with the governor’s plan, but sought to apply the changes one year earlier. Implementing the tax credit adjustments in 2024 allows the Legislature to adopt fewer cuts to other programs in its budget plan, saving more than $3 billion into 2026.

Loren Kaye, president of a think tank affiliated with the California Chamber of Commerce called the California Foundation for Commerce and Education , said that companies factor the credits into their future business plans and that abruptly losing those savings can force them to scale back on employees or inventory to cover the cost of an unexpected tax bill.

“In this case, the Legislature has made it a little bit worse because at least with the governor’s proposal you have a heads up because it begins in tax year 2025,” Kaye said.

The limit marks the second time in five years that the state has capped tax credits, which could serve as a disincentive to companies that operate in California because of generous research and development or motion picture credits, Kaye said.

“We’re all about innovation,” Kaye said. “It’s one of our great competitive advantages and it could be heartbreaking to see people think that we’re not supporting innovation the way we have historically.”

Newsom and Democratic lawmakers detail first California budget cuts totaling $17 billion

Democratic lawmakers and Gov. Gavin Newsom are scrambling to lessen California’s budget deficit, which Newsom estimated at $37.9 billion in January.

April 4, 2024

Taking shots at Newsom’s projects

The Legislature’s proposal highlights key differences between the governor and lawmakers in his own party over funding for some of his marquee policies, including homelessness and prison reform.

Lawmakers proposed an additional $1 billion in cuts to the Department of Corrections and Rehabilitation, which includes at least $12 million in reductions to the governor’s project to transform San Quentin. Newsom’s cuts included $80.6 million in savings from the newly announced deactivation of 46 housing units at 13 state prisons.

Democrats in the Legislature also want to spend $1 billion more than the governor on a sixth round of Homeless Housing, Assistance and Prevention grants to local governments to combat the homelessness crisis. At the same time, lawmakers proposed cutting $100 million in funding to clean up homeless encampments in the current budget year.

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Taryn Luna covers Gov. Gavin Newsom and California politics in Sacramento for the Los Angeles Times.

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News | Pasadena braces for potential funding cuts to…

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News | pasadena braces for potential funding cuts to public health, homeless housing programs, a proposed budget reduction by the governor could result in a loss of $1 million to the city’s “core” public health funding, city officials said..

On June 3rd, the Pasadena City Council received an update from staff on the city’s proposed operating budget for FY 2025, in anticipation of its adoption next Monday, June 10.

Among the items discussed was Governor Gavin Newsom’s proposed slashing of $300 million public health funding under a program called “ Future of Public Health ” to close the state’s $45 billion budget deficit, a move that would significantly impact local jurisdictions like Pasadena, city officials said.

The budget reduction could result in a loss of $1 million to the city’s “core” public health funding, which the state created during the pandemic, Finance Director Matt Hawkesworth said at the meeting.

“So it currently supports eight full-time positions, and then it funds a number of things where there are no grants or other public health funding sources to fund,” he said.

In Pasadena, this funding is mainly allocated to six public health areas, including homeless services coordination, climate change resiliency, epidemiology, infectious disease control, communicable disease prevention, as well as community health worker coordination, Manuel Carmona, Pasadena’s deputy director of public health, said Thursday.

“So it does touch on a variety of core public health programs that are designed to build the infrastructure needed to protect public health, as well as prepare and build the capability to respond to the next public health emergency such as COVID 19,” he said.

For example, department staff detected and responded to the first locally acquired case of dengue in California last October, thanks to this funding, Carmona said.

The funding also supports programs such as the Pasadena Outreach Response Team, or PORT, a multi-agency effort created in 2018 to help connect unhoused individuals with the resources needed. In addition, the funding supports public information initiatives and public health nurses that do general work in the community, Hawkesworth said.

“As of late last week, the Joint Legislative Budget Plan is rejecting this cut from the governor, so that’s positive,” he said. “And that just showed there are significant local advocacy efforts ongoing, both the city individually, and we signed on with other public health jurisdictions opposing this cut.”

The Homeless Housing, Assistance and Prevention Program (HHAP) 6 funding, which supports the city’s street outreach, emergency sheltering and Rapid Rehousing program, is also on the governor’s chopping board, Hawkesworth said.

“The Housing Department Director shared that because of HHAP 5 funds still remaining, we should have enough money to get through FY 25,” he said. “If HHAP 6 was cut, then we would have a shortfall going forward unless they funded it the following year.”

The state Legislature has until June 15 to pass the budget.

Eight full-time positions from the Public Health Department — one of a rare few municipal health departments in the state — would be lost if the cuts go through, but it’s possible that the department may be able to retain them through other grants, Carmona said.

“But in the situation for each staff, it’s going to depend on a variety of factors as to whether or not we’re able to move them to other vacant positions in the department,” he said. “They wouldn’t be dedicated to these areas of public health, but they would still retain their services through other programs that are funded through grants.”

In the meantime, Pasadena is going through its own budget process by collecting comments that came up from staff’s meetings with various subcommittees and community members.

During the Public Safety Committee, a question arose on whether the Police Department could fill its remaining positions. The agency has approved 240 sworn positions, but it’s currently funded for 235 due to long-term vacancies, Hawkesworth said.

“They are working hard to fill their full 235. However, they don’t expect to exceed 235 filled positions in the upcoming FY 25,” he said. “They are focusing on the attraction of new people and retention, and so their goal would be to fill all 240 through fiscal year 2026.”

There was also another question about whether the city can open Kennedy and Villa Parke pools for Sundays during the three months of summer. This is possible by using existing summer filled positions, Hawkesworth said. This would incur an estimated cost of $25,000 for FY2025 for 14 Sundays, 8 hours per day.

Among other changes to the budget, the Rose Bowl Operating Company was asked to take the Family Golf project off the budget, since it has not been approved, Hawkesworth said. The initiative would triple the company’s driving ranges and add 36-holes of mini golf. The removal reduces an estimated revenue of $1.6 million, expenses of about $1.5 million and net income of around $72,000, Hawkesworth said.

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Austin police, fire, EMS looking for more funding in next year's budget for unmet needs

Austin's public safety departments — police, fire and emergency medical services — will be asking for increases to their budgets next year along with additional funding to help fill gaps across their departments.

Each department, along with the appropriate union president, presented to the city's Public Safety Commission on Monday what it intends to ask for next year and how funding those needs will increase efficiency and public safety throughout the city.

Commissioners unanimously approved the recommendations of each department, urging Austin City Council members to provide more money to the departments to meet those priorities. Most of those unmet needs include adding more personnel to better respond to emergencies.

The city is about a month away from beginning its budget process, wherein the city will decide how much money various departments will receive.

The city's total budget last year was $5.5 billion. The public safety departments' budgets come from the city’s general fund, which also pays for other city services like parks. The largest revenue drivers for the city’s general fund are property taxes and sales taxes. 

The city's financial staff in April projected a growing deficit in Austin’s general fund in the coming years, meaning the projected revenue will be lower than expenses. 

How exactly that will play out in next year’s budget remains to be seen. The city manager’s office will present a proposed budget later this summer, which will provide a more detailed look at available funding and how the city plans to prioritize its resources. 

Funding for all city departments must be given the final stamp of approval by the City Council, which will vote on and amend the draft presented by the city manager this summer.

What is the Austin Police Department asking for?

The Austin Police Department expects a nearly $13 million increase in its budget for next year, bumping up to about $491 million from its current $478 million.

The Police Department makes up the largest portion of the general fund, accounting for 35% last year.

If approved, this would be the fourth year in a row the Police Department would receive an increase in its budget since the city slashed the department's budget by $150 million amid national calls for police reform in 2020. Per state law, a Texas city cannot lower a police department's budget after it's been approved.

Assistant Police Chief James Mason told commissioners the largest driver of the increase comes from personnel costs, which include insurance and the police retirement system.

Mason said the department wants to add 16 911 call takers and 10 dispatchers to the 911 call center. A year ago, the call center had nearly 60 vacancies, a number that's now down to 19, Mason said. The goal in adding more positions is to ensure workers can answer calls in 15 seconds or less.

Additionally, the Police Department wants to add more positions to its public information requests office — six new employees to handle requests and four to handle requests pertaining to audio and videos. The department also hopes to add six people to help comply with a state law that requires all information be released to someone accused of a crime.

Last year, an audit found the Police Department had a backlog of 20,000 public information requests.

The department also wants to add funding for sex crime investigations; marketing and website design to aid in officer recruiting efforts at a time of continued vacancies; and leadership training based on recommendations from Kroll, a consulting firm, to improve training tactics of the Police Department's cadet academy.

The department's unmet needs total $4.8 million.

What is EMS asking for?

Austin-Travis County Emergency Medical Services forecasts that its budget next year will be up by nearly $10 million, growing to $140 million.

Carlos Ledesma, EMS assistant director, said its unmet needs total $8.6 million, including adding more medics and ambulances to various places in the city such as in downtown and the Domain region.

Selena Xie, president of the Austin EMS union, said there aren't any dedicated medics and ambulances for the downtown area. On weekend nights when the bars close, she said, EMS sends ambulances from the surrounding neighborhoods.

Xie added that a shortage of medics and ambulances throughout the city also affects EMS communications, which often will triage calls to not send an ambulance unless it's absolutely needed. However, she said, EMS communications have not received additional positions in 20 years, despite call volumes growing by 25%.

What is the Austin Fire Department asking for?

The Austin Fire Department expects to see its budget increase by about $13.5 million for next year, up from its current $247.8 million.

The department is asking for two new positions to help it achieve a national accreditation that it lost 22 years ago, which would help the department more easily identify policies and procedures that can be improved, said Ronnelle Paulsen, Fire Department assistant director.

The department needs about $1.9 million to hire 16 people to staff two new aerial trucks, which have already been bought, Paulsen said.

Bob Nicks, president of the Austin Fire Association, said the department has not had a new aerial truck since 1995. In addition, he urged the city not to take anything else away from the public safety departments. He noted that in 2017 the three departments accounted for 67% of the general fund, and now it's closer to 62%.

"Enough's enough," Nicks said. "We can't stretch any further."

Activists call for more spending on housing, mental health

Along with the public safety departments, advocates from Equity Action and the Austin Justice Coalition spoke about the need to increase spending on various preventative measures. This includes more money for housing for homeless and formerly incarcerated people, increasing mental health services and violence intervention .

Chris Harris, Austin Justice Coalition policy director, said that currently there aren't mental health responders on call 24 hours a day, despite the option being available when someone calls 911 in Austin.

Taking care of marginalized members of the community, Harris said, "will actually address what we all consider to be public safety or community safety much better than the approaches we've relied on more solely in the past."