Penn MARCH CENTER
2009 Request for Proposals |
Current Pilot Projects |
About the Penn MARCH Center
For decades, much of the research data about disease and treatment that formed the basis of medical knowledge was drawn from research on men only - specifically those of European descent. As researchers have responded to this skew, the reality of the information and knowledge gap has been shown to be much greater than an issue of gender. Illness, treatment, health care access and quality are clearly not the same for everyone as research in heart disease, diabetes, pediatric health, and even breast cancer has shown. But what of older adults? Do the chronic illnesses and co-morbidities that accompany older age affect all older adults in the same way? Do clinicians and researchers have sufficient understanding about social, environmental, individual, health system and policy, and provider factors and how they interact to create health and health care disparities?
The new Penn MARCH (Minority Aging Research for Community Health) Center, funded with a $3.1 million grant from the National Institute on Aging and under the joint and unique leadership of Drs. Jerry Johnson, Penn School of Medicine (SOM), and Neville Strumpf, Penn School of Nursing Science (SON), is a research-based and mentoring investment to improve the health and well being of older minority populations by identifying mechanisms for closing the health disparities gap between minority and non-minority elderly populations. Penn MARCH Center represents an opportunity to translate research into practice at the population and community level for the most vulnerable segments of older adults.
“Neville [Co-Director of the Center] and I are excited about the opportunity this award presents for the Schools of Medicine and Nursing, in partnership with community stakeholders, to develop and facilitate research and research training pertinent to all stages of chronic disease from acute care to end-of-life health care, “ says Dr. Jerry Johnson, Chief of the Division of Geriatric Medicine and Director of the new center. "The Penn MARCH Center will create mechanisms that allow investigators with expertise in aging to apply that expertise to minority health problems and allow investigators with expertise in minority health issues to apply that expertise to aging. In this manner, we hope to translate aging research to minority communities and populations, with an emphasis on West and Southwest Philadelphia.”
Three main emphases of the Penn MARCH Center research include developing culturally-informed disease and disability prevention and health promotion strategies; improving community, group or individual based interventions that will result in optimal health outcomes, and improving the measurement of social, psychological, economic, demographic and other constructs germane to the health of older minority populations. Penn MARCH Centeri’s leadership draws from Penn faculty with significant expertise in health disparities and aging research and will also benefit from the involvement of a local community engagement board, an internal executive committee, and an external advisory panel.
Within the center, Drs. Johnson and Strumpf will lead the Administrative Core. Drs. Joe Gallo (SOM) and Lois Evans (SON) will oversee the Investigator Development Core. This Core is charged with increasing the knowledge base for health disparities in older adults by identifying contributing factors and by testing interventions that reduce health disparities at multiple levels; supporting research training and collaborations, and recruiting and training minority investigators focused on health disparities research among older adults.
Drs. Chanita Hughes-Halbert (SOM) and Eileen Sullivan-Marx (SON) will direct the Community Liaison Core, which will work to actively engage community involvement in minority aging research, develop methods for recruiting older minority adults into MARCH Center research studies, and disseminate information on research results to community stakeholders. Drs. Judy Shea (SOM), Julie Sochalski (SON), and Thomas Ten Have (SOM) will coordinate the Measurement Core, which, in collaboration with the Investigator Development Core, will create an infrastructure to initiate, conduct and facilitate research in health disparities and older African-Americans and Latinos and disseminate findings to practitioners, academics, policy-makers and the public. The Core will also provide training in methodology and measurement.
For more information about the new Penn MARCH Center, contact Dr. Jerry Johnson at jcjohnso@mail.med.upenn.edu or Dr. Neville Strumpf at strumpf@nursing.upenn.edu.
As part of the center, four pilot projects have been funded. Additional information about each pilot follows, with contact information for the pilot’s primary investigator provided.
Pilot Projects
- Perspectives of Older African-American Women on the Future Need for Personal Long-term Care Placement
- The Relationship of Spirituality and Mental Health to Blood Pressure Control in African-Americans
- Is There a Need for Rehabilitation After Adjuvant Treatment for Breast Cancer Among African-American Women?
- Health Disparities in Sleep Disorders: Evaluation and Treatment in Older Adults as a Function of Ethnicity
Perspectives of Older African-American Women on the Future Need for Personal Long-term Care Placement
According to the most recent Census Bureau report, older Americans today, on average, are more prosperous, better educated, and healthier than previous generations. There are vulnerable subgroups, however, among the elderly; older women are among the most vulnerable segments of the populations, with older African-American women among the poorest of the population. This study focuses on an ethical principle of justice in long-term care put forth by the World Health Organization and will explore the feasibility of applying mixed methods to deepen the understanding of older African-American women’s everyday experiences and challenges of living in the community, beliefs about long-term care (LTC) placement and concerns about end-of-life issues. The pilot’s long-term goal is to provide meaningful, utilizable data that gives a foundation for intervention designs that use consumer language and concepts and facilitates development of desirable, innovative end-of-life options and supportive care networks that honor a consumer’s rights to choose among available options for homecare or placement in a long-term care facility. The project will use participatory research strategies for recruiting a sample of older African-American women; feasibility of collection will be determined by self-report questions from the Longitudinal Study on the Aging. The objective of the planned independent investigator award will be to use the findings of this pilot to design a community-based, age and culturally appropriate intervention that enhances older African-American women’s understanding and effective use of LTC resources to maximize personal autonomy, functional abilities and quality of life.
Contact: Margaret Stineman, MD, Primary Investigator; email address: mstinema@mail.med.upenn.edu
The Relationship of Spirituality and Mental Health to Blood Pressure Control in African-Americans
The single most common explanation for morbidity and mortality disparities between African-Americans and Caucasian Americans is hypertension, the most common chronic disease in African-Americans. Patient beliefs about their hypertension and antihypertensive medications influence how patients manage their disease and adhere to treatment. Although scant, there is promising empirical data indicating that spiritual interventions may increase medication adherence and decrease blood pressure in older, hypertensive African-Americans as it is suggested that spirituality influences the decision-making process regarding health and increases social support and self-efficacy. However, these studies are plagued by several methodological flaws including small sample sizes, lack of control/comparison groups, and most importantly the absence of the measure of spirituality. Using a culturally appropriate measure of spirituality, this pilot will seek to determine the relationship between spirituality, medication adherence, and blood pressure control in hypertensive older African-Americans. Fifty African-American patients, with a diagnosis of hypertension, will be recruited from primary care practices serving predominantly minority and low-income populations in West Philadelphia. Pharmacy refill data will be collected on a subset of patients as an objective measure of medication adherence.
Contact: Lisa Lewis, PhD, Primary Investigator; email address: lisaml@nursing.upenn.edu.
Is There a Need for Rehabilitation After Adjuvant Treatment for Breast Cancer Among African-American Women?
Studies show that there is a significant subset of women for whom breast cancer treatment leads to meaningful decreases in physical function. Studies did not focus on African-American women, given the likelihood of more aggressive tumor types and thus more aggressive chemotherapy, and among whom mortality from breast cancer is higher when compared to Caucasian women. This study seeks to measure physical function changes and the possible mediators for these changes among African-American women before and after chemotherapy and radiation treatment and to explore whether there is a need for a rehabilitation intervention for this subset of breast cancer survivors who may be at particularly high risk for physical function declines. The pilot will show the feasibility of recruiting and retaining African-American women in an observational study and will compare changes in objectively and subjectively assessed physical functional status over one year among African-American women treated for non-metastatic breast cancer with surgery only (n=20) versus surgery, chemotherapy, and radiation (n=20). An additional aim is to examine relative contributions of potential physiologic, psychological, and behavioral mediators of changes in physical functional status resultant to breast cancer treatment. The study will recruit 40 African-American women at the first post-operative visit after curative breast cancer surgery (20 women who will have surgery only, 20 who will have surgery and adjuvant treatment [chemotherapy and/or radiation], respectively). All women will be measured at 2 time points: baseline (within 4 weeks of surgery but before chemotherapy or radiation treatment), and 6 months after the end of adjuvant treatment. Pilot recruitment will enable the investigators to plan appropriately for a larger study on the effects of breast cancer treatment on functional status among African-American breast cancer survivors.
Contact: Kathryn Schmitz, PhD, MPH, Primary Investigator; email address: kschmitz@cceb.med.upenn.edu.
Health Disparities in Sleep Disorders: Evaluation and Treatment in Older Adults as a Function of Ethnicity
Sleep disorders are common in older adults, with nearly 25% having sleep disordered breathing and up to 30% having complaints of insomnia. Differential attitudes and perceptions of sleep may account for the significant variations among minority populations in sleep disorders’ evaluation and management. This pilot’s long-term goal is to develop targeted interventions that can improve the management of sleep disorders within minority older adult populations and thereby reduce the significant morbidity and mortality associated with unrecognized sleep disorders. Attitudes towards sleep and sleep disorders among African-American minority older adults will be examined through focus groups to learn about minority group cognitive beliefs and to understand the perception and reality regarding sleep; this information will be used to develop specific screening tools for this population to explore the relationship between sleep and a broad range of minority health disparities, such as differences in mortality.
The screening tool will be added to the ongoing Philadelphia Health Management Corporation’s Household Health Survey, which samples 10,000 households and has been conducted since 1983. An analysis will be conducted to assess the inequality of sleep in different minority groups and determine whether inequalities in sleep mediate the inequalities in health, with univariate comparisons to determine the relationships between the predictor variables and sleep. Multivariate regression models with sleep as the dependent variable to assess the associations between sleep and minority status while adjusting for potential confounders such as age, gender and socio-economic status will then be conducted. The mediating effect of sleep will be examined by assessing the extent to which coefficients for the effect of ethnicity and SES variables on health are attenuated by the inclusion of sleep as a covariate. It is hoped the pilot will lead to quality of care indicators, interventions, and policy change in the care and evaluation of sleep problems among older minority populations. The data gathered from this pilot project will be instrumental in designing interventions that can increase access to care and compliance with treatments.
Contact: Nalaka Gooneratne, MD, MSCE, Primary Investigator; email address: ngoonera@mail.med.upenn.edu.