Pilot Grants for Anti-Racism Research

2022 Fall RAP Anti-Racism Research Pilot Grant

The Research Development Office and RAP are pleased to announce the latest cycle of the Anti-Racism Research Pilot Grant saw an increase in the number of applications to either the $50,000 research grant or $10,000 capacity building grant. There was also an increase in the number of supportive campus funders! Five awards, supported by the UCSF School of Medicine Strategic Plan in partnership with the Center for Community Engagement/CTSI, the Academic Senate, the School of Medicine's REAC program, and the National Center of Excellence in Women's Health, were made.

Marsha Treadwell, PhD (Professor of Pediatrics, Division of Hematology – School of Medicine)
Using Community Based Research Practices to Advance Anti-Racism in Sickle Cell Disease Clinical Care

Since it was identified in Western medicine in 1910, sickle cell disease (SCD), that affects primarily Black and Brown people, has received fewer clinical, research and public health resources compared with other conditions. Further, individuals with SCD face tremendous barriers, including racism, as they seek to obtain needed healthcare. At the UCSF Benioff Children’s Hospitals (BCH), our Sickle Cell Center has attempted to address these concerns by educating providers and by improving structures within pain management is delivered. The BCH Diversity, Equity, Inclusion and Anti-Racism (DEI/AR) Council focuses on improving experiences of our diverse workforce and our patients/families, by encouraging open, constructive communication about DEI/AR issues. We propose to partner with the community-based Sickle Cell 101, that is trusted and renowned for its global platform that engages and educates about SCD, using patient-friendly language. We will use this planning grant to create an equal partnership among these three entities, to: 1) update a community-based needs assessment, obtaining patient/family voices about remedies for the structural and interpersonal racism that patients with SCD face in their healthcare; 2) refine and pilot BCH staff education and skills building about SCD care within an anti-racism framework; 3) increase our knowledge and skills as a team to conduct community engaged research that better addresses SCD healthcare inequities. This planning grant will allow us to assemble a competitive grant proposal for future funding to answer research questions that contribute to our understanding about the influence of racism on SCD care, and to create and evaluate interventions to improve health and reduce healthcare disparities for the SCD population. As we obtain expert consultation on moving beyond naming racism to group action, we will lay the groundwork for interventions that ultimately create a culture at BCH that elevates and values the voices and experiences of People of Color.

Lealah Pollock, MD (Assistant Professor, Family Community Medicine – School of Medicine)
Developing a community-led collaborative research proposal on infant feeding choices for Black women and birthing people with HIV in high-resource settings

Breast/chestfeeding while taking HIV medications is the standard of care for women and other parents living with HIV in resource-limited areas of the world. It has been shown to increase HIV-free survival in areas of the world without reliable access to clean water and affordable infant formula, and the risk of HIV transmission has been shown to be less than 1% (WHO 2016; Flynn et al 2018). However, in high-resource settings like the United States and Canada, HIV and public health guidelines discourage breast/chestfeeding among women and other birthing people living with HIV (Panel 2022). These guidelines address neither the potential health benefits of breast/chestfeeding, nor the potential health risks to parent and child of not breast/chestfeeding. The information available can be confusing for those who may want to explore the option of breast/chestfeeding. Due to the effects of systemic racism, Black women and birthing people in the US are disproportionately vulnerable to HIV and perinatal morbidity and mortality while simultaneously experiencing multiple barriers to successful breast/chestfeeding, even when not living with HIV. Depite extant research highlighting the low risk of Black parents living with HIV feeding their child(ren) with human milk from their bodies, U.S. guidance lags and perpetuates discrimination, harm, and inequities in perinatal outcomes. This capacity building project aims to acknowledge and augment the existing expertise of a community-based organization supporting the needs of people living with HIV, particularly women, by leveraging the research skills and aptitude of academic scholars in service of their ongoing efforts to increase knowledge and access to information around breast/chestfeeding and HIV.

Alexander Smith, MD, MPH, MS (Professor, Medicine – School of Medicine)
Assessing the Impact of Anti-Asian American Pacific Islander Hate Incidents on the Health and Well-being of older AAPI

Anti-Asian Pacific Islander (AAPI) hate incidents are on the rise. While the media is focused on the impact of hate incidents on the direct victims of violence, the indirect impact of hate incidents on the health and well-being of AAPI elders is largely hidden from view. Many older AAPI are afraid to leave their homes, to go shopping for groceries (e.g. in Chinatown), and to walk for exercise. These experiences have compounded the enforced social isolation and feelings of loneliness due to Covid-19. The objective of this research project is to bring to light the hidden indirect impact of anti-AAPI hate incidents on older AAPI. To accomplish this objective, we will conduct a survey of 500 AAPI elders about their awareness of anti-AAPI hate incidents and impact on their physical, mental, and social well-being. We will supplement this survey with qualitative in-depth interviews to elicit stories from older AAPI and health care providers. Sometimes stories are more persuasive to the public and policymakers than data. We developed these questions by engaging community partners, including Dr. Russell Jeung, Professor of Asian Studies at San Francisco State and co-founder of Stop AAPI hate, an organization whose data are regularly cited in the lay press. These findings will expand the public narrative from a focus on the few people who are direct victims of heinous violence to the much larger group of older AAPI who are indirect victims of Anti-AAPI hate incidents.

Mara Decker, DrPH (Associate Professor, Institute for Health Policy Studies – School of Medicine)
Addressing inequities in sexual and reproductive health among the American Indian and Alaska Native population through community partnership and an anti-racism approach

Background: Despite growing awareness of the impact of systemic racism on health, few studies have applied anti-racist models for understanding health outcomes among the American Indian and Alaska Native (AI/AN) population. AI/AN people experience substantial inequities in sexual and reproductive health (SRH) and persistent disparities in structural factors, such as housing and food security, compared to the general U.S. population. Centuries of colonialism, racism, and intergenerational trauma underlie inequitable health outcomes for AI/AN people. Yet AI/AN health statistics are often omitted from public health reports leaving programs and policies unprepared to identify, prioritize, or meet the needs of the AI/AN population. Purpose: The purpose of this study is to compare SRH indicators among AI/AN people and the general US population using an anti-racist model that considers historical context and systemic inequities. Our three primary aims are to compare the AI/AN and general populations in 1) SRH indicators, including access to SRH and maternal health care, sexual violence, and maternal and infant health; and 2) systemic racism indicators, including disproportionate exposure to housing/food insecurity and experiences with school discipline and foster care; and 3) the relationship between these indicators. Methods: We will use combined 2011-2019 data from the National Survey of Family Growth (N = 42,060). The study design is cross-sectional and correlational. Multivariate regression models including interactions between AI/AN race and systemic racism indicators will be used to assess whether associations between SRH outcomes and inequity are greater for AI/AN than for the general population. Significance: We aim to improve the wellbeing of AI/AN people through partnership with AI/AN experts to guide the research, represent AI/AN values, incorporate community context, and ensure meaningful study impact, expanding the evidence on the relationship between systemic racism and SRH among AI/AN people, and informing culturally-specific interventions, future research, and policy recommendations.

Aimee Medeiros, PhD (Associate Professor, Humanities and Social Sciences – School of Medicine)
The Impact of the Use of Race as a Risk Factor in the American Academy of Pediatrics Clinical Practice Guideline for Urinary Tract Infection on Febrile Children Presenting to Emergency Rooms

We lack research on best practices for ameliorating institutional racism in health and medicine. In 2020, students and faculty affiliated with the UCSF Department of Humanities and Social Sciences (DHSS) founded The REPAIR Project as a capacity-building initiative designed to address Anti-Black Racism and augment Black, Indigenous, People of Color (BIPOC) voices and presence in Science and Medicine. REPAIR recognizes that long-standing racial inequities in health, health care institutions and scholarship result from systemic race-based violence and racism in society and seeks to promote efforts to rectify and eliminate these inequities. Our starting point is anti-Black racism, in accordance with legal studies scholar and civil rights activist Derek Bell who reminds us that “discussions of injustices experienced by Black Americans frame and guide the needed work to end racial injustice for other groups” (Bell 1993). REPAIR began and has continued as a result of the unfunded labor of students, faculty, and staff volunteers. It has served as a pilot project for promoting anti-racism and community engagement through conducting workshops, teach-ins, campus forums, electives, symposiums, and on-line resources. We seek funding to conduct a systematic impact evaluation and to disseminate our findings. We propose a qualitative study of in-depth interviews, focus groups, and surveys to identify best practices for anti-racist initiatives that are inclusive of community voices. Our goal is to evaluate the best practice for collective anti-racist work, including the burden of ‘minority tax’, avenues for critical consciousness development, and community building with community partners. With knowledge of best-practices, we hope to bring awareness and nuanced understandings of the root causes of racism in the health sciences and higher education and to advocate for anti-racism strategies and interventions to address oppressive systems and structures.

2022 Spring RAP Pilot Grants for Anti-Black Racism

We are excited to announce the recipients of the Spring 2022 RAP Pilot Grant for Anti-Black Racism. Congratulations!

Elizabeth Rogers, MD (Associate Professor of Clinical Pediatrics - School of Medicine) and Olga Smith, RN (School of Nursing)

REJOICE - Racial and Ethnic Justice in Outcome in Neonatal Intensive Care

It has been over a century since the connection between racism and health outcomes has been established (Sharon D. Jones-Eversley & Lorraine T. Dean, 2018). While contemporary health science researchers continue to document harms, remediating racial and ethnic disparities in health outcomes remains long overdue. The neonatal intensive care unit (NICU) is not exempt from this phenomenon; the neonatal population, one of our most vulnerable, is subjected to the same differential healthcare that we see across the United States of America. To understand local health disparities in the NICU, we conducted the REJOICE study. The REJOICE study is a local mixed methods study utilizing retrospective medical record reviews for metrics that include social stressors such as CPS involvement and behavioral contracts, quality care indicators (Profit et al., 2017) and conditions that increase morbidity/mortality (e.g., necrotizing enterocolitis). To qualitatively understand the experiences with racism and discrimination we are conducting parent and NICU staff member interviews. During our data collection and analysis phase our aims were 1) to assess the degree of disparate care and outcomes for infants hospitalized in the NICU by race and ethnicity and 2) to discern from the lived experiences of parents of hospitalized infants and providers in the NICU, including experiences of racism and discrimination, to later identify actionable goals in restructuring NICU care to achieve racial health equity. To share power and privilege, we have chosen to incorporate the communities most impacted by our work into this final stage of the research project by creating a community advisory board that will work in conjunction with NICU staff to identify critical areas for change.

Judy Tan, PhD (Associate Professor, Medicine School of Medicine)

Developing Metrics for (E)valuating Efforts that Promote Inclusion, Diversity, Equity, and Anti-racism (IDEA) at UCSF

At UCSF, we establish, apply, and periodically revise standards and metrics by which to assess and evaluate our scholarly and clinical efforts for the purpose of advancement and improvement. When it comes to evaluating efforts of inclusion, diversity, equity, and anti-racism (IDEA), however, empirically valid and reliable metrics are lacking to accurately capture the work that learners and postdocs, staff, and faculty do to promote IDEA in the Department of Medicine (DOM),UCSF. A lack of metrics on IDEA undercuts efforts of anti-racism and can inadvertently further marginalize minoritized persons. As awareness and accountability lead to important social and cultural changes within institutions, it is imperative that consistent and validated metrics are developed to evaluate growth and change within individuals over time and across groups of individuals overall, as a measure of IDEA impacts. Methods in developing these metrics should be consistent and accessible to allow replication as well as for refining and improving upon these metrics over time. Activities to promote IDEA also vary by roles (e.g., postdocs, staff, and faculty) and across contexts. As such, it is critical are IDEA metrics are developed by the individuals enacting the IDEA efforts and whom IDEA efforts are intended to support, i.e., experts. The overall goal of this project is to develop metrics that accurately capture the type, scope, and extent of work to promote IDEA at UCSF.

The UCSF Office of Research has committed to support efforts to guide equitable research conduct, building capacity for research on racism in biomedical research, and for research using anti-racist and racial equity approaches. Toward this goal, the Research Development Office (RDO) has developed and piloted an anti-racism research seed grant program through its Resource Allocation Program (RAP). Base funding for this initiative is provided by the Academic Senate and the School of Medicine’s Research Evaluation and Allocation Committee (REAC).

For this funding cycle, the program theme will again focus on research projects addressing anti-Black racism. We are modifying this mechanism to offer two separate award types:

  1. $10,000 for a Pilot for Anti-Racism Research Capacity Building Grant
  2. $50,000 for a Pilot for Anti-Racism Research Project Grant

We anticipate making 2-3 $10,000 capacity building grants and 1-2 $50,000 research project awards. Please see full RFA here.

2021 Inaugural Pilot Grant for Anti-Racism Research

The UCSF Office of Research has committed to the goal of anti-racism and racial equity in research. As one action for this initiative, the Office of Research has convened campus partners to create and fund an anti-racism research pilot grant program offered through the Resource Allocation Program (RAP). As funders for this inaugural program funding cycle, the Clinical and Translational Science Institute (CTSI), Academic Senate (AS), National Center of Excellence in Women's Health (NCOEWH), and (Research Development Office (RDO) are excited to announce the award recipients of the RAP Pilot for Research on Racism Impacting Black People grant. All awards were for $50,000. In alphabetical order:

Rosny Daniel, MD, (SOM) and William Martinez, PhD, (SOM)| Addressing Anti-Black Racism in Mental Health Emergency Settings at UCSF

UCSF Partners: Michelle Porche, EdD (SOM), and Paula Fleisher, MA, (CTSI)

Community Partners: Monique LeSarre, PsyD, (Co-I), Rafiki Coalition

Abstract - Disparities in health care for Black people are well known and persist, contributing to poor health care experiences and outcomes. The mental health emergency systems of care are no exception. For example, multiple studies have shown higher rates of restraint use in Black patients being treated for psychiatric emergencies compared to White patients. Internalized, interpersonal, institutional, and systemic anti-Black racism is prevalent in medical institutions, including the University of California, San Francisco (UCSF). While it is known that disparities in care and outcomes exist due to racism at multiple levels, the means by which institutional and structural racism contribute to the practices, processes, and policies that result in these differences in treatment are not well understood. Through an explanatory, sequential, mixed-method design, and in close collaboration with community stakeholders through partnership with the Rafiki Health Coalition for Health and Wellness, we aim to examine the experiences of patients presenting to the UCSF Parnassus Emergency Department for mental health emergencies and the providers and staff who evaluate and treat them. This project will contribute to eliminating a culture of anti-Black racism at UCSF by shedding light on treatment differences in mental health emergency care settings, raising awareness around our findings, and developing community-informed strategies for targeted innovation in policies and practices of psychiatric emergency care. Our efforts will create a platform for measurable and transparent clinical quality improvement to help provide excellent and equitable emergency-based mental health care at UCSF Parnassus through increased awareness of and strategies to counter anti-Black racism among staff, in the built environment, and through clear anti-racist policies and protocols which can serve as a model for other departments and institutions.

Elizabeth Dzeng, MD, PhD, MPH (School of Medicine) | Understanding how structural racism influences goal concordance around end-of-life care in older Black adults

Academic Partners: Kim Rhoads. MD, MPH, MS, Dan Dohan, PhD, Kirsten Bibbins-Domingo, PhD, MD, MAS, Ronit Elk, PhD (University of Alabama, Birmingham)

Abstract - Black Americans are less likely to receive goal-concordant end-of-life (EOL) care in part due to racial disparities such as poorer EOL care communication, inadequate pain treatment, and reduced palliative care access. Despite decades of predominantly quantitative research documenting racial disparities in palliative and EOL care outcomes and access, there has been little progress in rectifying these inequities. This is in part due to a failure to recognize structural racism as a root cause of racial health disparities. There is a critical research gap in our understanding of how structural racism influences racial disparities in the receipt of goal-aligned EOL care at multiple levels of the healthcare system and the strategies needed to address them. The objective of this RAP pilot grant is to use community based participatory research (CBPR) to understand at multiple levels of the UCSF healthcare system how structural racism influences the receipt of goal-aligned EOL care in older Black adults. The first aim of this study is to establish a Community Advisory Board and elicit their perspectives around structural racism to co-develop study instruments and materials and guide the overall project. The second aimis to understand how structural racism at the institutional and community level drives inequities in the provision of goal-aligned EOL care and the barriers and facilitators to institutional change. This proposal advances racial disparities in palliative care research by examining the institutional and community level drivers of structural racism in EOL care. This pilot project will clarify how structural racism at UCSF affects its ability to provide goal-concordant EOL care for older Black adults. Data from this project will be used to design, pilot, and implement interventions for future R-level applications to mitigate the impact of structural racism on goal-concordant EOL care in older Black adults at UCSF and nationally.

Jennifer James, Reproductive Justice in California’s Women’s Prisons: Racism, eugenics, and regulatory constraints

Community partner - California Coalition for Women Prisoners

Abstract - On September 14, 2020 Dawn Wooten, a Black nurse working for the Irwin County Detention Center in Georgia, came forward with allegations that physicians working for ICE had forcibly sterilized women held in the facility. Many across the country were shocked and outraged to learn that health providers might be sterilizing women without consent. Yet, this practice of sterilizing women, particularly women of color, who are under state control is not novel. The California Eugenics Program was ended in 1979, yet sterilizations continued in California State Prisons, with at least 148 women sterilized without proper informed consent from 2006- 2010. The stories out of Irwin along with a new documentary, Belly of the Beast, focused on the sterilizations that occurred in California State Prisons, erupted onto the national landscape at a time when the US was grappling with racial tension and police violence against Black Americans. To date, no research has examined the both the history of forced sterilizations and its impact on present day reproductive health decision-making for incarcerated Black women. Through this project, a community-academic collaboration, we will elucidate how formerly incarcerated women and health care workers in California prisons work together to make reproductive health decisions under the pervasive shadow of eugenics and racism. We will convene stakeholders from around the state to determine strategies to advance legislative and public health efforts to protect this population and develop a “Know Your Rights” pamphlet to help empower incarcerated women faced with issues of reproductive justice behind bars.

Malini Nijagal, MD | Convening a Stakeholder Group to Ensure a Novel, Community-based Model of Prenatal Care is Truly Antiracist

UCSF Partners: Schyneida Williams, Co-I, SF Respect Initiative; Patience Afulani, PhD, MD, MPH, Co-I

Community Partners: Rafiki Coalition (Monique LeSarre, PsyD, MA, Co-I), Homeless Prenatal Program, Sisterweb Doula Organization, Designing Justice + Designing Spaces (DJDS)

Abstract - Black birthing people in the US—and in San Francisco-- experience significantly higher rates of maternal mortality, preterm birth, and other adverse outcomes compared to White birthing people. Anti-Black racism contributes to these disparities and is deeply engrained within the structures, policies and practices that guide/govern our healthcare delivery and training systems. Therefore, how anti-Black racism manifests in healthcare delivery is often unrecognizable to non-Black leaders and providers working within the system. Achieving health equity requires new care models centered on the experiences of those facing inequities and built in partnership with community leaders who can identify racist patterns that those working within the system cannot. For 3 years, the San Francisco Respect Initiative has worked collaboratively with community members and our SF healthcare, public health and city institutions, to design a new model of pregnancy care delivery-- Pregnancy Pop-Up Village. Launching in 2021, the pilot brings together community organizations, healthcare institutions and public agencies to deliver pregnancy-related services within high-need neighborhoods, at one place and time, on a recurring basis. Beyond providing easier one-stop-shop access, Pregnancy Pop-Up Village aims to provide services through an environment/culture that is antiracist and can dismantle the oppression present within our traditional care delivery systems. To achieve this goal, deep engagement between institutional and community partners will be essential throughout implementation. Without the guidance of those working outside our institutions who bring wisdom, lived-experience and trusted connection to community members, our efforts will fail to achieve intended goals. Our goal is to convene, and adequately fund, a group of community and institutional stakeholders under community-academic co-leadership, to collaborate in ensuring the implementation of Pregnancy Pop-Up Village identifies and dismantles Anti-Black racism within the model. Results from this collaborative convening will inform future antiracism strategies in healthcare delivery as a means to eliminate health disparities.