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Most African American women described successfully navigating the challenges of a breast cancer diagnosis with their partners, finds a new analysis from the Brown School at Washington University in St. Louis.

However, one-third of the sample indicated relationship distress.

“We conducted a thematic analysis to examine how a breast cancer diagnosis affected not only African American patients but also how patients perceived their breast cancer to have affected their husbands’ health and their marriage,” said Tess Thompson, research assistant professor. “Our findings show variability in couples’ responses to cancer.”

Thompson is lead author of the paper “ We’re in this Together: Perceived Effects of Breast Cancer on African American Survivors’ Marital Relationships,” forthcoming in a print edition of the Journal of the Society for Social Work & Research.

Thompson and her co-authors conducted a thematic analysis of interviews with 15 married African American breast cancer survivors who had participated in a larger randomized controlled trial.

A number of themes around the challenges of maintaining mutually supportive relationships while facing cancer evolved from these interviews.

“The perceived effects of cancer on relationships varied across couples, as did perceptions of the adequacy of husbands’ emotional and tangible support,” Thompson said. “Many of the women described their husbands’ key role in promoting the wives’ positive body image, as well as the challenges involved in negotiating sexual activity during and after treatment. Most of the women did report being receptive to help from medical professionals in dealing with relationship issues.”

The results could prove helpful in guiding health professionals’ emotional and behavioral care.

“These findings show that close relationships such as marriage are an important source of support for many cancer patients. Most patients and couples adapted well, but others might benefit from additional services,” she said.

“Oncology social workers can use this information to help to screen and provide support and mental health services for women and for their families.”

Co-authors on the study are Maxine Davis, a Brown School alumna and assistant professor at University of Texas at Arlington; Maria Pérez, clinical research specialist, and Donna B. Jeffe, professor of medicine, both at Washington University School of Medicine in St. Louis; and Melissa Jonson-Reid, the Ralph and Muriel Pumphrey Professor of Social Work Research at the Brown School.

A new center directed by the Brown School’s Kim Thuy Seelinger is addressing human rights issues with a focus on gender- and migration-related issues locally and across the globe. The Center for Human Rights, Gender and Migration, based at Washington University in St. Louis’ Institute for Public Health, was established in 2020.

“The aim of the Center is to promote evidence-based solutions for challenges arising in the intersection of human rights violations, gender, and migration,” said Seelinger, research associate professor at the Brown School. “These are complex issues on their own – so when they overlap, problem-solving requires creative and transdisciplinary thinking. We’re interested in applied research – we draw on diverse methods and areas of expertise from across campus to address knowledge gaps. Then we work with policymakers and practitioners to devise and implement solutions.” Seelinger understands a thing or two about harnessing multiple disciplines – she is a social science researcher and lawyer, with faculty appointments both at the Brown School and the School of Law. She came to Washington University in late 2019 from the University of California, Berkeley, to start the Center with the support of her longtime colleague, Julia Uyttewaal. Uyttewaal serves as the Center’s manager.

Only a year old, the Center has become a powerful draw for students at the Brown School and across the university. Lacy Broemel, MSW ’21, serves as co-chair of the Center’s Student Advisory Council, a diverse group whose academic expertise includes social work, public health, law and English literature. “I’ve really enjoyed connecting with students from other programs to share research opportunities,” she said. She came to the Brown School to pursue her interest in refugee and immigration issues and the Center has well placed her to do that. “It’s been great to stay so connected to the field,” said Broemel.

One current project in that field, for which the Center recently received a $597,000 award from the U.S. State Department, addresses sexual and gender-based violence (SGBV) among refugees and migrants in Mexico, Greece and Kenya. The project has immediacy, as the Biden administration revisits immigration policy and more than 500,000 more migrants and refugees journey north from Central America through Mexico each year. The work is needed more than ever due to the heightened refugee crisis in Mexico, Uyttewaal said. “Asylum seekers have been stuck in informal settlements in Mexico in incredibly unsafe conditions for several years. Some tried to cross the border when Biden became president, but they were sent back to these dangerous areas to wait longer.”

Many of these migrants are vulnerable to sexual abuse and exploitation. Seelinger has spent years studying the barriers that survivors face in revealing experiences of SGBV suffered during armed conflict and forced displacement.

“It’s something I saw from my lawyer days, representing immigrants who had experienced sexual violence. Disclosure is the gateway to access support and protection,” Seelinger said. “This is particularly critical for refugees– they have often suffered terrible things at home or on the road. With this new funding, we can build on our recent research in Mexico and Central America to better understand and address disclosure barriers in other contexts, as well. Disclosure is important, but it has to be approached ethically, safely.”

Based on the initial research in Mexico and Guatemala, the Center partnered with the UN High Commissioner for Refugees and local organizations in Mexico to develop a practical toolkit to improve the way service providers understand and approach refugees’ disclosure of SGBV. Seelinger and Uyttewaal have spent the past two years developing the toolkit in workshops with service providers working with refugees there.

The current project will evaluate how that tool is working in Mexico and extend research to Greece and Kenya. The ultimate aim is to develop an adaptable toolkit for practitioners working in diverse humanitarian crises around the world. The UNHCR will disseminate the final tools and research as part of its global guidance related to SGBV.

Other Center projects led by Seelinger include:

The coronavirus pandemic has affected researchers across the academic spectrum, but it’s had an especially significant impact on the intensely personal, international nature of the Center’s work. “We’ve really had to rethink how we do everything,” Seelinger said. “We can’t travel, we can’t interview folks in person, and we’re supervising our army of graduate students remotely. We couldn’t even have our Center launch last April!”

“Research-wise, we can manage,” Seelinger added, although navigating Zoom meetings with study participants across international time zones has been a challenge. “You have to schedule meetings differently because your interviewee is eight hours ahead of you. You have to build rapport in a totally different way,” she said. “You have to think, ‘What is my face doing?’ and ‘Does this come across like actual eye contact?’”

Despite the roadblocks, the Center has been a major benefit to many students, including Lacy Broemel. “When I came to the Brown School, I was eager to continue my education focusing on people and policy by connecting with individuals and their life experiences,” said Broemel, whose concentration is in social and economic development. She learned about the Center last spring and reached out to Seelinger and Uyttewaal, who invited her to co-chair the advisory board with Grace Day, a law student. Broemel had other roles at the Center, including participating in a literature review about the impact of conflict-related sexual violence and reparations; and participating in a Center-hosted discussion of immigration policy in the Biden administration.

“The Center has been a wonderful part of my time here at the Brown School,” said Broemel, who plans to move to Washington D.C. after graduation and work in refugee and policy advocacy. “Working with the Center has expanded my field of understanding and helped prepare me for my next career.”

New research from the Center for Social Development (CSD) shows that parents of newborns with Child Development Accounts (CDAs) respond by deepening their commitment to the child’s higher education and their own efforts to save for that education.

The findings come from two newly released publications: a research summary of account and savings data from 2008 to 2019 and a report on analyses of 2020 survey responses. Both publications come from a long-running randomized social experiment, SEED for Oklahoma Kids (SEED OK).

“This new research reinforces the long-term benefits of effective policies to build assets for children automatically from the time of birth,” said Michael Sherraden, the George Warren Brown Distinguished University Professor at Washington University in St. Louis, the founding director of the Center for Social Development, and the experiment’s principal investigator.

A policy experiment with CDAs

CDAs are investments designed to develop assets for all children from their birth until the accumulated funds are tapped for college or other training. In CDA policy, a newborn’s birth record triggers the automatic state enrollment and a seed deposit on the child’s behalf.

That initial deposit, made automatically, is a feature of CDAs, which may also include progressively structured subsidies designed to ensure that all children grow assets, regardless of their family’s ability to save. Informed by the research in SEED OK, seven states — both red states and blue states — have enacted statewide CDA policies, and Pennsylvania is testing progressively structured subsidies.

In 2005, CSD researchers began partnering with the Oklahoma Treasurer’s Office to implement the CDA experiment using the Oklahoma 529 College Savings Plan (OK 529) as the financial platform. Working with a data collection firm, the research team identified a random sample of children born in 2007 and assigned them randomly to the treatment group, which received the CDA in SEED OK, or to the control group. This is a true experiment in a full statewide population, with oversamples of populations of color.

Children in the treatment group received a state-owned OK 529 account with a $1,000 deposit. Parents were offered time-limited incentives to open and contribute to their own OK 529. This investment in each child, a much smaller deposit than originally proposed, enabled the researchers to test the policy concept. In keeping with scientific protocol, children in the control group received none of the treatment — no account and no incentive — but their actions were not restricted in any way; control families were free to open a 529 account or make any other investment.

CSD researchers have followed the children’s progress for 13 years.

In March 2019, when the children were about 12 years old, the researchers made supplemental deposits to the state-owned OK 529 accounts of half of the children in the treatment group: $200 for all of the recipients and up to $600 for those from disadvantaged backgrounds.

All SEED OK parents completed a survey before the start of the experiment in 2007, a second in 2011, when the children were about 4 years old, and a third in 2020, during the height of the pandemic. Through the partnership with the state, the researchers also receive account and savings data for all OK 529 accounts opened for children in the experiment.

New findings

The new findings from the research summary and report show that the OK 529 assets increased substantially over time, primarily from investment earnings, which represent 40% of all OK 529 assets for the average treatment child. Balances in the state-owned accounts fell during the Great Recession but grew in subsequent years, and the initial $1,000 deposit almost doubled from 2008 to 2019.

“Our research shows that all children can have assets for college or trade school and that the CDA in SEED OK greatly increases OK 529 assets for disadvantaged children,” said Margaret Clancy. She added, “The CDA also has motivated SEED OK parents to open OK 529 accounts, especially for children from more diverse and less advantaged backgrounds. Due to rigorous research design, we know that many of those children would not have had any college savings at age 12 without the CDA.” Clancy is policy director with the Center for Social Development and director of the SEED OK experiment.

In fact, the new findings show that the parents of children with CDAs are over five times more likely to open their own OK 529 accounts. The CDA in SEED OK prompted a 15-percentage-point increase in the number of accounts opened for the children by their parents. Across parent-owned OK 529 accounts that held deposits from families in the treatment group, the average balance was $9,032. Funds deposited in the CDA at the child’s birth did not substitute for parental saving but instead spurred more parental saving.

On average, treatment children accumulated more than three times the OK 529 assets of the control children.

From 2007 through 2019, the percentage of low-income children with assets in an OK 529 account increased by 99 points and the percentage of children of color with such assets grew by 98 points. Among the children whose mothers have low levels of education, the percentage grew by 99 points. The researchers attribute these effects to the experiment’s universal and automatic enrollment. Much like the Social Security retirement system, policies that are universal and automatic can be efficient and have sizeable impacts.

Results in SEED OK’s new report also show that the accounts shape family planning and preparation for higher education. Relative to the parents of children in the control group, the parents of children with CDAs are more likely to have thought about and prepared for their child’s higher education, and for the costs of that education.

“Our findings demonstrate that CDAs create more positive outlooks and actions in the family, while also enabling families to grow assets for children’s higher education.

“The children of SEED OK, now about 13 years old, will soon begin making decisions about high school and planning for what will come after it. Their CDAs will be there for them, continuing to shape their options and future development,” Sherraden stated.

A diverse workforce, particularly one engaged in research, has been shown to drive scientific discovery and innovation. Yet over the past 50 years, the U.S. has seen increased racial and ethnic disparities in higher education enrollment, as well as gaps in earnings, employment, and other related outcomes for communities of color. Recognizing this trend, Washington University’s Commission on Diversity and Inclusion 2017 report, recommended strong institutional commitment to advancing equity, diversity and inclusion at Washington University.

The International Center for Child Health and Development (ICHAD), located in the Brown School, is committed to diversity through its mission to reduce poverty and improve health outcomes in low-resource settings. Over the last three year it has been building its NIH training grant portfolio – with a distinct and intentional goal: To engage and support more students and early career investigators from diverse backgrounds in research.

The Researcher Resilience Training program, funded in 2018 by the National Institute of Mental Health, is designed to train investigators of African descent interested in child and adolescent behavioral health, and provide them with the necessary research skills to address the significant challenges that exist within resource-poor settings. Co-led by Fred Ssewamala, Sean Joe and Mary McKay, the first cohort of students traveled to Uganda to visit local schools and health clinics and had the opportunity to engage with local policymakers and the community.

“This program gives trainees practical skills and unique supports from mentors who have themselves faced adversity in their research careers,” notes co-director Ssewamala. “For those of us coming from underrepresented backgrounds, it is more than just learning research methods. It is how to be resilient and resourceful, particularly when working in low-resource settings.”

In 2020, ICHAD’s training programs moved online due to COVID-19. This coincided with the launch of two additional NIH-supported training programs coordinated out of ICHAD. The Global LEAD program was funded by the National Institute of Minority Health to train students and postdocs from underrepresented backgrounds interested in health disparities in a global context and is co-directed by Patricia Cavazos in the Department of Psychiatry and Ssewamala.

The second program, the CHILD-Global Research Fellowship is funded by NIH’s Fogarty International Center and will train 18 Ugandan researchers over the next four years committed to examining issues related to the intersection of HIV and mental health in low resource settings. This program is co-led by Ssewamala, Mary McKay and Noeline Nakasujja located at Makerere University in Kampala, Uganda.

Despite being online, the programs were able to create a feeling of community and connectedness as together, students grappled with not only the isolating COVID-19 pandemic but also a summer that brought racial strife and tensions to the forefront. Special sessions were added to discuss race and racism as it applies to research, to coincide with more traditional trainings.

“I appreciate the investment in supporting scholars of color in conducting global research,” noted one fellow. “Coming from an [non-WashU] environment where senior researchers do not show much interest in empowering and mentoring upcoming scientists, I was glad to see a different attitude that is positive.”

To date, these three programs have trained 33 investigators from diverse backgrounds and early results are promising. Program alumni have published more than 60 manuscripts since starting the program and six have received funding to continue their research. “Mentoring is fundamental to the success of these programs” according to RRT co-Director Joe. “By building a community of underrepresented researchers through embedding trainees in our own labs and studies, we have seen tremendous results.”

The summer 2021 cohorts for all three programs have been selected and 22 new underrepresented researchers will join this broad research network. For more information please visit ichad.wustl.edu/capacity-building.

Moving scientific research results into public health and patient care more quickly could have a significant impact on health equity, finds a new paper from researchers at the Brown School at Washington University in St. Louis.

Implementation science is the study of methods and strategies that help to speed evidence-based practice and research into regular use by public health and medical practitioners.

“The rallying call for implementation science is that it takes 17 years for 14% of original research to reach patient care — this is sometimes called the ‘biomedical valley of death,’” said Ross Brownson, the Steven H. and Susan U. Lipstein Distinguished Professor and a leading researcher on dissemination and implementation science.

He is co-author of the paper “Implementation science should give higher priority to health equity,” along with the Brown School’s Matthew Kreuter, the Kahn Family Professor of Public Health, and Debra Haire-Joshu, the Joyce Wood Professor; and Shiriki K. Kumanyika, research professor at Drexel University Dornsife School of Public Health. The paper was published in the journal Implementation Science.

“COVID-19 has revealed glaring and unacceptable inequities in the United States and globally,” Brownson said. “In implementation science, this is sometimes called the ‘translation gap.’ The pandemic has also shown that when we mobilize political will and resources, we can speed up a process such as vaccine development that usually takes years and shrink that time frame to months.

“We now need to redouble efforts, apply principles from implementation science and deploy the vaccine to populations at highest risk of COVID — particularly minority groups,” he added.

In the paper, the authors propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice.

“Implementation science offers a roadmap for addressing the systematic injustices in research and practice necessary to achieve population health equity,” Haire-Joshu said.

With an intentional focus on health equity from funders, researchers, practitioners, advocates, evaluators and policy makers, the authors argue, the United States can harvest the rewards of the resources being invested in health-related research to eliminate avoidable disparities, resulting in greater health equity.

“We can’t just hope that science will lead to more equitable health outcomes,” Kreuter said. “We need to do things differently, from the questions we ask, to the research partners we choose, to the way we define success.”

Clinicians who treat substance use disorders may have a new tool to help them guide the treatment and recovery process, according to a new case study by the Institute of Clinical and Translational Sciences (ICTS) on the Community Academic Partnership on Addiction (CAPA) Collaboration.

Associate Professor David Patterson Silver Wolf, who leads the collaboration, stated that there has historically been a lack of data to guide clinicians serving these populations Measurement of treatment and recovery performance relies heavily on anecdotal, unreliable information, he believes.

Patterson Silver Wolf used his 15 years of experience providing addiction treatment services, along with his experience investigating how to implement evidence-based practices throughout treatment organizations, to co-create a clinical dashboard called Takoda in which therapists can track and visualize recovery metrics. He collaborated with Ken Zheng, a 2014 graduate of Washington University’s McKelvey School of Engineering. The dashboard, which includes mobile apps, was implemented under the leadership of Patterson Silver Wolf in partnership with addiction treatment providers in the St. Louis region. After clinicians were trained to use the dashboard, they saw an 11% increase in addiction treatment completion rates over six months.

Brown School Professor Douglas Luke led a multi-disciplinary team in partnership with ICTS to highlight the project’s impact in a Translational Science Benefits Model (TSBM) case study. The TSBM is a framework that public health scientists can use to demonstrate the clinical, community, economic and policy impacts of their work in the real world.

“We chose to highlight this research because it has already demonstrated impact in the Clinical, Economic, and Community realms. This important project is using data-based approaches to improve recovery outcomes, while also reducing healthcare and crime-related costs of addiction,” said Luke.

Patterson Silver Wolf is excited to move forward. “The next logical steps would be to randomly assign therapists to use treatment as usual services or technology dashboard tools measuring patient’s treatment retention and completion outcomes,” he said.