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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.”

The pandemic is exacerbating preexisting social and economic inequalities in the United States and abroad, finds a new study from the Social Policy Institute (SPI) at Washington University in St. Louis.

The study, “Household Spending Patterns and Hardships during COVID-19: A Comparative Study of the U.S. and Israel,” draws on national surveys conducted early in the pandemic to investigate COVID-19’s effects on self-reported consumer spending behaviors and hardship experiences for households in Israel and the U.S., two countries with very different responses to the pandemic.

“We found that the economic relief packages passed early in the pandemic were not sufficient to fully buffer economically vulnerable households from the effects of the pandemic,” said Stephen Roll, research assistant professor at the Brown School and first author on the paper.

Hardship was common during the early months of the pandemic and, while rates of skipping housing payments or utility bills were similar between the two countries, the rate of reported food insecurity in the U.S. was almost 50% higher than in Israel.

“Fortunately, this problem is likely not insoluble — the fact that middle-income households in Israel struggled less than their American counterparts indicates that these support gaps can be covered by well-designed social policies, both in reaction to and in preparation for economic crises,” he said.

Key findings from the analysis:

Co-authors on the study are: Michal Grinstein-Weiss, the Shanti K. Khinduka Distinguished Professor at the Brown School and director of the Social Policy Institute; Yung Chun and Olga Kondratjeva, both data analysts at SPI; and Mathieu Despard, associate professor at the University of North Carolina-Greensboro.

New research from faculty in the Brown School at Washington University in St. Louis is providing guidance to local policymakers on how they might contain the spread of the virus that causes COVID-19 until vaccination ramps up to levels high enough to provide widespread protection.

TRACE (Testing Responses through Agent-based Computational Epidemiology) is a collaborative effort by researchers from the university and Brookings Center on Social Dynamics and Policy to produce a sophisticated, computational simulation model to inform policy responses to the pandemic. It draws on the extensive body of evidence about both the current and past epidemics.

While previous simulations produced by the model, developed by Ross Hammond, the Betty Bofinger Brown Associate Professor at the Brown School, focused on national containment efforts, new simulations concentrate on how the COVID-19 pandemic might be effectively contained in St. Louis through this summer. Hammond and his team are working with officials from the St. Louis Department of Health.

“Our close collaborative engagement with the St. Louis Department of Health demonstrates the effectiveness of the agent-based computational modeling approach as a decision-support tool to assist policymakers in developing highly customized policies, while managing the substantial uncertainty that comes with the COVID-19 pandemic,” Hammond said.

TRACE researchers conducted approximately 50,000 simulations representing more than 1,000 different combinations of containment policy options across a range of epidemiological parameters.

They produced four main findings for the St. Louis area:

TRACE is not a forecasting model, Hammond pointed out.

It is intended instead as a policy laboratory to assist in the design of effective containment policies in the face of uncertainty, he said.

“This new work shows how our previous national-scale framework can be adapted and tailored to provide guidance to state and local policymakers and can be extended to help manage new uncertainties, such as the potential for novel variants of SARS-Cov-2 to become widespread,” Hammond said of the virus that causes COVID-19.

“Working closely with the St. Louis Department of Health, we developed a highly realistic, fine-grained simulation framework that captures empirically specific geography and demography of the area’s 2.5 million people, along with contact patterns driven by where citizens live, work, attend school and mix socially. We also characterized local distributions of individual-level COVID-19 case properties based on the most current, high-quality empirical research and represented current control measures in place across the region.”

Diana Parra Perez, a researcher at the Brown School’s Prevention Research Center, has been awarded a grant to develop programs to address high-risk populations for COVID-19 in St. Louis. The Center in St. Louis will work with the Missouri Department of Health and Senior Services in the Building Resilient Inclusive Communities (BRIC) program to boost existing efforts of partners and communities with a focus on health equity in nutrition security, access to safe physical activity and social connectedness.

“African Americans, Hispanics, Native Americans, aging adults, and people with disabilities have been disproportionally affected by COVID-19 across the United States,” Perez said. “With this funding, we will develop and support partnerships with key community organizations to address some of the underlying risk factors as well as some of the consequences from the pandemic. Health equity and sustainable change will be at the center of our work.”

The Center will provide one-on-one technical assistance to local partners, like health departments. PRC will also help set up monthly training programs, virtual learning webinars and share additional resources from the National Association of Chronic Disease Directors (NACDD), which provides the BRIC grants.  Other partners may include Area Agencies on Aging, planning and public works agencies, local economic developers, and local nongovernmental organizations that support the social and emotional needs of older adults, particularly those living in long-term care facilities.  

The team will also help develop activities in up to five communities to improve nutrition security, access to safe physical activity, transportation alternatives and social connectedness.  

NACDD is providing funding for the BRIC program to 20 states to promote healthy living and reduce social isolation during the COVID pandemic. The initiative is part of a collaboration with the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention, and a team of nationally recognized experts. NACDD supports state health departments and other organizations as they work with local communities on improving safe access to physical activity, promoting healthy eating through improved nutrition security, and reducing isolation and loneliness. All of these actions focus on improving people’s lives during the pandemic and on reducing health equities and promoting social justice for people who are impacted the most.

As part of the new $900 billion federal stimulus package, the moratorium on evictions for renters will be extended by one month, through the end of January. The help could not come soon enough, said an expert on social and economic development at the Brown School at Washington University in St. Louis.

However, without more intentional, long-term solutions and investments, this aid will only postpone an inevitable housing crisis, a new survey shows.

“Data from our recent survey indicates that the impact of COVID-19 on homeowners not only still exists, but it has significantly worsened, especially among Black and Hispanic households and young adults,” said Michal Grinstein-Weiss, the Shanti K. Khinduka Distinguished Professor and director of the university’s Social Policy Institute.

Grinstein-Weiss is the principal investigator for the institute’s Socioeconomic Impacts of COVID-19 Survey. The survey was administered in late April and early May (Wave 1) and late August (Wave 2) to over 5,000 nationally representative U.S. households each time.

“We found that the eviction/foreclosure rate of Black and Hispanic respondents increased by 7% as compared to only 2% among white respondents,” Grinstein-Weiss said. “Additionally, Black respondents were almost twice as likely to be forced to move as non-Hispanic white respondents in Wave 2 (late August), despite being least likely to be forced to move during Wave 1 (early May). While the jump in eviction risk among Black households is certainly alarming, Hispanic respondents maintain the highest vulnerability to eviction among the three groups both in Wave 1 and Wave 2.”

In addition to severe disparities in housing hardships based on race and ethnicity, the survey indicated a significant increase in hardship over time among young adults.

“In both survey waves, young adults (18-39 years old) were the most vulnerable to housing-related hardships, followed by middle-aged adults (40-54 years old), then older adults (55+ years old), and Wave 2 further widens the gap,” Grinstein-Weiss said.

Nearly twice as many young adults reported both eviction/foreclosure and mortgage/rent delinquency, or payment delay, in August as compared to May.

“This is compounding the financial situation of young adults who have had a shorter amount of time to accumulate protective financial assets, making it harder to weather the shock of the pandemic,” she said.

“Every member of society is impacted by this housing situation. Stable shelter is an essential tool to combat the spread of the coronavirus.”

For more from Grinstein-Weiss and co-author Yung Chun about their findings related to housing hardships, visit the Brookings Institution blog. Other research from the Socioeconomic Impacts of COID-19 Survey in the U.S. and Israel are available at the Social Policy Institute’s website.

Researchers at the Brown School are conducting discussion groups with parents and staff in the Special School District of St. Louis County (SSD) to develop communication tools surrounding COVID-19 testing and vaccination. The research is funded by a two-year, $5 million grant from the National Institutes of Health to the Washington University School of Medicine to offer 50,000 saliva tests to students, teachers and staff in the six special education schools operated by the district.

The grant will serve about 750 families in the district who have children in kindergarten through the 12th grade. The saliva tests will be voluntary and offered weekly to teachers, staff and students over the next year.

The pandemic has disproportionately impacted students with special needs, especially those with intellectual and developmental disabilities, in part because they rely on daily structure and in-person support for learning and social growth. Due to underlying medical conditions experienced by many such students, this student population is at a higher risk for developing COVID-19 and severe complications of the virus.

“The widespread closure of schools has particularly impacted the well-being of these children,” said Jason Newland, MD, co-principal investigator of the project and a professor of pediatrics in the Division of Pediatric Infectious Diseases at the School of Medicine. He has advised multiple school districts in Missouri on plans for reopening schools. “It is a major priority to get children with disabilities back into the schools while providing a safe environment for the students and staff, and a key component of achieving this goal is ample testing that can rapidly detect COVID-19 infections within the school community.”

The Brown School’s role will be to assess the perspectives of parents and school staff to develop messaging that can encourage participation in regular testing and overcome barriers to it.

“Our discussion groups are underway and have already provided valuable insights to inform communication with parents, teachers and staff. This information is also helping to shape the testing process being implemented in the schools by our medical school colleagues,” said Nancy Mueller, director of the Brown School Evaluation Center and an assistant dean who is leading that part of the research. “We hope that our findings can be useful not only for COVID testing but also for vaccinations to provide protection from the virus in the future.” Participating Brown School faculty include Charlene Caburnay, research assistant professor and co-director of the Health Communication Research Laboratory; Virginia McKay, research assistant professor; and Byron Powell, assistant professor.

The funding stems from $500 million awarded by the NIH National Institutes of Health as part of the agency’s Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP) initiative to provide underserved communities with rapid testing for COVID-19. The money was part of the CARES Act passed by Congress to respond to the pandemic.

The saliva test provides easy and fast testing with same-day results, ideal for screening large communities. It was developed by the School of Medicine’s Department of Genetics and the McDonnell Genome Institute, in collaboration with a biotechnology company.

“The Special School District is eager to partner with Washington University to improve the lives of students with disabilities, especially during this time of COVID,” said Elizabeth Keenan, Ph.D., SSD’s superintendent.

SSD’s special education schools serve students from all school districts in St. Louis County, including those residing in socioeconomically stressed neighborhoods, where many families have heightened exposure to COVID-19, as well as disproportionate vulnerability to its most serious consequences. SSD’s students returned part-time to in-person learning in November.