Center for Health Outcomes and Population Research CoBRE

Leverage Points for Equitable Systemic Change to Reduce Alcohol Exposed Pregnancy
There is a great need for higher quality alcohol and substance exposed pregnancy (ASEP) reduction programs that account for the constellation of interpersonal, intrapersonal and community-level contributors. Such programs are particularly important for addressing ASEP-related health disparities within at-risk communities, such as American Indian women. This proposal utilizes community-based system dynamics simulated models to test and discern high-impact areas for intervention and best strategies for translating these findings into action-based systematic change.

Influence of Behavioral Economics Techniques on Medical Decision Making
The study aims to examine behavioral economics within the construct of medical decisions by surveying medical decision makers.  Specifically, we will test the hypothesis that altering choice architecture (how a decision is presented) through various economics techniques will increase positive(better outcome, lower cost) medical decision making.  

Momentary Relationships between Stress and Weight Regulation Behaviors after Bariatric Surgery
Obesity has become a worldwide epidemic, with especially high prevalence in rural areas including North Dakota. While bariatric surgery is an effective treatment for severe obesity, the course of long-term weight loss is variable. Such evidence underscores the need to identify and target the processes that may impede weight loss and maintenance in daily life. Stress is a dynamic construct that may elevate risk for problematic eating and physical inactivity by reducing individuals’ ability to engage in effective self-regulation.
 
This study will use ambulatory assessment methods to examine a state based model of problematic energy balance behaviors (i.e., loss of control eating, physical inactivity) among postsurgical bariatric patients. This model posits that momentary increases in stress will lead to reduced inhibitory control; in turn, these states of disinhibition will increase the likelihood of engaging in behaviors that impede weight loss (i.e., increased loss of control eating, decreased physical activity, and increased sedentary behavior). Further, to examine these processes specifically in a population that is at higher risk for poor weight-related health outcomes, this study will recruit postsurgical bariatric patients from Sanford Health, which is the largest rural not-for-profit health care organization in the U.S., operating in some of the most remote/frontier regions of the U.S.
 

Polygenic risk score phenome-wide association study to identify novel associations
This study aims to develop novel methods to systematically identify the pleiotropic effects of coronary heart disease (CHD) and Breast Cancer polygenic risk scores (PRS) on all other phenotypes in the linked electronic medical record (EMR).  By doing so, it can also identify patients who may be at higher risk for developing undiagnosed CHD and/or breast cancer. 

An Exploration of Rural-Urban Disparities in Colorectal Cancer Care in North Dakota and South Dakota

 Colorectal cancer (CRC) is the second-leading cause of cancer mortality in the United States, despite being highly preventable, detectable, and treatable. Over the last decade, CRC incidence rates have decreased by 30% in the United States. North Dakota is in the lowest quartile for CRC screening and highest quartile for CRC incidence. While South Dakota has been faring better with screening, it has worse CRC outcomes with mortality, which may conversely be due to limited access to subspecialty care. We hypothesize that there are spatial/geographic and aspatial/socioeconomic disparities in access to care measures that impact CRC outcomes differently in these two rural Northern Plains states.

Using a conceptual framework for advancing disparities research within the health care system, our first aim will examine the implications of age of diagnosis and screening on cancer incidence in the Dakotas. Our second aim will focus on detecting and understanding geographic rural CRC disparities using multilevel modeling of spatial accessibility to colonoscopy and surgical services, accounting for travel barriers, provider capacity, population density, and socioeconomic factors. Our third aim will characterize the relative importance of spatial and aspatial barriers through analysis of questionnaires examining the attitudes, preferences, and beliefs of residents in hotspot (high CRC incidence) and non-hotspot counties in North Dakota and South Dakota. We foresee that these findings will allow us to better understand and address rural-urban differences in CRC mortality, allowing for future efforts to create interventions that can reduce these disparities.