Center for Health Outcomes and Population Research CoBRE

Researching Rural & Behavioral Health

The Center for Health Outcomes and Population Research fosters a collaborative and supportive environment to build capacity and work toward improving the health of patients and communities using unique data-driven techniques in rural areas of the Midwest.

How We’re Funded

The NIH National Institute of General Medical Sciences funds the Center for Health Outcomes and Population Research. The grant supports a Center of Biomedical Research Excellence (CoBRE) to facilitate the development of rural health in South Dakota. (NIGMS CoBRE P20GM121341)

What We Research

The level of health disparities in our region, coupled with the remote nature of our rural communities, calls for the development of a community and population health research center with a focus on rural populations. The center has expertise in:

  • Data science
  • Substance use and addiction
  • Community partnerships
  • American Indian (AI) Health
  • Mental Health
  • Healthcare services delivery
  • Behavioral science

How We Support the Scientific Community

The center supports and mentors junior investigators (project leaders) vested in issues specific to rural and AI health. This leads to greater stability, sustainability and growth of regional research infrastructure. The leadership team provides project leaders with an individualized mentorship plan to enhance their professional skills and further their research goals to become successful, independent investigators.

The center also supports three interdisciplinary cores:

  1. Research Design and Biostatistics Core
  2. Behavioral Economics Core
  3. Data Exchange Core

These research support cores provide center affiliates and regional scientists with key expertise and access to the most current approaches.

Our Publications

To learn more about the research center, see the published research under its CoBRE grant.

Real All Publications

Meet Our Team


Jill Weimer, Ph.D.
Principal Investigator

Clarence Weis
Program Manager

Tyler Sang
Core Director of the Biostatistics Core

Tamara Winden
Core Director of the Data Exchange Core

Susan Hoover
Clinical Liaison

External Advisory Committee

Donald Nease Jr., M.D.
Professor, Family Medicine
University of Colorado, Denver

Andrew L. Sussman, PhD, MCRP
Associate Professor
Department of Family and Community Medicine
University of New Mexico

Sterling M. McPherson,  PhD
Associate Professor and Assistant Dean for Research
Director of Biostatistics and Clinical Trial Design and the Program of Excellence in Addictions Research
Elson Floyd College of Medicine at Washington State University

Elizabeth Calhoun, PhD, MEd
Professor, Public Health Policy and Management
Associate Director, Population Sciences Cancer Center
Executive Director, Center for Population Science and Discovery
Associate Vice President, Population Science and Discovery University of Arizona, Tucson, AZ

Project Leaders

Anna Strahm, PhD
Assistant Scientist in Behavioral Sciences at Sanford Research
Project: Maternal stress and blood sugar metabolization during pregnancy, and associations with adverse outcomes

Lisa McFadden, PhD

Assistant Professor of Basic Biomedical Sciences at the University of South Dakota
Project: Midwestern changes in substance use and treatment during the COVID-19 pandemic

Santiago Lopez, MD
Associate Scientist at Sanford Research

Project: Outcomes during pediatric lower respiratory tract infections in American Indian children



Pilot Grants and Supplemental Awards

Arielle Deutsch, PhD

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.

Benson Hsu, MD, MBA

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.  


Lauren Schaefer, PhD

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.


Murat Sincan, MD

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. 


Sabha Ganai, MD, PhD, MPH

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.


Center Graduates

Emily Griese, Ph.D. 

Arielle Deutsch, PhD

DenYelle Kenyon, PhD

Jessica Hanson, PhD


Past Symposiums

Annual Health Care Delivery and Population Health Research Symposium
May 26, 2021

Transdisciplinary Approaches to American Indian and Rural Population
Nov. 7, 2019

Sanford Population Health & Data Collaborative Symposium
Oct. 11, 2018

Population Heath Research Summit “Finding Your Narrative”
April 17-18, 2018

Sanford Health News

Classes & Events