Disease Management

SARS-CoV-2 can be deposited on surfaces when shed from an infected individual. Hospitals have implemented increased routine cleaning protocols. The purpose of this study is to determine the level of contamination, the efficacy of the cleaning protocol, and if certain host factors influence the levels of the virus on surfaces. Multiple surfaces (bedside table, remotes, door handles, bathroom surfaces, scrubs, etc.) will be sampled prior to, and immediately following routine disinfection. The rooms that will be sampled will be active COVID-19 rooms. Hospital personnel will be trained on how to collect samples. Samples will be analyzed to determine the presence and the concentration of the virus on the surface to determine the efficacy of the disinfection protocol. In addition, de-identified patient data will be received from Banner University Medical Center. Information to be collected will include age, sex, underlying conditions, and onset/severity of the illness to determine correlations between these factors and the presence of the virus on surfaces.

The growing published data and literature of the COVID-19 pandemic suggest that underserved populations have been disproportionately affected when compared to their counterparts. According to the Centers for Disease Control and Prevention (CDC), Hispanic/Latino adults in the United States accounted for approximately 31.8% of all COVID-19 cases, the highest percentage in comparison to other racial/ethnic minority groups. In addition, Hispanic/Latino adults had the second-highest percentage of COVID-19 deaths among all racial/ethnic minority groups at 17.2%. Of the total Hispanic population residing in the United States, approximately 62.3% is of Mexican-origin descent. This Hispanic subgroup has higher rates of obesity-related diseases such as non-alcoholic fatty liver disease (NAFLD), type 2 diabetes, and certain forms of cancers. As stated by the CDC, individuals with underlying health conditions like obesity-related diseases are at an increased risk for developing severe symptoms associated to COVID-19, and if not treated in time, may result in death. Given the MO population is at an increased risk for obesity-related disease, there is a need to understand the impact COVID-19 has had on MO adults, a population that is often overlooked and understudied in the United States (U.S.). The aim of this project is to identify the impact of the COVID-19 pandemic on social determinants of health in a group of Mexican-origin adults previously recruited for a study focused on non-alcoholic fatty liver disease (NAFLD) and to determine participants’ preferences for recruitment strategies, health assessment screenings, and intervention strategies to inform future NAFLD research in response to the COVID-19 pandemic.  This project is funded through the Center for Health Disparities Research within the University of Arizona Health Sciences. 

This research will establish prevalence data of nonalcoholic fatty liver disease (NAFLD) and the frequency of a specific indicator of genetic risk, the PNPLA3 allele, in Tucson, AZ. This project will accomplish this by assessing relationships between the PNPLA3 genotype, liver fat, and dietary behaviors in Mexican-origin adults, and evaluating the knowledge, attitudes, and beliefs of NAFLD risk, including genetic risk, held by Mexican-origin men and women. This project is funded by the American Cancer Society through its Institutional Cancer Research Center Grant. 

In the United States, chronic diseases and conditions such as heart disease, stroke, cancer, type 2 diabetes, and obesity are among the most common, costly, and preventable of all health problems. These chronic diseases are more prevalent in underserved populations based on race/ethnicity, geographical location, and income levels. Despite these differences, engaging individuals in research and other health initiatives remains difficult. To address this concern, we are developing the Nosotros Network as a community-based outreach and engagement effort designed to work together with and through groups in Southern Arizona. Our goal is to increase health awareness in the community and provide a direct link to research and health initiatives designed to improve the health and well-being of our community. Dr. John Ruiz from the College of Psychology is also a collaborator on this project. 

Non-pharmaceutical interventions (NPI) are a critical set of actions that public health takes to mitigate the effects of infectious diseases in a population.  These actions can vary widely from isolation and quarantine, closure of public venues, environmental clean-up or decontamination, and hand hygiene.  However, studies have shown that the public’s compliance to NPI recommendations can be limited.  In order to better engage the public during an outbreak of an emerging or reemerging disease, such as Ebola, public health agencies could benefit from additional information on (1) ways to make NPIs more acceptable, (2) the best ways to disseminate the information to the general public and key target groups, particularly through social media, and (3) content that is more likely to motivate action.  The main objective of this project was to determine current engagement and successful messaging of NPI activities to across Arizona and determine acceptability of messaging by target groups; i.e. do they see the importance of the message being conveyed. This project received support from the Arizona Department of Health Services. 

The goal of this project was to advance understanding related to the impact of climate on the possible emergence of Dengue in the southern United States and northern Mexico. This project was funded by the National Institute of Allergy and Infectious Disease. 

 Many communities are not adequately prepared because there are too many information stores in communities and a related lack of essential collaborative preparation. The goal of this project was to improve community preparedness and response activities through sharing lessons learned, identifying and documenting best practices, and fostering national collaboration to strengthen community resiliency to reduce injury-related morbidity and mortality in public health emergencies. To achieve this goal, we created a Consensus Report by identifying issues in planning for and responding to disasters through input from national and federal partners. A Strategic Plan was also created to document lessons learned through qualitative methods to engage all member of communities. Six Proposal Requests were written to learn what made one community successful and how this success could be spread to other communities. Finally, Three after-action reports were generated to develop and pilot and exercise package in relation to inclusive planning moving forward. All these efforts were focused on improving the public health response of communities in order prevent mass injuries and casualties. This project was sponsored by the Center for Disease Control and Prevention. 

Each year, an estimated 8-10 million animals will be housed in animal shelter. These animals are susceptible to infectious diseases during their confinement. Many organisms have been discovered in animal shelters including feline noroviruses, sapovirus, canine circoviruses, canine influenza, feline calicivirus, and many others. Sheltered animals are at increased exposure and infection risk due to dense housing conditions and community transmissions of pathogens. The goal of this study is to evaluate the efficacy of a passive air purification technology developed by PetAirapy, LLC. Under controlled conditions of air flow, humidity, and containment, the PetAirapy unit will be evaluated for efficacy of seeded aerosolized virus (bacteriophage MS2) removal from the air.

Currently 1 in 9 Arizonan has T2D. African-American, Hispanics, American Indians and Asian-Americans, that account for 40% of Arizona residents, are about twice as likely to have T2D as are Whites. In 2008, 9,883 hospitalizations in Arizona were due to diabetes that make diabetes one of most costly diseases. Treatment regime for T2D is rather complex. After failure of diet and lifestyle efforts, step-wise addition of glucose-lowering medications is the usual course of T2D therapy. The decision of prescribing subsequent medications in the best sequence after initiation of the generally agreed upon initial oral medication (metformin) is strikingly challenging due to the unclear advantages of 2, 3, 4 and 5 drug regimens and the increased potential for adverse effects. Right now, most T2D treatments guidance are designed for the average patient. But one size doesn't fit all, and treatments that are very successful for some patients don't work for others. In addition, there are also new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications and the ideal target goals for therapy.
Comparative effectiveness studies are the traditional tools to preform comparisons. However, it is impossible due to its complexity, cost and length of the study. In this proposal, we focus on developing a data-driven paradigm to understand the medication treatment heterogeneity effects of T2D and to provide an evidence-based treatment guidance that is tailored to subgroups of patients sharing similar characteristics (precision medicine). Our data-driven approach will be based on the study of Veteran Healthcare Database, using the VA Informatics and Computing Infrastructure (VINCI). The clinical data includes the longitudinal data profiles starting from the year 2000.

We are in our fifth year of an established agreement for research and evaluation services for Arizona Department of Health Services (ADHS) Medical Marijuana Programs, using research, evaluation, compilation of statistical data on established resources, preparation of reports, development, update and maintenance of curriculum and technological resources and data sharing as requested for the Medical Marijuana division of ADHS. Deliverables from project work include the following: Yearly, comprehensive program implementation plan to be provided to ADHS no later than 30 business days from contract start date, including proposed total costs allocated to personnel, operations, travel, direct and indirect costs; and yearly total project costs;  Preparation and continual update of Continuing Medical Education/CEU/CME programs for medical providers and other interested parties, related to Medical Marijuana, including all administrative, maintenance and technological responsibilities associated; including, but not limited to the conversion of system requirements to TRAIN format.  Medical Marijuana Course update, conversion and maintenance shall include updates, as new or emerging information or changes become available, to the following content items:  Welcome Page (with as needed update from ADHS Director); Module 1-Introduction Page—Lessons 1-3; Module 2-Physician’s roles, duties and risks—Lessons 1-3; Module 3-Marijuana 101—The medicinal uses and risks of marijuana—Lessons 1-3; Module 4—Procedures and rules for the Arizona Medical Marijuana Program—Lessons 1-3; Module 5—Dispensary Medical Director—Lesson 1; Course rating survey; and Certificate of Completion (to include text approved by ADHS).  Total content shall include 84 screens in all lessons; 11 quizzes, introduction section, feedback survey and certificate. Review and evaluation, and/or addition or reformatting of new and debilitating conditions to the Clinical Trials database, including associated administrative, maintenance, travel-related, and technological responsibilities, to be updated as new conditions emerge and published to the Continuing Medical Education website in order to notify interested patients of studies that will be conducted in the United States, pursuant to ARS ss 36-2804.02 (B), Registration of qualifying patients and designated caregiver;. Quarterly progress reports to be provided to ADHS, in Department approved format, no later than 30 business days from the end quarter date, illustrating all progress “to-date.”; Quarterly CER reports (for ¼ of the total amount each quarter period; adjusted for clinical trials per request) to be provided to ADHS, in Department approved format, no later than 30 business days from the quarter end date; and, submitted to invoices@azdhs.gov and copied to the designated Medical Marijuana Program point-of contact (subject to change); and Submission of any project-specific products, according to timelines set out in an ADHS approved program implementation plan. 

Midlife (45-64 yr) Mexican-American (MA) men are susceptible to future burden from cardio-metabolic diseases because of numerous factors, most notably less healthful dietary and physical activity (PA) behaviors coupled with low participation in chronic disease prevention and management efforts. Thus, there is an urgent need to understand how to promote health-enhancing diet and PA behaviors in this understudied group of the population. The objective of this application is to use a mixed-methods approach to inform the development of and pilot test a gendered- and culturally-tailored diet- and PA intervention for cardio-metabolic disease prevention among midlife MA men. This objective will be attained by addressing the following specific aims: (1) conduct qualitative research with midlife MA men and their significant others (e.g. spouse, partner, close family member), and key informants (stakeholders from the MA community) to identify: (a) knowledge, perceptions, and behaviors regarding what constitutes healthful diet and PA practices; (b) perceived barriers and enablers of dietary and PA behavior change, (c) proposed strategies to promote dietary and PA behavior change, (d) perceived resources and assets for implementing dietary and PA behavior change interventions, and (e) masculine, cultural, and social identities that interact to influence interest and engagement in healthy lifestyle behaviors; and (2) assess the initial efficacy, feasibility and acceptability of a gender-tailored and culturally-relevant diet and PA behavior change pilot intervention targeting midlife MA men. Phase I of the project will entail focus groups to identify determinants of midlife MA men’s health behaviors, existing good practices and health- promoting values and behaviors, and acceptable intervention strategies. The proposed project will use intersectionality, which examines how the blending of identities and experiences create more accurate reflection of the determinants of men’s health behaviors, within the context of the sociocultural determinants of health, as the conceptual framework. A “grassroots” approach will also explore beliefs, barriers and enablers to dietary and PA change identified by significant others and community stakeholders Information collected during Phase I will inform the development of intervention materials and processes that will be pilot-tested during Phase II. Phase II will consist of a randomized controlled trial to test the initial efficacy, feasibility and acceptability of a gender-tailored, culturally relevant dietary and PA intervention targeting midlife MA men. Innovation lies in our study being the first to apply an intersectional approach in health disparities research with midlife MA men, a severely understudied and high-risk subgroup. To date, no interventions have been developed or adequately tailored to address issues unique to MA men 45-64 yr. Thus, the proposed research is significant be- cause it addresses a critical gap and will inform the development of lifestyle-based interventions targeting mid- life MA men. The proposed project will also establish the foundation for a subsequent test of intervention efficacy, as well as future translation and dissemination in varied community settings. ASU sub-award

Infections with Legionella have been steadily increasing over the past decade. Current strategies regarding Legionella have been focused on response-based approaches rather than prevention-based. The purpose of this study is to bring together the resources to create a comprehensive, interactive online training focused on preventative interventions. The training will include multiple modules aimed towards creating an understanding of Legionella, how it survives, thrives and moves throughout complex water systems, identifying critical control points and a variety of interventions. The content for the training will be delivered in multiple formats to maximize user engagement. Providing in-depth training on prevention of Legionella in complex water systems will help to decrease the number of infections throughout the United States.

The goal of this project was to develop a community-based participatory surveillance application and educational platform for arboviral diseases in the United States. Financial support from the Skoll Global Threats Fund (STGF) was used to support a University of Arizona developer migrate to a new push notification platform and convene 3-4 meetings of key stakeholders. These funds supplemented the CDC grant funding for the development of Kidenga and previous SGTF funding used for marketing of the tool.

Dr. Kacey Ernst (U of AZ, an epidemiologist). The role of Dr. Ernst on the project will be to inform the parameterization of the SEIR models for chikungunya and to refine the model for dengue as new information is generated in the literature. Further she will assist with informing the modifications to the DyMSiM model which includes the parameterization of humidity-related influences on the bionomics of the Ae. aegypti mosquito. She will assist in the validation of said models using multiple data sources. She will be responsible for coordinating access to data from multiple sources including 1) the Sonoran Department of Health for case data on dengue and chikungunya (as available) and 2) adult Ae. aegypti density and longevity information, and 3) ground measurements of humidity and temperature. She will assist in the interpretation of results and its relevance to informing stakeholders about the current risks and dynamics of chikungunya and dengue transmission in the region. She will participate in manuscripts and presentations that arise from the work conducted.

In the U.S., Hispanic males have the highest rate of overweight and obesity when compared to males of other racial/ethnic groups. Obesity contributes to the risk for certain cancers in Hispanics. For example, obesity is associated with non-alcoholic fatty liver disease (NAFLD), which is 1.4 and 1.9 times more common in Hispanics than in Non-Hispanic Whites (NHW) and African Americans, respectively. While not all individuals with NAFLD develop liver complications, nearly 30% will develop nonalcoholic steatohepatitis (NASH) and be at risk for hepatocellular carcinoma, the most common form of liver cancer in adults. Consequently, Hispanic males have the highest rates of liver cancer incidence in the U.S., twice those of NHW men. Weight loss is considered the first line of prevention for NAFLD progression. Yet, current research is lacking to inform best practices to engage Hispanic males in weight loss and/or to promote a successful weight loss trajectory. Without this information, the health disparities associated with obesity related cancer will continue to increase. Using existing practice guidelines and evidence from our qualitative assessments in overweight/obese Hispanic males, we will test a novel intervention approach to address this knowledge gap. We propose to 1) assess the feasibility, acceptability and preliminary efficacy of a gender- and culturally-sensitive weight loss intervention in 20 overweight/obese Hispanic males ages 18-64 over 24 weeks; and 2) examine pathologic changes in the liver (NAFLD, NASH, fibrosis, or cirrhosis) in 20 overweight/obese Hispanic males ages 18-64 over 24 weeks using a non-invasive Magnetic Resonance Imaging (MRI) of the liver. This project will be the first gender and culturally-sensitive weight loss intervention of which we are aware to explicitly target Hispanic males with an emphasis on reducing body weight. In addition, the intervention will provide highly impactful formative research on the effects of a weight loss lifestyle intervention on liver histology. Given the Hispanic population is the fastest growing in the U.S., efforts to identify strategies to promote weight control among Hispanic males has potential to significantly impact obesity-related cancer health disparities.

Located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona and funded by the state tax on tobacco products, The Arizona Smokers’ Helpline (ASHLine) is one of over 50 quitlines across the United States. Established in 1995, it is also one of the oldest and most seasoned quit lines in existence.  As a member of the North American Quitline Consortium, ASHLine is actively engaged in collaborations, research, evaluation and quality improvement to assure all Arizonans have access to high quality, evidence-based tobacco cessation services and support. Nationally, quit rates reported among North American quit lines vary, averaging around 30%.  The Arizona Smokers’ Helpline (ASHLine) has been helping people quit tobacco since its inception in 1995. We are a comprehensive quitline, offering free telephone (both reactive and proactive) and web-based quit services and four to twelve weeks Nicotine Replacement Therapy (NRT). In addition, we have fax and electronic provider referral program and provide free training and technical assistance to healthcare providers and community partners statewide. The Arizona Smokers’ Helpline (ASHLine) is a service entity well-positioned to contribute to ongoing tobacco control efforts by providing effective, evidence-based support to individuals in their effort to end tobacco use.

Residents of rural communities and Latinos continue to experience significant health disparities for chronic disease such as diabetes and cardiovascular disease.  The residents in these communities have significant disparities due to multiple social determinants of health including but not limited to a lack of access to opportunities for physical activity and other resources necessary to prevent chronic disease. Bike Ajo is a community-campus coalition with diverse membership including community health. Bike Ajo’s goal is to create a sustainable cycling hub that educates, trains, provides resources, and builds health-based partnerships within the Ajo community. The asset-based coalition includes community residents, Desert Senita Community Health Center, International Sonoran Desert Institute, Ajo Chamber of Commerce, Arizona Planning Association, Mel and Enid Zuckerman College of Public Health, UA Department of Mexican American studies, Pima County Parks & Recreation, Pima County Health Department, and Pima County Department of Transportation. The Bike Ajo works to increase access to environments promoting physical activity opportunities through the creation of the1) Bike Ajo Cycling Hub (ReaCH); and 2) expanding community-clinic linkages to chronic disease prevention resources for Desert Senita Community Health Center patients.  Successes, lessons learned, and process/implementation strategies will be shared through the Arizona REACH network as well as at local and national conferences.  Digital stories will be utilized to help community members tell their own compelling stories of the personal impact of inequities in public health. This project was funded by the National Center for Chronic Disease Prevention and Health Promotion and the Arizona Chapter of the American Planning Association. 

The American Lung Association Airways Clinical Research Centers (ACRC) network is a network of asthma and airways experts with access to a nationwide and demographically representative study population, for the purpose of decreasing the prevalence, morbidity and mortality of asthma and COPD. The basic activities of the network and its data coordinating center include:  Developing a collective data base of well characterized patients with asthma and COPD who can serve as potential research participants;  Collecting core data from recruited participants;  Communicating information gained from network activities to local Lung Associations and the populations they serve;  Participating interactively in developing grant and contract proposals. Such proposals may be extensions of initial projects proposed in the applications of individual centers, or may involve emerging new priorities that arise as a consequence of developments within the field.  Participate in development of presentations and publications based on network research.

The goal of this project is to 1) to demonstrate utility and feasibility of detection of LTBI among migrant farmworkers, and to compare outcomes in the US and Mexico and; 2)To assess follow-up of workers detected with LTBI and ability to link individuals to care. Through additional funding, we have been able to expand the work to include further care for participating migrant farmworkers in conjunction with the Migrant clinicians Network.

The goal of this project is to examine the association between stress and asthma morbidity, using our preliminary work from the Children’s Respiratory Study, and within the context of an ongoing school-base randomized clinical trial, to determine to what degree variations in asthma control and morbidity are associated with chronic school stressors. Eyal Oren was a contributor on this project but has since left the University of Arizona. 

The goal of this project is to determine whether texting can serve as a low cost technology for improving low LTBI adherence rates. This work is being completed in partnership with the Pima County Health Department TB Clinic in Tucson, AZ. Specifically, the project will focus on these aims: Aim 1. To determine the effectiveness of text reminders for improving adherence in latent TB patients using a randomized controlled single blinded trial. Aim 2. To establish the costs associated with text messaging. Aim 3. To determine patient experiences with the texting intervention. You can learn more about TXT4MED and its progress at http://txt4med.arl.arizona.edu  

Abstract not available. 

Abstract not available. 

This project is a contract, specifically contract 1202, with the Arizona Biomedical Research Commission. Project work will be done in conjunction with Hopi Pilot Survey funded under NACP (AzCC).

The study started in 1993 to evaluate health outcomes in aging postmenopausal women and to identify factors associated with healthy aging. Between 1993 and 1998, more than 161,000 women between 50 and 79 years of age joined the WHI. Beginning in October 2004, participants were consented for sequential 5-year WHI Extension Studies (ES). The research team continues to collect self-reported as well as medical record adjudicated health and mortality data. A team of junior investigators are engaged with data analysis in an effort to advance the dissemination of WHI research findings. Arizona research team members have published over 45 manuscripts in the past 8 years using this well-characterized and robust phenotypic information.

The ALA‑ACRC consists of 18 clinical centers and a data coordinating center who have the mission of improving asthma care through clinical research in diverse populations. The ALA‑ACRC conducts various clinical studies related to asthma. Core funding was provided by the American Lung Association and funding for individual protocols was provided by NIH, industry partners, and foundations.

This study is an NIH/NHLBI funded project that is examining the effectiveness of a school based hand sanitizer program on asthma exacerbations in elementary school children.