Current Funded Projects

Feeding in Elderly Late-Stage Dementia: The FIELD Trial
NIH/NIA R21 Project Dates: 06/01/2009 - 05/31/2012
Elaine Amella, PhD, GNP-BC, FAAN

The primary objective of this grant is to provide support to conduct a pilot study regarding the feasibility of randomizing subjects with late-stage dementia to two different modalities of feeding: deliberate hand-feeding versus enteral tube-feeding. In addition, we will determine the ability of both caregivers and physicians to participate in shared and informed decision-making regarding the process of informed consent for participation in a randomized feeding trial. Also, we will determine the practicability of our hand-feeding and tube-feeding protocols. Further we will determine willingness and feasibility of all data collection (staff and caregiver) and estimate completion and attrition rates and reasons for them. This issue greatly affects the public health of the United States, as thousand of feeding tubes are placed each year in late-stage dementia patients without the necessary supporting evidence for improved outcomes. The retrospective literature suggests that the placement of feeding tubes in this vulnerable population does not improve survival or other measurable clinical outcomes.

For more information contact Dr. Amella at  amellaej@musc.edu
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Nutrition and Food Safety Education Targeting Rural Older Adults: A Volunteer-Based Train-the-Team Approach
Clemson University/USDA  Projects Dates: 09/01/2010 - 08/31/2012
Elaine Amella, PhD, GNP-BC, FAAN and Martina Mueller, Ph.D. (Co-I)

This subcontract with Clemson University will examine the feasibility of using a volunteer-based, train-the-team approach to reach rural older adults with information about how to make safe and healthy food choices and to use safe and healthy preparation practices. Two pre-existing volunteer groups will serve as the model for the train-the-team approach - the SC Family and Community Leaders (SCFCL) and the South Carolina chapter of the American Association of Retired Persons (AARP). The study will build on current evidence, capitalize on the potential contribution of pre-existing community-based groups as a source of volunteers to reach older adults with information about food safety and nutrition, and extend the focus to minority populations in an effort to eliminate health disparities. The findings will contribute to the evidence base of effective train-the-team programs and their potential effects over time and might offer a way to shift the current nutrition and food safety education paradigm by offering a way to extend the knowledge base of Clemson Extension, which is usually channeled directly from Extension Agents to the public to a new model, Extension Agents to volunteers to the public.

For more information contact Dr. Amella at  amellaej@musc.edu
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Video Assisted Research Consent (SCTR Supplement)
NIH/NCRR   Project Dates: 05/15/2011 - 03/31/2012
Kathleen T. Brady, MD, PhD (PI), Kathryn Magruder, PhD (Co-PD) and Jeannette Andrews, PhD, APRN-BC, FNP (Co-PD)

The Specific Aims of this projects are to:

• Aim 1: Develop a multi-media approach to presenting important consent information by producing a video library of frequently encountered research procedures.
• Aim 2: Pilot test materials developed in Aim 1 through an "electronic" research informed consent process compared with the traditional "paper" research informed consent process.

We hypothesize that the electronic consent supplemented with video taped educational materials will be superior to the consent process.

The long term goal is to improve human subject comprehension and satisfaction with the research consent process by incorporating multi-media components, ultimately promoting improved community relationships.

For more information contact Dr. Andrews at andrewj@musc.edu
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Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) - Project 10
US Army/USAMRAA  Project Dates: 07/01/2010 - 06/30/2013
Sabra Slaughter, PhD and Jeannette Andrews, PhD, APRN-BC, FNP (Project 10 Project Director)

The goal of this cooperative agreement with the United States Department of Defense is to develop educational and outreach programs and conduct community-based research on health disparities and to address the high rates of disease occurrence, disability and mortality in rural, low-income or minority communities.

For more information contact Dr. Andrews at andrewj@musc.edu
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A Social Ecological Based Smoking Cessation Intervention for Women in Public Housing Neighborhoods
NIH/NHLBI R01 Project Dates: 12/01/2008 - 11/30/2013
Jeannette Andrews, PhD, APRN-BC, FNP

The broad, long-term objectives of this research will optimize smoking cessation outcomes and reduce associated health disparities in African American (AA) women who live in Southeastern US public housing neighborhoods. Using a participatory and social ecological approach, the academic investigators, advisory board, and public housing residents have developed a bundled, multi-level intervention (a.k.a. Sister to Sister) that has demonstrated feasibility and potential effectiveness in increasing short-term cessation outcomes. The primary aim of this study is to test the effectiveness of this bundled, multi-level intervention on long-term (6- and 12-month) cessation outcomes in women in public housing neighborhoods.

We will pair-match 14 public housing neighborhoods and randomly assign one neighborhood in each pair, (7 per condition), to either a treatment condition (Sister to Sister) or a control condition. We project 203 smokers for treatment and 203 smokers for control, a total of 406 participants (29 per neighborhood), will be needed at baseline to detect proposed treatment effects for the primary outcome of smoking cessation. Treatment participants will receive the 24-week, bundled Sister to Sister Intervention consisting of: a) individual level strategies with 1:1 community health worker contact to enhance smoking cessation self-efficacy and spiritual well-being; b) interpersonal level strategies with behavioral counseling in small peer groups to enhance social support; c) neighborhood level strategies with policy and counter-marketing campaigns led by a neighborhood advisory board; and, d) an 8-week supply of nicotine patches and study-specific written cessation materials. Control participants will receive written, socio-culturally appropriate cessation materials at baseline, (Pathways to Freedom), and mailed written cessation materials at weeks 6, 12, and 18. In accordance with community preferences, the control participants will be offered a delayed intervention, behavioral counseling, community health worker interactions, and nicotine replacement therapy, at the end of the study. Secondary aims are to test the effects of intervention mediators, (self-efficacy, spiritual well-being, social support, cessation resources), and moderators, (perceived stress, social influences, social ties, neighborhood cohesion, neighborhood smoking prevalence, neighborhood stress), on cessation outcomes. Measures will be assessed at baseline, 6 months, and 12 months.  Demonstrating success with this socio-cultural, multi-level approach may lead to wide-scale dissemination and adoption, and decrease disparities of tobacco-related morbidity and mortality in AA females.

For more information contact Dr. Andrews at andrewj@musc.edu
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The Impact of Tobacco Control Intervention in African American Families
NIH/NCI R01 (Sub to MCG)  Project Dates: 01/01/2007 - 05/31/2012
Jeannette Andrews, PhD, APRN-BC, FNP

Nearly 25 million US adults and 6.4 million children living today will die prematurely from tobacco-attributable diseases unless adults are successful with cessation and rates of child tobacco use are halted. Fifteen million US children <18 years old are exposed to environmental tobacco smoke (ETS) mostly in their homes, and parent modeling of smoking is identified as an important factor for the 4,000 children who initiate tobacco use each day. With widening gaps in health disparities for African Americans (AAs) related to the health effects of tobacco use, culturally sensitive approaches that may be effective need to be fully tested. Based on concepts from Social Cognitive Theory and taking a social ecological perspective, this research will investigate the effects of a family approach that includes child and parent/guardian (P/G) interventions on tobacco control. Subjects will include 4th grade AA children (N=400) and Ps/Gs; 50% rural and 50% inner-city. Using a two group design with repeated measures, schools (20) will be randomly assigned to treatment or control. Children and Ps/Gs in the treatment group will receive a yearly intervention for two years and the control group will receive matched contact and attention on general health education. The child intervention, Botvin's Life Skills (BLS), consists of 8 classroom sessions taught during 4th and 5th grades for a total of 16 sessions by trained school personnel. The P/G intervention, (BLS Parent), consists of 8 home-based modules during the 4th and 5th grades that promote P/G use of anti tobacco socialization in the home and reinforce the school-based child intervention. Ps/Gs who smoke will also receive motivational interviewing and nicotine replacement therapy based on their readiness to quit. Behavioral change will be measured by self-report in children and Ps/Gs at baseline, 12 weeks (short-term) and 9 months (long-term) after each year of intervention and also via salivary continine at three time points (baseline, at year 2 and at year 4).

We propose this family approach will foster development of personal and environmental protective factors in children and their Ps/Gs for tobacco control. The primary hypotheses are: Children and Ps/Gs in the treatment group will have improved behavioral outcomes of: 1) lower ETS exposure in children; 2) lower rates of tobacco experimentation in children; 3) higher P/G self-efficacy in delivering anti-tobacco socialization in the home; and 4) higher tobacco cessation rates in Ps/Gs. This research addresses a significant public health concern, tobacco use, which remains the single most preventable cause of morbidity or mortality. Consistent with both the NCI and the NICHD, this project targets the advancement of socio-cultural behavioral treatment for children and their families, the prevention of tobacco-related diseases, particularly cancer, and the elimination of health disparities among an ethnic minority group, AA. The need for theory-based effective interventions validated by biochemical measures is imperative for tobacco control. If effective, implementation of this family approach via the school systems as the primary point of entry is highly probable.

For more information contact Dr. Andrews at   andrewj@musc.edu
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Advanced Nursing Education Grants: Growing the Next Generation of Nursing Leaders (NGNL)
HRSA   Project Dates: 07/01/2011 - 06/30/2014
Gail A. Gilden, RN, ScD

The goal of this project is to grow the next generation of young nurse leaders from our Medical University of South Carolina (MUSC) online PhD and DNP programs, who will be the vanguards in solving health care disparities among rural and underserved populations in our complex health care environment. Our aim is to produce a nursing leadership workforce that is 1) early career 2) diverse and culturally competent and 3) adept in interprofessional team research skill sets. We will attract early career Post-BSN students to the PhD and DNP Online programs through creative recruitment, innovative marketing and focused mentoring strategies that encourage a younger and diverse applicant pool to study at our programs. Once admitted, we will bolster the skills sets of younger, disadvantaged, and minority online students to navigate doctoral level coursework using the Next Generation of Nursing Leaders Program (NGNL). With the guidance of a nationally recognized consultant on cultural competence, faculty will evaluate and expand the DNP and PhD curricula and clinical experiences to ensure the cultural competencies of our graduates for use with rural and underserved populations. To develop graduates with interprofessional team research skill sets, the faculty will utilize the online environment to construct interdisciplinary group learning experiences that supplement the traditional model of one-on-one research mentorship. Faculty will first map the core concepts of interest among the DNP and PhD students and faculty, and then create what we will call Scholarly Communities of Practice (SCOP). We will use SCOP forums to organize and scaffold research and clinical projects of the DNP and PhD students and faculty, so that the full continuum of knowledge development to knowledge dissemination in a particular topic is readily shared. Each group, led by experienced faculty mentors, will model and practice core teamwork skills in their interaction on projects. Online PhD and DNP students will engage in collaborative efforts of scholarly production with faculty and peers of like interests, learning to work in teams with a common interest but composed of diverse talents and perspectives. Invited interdisciplinary and international guests will be encouraged to collaborate within the SCOP forums.

For more information contact Dr. Gilden at barbosag@musc.edu
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The Technology Center to Enhance Healthful Lifestyles
Center of Economic Excellence (CoEE) 
Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, RNC, FAAN

Dr. Carolyn Jenkins and Dr. Steve Blair from USC School of Public Health will be leading the efforts of a new Center of Economic Excellence that will develop technology, such as interactive, web-based coaching programs, to help people make healthier lifestyle choices and delay or prevent chronic diseases such as type 2 diabetes, heart disease, and cancer.The Technology Center to Enhance Healthful Lifestyles is a partnership between the University of South Carolina and the Medical University of South Carolina. The review board approved $3 million in funds for the center. Health Sciences South Carolina is providing a portion of the private funds to help match the state’s investment. Center researchers will develop new technologies for improving health, preventing illness, and successfully managing chronic health problems. In particular, they will develop interactive tools that can reach all segments of society and reduce health disparities. Two world-class scientists, known as CoEE endowed chairs, will be recruited to lead the center. MUSC will recruit a chair to focus on technology applications to prevent and manage disease and reduce risk.USC will recruit an endowed chair to focus on technology applications for changing health behavior. The center’s work could help the state become a national leader in an emerging high-growth field and result in marketable products such as new communications technologies and applications for individuals, worksites, health professionals, and health systems. Products could include software and information systems for cell phones, iPod technologies, and computerized kiosks. The center could help attract new software development, lifestyle coaching, and computer hardware companies to the state and result in start-up companies based on South Carolina discoveries.

For more information contact Dr. Jenkins at jenkinsc@musc.edu
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REACH U.S.  Southeastern African American Center of Excellence for Eliminating Disparities (SEA-CEED)
Centers for Disease Control  Project Dates: 09/30/2007 - 09/29/2012
Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, RNC, FAAN

The SEA-CEED partnership will expand the Charleston-Georgetown Diabetes Coalition's focus to include prevention and risk reduction related to HTN and stroke in African Americans at risk or with diabetes. Additionally, successful and ongoing community and systems change, increased advocacy, and policy change strategies will be modified to include intergenerational activities to reduce modifiable risks. Previous and current community development strategies will be defused via the Legacy Projects which will expand the coverage area to counties in SC, GA, and NC. The Carolinas and Georgia Chapter of the American Society of Hypertension, American Association of diabetes Educators, Public Health Practice Group, Urban League, Alpha Kappa Alpha Sorority, and Black Nurses Association have expanded our partnership in high-risk areas in the region. Additionally, we will network with the American Diabetes Association for programmatic activities and guidelines for diabetes care.

The central Coordinating Organization is the Medical University of South Carolina. The community action plan is guided by a collaborative model which stresses identification of change agents, involvement in health organizations and other community organizations, with a focus on ploicy and systemes change to enable and encourage individual behavior change. Strong science is applied within a tailored and culturally appropriate community context--as evidenced in specific protocols for community programs and health organization quality improvement initiatives. A logic model identifies levels of activity and change with parallel plans for monitoring achievement of multi-level of objectives. Legacy projects in the tri-state area are awarded to local groups in the tri-state area.

The SEA-CEED a) addresses a geographic area with high burden and great disparity for African Americans, b) builds on the success of previous REACH coalitions, c) capitalizes on a broad network of academic and community partners which have worked effectively with mutual respect, d) represents rigorous application of community based participatory action principles and application of evidence based guidelines, and e) has the infrastructure and recognized leadership to work effectively at the local, state, and multistate levels, and with the Centers for Disease Control and other CEEDs.

For more information contact Dr. Jenkins at jenkinsc@musc.edu
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A Physical Activity Intervention, MECALF, to Reduce Pain in Patients with Critically Colonized/Infected Chronic Leg Ulcers
Wound, Ostomy Continence Nurses Society (WOCN)  Project Dates: 07/12/2011 - 07/11/2012
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN

Significance: Pain is prevalent in patients with chronic leg ulcers, and can be severe when ulcers are critically colonized/infected (CCI). These patients disproportionately suffer from functional impairments, specifically reduced ankle range of motion (AROM) and strength that limit physical activity (PA). Without physical activity (PA), function remains poor, pain persists, and wound healing or infection resolution is hindered. While PA can confer many benefits, patients with CCI ulcers and pain are unlikely to adhere. Motivation and self-efficacy play key roles.

Purpose: To evaluate a Wound Ostomy and Continence (WOC) nurse directed, patient-centered intervention called MECALF: motivational enhancement (ME) and conditioning activity for leg function (CALF), in a sample of patients with CCI ulcers and pain who are receiving care in an outpatient wound clinic.

For more information contact Dr. Kelechi at kelechtj@musc.edu
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Preventing Venous Leg Ulcers with Cryotherapy: A Randomized Clinical Trial
NIH/NINR  Project Dates: 03/07/2011 - 12/31/2014
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN

The R21 Pilot Project (NINR—1R21NR010604-01) “Cryotherapy for Venous Disorders: A Pilot” demonstrated that cooling inflamed skin affected by venous disorders significantly reduced blood flow after a four-week intense cryotherapy intervention. This new trial will assess the efficacy of this home-based cryotherapy intervention by adding sequenced tapered cooling after a 30-day intense cooling period. The goal is to reduce skin blood flow of chronically inflamed skin, decrease the incidence of venous leg ulcers and pain, and improve quality of life. A myriad of surgical, pharmacologic, and non-pharmacologic therapies such as compression bandages are often tried, many with limited success. More than 70% of patients with venous disorders such as insufficiency develop edema, skin damage, and ulcers. Ulcer prevention is warranted because of the significant socioeconomic implications in terms of lost workdays and wages, decreased productivity and increased health care costs. Clinicians focus on the multiple treatment approaches, often without consideration of how patients can contribute to their own self-care. Our 9-month intervention is based on principles of heat transfer and cryotherapy theories involving microcirculation. With input from a cryotherapy expert and participants who completed the R21 pilot, we propose a sequenced intervention strategy, where cooling will be dosed daily for 30 minutes for the first month, and then decreased to twice weekly dosing in months 2–3, once weekly in months 4–6, then prn in months 7–9. We will measure blood flow, skin temperature, pain, quality of life, and the incidence of leg ulcers after months 1, 3, 6 and 9. Eligible participants will be randomized to treatment (low compression cooling wrap) or usual care (low compression non-cooling “sham” wrap). Participants in both groups will receive all study related materials including standardized instruction, skin thermometer, specially designed low compression wraps, leg elevator pillow, and compression stockings, and during an in-depth orientation session. We hypothesize that cryotherapy will enhance the largely ineffective non-pharmacologic self-care usual care model, that is, telling patients to wear compression stockings, elevate the legs, and get more exercise. These strategies are generally inadequate in achieving sustained change. Among our research methods we include rigorous process, impact and outcome monitoring. In an era of expectation for technological and pharmaceutical “fixes”, this self-care strategy, if efficacious, could be an economical way to decrease morbidity and pain for thousands of patients, frequently viewed as non-responsive to self care. Prevention of ulcers is also a major potential source of saved medical dollars. This trial is significant due to the burden of venous disorders, the complex physical characteristics of the population including excessive obesity and co-morbidity and the need to reach patients with a feasible, motivational, and supportive strategy to promote self-care. The objective is to establish a new practice standard for prevention.

For more information contact Dr. Kelechi at kelechtj@musc.edu
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A Partnership to Promote Physical Activity and Healthy Eating in AME Churches
University of South Carolina  Project Dates: 06/01/2006 - 03/31/2012
Marilyn Laken, PhD, RN, FAAN

The purposes for this program is to help members of AME congregations become more physically active and eat a diet that is high in fruits, vegetables, and whole grains and low in saturated fat and sodium. The program is a partnership between the University of South Carolina (USC), the Medical University of South Carolina (MUSC), Clemson University, and the Palmetto Conference of the African Methodist Episcopal Church.

For more information contact Dr. Laken at lakenm@musc.edu
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Decision Support in the Care of Preterm Newborns-Tool Development
NIH/NHLB R21  Project Dates: 08/01/2008 - 06/30/2012
Martina Mueller, Ph.D.

Even after many advances in ventilator management, prediction of extubation outcome for a mechanically ventilated premature infant with respiratory distress syndrome (RDS) remains a challenging task for clinicians. We recently developed a machine-learned model (an Artificial Neural Network, ANN) to assist in decision- making regarding extubation of premature newborns (Mueller et al., 2004, 2006). The ANN model was found to perform with accuracy comparable to that of experienced clinicians; however, this approach needs to be compared to equally powerful machine-learning approaches before it can be evaluated in clinical practice. An appropriately validated decision-support tool could help in reducing the number of days a premature infant spends on a mechanical ventilator, and hence the risk of developing short and long-term side effects of mechanical ventilation, resulting in a corresponding decrease in overall health care costs. In this R21 proposal, we will use several machine-learning approaches combined as a committee formation to obtain the best prediction of extubation success for a given infant. Further, we will build on the previously developed ANN prototype to create an enhanced decision support tool by developing data representation, storage, management, and most important, causal inference, which will enable effective integration of the resulting web-based decision-support tool with clinical practice. This last feature is only possible due to the integrated nature of the proponents themselves, which range from data structure and mathematical modeling experts to experienced neonatologists with a well established working relationship. The proposed effort aims at using advanced modeling tools for translational research by developing a web-based decision-support tool to aid primarily inexperienced clinicians in their decision-making and by promoting interoperability and data exchange among researchers in this field. The critical feature of this infrastructure is its web-based nature, which enables clinicians to evaluate a predictor's accuracy and parametric sensitivity individually for each neonate without having to use any other software than a web-browser. Such a prediction model will be of critical value not only to increase overall clinical accuracy but also to identify effective measures of validity of the original predictions. The overall aim of this study is to develop a high performing web-based prediction system to use as a decision-support tool in clinical practice and to promote interoperability, and thus, data sharing and interaction among researchers in the neonatal community.

For more information contact Dr. Mueller at muellerm@musc.edu
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Synthesizing Lessons Learned Using Health Information Technology
AHRQ R03  Project Dates: 05/01/2010 - 04/30/2013
Lynne S. Nemeth, PhD, RN

This proposed research addresses the use of health information technology (HIT) to improve health care decision-making by evaluating how quality of care is improved while using EMRs, and how to increase the adoption of new roles in practice settings to improve communication between patients and practices about health care. The specific aims of this two year project are to: 1) Complete a mixed methods secondary analysis to synthesize findings related to improving quality using HIT in primary care across seven nationally funded PPRNet initiatives. 2) Examine current perspectives of PPRNet-TRIP study practice participants related to: developing and sustaining QI efforts; and team development for an increasingly more active health care delivery role through robust EMR implementation.  3) Integrate findings from PPRNet’s previous studies with the current perspectives of practice representatives to refine the overarching theory-based “PPRNet-TRIP QI Model”. The aims and products of the proposed R03 will further the goals of supporting safe, efficient and effective health care for all Americans through use of HIT to improve performance in real world of primary care practices.

For more information contact Dr. Nemeth at nemethl@musc.edu
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A Peer Navigator Intervention for Individuals with Spinal Cord Injury
NIH/NICHD K23  Project Dates: 02/01/2010 - 03/31/2015
Susan Newman, PhD, RN, CRRN

This 5-year K23 Mentored Patient-Oriented Research award proposal is designed to provide the scholarly training, mentorship, and support necessary for the candidate to develop into an independent investigator. The candidate’s goal is to gain expertise in the development and testing of effective and cost-beneficial evidence-based rehabilitative health promotion interventions in partnership with people with spinal cord injury (SCI) in community settings. To achieve this goal, a focused career development plan is proposed to 1) gain expertise in the rigorous conduct of theoretically grounded, community-based health promotion intervention research, 2) develop proficiency in the use and application of research designs that incorporate both qualitative and quantitative methods, 3) enhance skills in community-based participatory research (CBPR), and 4) advance competence in analytical and evidence-based decision making skills related to intervention research with an emphasis on interpretation of health related outcomes and cost effectiveness. The Medical University of South Carolina provides a rich training environment that includes senior experts in community-based participatory research, health disparities research, and applied SCI research. The candidate has identified mentors with complementary expertise in the development and implementation of randomized controlled trials of community-based health promotion interventions with vulnerable populations using a CBPR approach, as well as measurement and interpretation of health and social outcomes after SCI. The mentoring team will be responsible for monitoring and evaluation of the candidate’s progression during the five-year training plan. The research plan, which builds on the training objectives, is designed to respond to a recent NIH initiative to incorporate CBPR approaches to more effectively research health issues in high-risk communities. The proposed work also incorporates the National Health Promotion and Disease Prevention Objectives for 2020 to address the environmental factors that contribute to our health. The research plan includes strategies to address health promotion after SCI beyond the level of the individual and incorporate an ecological approach to identify and address issues in the physical and social environment that affect health after SCI. The objective of the proposed two-phase feasibility study is to investigate a novel ecological approach to health promotion after SCI, using a CBPR approach, in partnership with a local center for independent living. Building on evidence from other fields, we propose an intervention using community-based peer navigators with SCI to proactively mitigate barriers and facilitate access to health care and other community-based services by people with SCI. Our overall goal is to reduce rehospitalizations and secondary conditions and improve community participation and satisfaction with life after SCI. Upon training completion, the candidate will be prepared to design, obtain funding for, and conduct a large-scale randomized controlled trial of a community-based health promotion intervention for and in partnership with people with SCI. This future research will provide empirical data to support development of cost-effective, evidence-based rehabilitative health promotion interventions to improve health and quality of life of this vulnerable population.

For more information contact Dr. Newman at   newmansu@musc.edu
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Communication Intervention for Adolescent Immunizations: Cluster Randomized Trial
Sub to University of Oklahoma HSC/HRSA R40: Maternal and Child Health Research (MCHR)  Project Dates: 02/01/2011 - 01/31/2014
Charlene Pope, PhD, MPH, BSN

Though recommendations for adolescent immunizations have increased, adolescent immunization rates fall well below childhood rates. Missed opportunities for immunization are documented, though the conversations that contribute to vaccine hesitancy and refusal are less documented. The process of health communication between health providers, adolescents, and parents that characterizes information transfer in preventive health visits remains a critical but under-explored site for intervention. Most communication studies between adolescents and health providers use surveys, post-hoc interviews, or code health topics.

This study will record 120 spoken interactions pre- and 120 post-intervention between providers and diverse adolescents and parents in South Carolina and Oklahoma discussing recommendations for tetanus/diphtheria toxoid/acellular pertussis (Tdap), meningococcal conjugate vaccine (MCV 4), and human papillomavirus vaccine (HPV) at preventive health visits. Using methods from discourse analysis, patterns of communication and decision making will be compared to parental willingness to accept vaccines to determine best practices. Applying an integrated health behavior model, findings will be used to develop, test, and implement a provider-patient/parent communication intervention in two pediatric practice-based research networks representing multicultural populations to monitor variations for cultural tailoring.

Focus groups of adolescents, parents, and providers in online and face-to-face environments will refine the intervention and preferences for intervention delivery. Using simulation methods for provider prompting and patient priming, the intervention will be randomly allocated to 6 clinical practices in a cluster randomized trial. Guidance from the USPSTF Counseling and Behavioral Interventions Work Group will be used to evaluate the intervention. Subsequent follow-up will rate visits using the Structured Communication Adolescent Guide (SCAG) recording and repeating discourse analysis to determine changes in communication practices and immunization rates at the practice level.

For more information contact Dr. Pope at  popec@musc.edu
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Ethno-Cultural Barriers to Health Literacy/Disease Management in AAs
NIH/NINR Project Dates: 04/01/2012 - 01/31/2015
Ida J. Spruill, PhD, RN, LISW, FAAN

More research is needed in this area, as health literacy not only measures a person’s ability to read and comprehend, but also the ability to act on medical instructions and information. This is particularly true for the African American (AA) community which suffers disparate impact from chronic illness. The substantive aim of this descriptive, mixed method study is to explore the effects of beliefs and culture on health literacy and ultimately the management of diabetes in AAs from four regions in South Carolina.  Our methodological aim is to develop a reliable, valid and generalizable survey tool with items that represents cultural beliefs, values, experiences and preferences for health information. This study is innovative in that it acknowledges the heterogeneity of the AA community and will apply theoretically grounded models to guide the substantive and methodologic aims. We will use focus groups and cognitive interviews in year one and instrument pre-testing and population survey implementation in years two and three. Findings from this study will guide the selection of messages and strategies that will be subsequently tested within targeted populations to improve health outcomes. This study can advance the science as it relates to promoting health literacy and disease management among vulnerable populations.

Advanced Nursing Education Expansion (ANEE)
HRSA  Project Dates: 09/30/2010 - 09/29/2015
Sally D. Stroud, EdD, APRN, BC

This award is to support students enrolled in the newly implemented online Doctor of Nursing Practice/ Master of Science in Nursing (DNP/MSN) primary care Nurse Practitioner (NP) program. The objective of this ANEE Project is to maintain the high number of full time nurse practitioner (NP) students who are enrolled in this program by providing additional funding for full time enrollment. The second objective is to offer strong MSN students who apply part-time an opportunity to come into the program in a full time position with financial support.

For more information contact Dr. Stroud at stroudsd@musc.edu
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Helene Fuld Health Trust Scholarship Fund for Baccalaureate Nursing Students
Helene Fuld Health Trust   Project Dates: 09/01/2010 - 08/31/2013
Sally D. Stroud, EdD, APRN, BC

The primary mission of the Helene Fuld Health Trust is to support and promote the health, welfare and education of student nurses. The first priority of the Trust is financial aid to nursing students. This grant is made exclusively to fund financial aid for students enrolled in the Baccalaureate degree nursing program here in the College of Nursing.

For more information contact Dr. Stroud at stroudsd@musc.edu
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New Careers in Nursing: Changing the Face of Nursing
Robert Wood Johnson Foundation (RWJF)  Project Dates: 09/01/2010 - 08/31/2012
Sally D. Stroud, EdD, APRN, BC

The purpose of this program is to increase the diversity of the student body. Scholarships to minority and disadvantaged students would assist the College in attracting highly qualified students who historically attend schools out of state where they receive substantial scholarships. The recruitment efforts will be multifaceted and embrace the latest technologies. 

For more information contact Dr. Stroud at stroudsd@musc.edu
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Advanced Education Nursing Traineeship Program
HRSA  Project Dates: 07/01/2011 - 06/30/2012
Sally D. Stroud, EdD, APRN, BC

This grant will support students enrolled in three advanced education nursing degree programs of the College of Nursing: The Master of Science in Nursing (MSN) degree program, Doctor of Nursing Practice (DNP) and Doctor of Philosophy in Nursing (PhD) degree program in addition to first year nurse anesthesia students in the Anesthesia for Nurses program in the College of Health Professions.

For more information contact Dr. Stroud at   stroudsd@musc.edu
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Nurse Faculty Loan Program
HRSA  Project Dates: 07/01/2011 - 06/30/2012
Sally D. Stroud, EdD, APRN, BC

This grant is for financial loan support for students enrolled in a Doctor of Philosophy in Nursing (PhD), Doctor of Nursing Practice (DNP) program (both post-BSN and post-MSN options) and students enrolled in a Master of Science in Nursing (MSN) degree program at the College of Nursing, Medical University of South Carolina, a school accredited by CCNE and ACNM.

For more information contact Dr. Stroud at   stroudsd@musc.edu
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Sociodemographic Regulation of CV Function and Structure
NIH/NHLBI  Project Dates: 04/01/2010 - 03/31/2013
Frank A. Treiber, PhD

The fundamental objective of this proposal is to identify whether exposure to chronic stress is associated with development of early risk markers of Cardiovascular disease (CVD) and type 2 diabetes (T2D) and whether this differs between African Americans (AAs) and European Americans (EAs). Collecting data on 2 additional occasions in the Georgia CV Twin study (523 pairs, 302 EA and 221 AA) who will be 19.5±3.5 yrs. old will yield 5 evaluations over a crucial time span capturing the transition from childhood into adulthood. Particularly informative will be addition of new indices of sympathetic nervous system and hypothalamic-pituitary-adrenal axis activation (i.e., blood pressure, high density lipoprotein, triglycerides, waist circumference, fasting glucose and insulin), environmental stress (e.g., childhood trauma, job strain, perceived discrimination and unfairness, community social status) and a measure of vascular function (i.e., arterial stiffness).

For more information contact Dr. Treiber at treiberf@musc.edu
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Stress Reduction: Impact on BP in African American Youth
NIH/NHLBI  Project Dates: 01/01/2009 - 12/31/2012
Frank A. Treiber, PhD

This proposal will examine the effects of 2 behavioral stress reduction programs, mindfulness meditation (MM) and the Lifeskills Program (LP), and a health education control program (CTL) on cardiovascular function at rest, during laboratory stress and in the natural environment. Subjects will be 320 ninth graders (50% male) with high normal systolic BP (i.e., SBP from greater than or equal to 85th percentile to less than or equal to 95th percentile on 3 occasions). Following BP screenings and baseline evaluation, subjects will be assigned to a CTL, MM, LP or MM and LP group. Subjects will be reevaluated after a 12-week intervention and again at a 12 week follow-up. Specific aims are to determine whether MM and/or LP results in:(1) decreases in the primary outcome variables of resting SBP and 24-hour ambulatory SBP; (2) decreases in sympathetic nervous system (SNS) tone (i.e., decreased overnight urine norepinephrine [NE] excretion) and decreases in sodium intake (i.e., decreased overnight sodium excretion); (3) decreases in SBP reactivity to behavioral stressors; (4) decreases in SNS arousal (i.e., decreased urinary NE excretion) and greater increases in renal function (i.e., increased urinary sodium excretion) to the behavioral stressors; (5) decreases in self-reported hostility and anger; (6) improvement in vascular function (i.e., increases in % endothelium dependent arterial vasodilation to reactive hyperemia); (7) improvement in ventricular structure and function (i.e., decreases in left ventricular mass index and resting heart rate). The study will be conducted during health classes at school by teachers.

For more information contact Dr. Treiber at treiberf@musc.edu
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"Abrazos"
CCSD (Charleston County School District)  Projects Dates: 07/01/2009 - 06/30/2012
Deborah Williamson, DHA, RN, MSN, CNM

Abrazos is a bilingual early childhood development program designated for 3-year old Spanish-speaking children in order to promote school readiness as well as improve their mother's English and literacy skills. Childcare is also provided for siblings under 3 years old.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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"PASOs" (Perinatal Awareness for Successful Outcomes)
Duke Endowment (Sub to USC)  Project Dates: 07/01/2010 - 06/30/2012
Deborah Williamson, DHA, RN, MSN, CNM

This project will provide coordinated leadership for the development and implementation of this program in the Charleston, Berkeley and Dorchester counties. Like most mothers, immigrant Latina mothers share the desire to have healthy families. However, in their new communities here in SC, they oftentimes lack the information and power to make an informed decisions for themselves and their families. PASOs provides a bridge between the Latino community and the health care system in order to maximize the health of Latino women and children, and provide them with access to needed resources.
The mission of PASOs is to empower Latino families to optimize maternal and child health within their social and cultural context through education, outreach, partnerships, and advocacy. This community based program works to achieve this mission through:

• Prenatal education with groups of Latinas that focus on participants' strength and work to build trusting relationships
• Training of community-based peer educators to sustain healthy practices and increase access to care
• The formation of partnerships between the Latino communities of SC, academia, the non-profit sector, and the public health care system

For more information contact Dr. Williamson at wilmsnd@musc.edu
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Teen Health Advocate Leadership Program Planning Plan
Center for Public Service Communications/NLM   Project Dates: 02/01/2008 - 06/30/2012
Deborah Williamson, DHA, RN, MSN, CNM

Entering its fourth year, the Teen Health Leadership Program (THLP) demonstrates an effective partnership between an academic medical center and local public high school to address community concerns related to adolescent health and development. Johns Island, the site of the THLP, is a rural community plagued by poverty and isolation. Partnerships with community organizations and larger institutions are critical to bring necessary resources to the island. In collaboration with the school district and multiple community organizations, THLP seeks to empower high school students to assist and serve their community. Through innovative computer technologies and the internet, the THLP provides health literacy training, enabling the students to design and implement outreach projects to improve the awareness and use of quality health information in their community. The THLP has produced relevant results related to sustainable partnerships, health literacy and community engagement. First, participatory development of the program among partners and integration of the program into existing structures has produced a sustainable mechanism to support the program for years to come. Second, the internet and use of creative technologies are critical components to achieve health literacy when working with adolescents. Finally, with adequate support, adolescents can serve as messengers of positive health promotion to address the health concerns of their community.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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Early Intervention to Reduce Domestic Violence
MUSC Fdn.  Project Dates: 07/01/2008 - 06/30/2012
Deborah Williamson, DHA, RN, MSN, CNM

Our goal is to reduce interpersonal violence through the work of a network of community partners using primary prevention and early intervention approaches in school and primary care settings. The project will build capacity in communities through GIS mapping of information for participatory decision-making, skill building for parents, students and teachers to improve academic performance including skills for teachers in classroom strategies to reduce peer aggression and disruptive behaviors, and training and quality assurance measures for primary care providers for effective screening and referral for victims of interpersonal violence. Our ecological approach unites health care providers, teachers, and community members to address a significant public health concern in the context of a neighborhood. The project will identify strategies of value to other communities.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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