Sarah Wiehe
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Engaging the Community to Inform Patient-Centered Outcomes Research
Despite well-known associations between where a person lives and his/her health, few patient-centered approaches have been used to develop and implement place-based health interventions. For the first time in the United States, Avondale Meadows, a Purpose Built Community in Indianapolis, is incorporating health as part of its community development strategy.
Avondale Meadows is an 800-unit, mixed income housing development with a key emphasis on housing, education, and health. Now, nearly all units leased and health-related amenities, including a Health and Wellness Center, are about to be implemented. Dr. Wiehe, with a team of academic and community partners, have engaged all stakeholders, including current and future residents, to discuss how to improve the community’s health. Through mixed-methods and participatory design, the team has elicited and engaged residents to develop health-promoting interventions in their community. These ideas were presented back to the larger community for validation and further resident engagement. Now, as the community members are incorporated into the ‘research team,’ they will work together to translate their ideas into action.
Dr. Wiehe’s work to engage the community in ways to improve their health is another example of how IUPUI’s faculty members are TRANSLATING their RESEARCH INTO PRACTICE.
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Recent Submissions
Item Epidemiology of Sexually Transmitted Infections Among Offenders Following Arrest or Incarceration(American Public Health Association, 2015-12) Wiehe, Sarah E.; Rosenman, Marc B.; Aalsma, Matthew C.; Scanlon, Michael L.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of MedicineOBJECTIVES: We sought to estimate rates of sexually transmitted infections (STIs) among criminal offenders in the 1 year after arrest or release from incarceration. METHODS: We performed a retrospective cohort study of risk of having a positive STI (chlamydia, gonorrhea, or syphilis) or incident-positive HIV test in the 1 year following arrest or incarceration in Marion County (Indianapolis), Indiana. Participants were 247,211 individuals with arrest or incarceration in jail, prison, or juvenile detention between 2003 and 2008. RESULTS: Test positivity rates (per 100,000 and per year) were highest for chlamydia (2968) and gonorrhea (2305), and lower for syphilis (278) and HIV (61). Rates of positive STI and HIV were between 1.5 and 2.8 times higher in female than male participants and between 2.7 and 6.9 times higher for Blacks than Whites. Compared with nonoffenders, offenders had a relative risk of 3.9 for chlamydia, 6.6 for gonorrhea, 3.6 for syphilis, and 4.6 for HIV. CONCLUSIONS: The 1-year period following arrest or release from incarceration represents a high-impact opportunity to reduce STI and HIV infection rates at a population level.Item Brief report: Using global positioning system (GPS) enabled cell phones to examine adolescent travel patterns and time in proximity to alcohol outlets(Elsevier, 2016-07) Byrnes, Hilary F.; Miller, Brenda A.; Morrison, Christopher N.; Wiebe, Douglas J.; Remer, Lillian G.; Wiehe, Sarah E.; Department of Pediatrics, IU School of MedicineAs adolescents gain freedom to explore new environments unsupervised, more time in proximity to alcohol outlets may increase risks for alcohol and marijuana use. This pilot study: 1) Describes variations in adolescents' proximity to outlets by time of day and day of the week, 2) Examines variations in outlet proximity by drinking and marijuana use status, and 3) Tests feasibility of obtaining real-time data to study adolescent proximity to outlets. U.S. adolescents (N = 18) aged 16–17 (50% female) carried GPS-enabled smartphones for one week with their locations tracked. The geographic areas where adolescents spend time, activity spaces, were created by connecting GPS points sequentially and adding spatial buffers around routes. Proximity to outlets was greater during after school and evening hours. Drinkers and marijuana users were in proximity to outlets 1½ to 2 times more than non-users. Findings provide information about where adolescents spend time and times of greatest risk, informing prevention efforts.Item Mortality of Youth Offenders Along a Continuum of Justice System Involvement(Elsevier, 2016-03) Aalsma, Matthew C.; Lau, Katherine S. L.; Perkins, Anthony J.; Schwartz, Katherine; Tu, Wanzhu; Wiehe, Sarah E.; Monahan, Patrick; Rosenman, Marc B.; Department of Pediatrics, IU School of MedicineIntroduction Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts. Methods Criminal and death records of 49,479 youth offenders (ages 10–18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014. Results From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality. Conclusions Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention.Item The IUPUI Center for Urban Health Enhancing Community Wellness Through Research(Office of the Vice Chancellor for Research, 2011-04-08) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah; Zollinger, TerryUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. The central theme of the IUPUI Center for Urban Health is Environment, Community, and Health. Each of these “spheres” is connected by the built and social environment from a contextual standpoint and by geospatial referencing from an integration standpoint. The goal of the Center for Urban Health is to enhance health and sustainability for urban populations, with an eye toward both environmental legacies (i.e., reduced contamination, removing social and economic disparities) and emerging threats (i.e., climate change, water quality and quantity). The Center is currently recruiting Investigators across campus and across the community to provide research linkages, is funding several Urban Health Graduate Fellows, is developing a Seed Funding program for investigators through a Protocol Development Team, and is funding a Visiting Scholars program to enhance research at IUPUI.Item Spatial Integration of Community Data with Clinical Data in Support of Community Health Research and Practice(Office of the Vice Chancellor for Research, 2011-04-08) Frederickson Comer, Karen; Wiehe, Sarah E.; Wilson, Jeffrey S.; Dixon, Brian E.; Grannis, ShaunThis poster will describe the recent integration of one of the nation’s largest health information exchanges, the Indiana Network for Patient Care developed by the Regenstrief Institute, with one of the nation’s most comprehensive community information system, the SAVI CIS developed by The Polis Center at IUPUI. Integrating community data that quantifies the social and physical environment with clinical data has great potential for supporting and advancing community health research and practice. Multi-sector collaboration on the development and evaluation of associated uses cases informed system integration is allowing spatially-aware research and practice to be more quickly realized.Item Finding the Patient’s Voice Using Big Data: Analysis of Users’ Health-Related Concerns in the ChaCha Question-and-Answer Service (2009–2012)(JMIR, 2016) Priest, Chad; Knopf, Amelia; Groves, Doyle; Carpenter, Janet S.; Furrey, Christopher; Krishnan, Anand; Miller, Wendy R.; Otte, Julie L.; Palakal, Mathew; Wiehe, Sarah E.; Wilson, Jeffrey S.; IU School of NursingBackground: The development of effective health care and public health interventions requires a comprehensive understanding of the perceptions, concerns, and stated needs of health care consumers and the public at large. Big datasets from social media and question-and-answer services provide insight into the public’s health concerns and priorities without the financial, temporal, and spatial encumbrances of more traditional community-engagement methods and may prove a useful starting point for public-engagement health research (infodemiology). Objective: The objective of our study was to describe user characteristics and health-related queries of the ChaCha question-and-answer platform, and discuss how these data may be used to better understand the perceptions, concerns, and stated needs of health care consumers and the public at large. Methods: We conducted a retrospective automated textual analysis of anonymous user-generated queries submitted to ChaCha between January 2009 and November 2012. A total of 2.004 billion queries were read, of which 3.50% (70,083,796/2,004,243,249) were missing 1 or more data fields, leaving 1.934 billion complete lines of data for these analyses. Results: Males and females submitted roughly equal numbers of health queries, but content differed by sex. Questions from females predominantly focused on pregnancy, menstruation, and vaginal health. Questions from males predominantly focused on body image, drug use, and sexuality. Adolescents aged 12–19 years submitted more queries than any other age group. Their queries were largely centered on sexual and reproductive health, and pregnancy in particular. Conclusions: The private nature of the ChaCha service provided a perfect environment for maximum frankness among users, especially among adolescents posing sensitive health questions. Adolescents’ sexual health queries reveal knowledge gaps with serious, lifelong consequences. The nature of questions to the service provides opportunities for rapid understanding of health concerns and may lead to development of more effective tailored interventions. [J Med Internet Res 2016;18(3):e44]Item Test positivity for chlamydia, gonorrhea, and syphilis infection among a cohort of individuals released from jail in Marion County, Indiana(Wolters Kluwer, 2015-01) Wiehe, Sarah E.; Barai, Nikita; Rosenman, Marc B.; Aalsma, Matthew C.; Scanlon, Michael L.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of MedicineBACKGROUND: Individuals entering jails have high rates of sexually transmitted infections (STI), but there are few data on STI in the postincarceration period. This study aimed to describe rates of chlamydia, gonorrhea, and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails. METHODS: We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003 to 2008 (n = 118,670). We linked county jail and public health data to identify individuals with positive STI test results in the 1 year after release from jail. Rates per 100,000 individuals and Cox proportional hazard analyses were performed for each STI, stratified by demographic, STI, and jail characteristics. RESULTS: We found significantly higher rates of STI in this cohort than in the general population, with rates in the 1 year after release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared with rates in the general population. Characteristics most associated with increased risk of a positive STI test result among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration. CONCLUSIONS: This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population.Item The Unanticipated Benefits of Behavioral Assessments and Interviews on Anxiety, Self-Esteem and Depression Among Women Engaging in Transactional Sex(Springer, 2015-02) Gunn, Jayleen K. L.; Roth, Alexis M.; Center, Katherine E.; Wiehe, Sarah E.; Department of Pediatrics, IU School of MedicineWomen engaging in transactional sex have disproportional mental health co-morbidity and face substantial barriers to accessing social services. We hypothesized that participation in a longitudinal research study, with no overt intervention, would lead to short-term mental health improvements. For 4-weeks, 24 women disclosed information about their lives via twice daily cell-phone diaries and weekly interviews. We used t tests to compare self-esteem, anxiety, and depression at baseline and exit. Tests were repeated for hypothesized effect modifiers (e.g., substance abuse severity; age of sex work debut). For particularly vulnerable women (e.g., less educated, histories of abuse, younger initiation of sex work) participation in research conferred unanticipated mental health benefits. Positive interactions with researchers, as well as discussing lived experiences, may explain these effects. Additional studies are needed to confirm findings and identify mechanisms of change. This work contributes to the growing body of literature documenting that study participation improves mental health.Item Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment(Office of the Vice Chancellor for Research, 2012-04-13) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah; Zollinger, TerryUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program.Item Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment(Office of the Vice Chancellor for Research, 2013-04-05) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah E.; Zollinger, TerrellUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program.
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