Advancing Health Equity Research

Our Mission

The Mongan Institute is dedicated to achieving health equity and improving the lives of people with complex health needs through research and training in population and health care delivery team science. Across the Institute’s centers and programs, our faculty conduct research spanning a range of health disparities, highlighted below. 

Race/Ethnicity

 

Allison Byrant, MD, MPH

Vice Chair of Quality, Equity, & Safety, MGH Department of Obstetrics and Gynecology

Aswita Tan-McGrory, MBA, MSPH

Director, Disparities Solutions Center

Karey Kenst, MPH

Senior Program Manager, Disparities Solutions Center

Esteban Barreto, PhD

Director of Evaluation, MGH Equity and Community Health

Disparities in Rates of NTSV C-Section and Exclusive Breastfeeding

The Disparities Solutions Center and the Edward P. Lawrence Center for Quality and Safety are leading implementation of Initiative 4 of Mass General’s Structural Equity 10-point Plan, "Assure Equity in Access to and Delivery of Clinical Care." As part of this effort we are working with the Department of Obstetrics and Gynecology to address disparities in rates of NTSV C-section and exclusive breastfeeding.

Disparities in NTSV C-Section

Monitoring and analysis through the MGH Annual Report on Equity in Health Care Quality revealed disparities in NTSV Cesarean rates, with Black patients having Cesarean deliveries at a higher rate than White patients (32.1% vs. 21.%, respectively from 2016-2019). Research shows high rates of mistreatment of birthing patients in the US, especially patients of color. The OB/Gyn Department, the Disparities Solutions Center, the Center for Quality and Safety, and MGH Equity and Community Health are collaborating on a QI initiative to better understand and address this disparity. We are conducting in-depth semi-structured qualitative interviews with up to 25 NTSV C-Section patients to explore their experience with their delivery and the care they received at Mass General. Goals of the project include:

  • Investigating the experience of patients who had an NTSV Cesarean birth at Mass General

  • Understanding patients’ expectations for the birth and how they feel about having had a C-Section

  • Understanding patients’ perspectives on the reason(s) for having a C-Section

  • Comparing patients’ understanding of why they had a C-Section with the reasons recorded in their chart

  • Exploring patients’ perceptions of the birth experience, how they were treated, and satisfaction with the results of care

  • Understand patients’ experience of care provided by physicians, nurses, midwives, and other staff

Disparities in Breastfeeding

Analysis of exclusive breastfeeding rates also revealed disparities, with lower rates among Black and Asian patients, as well as patients of other races and Hispanic ethnicity compared with white and non-Hispanic patients. Rates were also lower among patients who speak a language other than English and patients on Medicaid compared to commercial and other payers. The first stage of work to address this disparity involves creating new documentation workflows in Epic to better capture breastfeeding in post-partum visits to enable tracking of outcomes.

Future phases of this work are likely to involve development of a patient education improvement plan, with a focus on education at antenatal visits and on locations where birthing patients of color, and those who are on MassHealth, are seen. Patient education will be provided in multiple languages through partnerships with community organizations, a peer support model, and the use of technology where possible. Over time, we anticipate expanding these efforts to post-partum support and focusing on improving provider communication and documentation.

Alexander Tsai, MD, PhD

Associate Professor of Psychiatry, Harvard Medical School

Racial Disparities in Police Use of Deadly Force as a Cause of Racial Disparities in Sleep Health across the Life Course

Alexander Tsai, MD, PhD (joint with Atheendar Venkataramani, MD, PhD, of the Perelman School of Medicine at the University of Pennsylvania), is leading a study that seeks to understand how racism in policing is associated with poor sleep health among Black children and adults in the US. Numerous studies have documented racial and ethnic disparities in poor sleep health among adolescents and adults. These disparities are thought to be explained partially by experiences of interpersonal racial discrimination. What remains lacking is knowledge of the causal mechanisms linking racism to poor sleep health. The scientific objective of this study is to determine the extent to which racism in policing is responsible for racial disparities in sleep health, and focuses on police use of deadly force on unarmed Black people as a cardinal manifestation of structural racism. Detailed understanding of the causal mechanisms linking racism to poor sleep health is likely to offer a strong scientific framework for developing and targeting structural and psychosocial interventions to reduce racial disparities in sleep, cardiometabolic, and other health outcomes.

Efren Flores, MD

Staff Radiologist, MGH

Assistant Professor in Radiology, Harvard Medical School

Radiology and Racial/Ethnic Differences in COVID Severity

Efren Flores, MD, ​is a member of a COVID-19 research team that focuses on projects at the intersection of imaging findings of COVID-19, health disparities in the pandemic related to social determinants of health, and clinical operations. A key finding has been that Black and Hispanic patients faced more severe COVID-19 and greater lung damage than white patients. Learn more about his research.

Publications:

Andrew Chan, MD, MPH

Chief, Clinical and Translational Epidemiology Unit 

David A. Drew, PhD

Director of Biobanking, CTEU

Instructor of Investigation, MGH Division of Gastroenterology

Long Nguyen, MD, MS

Assistant in Medicine and Gastroenterology, MGH and Harvard Medical School

COVID Symptom Study, COronavirus Pandemic Epidemiology (COPE) Consortium, and the COVID Corps Program

The Clinical & Translational Epidemiology Unit launched the international COVID Symptom Study and formed the COronavirus Pandemic Epidemiology (COPE) Consortium in an effort to understand community-level impacts of the COVID-19 pandemic. We have led work demonstrating the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities especially in the United States (U.S.), but also the United Kingdom (U.K.). We similarly observed disparities in COVID-19 risk among healthcare workers by which healthcare workers of color were at increased risk of COVID-19, and this risk was at least partially mediated by insufficient access to adequate personal protective equipment and a greater likelihood of working in higher risk care settings. In addition, we have documented a several-fold higher rates of vaccine hesitancy among racial-ethnic minorities in both countries. However, a significant disparity for vaccine receipt persisted only among Black individuals in the U.S. compared with the U.K., even among participants who specifically endorsed their willingness to receive a vaccine. The findings highlight potential inequities in vaccine access that are perhaps more pervasive in the U.S. compared with the U.K.

 

Through ongoing use of this novel real-time epidemiology study, we are committed to continuing our work to identify health disparities and propose novel solutions to improve the health of minority populations during this global pandemic.  We are also working to understand the long-term effects that COVID-19 may have on future health outcomes. Finally, the COVID Symptom Study has become a foundational program to provide meaningful and substantial research experiences for participants in our COVID Corps Program which we launched in response to the need to provide work experience for college and medical students from groups traditionally underrepresented in medicine.

Fatima Cody Stanford, MD, MPH, MPA, FAAP

Obesity Medicine & Nutrition, MGH

Comparison of Knowledge and Information-Seeking Behavior After General COVID-19 Public Health Messages and Messages Tailored for Black and Latinx Communities

Public health video messages featuring a racially diverse set of physicians were found to decrease knowledge gaps about Covid-19 symptoms and transmission — generating important lessons about how we communicate about, and work to mitigate the effects of, the virus. Study results also indicated that, for Black individuals, watching a video with a racially concordant (Black) physician increased the degree to which they sought out more information about Covid-19.

Black and Latinx communities have significantly higher infection and mortality rates and are more likely to have severe symptoms and be hospitalized as a result of the Covid-19 pandemic compared to white communities. Although these disparities stem from many complex factors, including inequalities in access to health care, systemic racism, and the overrepresentation of communities of color in front-line and essential jobs, one contributing factor may be knowledge gaps around Covid-19 symptoms and transmission. To date, few public health messages around the coronavirus pandemic directly address communities of color and, as a result, these communities may be left behind in the nationwide efforts to contain, respond to, and recover from the pandemic.

The study evaluated the effectiveness of three different video messages about the coronavirus that varied in three ways: the featured physician’s race or ethnicity, the degree to which the physician acknowledged the difficulties faced by communities of color in accessing health services, and messaging around community perceptions of wearing a mask. Physicians from Massachusetts General Hospital (MGH) and Lynn Community Health Center of different racial and ethnic backgrounds were featured in the study’s videos.

Erica Warner, ScD, MPH

Assistant Investigator, Clinical & Translational Epidemiology Unit

Assistant Professor, Harvard Medical School

Disparities in Breast Cancer

Erica Warner, ScD, MPH, is conducting two projects examining disparities in breast cancer survivorship. 

Increasing Receipt of Guideline Concordant Survivorship Care Among Black Breast Cancer Survivors

Black women experience significant disparities in breast cancer across the care continuum including survivorship. Black women of diverse ethnic backgrounds, particularly those of lower socioeconomic status are less likely to receive guideline concordant survivorship care including: 1) Surveillance for breast cancer recurrence and/or second primary breast cancer; 2) Assessment and management of long-term physical and psychosocial effects of breast cancer and treatment; 3) Healthy lifestyle promotion and maintenance; 4) Care coordination between oncology and primary care. This project, funded by Pfizer and the American Cancer Society, will develop a survivorship education program for patients and PCPs. It builds upon an existing cancer survivorship education program for primary care providers at local health centers and will be conducted in partnership with multiple local organizations including Boston Medical Center, the Boston Breast Cancer Equity Coalition, Boston Public Health Commission, and three local health centers.

 

Impact of a Comprehensive Patient Navigation Intervention on Endocrine Therapy Adherence and Persistence among Vulnerable Women in Boston

Data suggest that up to 50% of women do not complete five years of endocrine therapy, a key medication for women with hormone receptor positive breast cancer, and this may be even worse among lower income and minority women and may contribute to persistent racial and socioeconomic disparities in breast cancer survival. Previous interventions to address gaps in endocrine therapy (ET) initiation, adherence and persistence have focused on education and cognitive behavioral training among patients, with limited success, however, a small, but growing body of evidence demonstrates system level interventions may be effective. Translating Research into Practice (TRIP) is a three-pronged city-wide patient navigation intervention targeted at breast cancer patients who are at risk for delays in care due to their race/ethnicity, language, or insurance status. We will: 1) Determine the feasibility and validity of an online medication database compared to EMR data abstraction to measure ET adherence and persistence; and 2) Evaluate the impact of TRIP on ET early discontinuation and adherence among 342 intervention patients and 263 historic controls with HR+ breast cancer.

Mario Cruz-Gonzalez, PhD

Research Scientist, Disparities Research Unit

Instructor, Harvard Medical School

Understanding the Role of Social Context, SES, Culture, and Minority Status in Racial/Ethnic Disparities

Mario Cruz-Gonzalez, PhD, is primarily involved in performing statistical analyses for several studies aimed at understanding the role that social context, socioeconomic status, culture and minority status play in explaining racial/ethnic disparities in mental disorders and mental health service use. His most recent work has analyzed differences in individual and community-level factors that can explain racial/ethnic disparities in mental health service use among emerging and older adults, racial/ethnic differences in access to mental health care and treatment dropout, the role of educational achievement in explaining racial/ethnic differences in distressing physical symptoms, as well as whether patients who seek mental health and substance abuse treatment from providers of the same racial/ethnic background have better treatment outcomes. His work has also examined the effect of evidence-based mental health and disability prevention interventions in community-based organizations serving minority older adults, whether the assessment instruments measuring health outcomes are interpreted similarly across cultures, and the importance of studying potential positive externalities where patient and clinician interventions can affect other outcomes besides the ones originally intended.

Publications: 

  • Factors Associated with Mental Health Service Use among Black, Latinx, and Asian Older Adults in Community Based Organizations (2021; Journal of Applied Gerontology).

  • The Impact of Social Support on Treatment Participation and Completion in a Disability Prevention Intervention for Older Adults (2021; Journal of Aging and Health).

  • Similarities in client-clinician perceptions of subjective social status and its association to similarities in the quality of working alliance and client anxiety symptoms (2021; Psychotherapy Research).

  • Racial/ethnic disparities in depression treatment for caregivers investigated by the U.S. child welfare system (2021; Academic Pediatrics).

  • Measurement Invariance of Screening Measures of Anxiety, Depression, and Level of Functioning in a US Sample of Minority Older Adults Assessed in Four Languages (2021; Frontiers in Psychiatry).

  • Associations Between Trauma, Sleep, and Cognitive Impairment Among Latino and Asian Older Adults (2020; Journal of the American Geriatrics Society).

 

Age

Carlos Camargo Jr., MD, DrPH

Conn Chair in Emergency Medicine, MGH Department of Emergency Medicine

Margaret Samuels-Kalow, MD

Assistant Professor of Emergency Medicine and Pediatrics, Harvard Medical School

Pediatric Emergency Care

Carlos Camargo, MD, DrPH, and Maggie Samuels-Kalow, MD, are leading work to improve emergency care for pediatric patients. Although over 90% emergency visits for children occur in general EDs (rather than children’s hospitals), multiple studies have shown that general EDs face significant challenges in providing high quality care for children. Having a pediatric emergency care coordinator (PECC) has been identified as a critical step in improving the readiness of general emergency departments to appropriately care for children. This ongoing project has demonstrated the limited availability of PECCs in EDs across the country, and the success of an intervention to improve the appointment of PECCs in MA. Current work is focused on characterizing the tasks completed by PECCs, and understanding how those are associated with outcomes of care for pediatric patients. 

Publications:

Sexual Orientation and Gender Identity

 

Alex McDowell, PhD, MSN, MPH, RN

Postdoctoral Research Fellow, Health Policy Research Center

Health Inequities in LGBTQ Communities

LGBTQ communities experience substantial health inequities, yet limited availability of data on gender identity and sexual orientation restricts researchers’ ability to study and address these inequities. Dr. McDowell’s research aims to improve methods for identifying transgender and gender diverse populations in existing data and to characterize LGBTQ health inequities using large administrative databases. A key finding of her work is that state-level nondiscrimination policies are one potential mechanism for addressing high rates of suicidality among transgender and gender diverse communities.

Publications:

Disability

 

Margarita Alegria, PhD

Chief, Disparities Research Unit

Building Community Capacity for Disability Prevention for Minority Elders

Margarita Alegría, PhD, is leading a study to test the implementation of an intervention to reduce mental and physical disability among ethnic minority elders, and to build the research and programming capacity of the partner community-based organizations. Although minority elders represent the fastest growing segment of an aging US population, they have less access to mental health care and prevention of disability, lagging well behind non-Latino whites, and suffering significant disparities. This study has 3 specific aims: (1) Develop collaborative partnerships to support research that can evaluate the capacity of community-based organizations to provide mental health and disability prevention services to minority elders as a model to reduce disparities; (2) Evaluate the acceptability and efficacy of a combined mental health and disability prevention intervention for minority elders being offered by community health workers and exercise trainers in community-based organizations; and (3) Determine the organizational feasibility and sustainability of the combined mental health and disability prevention intervention, assessing issues such as feasibility, planned adoption, and potential barriers to long-term sustainability. Through a COVID-19 supplement, she is examining the feasibility, adoption, and impact of public health interventions used to manage and prevent exposure to COVID-19 in this population. Read more.

Lisa Iezzoni, MD, MSc

Professor of Medicine, Harvard Medical School

Disability Disparities and the Lived Experience of Disability

Over the last three years, Lisa Iezzoni, MD, MSc, and her colleagues have conducted three major studies exploring disability disparities, particularly in cancer screening and diagnosis, sexual and reproductive health care, and quality of medical care, and the lived experience of disability. 

For a study titled “Exploring Timeliness of Cancer Diagnoses in Persons with Significant Physical Disability,” we explored associations between cancer and disability. We found that persons with pre-existing disability had significantly higher rate of cancer than did those without disability for the same cancers. Women with disability had significantly lower recent mammography and pap test rates than women without disability, and we concluded that physical and attitudinal barriers affect the process of cancer diagnosis in people with mobility disability. 

  • Iezzoni LII, Rao SR, Agaronnik N, El-Jawahri. Cross-sectional analysis of the association between four common cancers and disability. J Natl Compr Canc Netw. 2020;18(8):1031-44. PMID: 32755976

  • Iezzoni LI, Rao S, Agaronnik ND, El-Jawahri A. Associations between disability and breast or cervical cancers, accounting for screening disparities. Med Care. 2021;59:139-147. PMID: 33201087

  •  Agaronnik N, El-Jawahri A, Iezzoni LI. Perspectives of patients with pre-existing mobility disability on the process of diagnosing their cancer. J Gen Intern Med. 2020 Nov 17 [online ahead of print] PMID: 33205226

For a study titled "Surveying Physicians to Understand Health Care Disparities Affecting Persons with Disabilities and Identify Approaches to Improve Their Care,” we conducted the first-ever national survey of the experiences with and perceptions of patients with disability among U.S. practicing physicians, in collaboration with colleagues at the University of Colorado, Anschutz Medical Campus, and University of Massachusetts-Boston. Our survey of 714 practicing U.S. physicians nationwide found that 82.4% reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7% of physicians were very confident about their ability to provide equal quality care to patients with disability, just 56.5% strongly agreed they welcome disabled patients into their practices, and 18.1% strongly agreed that the health care system often treats these patients unfairly.

  • Agaronnik N, Pendo E, Campbell E, Ressalam J, Iezzoni LI.  Knowledge of practicing physicians about their legal obligations when caring for patients with disability.  Health Affairs.   2019;38(4);545-553. PMID: 30933590

  • Agaronnik N, Pendo E, Lagu T, DeJong C, Perez-Carraballo A, Iezzoni LI.  Ensuring the reproductive rights of women with intellectual disability. J Intellect Develop Disabil. 2020;45:365-376.

  • Iezzoni LI, Rao SR, Ressalem J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, Lagu T, Campbell EG. Attitudes of physicians about people with disability and their health care. Health Affairs.  2021;40:297-306. PMID: 33523739

The study, “Addressing Future Home-Based Health and Personal Care Needs for a Growing and Diverse Population," explored policy issues and interpersonal dynamics relating to paid personal assistance services (PAS), to support people with significant disability living in their homes and communities. We conducted a detailed policy synthesis and LII conducted individual in-depth interviews with 20 PAS consumers and 21 PAS workers from around the country, in collaboration with PHI (formerly known as Paraprofessional Healthcare Institute).

  • Iezzoni LI, Gallopyn N, Scales K. Historical mismatch between home-based care policies and laws governing homecare workers. Health Affairs. 2019;38(6):973-980. PMID: 31158005

  • Gallopyn N, Iezzoni LI. Views of electronic visit verification (EVV) among home-based personal assistance services consumers and workers. Disabil Health J. 2020;13(4):100938. PMID: 32417147

  • LI Iezzoni. Making Their Days Happen. Paid Personal Assistance Services Supporting People with Disability Living in Their Homes and Communities. Philadelphia: Temple University Press.

Mental Health

 

Margarita Alegria, PhD

Chief, Disparities Research Unit

Latino Youths Coping with Discrimination: A Multi-Level Investigation in Micro- and Macro-Time

Margarita Alegría, PhD, is leading a study that explores why and how discrimination-related stressors for Latinx youth, the largest minority group in the United States (17.9 million under the age of 18), convey risk for negative mental health outcomes, and the mechanisms leading to or moderating such risk. Guided by a socioecological, life course perspective, the project has three specific aims: (1) determine within-person discrimination-related stressors that impact Mexican-American origin youth’s mental health outcomes as well as the mechanisms of action at both micro- and macro-time levels; (2) identify protective factors that could help youth to successfully cope with discrimination-related stressors and the conditions under which those protective factors work; and (3) elucidate the youth, parent, and neighborhood risk factors that moderate the link between discrimination-related stressors and mental health in youth. The project’s long-term goal is to improve the mental health of Mexican-origin youth by reducing the deleterious effects of racism, “othering,” and negative neighborhood interactions. Considering the current growth of Latinx immigrants, it is imperative to test a socioecological model of risk and resilience for Mexican-origin adolescents that is responsive to both their immediate context and the larger global forces around migration. Learn more about the study.

Stephen Bartels, MD, MS

Director, Mongan Institute

James J. and Jean H. Mongan Chair in Health Policy and Community Health, MGH

People with Serious Mental Illness & Intellectual/ Developmental Disabilities in Congregate Living Settings

Stephen Bartels, MD, MS, is leading a research team to determine best practices to prevent COVID-19 for people with serious mental illness and developmental and intellectual disabilities in congregate living settings and for the staff who provide care. His team received a $4.9 million funding award from the Patient-Centered Outcomes Research Institute (PCORI). The study team will also work to develop approaches that address COVID-19 health disparities that may be associated with race, ethnicity, and degree of disability. Learn more about his study. 

Kiara Alvarez, PhD

Instructor, Disparities Research Unit

Disparities in Mental Health and Substance Use Disorders, and Culturally-informed Approaches to Suicide Prevention in Immigrant Youth

Dr. Kiara Alvarez’s work includes two interrelated lines of research: clinical intervention research on family-based, culturally-informed approaches to prevention of suicide among immigrant youth and health services research related to examining and addressing disparities in the prevalence, etiology, and treatment of mental health and substance use disorders. Her research is funded by a K23 from the NIMH via which she is developing and testing a family-based intervention for immigrant-origin adolescents experiencing suicidal ideation, with the goal of advancing the evidence base in suicide prevention and intervention. She was also co-principal investigator with Dr. Margarita Alegria for a William T. Grant Foundation-funded study utilizing the Photovoice method to examine youth perspectives on neighborhood context, social inclusion, and mental health in four ethnically diverse Greater Boston communities. Her work from this study to date has included advancing a novel mixed methods framework integrating participatory approaches with multilevel mixed methods data collection and analysis. 

 

Publications: 

Irene Falgas-Bague, MD, PhD

Research Scientist, Disparities Research Unit

Instructor of Medicine, Harvard Medical School

Improving Access and Quality of Mental Health Care for Diverse Communities

Irene Falgas-Bague, MD, PhD, focuses on intervention trials that aim to improve access and quality of mental health care for diverse communities. Her expertise is on adapting evidence-based interventions to be provided by community health workers following a cultural adaptation and community-engaged framework. Her current research focuses on understanding the linkage between adverse social context and mental health disorders. Specifically, she is currently working on developing an integrative research and implementation plan to reduce domestic violence in Guayaquil, Ecuador, through capacity building, examining the links between social context and domestic violence through spatial analysis framework and implementing an empowerment intervention for women exposed to violence. 

Publications:

  • Falgas-Bague, I., Ramos, Z., Del Cueto, P., Kim, E., Zhen-Duan, J., Wong, Y. J., ... & Alegría, M. (2021). Adaptation of an evidence-based intervention for disability prevention, implemented by community health workers serving ethnic minority elders. The American Journal of Geriatric Psychiatry, 29(3), 260-269.

  • Fortuna, L. R., Falgas-Bague, I., Ramos, Z., Porche, M. V., & Alegría, M. (2020). Development of a cognitive behavioral therapy with integrated mindfulness for Latinx immigrants with co-occurring disorders: Analysis of intermediary outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 12(8), 825.

  • Alegria, M., Falgas‐Bague, I., & Fong, H. F. (2020). Engagement of ethnic minorities in mental health care. World Psychiatry, 19(1), 35.

  • Alegría, M., Falgas-Bague, I., Collazos, F., Camacho, R. C., Markle, S. L., Wang, Y., ... & Shrout, P. E. (2019). Evaluation of the integrated intervention for dual problems and early action among latino immigrants with co-occurring mental health and substance misuse symptoms: a randomized clinical trial. JAMA network open, 2(1), e186927-e186927.

  • Falgas-Bague, I., Wang, Y., Banerjee, S., Ali, N., DiMarzio, K., Palao Vidal, D., & Alegría, M. (2019). Predictors of adherence to treatment in behavioral health therapy for Latino immigrants: the importance of trust. Frontiers in psychiatry, 10, 817.

 

Community Health

Joseph Betancourt, MD, MPH

MGH/MGPO Senior Vice President for Equity and Community Health

Aswita Tan-McGrory, MBA, MSPH

Director, Disparities Solutions Center

Health Equity in the Response to COVID-19

Joseph Betancourt, MD, MPH, and Aswita Tan-McGrory, MBA, MSPH, are part of the MGH Equity and Community COVID Response Team working to ensure that all we do to address COVID-19 at Massachusetts General Hospital has equity and community health as our foundation.

Read their 3-part series in the Harvard Health Blog on the impact of COVID-19 on communities of color and responses aimed at improving health equity.

Publications:

Margarita Alegría, PhD

Chief, Disparities Research Unit

1/2-Building Infrastructure for Community Capacity in Accelerating Integrated Care

Through a collaborative grant funded by the National Institute of Mental Health, the Disparities Research Unit at Massachusetts General Hospital and the University of North Carolina Greensboro seek to reduce mental health disparities for racial/ethnic and linguistic minorities. Despite the promise of accountable care organizations (ACOs) in transforming the healthcare landscape, a recent study revealed that ACOs serving a greater proportion of racial/ethnic minorities scored worse on quality performance measures and that 37% of ACOs had no formal relationship with a mental health provider. Margarita Alegría, PhD, is leading a study to (1) establish community-ACO-academic partnerships to expand capacity for mental health care, (2) train community health workers to provide an integrated, evidence-based intervention in clinical and community settings, and (3) assess intervention implementation. The project is being conducted in collaboration with clinical sites and community-based organizations serving a diverse population. Learn more.

Adjoa Anyane-Yeboa, MD, MPH

Instructor of Investigation, Clinical & Translational Epidemiology Unit

Instructor of Medicine, Harvard Medical School

Improving Community Access to Colorectal Cancer Screening

Adjoa Anyane-Yeboa, MD, MPH, is leading a study to improve access and remove barriers to colonoscopy for colorectal cancer screening at a community health center using a digital smartphone application, with funding from the MGH/American Cancer Society Institutional Research Grant. Colorectal cancer screening rates at community health centers are far lower than the national rates for average-risk adults. Community health centers serve a large proportion of racial and ethnic minorities and low-income patients and face unique barriers to colorectal cancer screening with colonoscopy.

The aims of this study are to 1) develop a web-based/digital application platform to allow community health centers to schedule patients for colonoscopy at MGH and 2) assess the feasibility, acceptability, and preliminary efficacy of the web-based/digital application platform at a single community health center.

Sanja Percac-Lima, MD, PhD, MPH

Associate Professor in Medicine, Harvard Medical School

Physician Leader for Cancer Outreach, MGH Cancer Center

Improving Patient Centered Cancer Treatment

Sanja Percac-Lima, MD, PhD, MPH, Physician Leader for cancer outreach programs, develops and evaluates patient navigation programs to improve cancer care and eliminate disparities particularly for ethnic and racial minorities. She is currently leading a 5-year study of patient navigation to improve patient centered cancer treatment. Patients who receive care in one of the Massachusetts General Hospital community health centers and have a new cancer diagnosis are randomly assigned to patient navigator or phone call reminders prior to upcoming appointments for cancer treatment. Preliminary data revealed that patients in both arms had very low no-show rate even during the COVID-19 pandemic.

Publications:

  • Percac-Lima S, Warner ET, Whited EC, Irwin KE, Navarrete A, Benjamin C, Pichardo AR, Friese CR, Ford C, Wheeler AE, Morrill J, Moy B. Abstract PO-077: Impact of COVID-19 on patient navigation for cancer treatment. Cancer Epidemiol Biomarkers Prev. 2020 Dec 1;29(12):PO-077. doi: 10.1158/1538-7755.DISP20-PO-077.

  • Sebastian A. Rodriguez-Torres, Anne Marie McCarthy, Wei He, Jeffrey M. Ashburner, Sanja Percac-Lima. Long-Term Impact of a Culturally Tailored Patient Navigation Program on Disparities in Breast Cancer Screening in Refugee Women After the Program's End. Health Equity. 2019; 3(1): 205–210. Published online 2019 May 14. doi: 10.1089/heq.2018.0104

  • Percac-Lima S, Ashburner JM, Atlas SJ, Rigotti NA, Flores EJ, Kuchukhidze S, Park ER. Barriers to and interest in lung cancer screening among Latino and non-Latino current and former smokers. J Immigr Minor Health. 2019 Jan 30. doi: 10.1007/s10903-019-00860-2.

  • Percac-Lima S, Ashburner JM, Zai A, Chang Y, Oo S, Guimaraes E, Atlas SJ. Patient Navigation for Comprehensive Cancer Screening in High-Risk Patients Using a Population-Based Health Information Technology System: A Randomized Clinical Trial. JAMA Intern Med. 2016 July 1;176(7);930-7. doi: 10.1001/jamainternmed.2016.0841

Jenny Zhen-Duan, PhD

Instructor in Medicine, Harvard Medical School

Community-Engaged and Community Based Participatory Research to Address Health Disparities

Jenny Zhen-Duan, PhD, uses community-engaged and community based participatory research approaches to address health disparities. Her current research focuses on examining the biological pathways (i.e., endocrine, epigenetic) linking childhood adversities (e.g., maltreatment, migration stressors) and mental health and substance use among Latinxs. Dr. Zhen-Duan’s recent work also highlights ways to increase behavioral health services for underserved communities, including racial/ethnic minority children and individuals with substance use disorder living in poverty.

 

Publications:

  • Zhen-Duan, J.  & Taylor, M. J. (2014). The Use of an Ecodevelopmental Approach to Examine Substance Use Among Rural and Urban Latino/a Youth: Peer, Parental, & School Influences. Journal of Ethnicity in Substance Abuse, 14(2), 104-125.

  • Zhen-Duan, J., Nuñez, M., Solomon, M., Geracioti, T., & Jacquez, F. (revise & resubmit). The biological and behavioral impact of Adverse Childhood Experiences among Latino adolescents. 

  • Espinola, M., Zhen-Duan, J., Suarez-Cano, G., Mowry-Mora, I., & Shultz, J.M. (2019).  Prejudice against Latino children in the U.S. In Fitzgerald, H., Johnson, D., Baolian Qin, D., Villarruel, F. A., & Norder, J. (Eds.), Children and Prejudice. New York: Springer.

  • Zhen-Duan, J., Fukuda, M., DeJonckheere, M., Falgas-Bague, Miyawaki, S., Khazi, P. & Alegria, M. (accepted). Ensuring access to high-quality substance use disorder treatment for Medicaid enrollees: A qualitative study of diverse stakeholders’ perspectives.  Journal of Substance Abuse Treatment.

  • Torres- Pagan, L., Terepka, A., Zhen-Duan, J., & Piombo, M. (2021). Multiphasic Process Model of Interventions: Revisiting School Based Mental Health Provider Responses to Students’ Mental Health in the wake of COVID-19. Psychological Services.

  • Vaughn, L. M., Jacquez, F., & Zhen-Duan, J. (2018). Perspectives of Community Co-Researchers About Group Dynamics and Equitable Partnership Within a Community-Academic Research Team. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 45(5),682-689. https://doi.org/10.1177/1090198118769374.

Gina Kruse, MD, MPH

Implementation Lab Director, ISCCCE

Clinician Investigator, MGH Division of General Internal Medicine

Implementation Science Center for Cancer Control Equity

The Implementation Science Center for Cancer Control Equity (ISCCCE) is an NCI funded center led by the Harvard T.H. Chan School of Public Health, the MGH Kraft Center for Community Health, and the Mass League of Community Health Centers. Mongan Institute investigators are leading several ISCCCE units and programs. Steve Bartels, MD, MS, leads the Methods Unit research program and works with Erica Warner, ScD, MPH, and Doug Levy, PhD, to advance the science of equity in implementation and adaptation of evidence-based interventions. Included in this research program is a pilot study led by Dr. Levy that examines practical, low-burden methods for measuring the costs of implementation in community health center practices. Sanja Percac-Lima, MD, PhD, MPH and Jennifer Haas, MD, are leading a pilot study of the implementation of a paired screening intervention. The study tests an efficient model for outreaching community health center patients with education about colorectal cancer screening and assistance with social determinants of health. Gina Kruse, MD, MPH, is the ISCCCE Implementation Lab Director, building relationships and a research infrastructure with a network of federally qualified health centers through capacity building and facilitation of implementation science pilot studies. 

Vulnerable Populations

 

Nancy Rigotti, MD

Director, Tobacco Research & Treatment Center

Reducing Health Disparities by Improving Treatment for Tobacco Use in Vulnerable Populations

Tobacco use is a major cause of health disparities among individuals with less education, low incomes, LGBTQ orientation, and psychiatric and other substance use disorders because tobacco use in these groups far exceeds the prevalence in the general population and quit rates are lower following treatment.  Investigators in the Tobacco Research and Treatment Center are investigating strategies to improve smoking cessation rates in these groups. 

 

Nancy Rigotti, MD, and Joanna Streck, PhD, post-doctoral fellow, assessed cigarette and e-cigarette use and interest in quitting among MGH Community Health Center patients who are in treatment for opiate use disorders. They identified high smoking rates and interest in quitting, including trying e-cigarettes. Based on their findings, they will explore the potential to use e-cigarettes for harm reduction in smokers who have not been able to quit by other methods.  

Travis Baggett, MD, MPH

Associate Professor of Medicine, Harvard Medical School

Physician-Investigator, MGH Division of General Internal Medicine

Director of Research, Boston Health Care for the Homeless Program

MGH Site Director, Harvard Fellowship in General Medicine and Primary Care

People Experiencing Homelessness

Travis Baggett, MD, MPH, conducts community-based research focused on understanding and improving the health of people experiencing homelessness across several conditions.

 

Tobacco use, consequences, and management

Dr. Baggett is the PI of a 5-year R01 award from the National Cancer Institute in support of an RCT of financial incentives for smoking abstinence among adult cigarette smokers at Boston Health Care for the Homeless Program. In a related line of work funded by the American Cancer Society, he is leading a pragmatic trial of patient navigation to promote lung cancer screening at Boston Health Care for the Homeless Program, whose patients experience more than 2-fold higher rates of lung cancer incidence and death in comparison to the Massachusetts adult population.

  1. Baggett TP, Lebrun-Harris LA, Rigotti NA. Homelessness, Cigarette Smoking, and Desire to Quit: Results from a U.S. National Study. Addiction 2013;108(11):2009-18.

  2. Baggett TP, Chang Y, Singer DE, Porneala BC, Gaeta JM, O’Connell JJ, Rigotti NA. Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. American Journal of Public Health 2015;105(6):1189-97.

  3. Baggett TP, Chang Y, Porneala BC, Bharel M, Singer DE, Rigotti NA. Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program. American Journal of Preventive Medicine 2015;49(5):694-702

  4. Baggett TP, Chang Y, Yaqubi A, McGlave C, Higgins ST, Rigotti NA. Financial incentives for smoking abstinence in homeless smokers: A pilot randomized controlled trial. Nicotine Tob Res 2018 15;20(12):1442-1450.

Opioid epidemic and treatment

Dr. Baggett conducted epidemiologic work describing 20-fold higher rates of drug overdose death among people experiencing homelessness in Boston in comparison to the Massachusetts adult population. Subsequent work in collaboration with colleagues at Boston Health Care for the Homeless Program has advanced this line of inquiry, culminating in recent work by DGIM and Mongan colleague, Dr. Danielle Fine, focusing on treatment outcomes among patients of the BHCHP office-based addiction treatment program.

  1. Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, Singer DE, Rigotti NA. Mortality Among Homeless Adults in Boston: Shifts in Causes of Death Over a 15-year Period. JAMA Internal Medicine 2013;173(3):189-195.

  2. Bauer LK, Brody JK, Leon C, Baggett TP. Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review. Journal of Health Care for the Poor and Underserved 2016;27(2):846-59.

  3. Chatterjee A, Lopez D, Ramkellawan S, Brown R, Smith K, Gaeta JM, Baggett TP. "That's what we call the cocktail": Non-Opioid medication and supplement misuse among opioid users. Subst Abus 2019 Oct 22:1-8.

  4. Wishik G, Gaeta JM, Racine MW, O'Connell JJ, Baggett TP. Substance consumption and intoxication patterns in a medically supervised overdose prevention program for people experiencing homelessness. Subst Abus 2021 Feb 22:1-12.

  5. Fine DR, Lewis E, Weinstock K, Wright J, Gaeta JM, Baggett TP. Office-Based Addiction Treatment Retention and Mortality Among People Experiencing Homelessness. JAMA Netw Open 2021 Mar 1;4(3):e210477.

 

COVID-19 burden and management

Dr. Baggett collaborated with colleagues at Boston Health Care for the Homeless Program to report the first outbreak of SARS-CoV-2 infection in a large homeless shelter in Boston. Subsequent work described the Boston-wide COVID-19 response model for people experiencing homelessness and used simulation modeling developed by colleagues in the Medical Practice Evaluation Center to examine the cost-effectiveness of strategies for addressing COVID-19 in homeless shelter settings.

  1. Baggett TP, Keyes H, Sporn N, Gaeta JM. Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston. JAMA 2020 Apr 27;323(21):2191-2.

  2. Mosites E, Parker EM, Clarke KEN, Gaeta JM, Baggett TP, Imbert E, Sankaran M, Scarborough A, Huster K, Hanson M, Gonzales E, Rauch J, Page L, McMichael TM, Keating R, Marx GE, Andrews T, Schmit K, Morris SB, Dowling NF, Peacock G; COVID-19 Homelessness Team. Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters - Four U.S. Cities, March 27-April 15, 2020. MMWR Morb Mortal Wkly Rep 2020 May 1;69(17):521-522.

  3. Baggett TP, Racine MW, Lewis E, De Las Nueces D, O'Connell JJ, Bock B, Gaeta JM. Addressing COVID-19 Among People Experiencing Homelessness: Description, Adaptation, and Early Findings of a Multiagency Response in Boston. Public Health Rep 2020 Jul/Aug;135(4):435-441.

  4. Baggett TP, Scott JA, Le MH, Shebl FM, Panella C, Losina E, Flanagan C, Gaeta JM, Neilan A, Hyle EP, Mohareb A, Reddy KP, Siedner MJ, Harling G, Weinstein MC, Ciaranello A, Kazemian P, Freedberg KP. Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for People Experiencing Sheltered Homelessness During the COVID-19 Pandemic. JAMA Network Open 2020;3(12):e2028195.

Altaf Saadi, MD, MSc

Neurologist, MGH

Instructor of Neurology, Harvard Medical School

Associate Director, MGH Asylum Clinic

Medical Expert, Human Rights Asylum Network

Addressing the Needs of Immigrants, Refugees, Asylum-Seekers, and Patients with Limited English Proficiency

Altaf Saadi, MD, MSc, is a general academic neurologist at Massachusetts General Hospital and MGH Chelsea HealthCare Center, Instructor of Neurology at Harvard Medical School, Associate Director of the MGH Asylum Clinic, and medical expert with the Physicians for Human Rights Asylum Network. Her research focuses on 1) Neuropsychiatric health disparities, particularly among immigrant patients and those with limited English proficiency; 2) Health-related needs of refugees and asylum-seekers, with a focus on those with cognitive impairment, traumatic brain injury and comorbid psychiatric issues; 3) Health-related needs of people in immigration detention; and 4) Determinants of healthcare system trust among immigrant populations. She is committed to addressing inequities through community-partnered and policy-relevant scholarship and action. She was recently selected as a 2020 STAT Wunderkind for early-career investigators conducting ground-breaking research, awarded the Academy of Women Achievers 2021 Sylvia Ferrel-Jones Award from YW Boston for a young woman leader of color changing Boston, and selected as a 2021 National Minority Quality Forum “40 under 40 Leader in Health” for thought leaders in reducing health disparities.

Publications: 

  • Saadi A, Bannon S, Watson E, Vranceanu AM. Racial and Ethnic Disparities Associated with Traumatic Brain Injury Across the Continuum of Care: a Narrative Review and Directions for Future Research. J Racial Ethn Health Disparities. 2021 Mar 17. PMID: 33733427.

  • Saadi A, Anand P, Kimball SL. Traumatic brain injury and forensic evaluations: Three case studies of U.S. asylum-seekers. J Forensic Leg Med. 2021 Mar 11; 79:102139. PMID: 33740607.

  • Patler C, Saadi A. Risk of Poor Outcomes with COVID-19 Among U.S. Detained Immigrants: A Cross-Sectional Study. J Immigr Minor Health. 2021 Mar 04. PMID: 33661415.

  • Rodriguez JA, Saadi A, Schwamm LHBates DWSamal L. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Aff (Millwood). 2021 Mar; 40(3):487-495. PMID: 33646862.

  • Saadi A, Al-Rousan TAlHeresh R. Refugee Mental Health-An Urgent Call for Research and Action. JAMA Netw Open. 2021 Mar 01; 4(3):e212543. PMID: 33724386.

  • Woolhandler S, Himmelstein DU, Ahmed S, Bailey Z, Bassett MT, Bird M, Bor J, Bor D, Carrasquillo O, Chowkwanyun M, Dickman SL, Fisher S, Gaffney A, Galea S, Gottfried RN, Grumbach K, Guyatt G, Hansen H, Landrigan PJ, Lighty M, McKee M, McCormick D, McGregor A, Mirza R, Morris JEMukherjee JS, Nestle M, Prine L, Saadi A, Schiff D, Shapiro M, Tesema L, Venkataramani A. Public policy and health in the Trump era. Lancet. 2021 Feb 20; 397(10275):705-753. PMID: 33581802.

  • Saadi A, Cruz-Gonzalez M, Hwang A, Cohen L, Alegria M. Associations Between Trauma, Sleep, and Cognitive Impairment Among Latino and Asian Older Adults. J Am Geriatr Soc. 2021 Jan 05. PMID: 33399223.

Policy

 

Vicki Fung, PhD

Assistant Professor of Medicine, Harvard Medical School

Medicare Policy Effects on Mental Health Care

Vicki Fung, PhD, is leading a study to assess the impact of recent Medicare policy changes on racial/ethnic disparities in mental health care. Recently, the Medicare program implemented two policies that increased physician payments for care provided to the poorest beneficiaries and reduced beneficiary out-of-pocket costs for specialty mental health care.

 

These policies could increase access to primary and mental health care for racial and ethnic minorities with mental illness and reduce existing disparities. The findings from this study have the potential to inform decision-makers seeking to reduce the substantial disparities in mental health care with actionable findings, especially as the federal government and states make ongoing decisions about payment policy and benefit design.

Doug Levy, PhD

Associate Professor of Medicine, Harvard Medical School

Assessing the Impact of Smoke-Free Rules on the Health of Public Housing Residents

Douglas Levy, PhD, is leading a research team investigating whether the health of public housing residents improves when the housing authorities in which they live institute rules prohibiting smoking anywhere in the buildings, include in residents’ apartments. The Surgeon General has determined there is no risk-free level of secondhand smoke exposure and yet such exposure is a significant issue in low-income housing. Public housing residents have higher smoking prevalence than the general population and at the same time are more likely to experience chronic illness. Because public housing is often a resource of last resort, residents who are exposed to their neighbor’s tobacco smoke have few means of avoiding this exposure. Dr. Levy has been funded since 2012 by R01 grants from the National Heart Lung and Blood Institute to investigate whether smoke-free rules are effective at protecting resident health. Work led by his team as well as work he has conducted with collaborators has demonstrated how secondhand smoke travels across units in public housing. They also provided evidence that smoke-free rules could improve air quality in public housing. At the same time, survey work conducted by his team has shown that residents in smoke-free housing have concerns that smokers do not comply with the smoke-free rules and that the rules are not adequately enforced. The culmination of these initial studies was a set of recommendations for how smoke-free rules might be instituted in public and low-income housing so that it would maximally protect resident health. Now, Dr. Levy, together with Mongan co-investigators Nancy Rigotti, Vicki Fung, David Cheng, and others, are conducting a study of smoke-free rules in public housing across Massachusetts, using health care claims data to assess whether smoke-free rules in public housing benefit resident health and whether the benefits vary according to the characteristics of smoke-free policy implementation efforts.

Publications: 

Anne Thorndike, MD, MPH

Associate Professor of Medicine, Harvard Medical School

Director, Metabolic Syndrome Clinic, MGH Cardiovascular Disease Prevention Center

Impact of Medicaid ACO Funding for Health-Related Social Needs on Dietary Quality and Health: LiveWell/ViveBien Study

Anne Thorndike, MD, MPH, is leading a study to evaluate how the MassHealth Accountable Care Organization (ACO) Flexible Services program affects the dietary quality, psychological stress, health, and health care utilization of adult ACO participants and to assess program implementation. Starting in 2020, the state of Massachusetts began providing funding directly to Medicaid (MassHealth) ACOs to address food and housing needs. The Live Well/Vive Bien study has enrolled over 1,000 adult Medicaid and commercial ACO participants who receive primary care at five community health centers affiliated with Massachusetts General Hospital or Brigham and Women’s Hospital, and participants will be followed over 4 years with survey, 24-hour dietary recall, electronic health record, and medical claims data. The primary outcomes will be change in dietary quality, stress, and food/housing insecurity (Aim 1) and change in body mass index, blood pressure, and acute health care utilization (emergency department visits; hospitalizations) (Aim 2) by comparing Medicaid ACO participants (eligible for Flexible Services) with commercial ACO participants (not eligible for Flexible Services) who screen positive for food and housing insecurity before implementation of the program. The study will also assess the implementation factors that influence the effectiveness of the program. Results of this research will inform policymakers and researchers about the effectiveness of a novel state-level program for delivering food and housing resources through Medicaid ACOs and will help refine ongoing and future state and community programs that will reduce income disparities in cancer and cardiometabolic disease.