Selected publications

• Study protocol for Project SHINE (Sleep Health INitiative for Equity): A community-based pilot RCT to promote sleep and physical activity among Black/African American adults

  Contemporary Clinical Trials Communications · 2025-08-29

  articleOpen access

  Background: Black/African American (AA) adults experience shorter sleep duration and poorer sleep quality compared to White counterparts, contributing to higher risks of chronic diseases. Project SHINE (Sleep Health INitiative for Equity) aims to address these sleep disparities by evaluating the feasibility, satisfaction, and plausibility (i.e., preliminary efficacy) of a culturally tailored sleep intervention designed to improve sleep duration and physical activity among AA adults with body mass index (BMI) ≥ 25 not meeting physical activity and sleep guideline recommendations. Methods: This pilot community-based randomized controlled trial (RCT) includes two phases. Phase 1 involves qualitative interviews with AA adults to explore sleep-related sociocontextual factors to refine the intervention. Phase 2 is an RCT (n = 80) assigning participants to a four-week sleep extension intervention or a contact control. The sleep extension intervention aims to improve sleep duration and physical activity. Sessions occur via Zoom, with in-person baseline and follow-up visits. Primary outcomes include feasibility and satisfaction of the intervention. Secondary outcomes include self-reported and objective sleep and physical activity measures, plus exploratory biomarkers for cancer and cardiovascular risk. Additional self-reports assess sleep-related psychosocial factors and health behaviors. Discussion: aims to inform a larger-scale trial and support scalable behavioral interventions to improve sleep health and reduce disparities.

  PublisherDOI

• The Effects of Three Forms of Provider Discrimination on Access to Health Care and Mental Health

  Medical Care · 2025-05-06

  articleSenior author

  BACKGROUND: Provider discrimination can diminish access to care and lead to poor health outcomes, especially in marginalized populations. We extend past research by exploring the combined or intersecting effects of 3 forms of provider discrimination and by looking beyond access to care to include the impact of provider discrimination on mental health. OBJECTIVES: To examine reports of multiple forms of provider discrimination, including the prevalence, associated characteristics, and effects on health care access and mental health. RESEARCH DESIGN: Secondary analysis of pooled 2021 and 2023 Minnesota Health Access survey data. SUBJECTS: Adults aged 18-64 who responded to the survey (unweighted sample size 11,908). MEASURES: Reports of 3 forms of provider discrimination based on: (1) race, ethnicity, or nationality; (2) gender or sexual orientation; or (3) insurance type or lack of insurance. RESULTS: Nearly 1 in 5 adult Minnesotans reported at least one form of provider discrimination (19.6%), with some populations of adults reporting disproportionately higher rates. Experiencing insurance-based discrimination or gender or sexual orientation-based discrimination alone, together, and in combination with race-based discrimination was associated with foregone mental or behavioral health care, diminished confidence in getting needed care, and mental distress. CONCLUSIONS: Provider discrimination comes in different forms, which intersect to impair access and mental health. Experiences of provider discrimination were concentrated among the most marginalized members of our communities based on their gender identity, sexual orientation, race, ethnicity, nationality, age, income, public insurance, and lack of insurance. We recommend several structural solutions.

  PublisherDOI

• Project SHINE (Sleep Health INitiative for Equity): A Community-Based Pilot RCT to Promote Sleep and Physical Activity Among Black/African American Adults

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• The Interplay of Local- and State-Level Alcohol Policies in the US

  Journal of Studies on Alcohol and Drugs · 2024-02-27 · 1 citations

  articleOpen access

  OBJECTIVE: Most research on alcohol control policies in the United States has focused on the state level. In this study, we assessed both local and state policy prevalence and restrictiveness in a nationwide sample of cities. METHOD: We conducted original legal research to assess prevalence of local-level policies across 374 cities (48 states) in 2019 for the following seven policy areas: (a) drink specials; (b) beverage service training; (c) minimum age for on-premise servers and bartenders; (d) minimum age for off-premise sellers; (e) prohibitions against hosting underage drinking parties (i.e., social host provisions); (f) bans on off-premise Sunday sales; and (g) keg registration. We obtained parallel state-level policies from the Alcohol Policy Information System. We assessed the restrictiveness of existing policies and how these compared across local and state levels. RESULTS: We found that for six of the seven policy areas, the majority of cities (53% to 83%) had only a state-level policy. Few cities (0% to 8% across policy areas) had only a local-level policy. The percentage of cities that had an alcohol policy at both the local and state levels ranged from less than 1% to 19% across policy areas, and the policies were mostly equally restrictive at both levels. CONCLUSIONS: The lack of local policies may point to areas where these localities could strengthen their alcohol policy environments. Additional research is needed to understand how the prevalence and restrictiveness of local and state policies are associated with public health harms such as traffic crashes.

  PublisherOA PDFDOI

• Strategies To Address Racial and Ethnic Disparities in Health and Healthcare: An Evidence Map

  2024-03-07 · 2 citations

  report

  Background. Racial and ethnic disparities in health and healthcare continue to endure in the United States despite efforts in research, practice, and policy. Interventions targeted at patients, clinicians, and/or health systems may offer ways to address disparities and improve health outcomes in prevention/treatment of chronic conditions in adults. Purpose. This evidence map identifies existing interventions to be considered for implementation by healthcare system leaders and policymakers, and to inform researchers and funding agencies on gaps in knowledge and research needs. Methods. We searched MEDLINE, CINAHL, and Scopus from January 2017 through April 2023 for U.S.-based studies from the peer-reviewed published literature. We incorporated supplementary information from systematic reviews. We supplemented this with the gray literature, when available, from pertinent organizations, foundations, and institutes. We held discussions with Key Informants who represented stakeholders in healthcare disparities. Findings. A vast and varied literature addresses healthcare system interventions to reduce racial and ethnic health and healthcare disparities. We identified 163 unique studies from 174 reports, and 12 intervention types not mutually exclusive in their descriptions. The most studied intervention type was self-management support, followed by prevention/lifestyle support, then patient navigation, care coordination, and system level quality improvement (QI). Most of the interventions specifically targeted patient behaviors. Few studies (5) used a comparator, which made it difficult to determine whether disparities between groups were reduced or eliminated. Most of the studies (45%) included multiple race/ethnic groups (i.e., enrolled participants from more than one racially/ethnically minoritized group or enrolled racially minoritized people and non-minoritized groups). We found few studies that exclusively enrolled Asians (6%) and American Indians/Alaska Natives (1%). Cancer was the most studied chronic condition. Randomized controlled trials were common; but less rigorous study designs were often used for system level quality improvement (QI) and collaborative care model interventions. Few studies reported patient experience as primary outcomes. Studies did not report on harms or adverse events and nor did they report on factors necessary for determining applicability or sustainability of the interventions. A number of studies reported on cultural adaptation or community involvement (either partnership or collaboration). Future studies should seek to standardize the terms in which they describe interventions and aim to specifically address whether disparities between groups are reduced or eliminated. Nonetheless, this evidence map provides a resource for health systems to identify intervention approaches that have been examined elsewhere and that might be imported or adapted to new situations and environments.

  PublisherDOI

• Strategies to Address Racial and Ethnic Disparities in Health and Health Care for Chronic Conditions

  Annals of Internal Medicine · 2024-12-16 · 9 citations

  reviewOpen access

  BACKGROUND: Racial and ethnic disparities in health and health care persist in the United States, adversely affecting outcomes in prevention and treatment of chronic conditions among adults. PURPOSE: To map interventions aimed at reducing racial and ethnic disparities and improving health outcomes in the prevention and treatment of chronic conditions in adults. DATA SOURCES: Searches of MEDLINE, CINAHL, and Scopus from January 2017 to April 2024, supplemented with gray literature. STUDY SELECTION: U.S.-based studies of interventions targeting racial and ethnic disparities in adults with chronic conditions. DATA EXTRACTION: Information on intervention types, targets, outcomes, study designs, study settings, chronic conditions, and delivery personnel was extracted and categorized. DATA SYNTHESIS: Among 174 unique studies, 12 intervention types were identified, with self-management support and patient navigation the most common. Most interventions targeted patient behaviors; few studies addressed disparities directly or focused on underrepresented racial and ethnic marginalized groups. LIMITATIONS: The lack of standardized terminology and the underrepresentation of certain racial and ethnic groups limit the evidence base. Although the literature search accurately reflects the current state of the literature, it also limits the body of evidence by excluding health disparities research conducted before January 2017, so significant findings from earlier studies may have been overlooked. CONCLUSION: The literature highlights diverse interventions targeting health disparities, but few studies evaluated their effectiveness in reducing the health disparities gaps. There is an urgent need for research focused on underrepresented racial and ethnic groups, particularly in promising areas such as patient navigation for cancer and diabetes self-management. Future research should prioritize robust study designs to assess the long-term effect and broader applicability of interventions, thus helping organizations and stakeholders to tailor strategies to community-specific needs. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

  PublisherOA PDFDOI

• Cannabis Enforcement Lags Behind Alcohol: A National Study of Law Enforcement Practices in Legal and Nonlegal States

  Journal of Studies on Alcohol and Drugs · 2024-11-26 · 1 citations

  articleOpen access

  OBJECTIVE: As the legalization of adult-use cannabis has expanded to include almost half of the states in the United States, substance use-related enforcement responsibilities for state and local law enforcement agencies may have changed. We assessed the use of cannabis and alcohol enforcement strategies at local and state levels and in legal and nonlegal cannabis states. METHOD: We conducted surveys of 1,024 local law enforcement agencies, 53 state alcohol beverage control agencies, and 48 state patrol agencies. We calculated the prevalence of cannabis enforcement strategies and their analogous alcohol strategies and analyzed differences across legal and nonlegal cannabis states. We assessed associations between cannabis enforcement strategies, cannabis legalization status, and agency and jurisdiction characteristics. RESULTS: Cannabis enforcement strategies were less common than their analogous alcohol strategies. The percentage of agencies conducting enforcement of cannabis-impaired driving and public use of cannabis did not differ significantly across agencies in legal and nonlegal states. Agencies in cannabis-legal states (compared with nonlegal states) were more likely to train officers in identifying cannabis impairment among drivers (risk ratio [RR] = 1.23, 95% CI [1.08, 1.42]). Several local agency and jurisdiction characteristics were associated with a higher likelihood of conducting cannabis enforcement, but results were inconsistent across strategies. CONCLUSIONS: Our study shows that cannabis enforcement strategies were used less than analogous alcohol strategies in legal and nonlegal jurisdictions, suggesting that increased cannabis enforcement could lead to reductions in public health harms. This study provides a foundation for much-needed research on cannabis and alcohol enforcement during a changing cannabis legalization landscape.

  PublisherOA PDFDOI

• Effects of Sunday Liquor Sales Legalization on Alcohol Policy Attitudes and Alcohol Purchasing Behavior

  Journal of Drug Education · 2023-09-01

  article

  We examined how legalization of Sunday alcohol sales relates to attitudes towards Sunday sales, and how both attitudes and alcohol consumption patterns relate to Sunday alcohol purchasing. A total of 1,384 adults of legal drinking age completed a survey one year post-legalization of Sunday sales. A majority of respondents (51%) were supportive of Sunday sales legalization both before and after legalization. People were more likely to support Sunday sales legalization if they reported binge drinking (PR: 2.19; CI: 1.51 3.18). Following Sunday sales legalization, 59% of participants reported purchasing alcohol in Minnesota on Sunday. Binge drinking (PR: 1.39; CI: 1.27, 1.52) or supporting Sunday sales legalization (PR: 1.85; CI: 1.56, 2.17) were associated with higher likelihood of purchasing alcohol on Sunday. Legalizing Sunday sales may have increased access to alcohol for people with more unhealthy drinking behaviors.

  PublisherDOI

• Alcohol Enforcement in the United States From 2010 to 2019

  Journal of Studies on Alcohol and Drugs · 2023-01-16 · 5 citations

  articleOpen access

  OBJECTIVE: Despite the important role of enforcement in reducing alcohol-related harms, few studies have assessed alcohol enforcement efforts, particularly over time. We assessed the prevalence of alcohol law enforcement strategies at two time points. METHOD: Of a random sample of U.S. local law enforcement agencies (i.e., police, sheriff) surveyed in 2010, 1,028 were resurveyed in 2019 (742/1,028 [72%] response rate). We assessed changes in alcohol enforcement strategies and priorities within three domains: (a) alcohol-impaired driving, (b) alcohol sales to obviously intoxicated patrons (i.e., overservice), and (c) underage drinking. RESULTS: Agencies reported placing higher priority on enforcement of alcohol-impaired driving and overservice in 2019 versus 2010. For alcohol-impaired driving enforcement strategies, we found increases over time in use of saturation patrols and in enforcing laws prohibiting open containers of alcohol in motor vehicles, but not in use of sobriety checkpoints. Approximately 25% of agencies conducted overservice enforcement in both years. For all strategies directed at underage drinking, enforcement decreased over time with more agencies using strategies aimed at underage drinkers versus alcohol suppliers (alcohol outlets, adults) in both years. CONCLUSIONS: Agencies reported continued low levels or declines in enforcement across most strategies despite reported increases in prioritizing alcohol enforcement. More agencies could adopt alcohol control enforcement strategies, including an increased focus on suppliers of alcohol to youth rather than on underage drinkers, and increased awareness and enforcement of selling alcohol to obviously intoxicated patrons. Use of these strategies has the potential to reduce health and safety consequences of excessive alcohol use.

  PublisherOA PDFDOI

• Strategies Used by Local Law Enforcement Agencies to Prevent Overservice of Alcohol in the United States

  Journal of Community Health · 2022-08-25 · 7 citations

  articleOpen access
  PublisherOA PDFDOI