Following the people and events that make up the research community at Duke

Category: Policy Page 1 of 3

Dr. Laura Richman is Defining Health by its Social Determinates

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In 2010, the Affordable Care Act sparked a nationwide debate on the extent of responsibility the American government has over our healthcare. But Dr. Laura Richman has been asking that question since long before that. 

Richman is a health psychologist. “I examine psychosocial factors that have an impact on health behaviors and health outcomes,” she explains, sitting across from me at the Law School café. (Neither of us were wearing a cardigan. It was rather hot outside). 

Laura Richman Ph.D. is an associate professor in population health sciences. (image: Scholars@Duke)

Richman is an associate professor at Duke in the Population Health Sciences, an associate of the Duke Initiative for Science & Society, and, coincidentally, my professor in the Science & the Public FOCUS cluster. She co-teaches the course Science, Law, and Policy with Dr. Yousef Zafar, in which we examine the social determinants of health through the lens of cancer screening, diagnosis, and treatment.

After graduating from the University of Virginia in 1997 with a Ph.D. in social psychology, Richman worked at a sort of think-tank for health professionals collaborating on social issues. This inspired her to pursue health research through the lens of social determinants.

“There was a lot of work on substance use, on mental health, on behavioral disorders. That certainly contributed to my continued interest in factors that have an influence on these [health] outcomes,” she said. 

Continuing in this work, she became a research associate at the School of Public Health at Harvard University; Richman described her time at Harvard as “exciting,” which is not a word used by many to describe empirical research environments. “Certainly there’s that really robust relationship between low income, low education, low job status and poor health outcomes, but a lot of those pathways— like the ones we talk about in class, Olivia— had not been studied.” 

She’s referring to the public health concept of ‘upstream’ and ‘downstream’ solutions. (The river parable goes as follows: when you observe a trend in people drowning in a certain river, you are presented with different ways of solving the problem. You can start pulling people out of the river and saving them one at a time, which is called a “downstream” solution in public health. You can also prevent people from falling into the river, which is called an “upstream” solution.)

(courtesy of SaludAmerica!)

Richman’s professional research explores another crucial social determinant of health we discussed in class: perceived versus actual discrimination. She asked whether marginalization — objectively or subjectively — can affect functioning, “both psychologically and cognitively. Like, how does it affect their thought processes? Their decision-making? Then, how does that affect their health?” You can read her study here

One thing I noted immediately was Richman’s affinity for creative research design. In a lab she headed at Duke, she conducted one experiment with a student that tested the aforementioned effect of marginalization on health decisions. They provided subjects with a choice between unhealthy and healthy snack options after watching a video of, reading a passage about, or imagining members of their community experience discrimination.

In one study we read for Science, Law, and Policy, the stress effect of discrimination towards Arabic-named individuals after 9/11 was measured through the birth outcomes of Arabic-named mothers pregnant during that time. When I asked her about this, she said, “Particularly working with students, I think that they just bring so much energy and creativity to the research. Surveys serve their purpose — I think they’re really important, but I think there are just lots of opportunities to do more with research designs and research questions. I like trying to approach things from a different angle.” 

Richman is also working on a book. She is studying relational health — health as determined by the opioid epidemic, the obesity crisis, and social isolation associated with aging. She hopes her project will be used in classrooms (and by the interested layman), and that the value of social determinants of health is reflected in increased funding dollars, more people interested in health disparities, more focus in medical education on the screening and referral system, and stimulating dialogue among people in positions of power on a policy level.

Post by Olivia Ares, Class of 2025

The Major Player in Global Infrastructure Investment – And What That Means for the Climate

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Perhaps no singular economy in the world has grown and expanded as rapidly as China’s. “Made in China” labels prove just how far of a reach China has globally – from clothes to technology to automotive parts. But there’s another facet of this expansion that is poised to become more and more important.

Developing countries across the world face infrastructure challenges that hinder their growth and prosperity, and these challenges have only been exacerbated by COVID-19. China, along with other key economic players, is sensing this sore lack, and competing to invest in global infrastructure projects. There are many questions to be asked about the ethics and impact of global infrastructure investment, but one thought in particular rises to the top: what does infrastructure investment mean for the climate?

To prod at this question, the Duke University Center for International and Global Studies hosted a conversation with Dr. Jackson Ewing on September 29 entitled “The Great Infrastructure Game: Why Asia, Europe, and America are Competing to Build in the Developing World and What It Means for the Global Climate”. Ewing, who holds a joint appointment as a senior fellow at Duke University’s Nicholas Institute of Environmental Policy as well as adjunct associate professor at the Sanford School of Public Policy, unpacked the “game” by taking a specific deep dive into China’s investment sources, standards, and approaches.

Dr. Jackson Ewing

A couple of key things stood out from the conversation. The first is that to understand China’s infrastructure investment impact, it’s important to understand the Belt and Road Initiative (BRI). The BRI is arguably the most important “umbrella mechanism” for China’s infrastructure investment, associated with projects such as ports, railways, airports, and power plants. Launched in 2013, its name comes from the concept of the Silk Road, an ancient network of trade routes connecting China to the Mediterranean, that was established during the Han Dynasty 2,000 years ago. This modern-day Silk Road connects Asia with Africa and Europe via land and maritime networks. The initiative defines its five major priorities to be “policy coordination, infrastructure connectivity, unimpeded trade, financial integration, and connecting people.”

Mapping the Belt-and-Road Initiative

The BRI has led to what Ewing called “meteoric investment growth.” What does that investment look like? Ewing made note of several key characteristics. One is that Chinese lending has shifted significantly, from lending to sovereign banks to lending to companies and organizations in destination countries. This type of investment makes up nearly 70% of China’s portfolio. Another characteristic of this investment is that a chunk of the BRI project portfolio – 35%, to be exact – has encountered massive criticism on the grounds of corruption and environmental issues.

Slide from the presentation by Dr. Ewing

Previously, energy investment along the BRI looked mostly like coal. Between 2007 and 2015, China led all nations in financing nearly 25 billion dollars of outbound coal creation, with India, Indonesia, Mongolia, Turkey, and Vietnam being its biggest recipients.

Slide from the presentation by Dr. Ewing

Ewing noted that while China arguably does have a coal overcapacity problem, “it still compares significantly in outbound renewables.” The diagram below gives a breakdown of BRI energy investments – while the orange chunk of coal is still the biggest chunk of investment, the green renewable chunks don’t lag far behind. This increased interest in the renewable space is largely fueled by capacity problems, as well as domestic and environmental challenges. There has been a plateauing of coal consumption in the country – but is that something to get excited about?

 There have been cross-ministerial efforts to promote a Green BRI in response to criticism, but as Ewing put it, “They’ve led to debatably meaningful practices to undergird existing initiatives.” While coal investment has slowed down as hydro investment has picked up the pace, China’s annual energy finance from policy banks has taken a hit and is slowing down. So what can we conclude?

Slide from the presentation by Dr. Ewing
Slide from the presentation by Dr. Ewing

Well, it’s safe to conclude two things. The first is that this Chinese shift away from coal does matter – but whether this will lead to a change in Chinese investment philosophy that will mark the next decade remains to be seen. The second thing to conclude is that as China dips more into the renewable space, other countries will follow. In fact, the U.S and EU have been prioritizing renewable investments for a while. This competition may very well mean that we see a growing number of renewable projects, which is undoubtedly good news for the climate.

Post by Meghna Datta, Class of 2023

New Blogger Nhu Bui: Discovering Science Communication

My name is Nhu Bui, pronounced “New Buoy.” I’m a sophomore from Cypress, Texas hoping to major in Environmental Science & Policy and English (that’s only two, I promise), and I’m thrilled to join the Duke Research Blog team.

Thanh-Nhu Bui, Nhu for short

I’ve loved science ever since I could waddle into my backyard to catch ladybugs and earthworms. For the longest time, I was convinced I was going to be a zookeeper, or maybe a veterinarian – anything that would allow me to work with animals. (I also toyed with the idea of becoming a physician, treating the most ferocious of creatures.) But I also knew that reading and writing were my fortes and that I was always happier in a library than in a laboratory. 

In high school, I joined the speech and debate team. My primary (and favorite) event was informative speaking: 10 minutes of educational entertainment on a topic of choice. I always chose to speak on environmental issues – from bees to coral reefs – and I loved it. The event was my perfect storm of science and communications… so imagine my excitement upon entering college and discovering that science communication is a whole thing.

Some highlights of my informative visual aids

With the blog, I hope to be able to discover new interests and explore my intrigues across the wide world of research at Duke University. But most importantly, I hope to be able to hone my craft. Effective science communication is more crucial than ever; issues like climate change and vaccination impact every aspect of life, but the public’s view of science is mired in perceptions of bias and manipulation. While science and politics are inextricable, trust and awareness are critical for a functioning society.

Of course, constantly questioning the world is also critical – it’s the foundation of scientific discovery – but as with everything, it’s all about balance. Who knows where that balance is? I’m still looking for it myself, but I’m hoping that joining the Duke Research Blog will help me on the way. 

Keeping a respectful distance while admiring monkeys.

Outside of my love for science and writing, here are the most important things to know about me: my favorite movies are Paddington 1 and 2 (can’t choose), my top genre on Spotify is show tunes (I’ve never done theater), and I once walked through a Whataburger drive-thru (it’s a Texas thing). 

Thanks for getting to know me, and I hope to see you back on the blog soon!

Post by Nhu Bui, Class of 2024

Cemetery, Community, Classroom: Collaborating to Honor the Dead

Open Durham

The institutional neglect and indignity faced by many African Americans during and after the Jim Crow era in the South didn’t end when their lives did. In a panel hosted by the Duke Office of Durham & Community Affairs on Sept. 10, a community leader, Duke professor, and undergraduate student discussed some of the work they are doing to combat the marginalization of Durham’s deceased in Geer Cemetery, two miles from Duke’s campus. 

Debra Taylor Gonzalez-Garcia, President, Friends of Geer Cemetery

Founded on land purchased from Frederick and Polly Geer by John O’Daniel, Nelson Mitchell, and Willie Moore in 1877, Geer Cemetery is the final resting place for over 3000 of Durham’s African American citizens. As Maplewood Cemetery was segregated, from 1877 until the opening of Beechwood cemetery in 1924 Geer served as the only cemetery for the African American dead. Lacking public funding and under fire from the health department for overcrowding, Geer Cemetery closed in the 1930s and, in the absence of a plan for its continued upkeep, fell into a state of disrepair

President of Friends of Geer Cemetery Debra Taylor Gonzalez-Garcia provided a brief history of Geer Cemetery. 

The nonprofit Friends of Geer Cemetery was formed in 2003 by “concerned citizens and neighbors” and has worked to “restore the cemetery’s grounds and research its histories” under their mission statement “restore, reclaim, respect.” According to Gonzalez-Garcia, work consists of maintaining the cemetery grounds, repairing headstones, writing life stories, and advocating for recognition. 

Friends of Geer Cemetery has accomplished a lot in terms of restoration: in 2004 the cemetery was unrecognizable, with broken headstones, overgrowth, and sunken burials. Today, with the help of Keep Durham Beautiful, Preservation Durham, and other volunteers, the entire cemetery can now be easily viewed.

The organization also continues to work tirelessly toward their other objectives, reclamation and respect. By mining local records, research volunteers have created a database which includes approximately 1,651 burials, but efforts are ongoing. 

Gonzalez-Garcia expressed excitement about the organization receiving grant funding for an archaeological survey. “[The survey] will help us to map out burials, because currently, there is no map,” Gonzalez-Garcia said. “We aren’t sure where people are buried.” 

The community leader discussed how efforts to reclaim Geer Cemetery bring about questions that reckon with white supremacy in general. “We’re not told stories of the African Americans who built Durham,” Gonzalez-Garcia said. “Why do we know so much about Washington Duke, and nothing of Augustus Shepard? Why should Maplewood still exist and not Geer Cemetery?” 

Adam Rosenblatt

Associate Professor of the Practice in International Comparative Studies Adam Rosenblatt expressed his interest in how care for the dead is “bound up with human rights and social justice.” This interest is personal: he has his own graveless ancestors who disappeared in the Holocaust. He expressed his passion for educating others about “places of mourning in our midst” through “community-engaged” scholarship.

Along with Gonzalez-Garcia, Rosenblatt sponsored a Story+ program at Duke entitled Geer Cemetery: Labor, Dignity, and Practices of Freedom in an African American Burial Ground. With the help of sponsors and a graduate mentor, Duke undergraduates Nyrobi Manuel, Kerry Rork, and Huiyin Zhou researched the cemetery closely in order to “uncover the stories of ordinary citizens and add these stories back into the historic narrative about Geer.” The researchers produced three unique, interactive digital projects which will contribute to the Friends of Geer Cemetery’s online platform for education and outreach. 

Rosenblatt discussed one challenge the Story+ engaged with: What really constitutes a human subject? The IRB’s definition doesn’t include the dead; there’s no IRB protocols for researching the dead and their stories. Many archives disappear entirely, or are fragmented.

Nyrobi Manuel

Nyrobi Manuel, a Duke undergraduate, was one of Rosenblatt and Golzalez-Garcia’s mentees. Manuel took Rosenblatt’s course “Death, Burial, and Justice in the Americas” and says the course inspired her to dig deeper into African American death practices. Through the Story+, Manuel researched John C. Scarborough, who established the fifth-oldest Black-owned funeral home in the country. She produced a project entitled “Scarborough and Hargett Funeral Home: Dignified Death and Compassion in the Black Community.” 

Manuel discussed her findings. Many funeral directors became important figures in their community, and John C. Scarborough was no different. A philanthropist and important community member, he helped to establish Scarborough Nursery School, North Carolina’s oldest licensed nursery school.

What’s always drawn Gonzalez-Garcia to Geer Cemetery is its “quiet beauty” and sense of connection. Though her ancestors are buried in Virginia, where she’s from, Geer Cemetery seeks to tell stories of African Americans through “emancipation and reconstruction: throughout history.” Geer is special because it seeks to tell the story of her “blood relatives” while also celebrating the history of Durham, which, she said fondly, is “my community now.”

New Blogger Skylar Hughes: ‘Up for the Challenge’

When I was a young girl, My mother once explained to me the importance of a first impression. “You can only make it once, after all,” she’d say. Here I am writing this introduction for you guys, and her words echo in my mind, so I’ll give it my best shot.

Senior pictures, time flies!

Hi, my name is Skylar Hughes, and I’m a part of the class of 2025. Atlanta, Georgia, is where I call home, and from my slang to my walk, it’s quite obvious where I grew up. I’m the person who will talk to everyone and is not at all afraid to speak her mind. A random fun fact about me is that I was actually on the Ellen Show in January!! (kind of cool, right?) It still feels unreal that I am here, and you will most likely see me wandering around lost one day like the freshman I am. My major is undecided, but currently I am between Marine Science and Public Policy. (confused isn’t even the word. )

I’m still in shock from this… https://youtu.be/OivXTYYiUj4

Marine science was my first love, the major that I’ve had a crush on since middle school, and invested countless hours researching online and through documentaries. I even went to a Duke TIP marine science program in the Gulf of Mexico my sophomore year of high school and loved every second of it. I’ve watched every episode of Deep Blue on National Geographic and probably know more than a person should about coral reefs. But public policy? That was like my celebrity crush, the major I eyed from a distance and really admired, but never had the privilege to closely interact with. I remember watching figures like Alexandria Ocasio-Cortez and Stacey Abrams dominate the field with their intelligence, being the change they wanted to see in their communities, and I was hooked. As a teenager, I often found myself frustrated with government decisions and realized that public policy gave me the chance to make genuine change. I was sold.

My High School Graduation!

So now here I am at Duke, which maintains an outstanding program for marine science AND public policy, and I am like a kid in a candy store. Along with hoping to figure my major out this year, I’m also planning on being involved with the Black Student Alliance here at Duke, as well as joining Duke’s Climate Change Coalition, and volunteering at the Geer Street Learning Garden.

For me, research blogs are a brilliant way to reach the masses with reliable information, research, and content that can be trusted, which is profoundly important to me. Education is the only process by which growth is made. Without education, we’re, in essence, doomed for retrogression. Education arms people with a weapon that cannot be stolen, one that can not only rid them of their current circumstances but be a guiding light towards their desired ones.

Education refines new ideas, which are the only reasons man is not still living in caves and figuring out fire. The education of one can be utilized to educate another, creating a snowball effect of intellect that cannot be restrained. An educated population leads to educated decisions in society, which leads to educated leaders in office, leading to more authentic community at Duke, in Durham, and beyond.

Sunset view from one of my favorite spots in Atlanta: Stone Mountain!

I take great pleasure in writing, and it was one of the few activities in school that I viewed as a stress reliever instead of a stressor. In a society as dynamic and saturated as the one we’re submerged in, research blogs are essential. Durham represents such a culturally rich and diverse community with so many stories to tell and issues to be brought to light. There are people from all ranges of socioeconomic status, gender, race, and religion, with narratives that are worth their weight in gold. I can only imagine the growth as an intellectual and the valuable experience gained with this position, and I am up for the challenge.

Post by Skylar Hughes, Class of 2025

Child Protective Services Do Work, But They Are Unevenly Distributed

Roughly one in seven  New York City children suffer confirmed mistreatment at home and many are placed in foster care. But relatively few children are permanently separated from their parents by the termination of parental rights, according to new research from Duke University and Rutgers University-Newark.

The data points to a relative success story in the world of child welfare, said Chris Wildeman, a Duke University sociologist and co-author of the research. In New York City, child welfare specialists intervene often in abuse and neglect cases but are often able to avoid terminating parental rights, even when they do remove the child from the home, Wildeman added.

Wildeman’s co-authors are Kieran Healy, a Duke sociologist, and Frank Edwards and Sara Wakefield from the School of Criminal Justice at Rutgers University – Newark.

In New York City, roughly two in five children will be involved in an investigation by their local child protective services office; one in seven will experience confirmed maltreatment, one in 35 will be placed in foster care. (Dallas Clemons)

“I think the core takeaway there is that New York is the prime example of taking maltreatment seriously and intervening as a system,” Wildeman said. “But also taking seriously the idea that permanent termination of parental rights totally closes off any chance for family reunification, so only doing it in the most extreme circumstances.”

The peer-reviewed study, appearing the week of July 19 in the Proceedings of the National Academy of Sciences, derives from an analysis of child welfare data from the nation’s 20 most populous counties. (The New York data is from all five boroughs because the entire city’s child welfare system is under a single governing umbrella)

The study looked at how often children were the subject of a child services investigation; suffered confirmed mistreatment, were placed in foster care, and removed permanently from their homes through the termination of parental rights.

Nationally, roughly one in three children will be involved in an investigation by their local child protective services office; one in eight will experience maltreatment, one in 17 will be placed in foster care and one in 100 will have parental rights terminated, according to the study.

In New York City, roughly two in five children will be involved in an investigation by their local child protective services office; one in seven will experience confirmed maltreatment, one in 35 will be placed in foster care and one in 600 will have parental rights terminated, according to the study.

Nationally, one in 100 parents will have their rights terminated, while in New York that figure is one in 600. (Dallas Clemons)

“The system is functioning more the way many child welfare advocates would like it to function,” Wildeman said. “Make sure you identify maltreatment, but attempt to use services rather than foster care treatment, at least initially, and then only terminating parental rights in only the most extreme circumstances. And trying to be aware of racial disparities in those processes.”

CITATION:  “Contact with Child Protective Services is Pervasive but Unequally Distributed by Race and Ethnicity in Large US Counties,” PNAS, July 19, 2021. DOI: 10.1073/pnas.2106272118

Post by Eric Ferreri , Duke University Communications

Black Americans’ Vaccine Hesitancy is Grounded in More Than Mistrust

Covid-19 is considered a “general pandemic,” but its impacts have been disproportionate along the lines of race and ethnicity. Though vaccines may serve as our best chance to put an end to Covid, the problem of vaccine hesitancy amongst Black people in the U.S. is particularly pervasive and grounded by more than simple mistrust.

Gary Bennett (Ph.D.) discussed the issue of complex determinants of vaccine hesitancy among Black Americans Monday, April 5. Bennett is a Professor of Psychology, Neuroscience, Global Health, and Medicine at Duke, as well as director of Duke Digital Health and Vice Provost for Undergraduate Education.

Gary Bennett, Ph.D.

“At the end of the day, we are dealing with an issue that demands pragmatic attention,” Bennett said, “How do we get shots in arms?” It turns out, the answer is quite complex and historically confounded.

While Black people have experienced much higher burdens from Covid-19 despite contracting the disease at a similar rate to whites, they have been disproportionately vaccinated at lower rates than white people.

“Access matters and it matters a lot,” Bennett said. One clear example of decreased access for Black Americans is that fewer vaccination sites are located in areas with high concentrations of Black people.

However, Bennett said, access does not simply equal place. “How much friction are you creating in this process?” he prompted, pointing to examples of complicated registration systems, inadequate public transportation to vaccine sites, or overall distance from a location. All of these factors already limit who is able to access vaccinations without the added influences of reduced vaccine uptake due to vaccine hesitancy.

A slide from Dr. Bennett’s presentation which outlines the plethora of impactors on access.

Vaccine hesitancy was listed by the World Health Organization as a top 10 global threat in 2019, when vaccines were preventing 2-3 million deaths per year in the pre-Covid era. Though Bennett said that vaccine hesitancy “has been with us for a long time,” there “are real consequences” to continued reluctance and refusal to get vaccinated with heightened risks due to the nature of the pandemic.

Bennett said that many claims around hesitancy blame communities for their inability to access vaccines, but this fails to consider or to change the underlying behaviors that drive hesitancy. Bennett outlined these underlying drivers as 1) mistrust, 2) social norms, and 3) understandable uncertainties.

A slide from Dr. Bennett’s presentation showing the unequal distribution of vaccination sites in Atlanta GA in predominantly white areas.

“It’s not just mistrust of the medical system, it’s mistrust of institutions,” Bennett said, “There’s a lot of reasons for [Black people] to mistrust institutions.” The murder of George Floyd stands as one poignant contemporary example, but “Tuskegee [still] looms large in the minds of Black Americans.” The Tuskegee experiment exploited 600 Black men working as sharecroppers who had syphilis by knowingly withholding treatment and simply seeing what happened to their bodies as a result of the disease for over 40 years.

This experiment was not the first of its kind: Whole body radiation was tested on Black people. Fistula surgery was developed on enslaved Black women by the “father of modern gynecology.” The immortal cells of Henrietta Lacks, a Black woman, have been used far and wide to advance science after a sample of her cancerous cervix was unknowingly stolen from her. Modern studies have also shown how different implicit biases of Black patients shape their treatment outcomes due to skewed physician perceptions.

The capital riot, the murder of George Floyd, and the Jim Crow Era all exemplify the pervasive institutionalized racism that erodes Black trust in U.S. institutions of all kinds.

Our social networks are also vitally important to influencing our feelings about receiving the Covid vaccine. In Black communities, Bennett said, fewer people in their networks have gotten vaccinations and those who have received vaccines are less vocal about it leading to a collective lack of interest in receiving vaccinations.

These two factors, paired with understandable uncertainties about the side effects of the vaccine or potentially getting Covid itself, generate the need to change our approaches to vaccine hesitancy and increased uptake amongst Black communities in the U.S.

White people have been disproportionately vaccinated over all other racial/ethnic categories in the U.S.

To do this we need to lead with empathy and appreciate the fact that changing attitudes towards vaccines is a process. “Shaming people is bad,” Bennett said. “Stigmatizing people will actually lead to the converse of what we expect.”

Over time, we can work to correct misconceptions, contextualized uncertainties, and share stories rather than statistics to push people further from vaccine refusal and closer to vaccine demand.

And when more Black Americans are ready, “vaccination should be an easy choice.” By implementing opt-out policies, rather than opt-in and by taking more direct actions like making vaccination appointments for people, Covid vaccines may indeed be the key to ending the pandemic – in an equitable and proportionate way.

Post by Cydney Livingston

Duke Junior Mixes Memory Research with Criminal Justice Reform

What do you get when you mix double majors in Philosophy and Psychology with a certificate in Philosophy, Politics, and Economics? You get someone like Kelis Johnson, a junior from Lithonia, Georgia in suburban Atlanta, who works in not one research lab at Duke, but two.

Kelis is a member of The Marsh Lab studying learning and memory in Psychology and Neuroscience, and The Wilson Center for Science and Justice at Duke Law, using legal and scientific research to advance criminal justice reform.

Kelis Johnson, member of the Marsh Lab and the Wilson Center for Science and Justice

“Managing two research assistant positions while working as an embedded writing consultant with the Thompson Writing Studio, on top of my academics, can definitely be a challenge,” Kelis says. But, she said, “The way that I have been able to manage these positions along with the rest of my busy schedule is cohesion: Although working in a lab provides a different context than the material from my classes, I think my lab work and classwork supplement one another in a profound way.”

After taking a class with Elizabeth Marsh, the lab’s Principal Investigator, Kelis found herself “interested in deepening [her] knowledge of and experience with memory research,” so she reached out to get involved in the summer of 2020. The lab has provided her a means to explore her interests in the “intersections between memory and personal identity, education and the law.”

Simultaneously, in the midst of the (first) Covid-19 summer, Kelis worked with the Microworlds Lab. She conducted historical research that profiled Black female activists. “I felt like my interests and passions began to converge on activism and bringing about change while also exploring empirical research,” she said, “This passion aligned with the work being done at the Wilson Center who use research to advance civil rights.” She joined her second lab in the fall of 2020.

Dr. Elizabeth Marsh surrounded by research assistants of the Marsh Lab

In both positions, Kelis meets weekly with her fellow colleagues to discuss an overview of the labs work or the current research in the field. She finds this fulfilling, knowing that the work she and fellow research assistants have contributed to is providing “concrete advancements … in the labs and the world more broadly.” Kelis’ work consists mostly of coding or scoring data. This means reading study participants’ responses and using a codebook (like a grading rubric) to determine how each response compares to the standard established in the experimental protocol. Kelis also participates in literature reviews and stimuli creation, where she generates relevant material such as questions, statements, or images that will be used in experiments to test research questions.

This work has enabled Kelis to meet fellow undergraduates, along with graduate students and faculty mentors, who have similar interests to her own. She has learned more about grant writing, research ethics, and statistical tools. Along with providing her invaluable research experience, strengthening her passions for criminal justice reform, and reinforcing her plans to go to law school following graduation from Duke, through her work with the Wilson Center, Kelis has been able to learn more about Durham and North Carolina. This prompted her to think deeper about her role in the larger communities around her.

Image of Duke Law School, where the Wilson Center is located.

Kelis’ research is valuable outside of the lab. “Memory research is essential to how we learn, how we structure our life and personal identity, and how we form relationships with others,” Kelis said. She also stated that, “Learning about and reforming our criminal justice system is something we must all care about. In order to attack the systematic oppression of marginalized groups, we have to understand it.”

Unfortunately, due to Covid-19, Kelis has been unable to participate in person with either of her labs. This is something she is emphatically looking forward to. However, the virtual realm has enabled other forms of meaningful interactions and experiences through digital platforms. Kelis says she really appreciates “the events hosted by the [Wilson Center] Lab that often feature exonerated individuals who speak about their experience within the criminal justice system.”

Kelis’ contributions to projects from memory difference in older and younger adults to autobiographical memory are surely only the first steps in a planned lifetime of standing at the intersection between memory, identity, and the structures of our society.

Post by Cydney Livingston

Centering Patients and Expanding Access in the Opioid Epidemic

We are still in the midst of an opioid epidemic. In 2019, an average of six North Carolinians died each day from unintentional medication or drug overdose. A striking 79% of drug overdose deaths in NC in 2018 involved opioids. This has garnered attention from many organizations and institutions in the state and prompted new concerns relating to patient-centered care.

A Duke Global Health discussion on March 17 concluded that the social response can be aided by a refined focus on mental health, as well as the use of telehealth – the delivery of health care and education remotely through various technologies.

Moderated by Brandon Knettel (Ph.D.), the Duke Global Health Institute panel considered treatment, community engagement, and public policy in addressing the opioid epidemic with panelists Nidhi Sachdeva (MPH), Padma Gulur (M.D.) Hilary Campbell (PharmD, J.D.), and Theresa Coles (Ph.D.)

Sachdeva is a Senior Research Program Leader with the Department of Population Health Sciences at Duke Medical School. Dr. Gulur is a Professor of Anesthesiology and Population Health with Duke Medical School and Executive Vice Chair of the Pain Management and Opioid Surveillance with Duke University Health System. Campbell is director of Sheps Health Workforce Health Professions Data System at UNC-Chapel Hill. Coles is Assistant Professor in Population Health Sciences with Duke Medical School.

Sachdeva opened the panel with a discussion of the Duke Opioid Collaboratory. The Collaboratory currently houses 25 different projects relating to improving data surveillance, health system quality, and public health in the realm of research on opioids.

“We’re losing more and more folks every day,” said Sachdeva. Duke’s projects represent a systems approach to the opioid epidemic, meaning there is lots of valuable overlap and connectivity between projects, and external partnerships that have provided a unique opportunity for academic and community collaboration.

Dr. Gulur stated that Duke Health has seen improvements in opioid use and prescription over the last five to six years: the ambulatory prescribing rate has gone down, fewer patients are requiring high-dose opioids overall, and there has been significant increase in availability to offer medication-assisted treatment for opioid use disorder. Like Sachdeva, Gulur’s work with Duke’s Pain Management and Opioid Surveillance exists within a larger network of organizations dedicated to the opioid issue.

“We have a very committed and collaborative infrastructure with [other] initiatives in the state,” said Gulur, who added that she is dedicated to making “sure we have all the voices at the table.”

A collective display of the Duke Opioid Collaboratory projects

Simply decreasing opioid prescriptions “doesn’t necessarily work” and solving this issue will not be a quick fix. Campbell said that her own research found that at the same time the “supply side” of opioids was shrinking, the state was “seeing the crisis getting worse.”

Enter telehealth and the need for expanded support to mental health resources. Coles explained their pertinence through discussion of her work with Granville-Vance Public Health. Coles has been working on an expanding project that assesses training, operational challenges, patient centered goals, and success from the patient’s perspective within Granville-Vance’s opioid program.

Coles found that inconsistent funding lead to lapses in access to mental health support and the “dropout of someone there to help [with behavioral health] was challenging for patients.” Telehealth bridges the gaps of inconsistent access. Further, in the case of Coles’ study, it also played a large role in increased access for patients who experienced transportation issues since the investigation took place in conjunction to Covid-19, which lowered patients’ abilities to physically attend the program in-person.

Because “no one person experiences opioid abuse … in a vacuum,” as Sachdeva said, it is important to get a comprehensive “assessment of what a person’s life looks like and their priorities for treatment” before jumping into treatment.

This map displays the concentration of unintentional medication and drug overdose death rates across the 100 counties of North Carolina.

Though the last year living under the Covid-19 pandemic has been difficult for the entire globe, the increased need for access to resources through the internet and various technologies has been positively reinforced. With new understandings of relationships to others and limited physical access to in-person healthcare, telehealth has emerged as a means to resolve decreased access. It can also serve as a way to expand access for populations who have historically suffered from inadequate access to healthcare resources, like rural populations.

Opioids “have and will continue to play a role in pain management,” Dr. Gulur said. However, better efforts to involve patients and their families in decision making around opioids, as well as more fully informed understandings of the potential risks and side effects, is necessary for centering patient priorities in care management.

Sachdeva emphasized a “nothing about us without us” philosophy for approaching the opioid epidemic. This means that the systems of care being changed to address opioid crises must depend directly on people who use opioids. It is important to center “lived experience through the whole thing.” Because each community is different, it is inadequate to make assumptions about “what a community is, what it might need, or what its story is.”

The self-described objectives of the Duke Opioid Collaboratory, which overlaps largely with other initiatives discussed during the panel.

Underlying this work is a question from Dr. Gulur, “What are you trying to treat?”

To treat the opioid epidemic, we need to treat people as complex, multi-dimensional people living complicated lives. Opioid use is only one facet of this narrative, making it pertinent to understand the rest of the story to adequately tackle this problem our nation faces. Mental health and access to care are central to this collective narrative more largely.

Post by Cydney Livingston

Bass Connections Teams Tackling COVID-19 Problems, from Food Security to Voting-by-Mail

Most people at Duke are familiar with Bass Connections, the powerhouse interdisciplinary research program that brings together students and faculty from a wide variety of backgrounds to tackle complex problems.

Like most people, when the country went on COVID-19 pandemic lockdown, team leaders and members within Bass Connections needed to adapt their approach.

Instead of merely adapting, though, some Bass Connections teams saw a problem-solving opportunity. They pivoted to address some of the most pressing problems that the pandemic has created or exacerbated. On Tuesday, March 2nd, eight teams gathered to present their research at the first Bass Connections Works in Progress Symposium.

Equity and Efficiency of Using Wearables Data for COVID-19 Monitoring was one team that presented at the Symposium.

These teams tackled issues ranging from the ethics of contact tracing to the availability and access to contraception.

One team focused on the issue of food security amongst Latinx populations in Durham. Their presentation was lead by Elaijah Lapay, Faraan Rahim, and Karina Moreno Bueno. The team aimed to tackle three major goals: “How is the pandemic affecting the food security of Latinx residents, and how do environmental public health factors contribute to this population’s risk for COVID-19 infection? How does the incorporation of fresh, local foods mitigate these effects? How is the pandemic affecting the food assistance services locally, nationally, and internationally for the Latinx community?”

Of the Hispanic/Latinx respondents to the 2019 Durham Community Health Survey, 20.9% said they sometimes skipped or limited their meals. Combining that with the fact that 36% of the total number of COVID-19 cases in Durham have been within the Hispanic population, it’s fairly clear that there is a link between food security and health outcomes.

To this end, the Bass Connections team partnered with Root Causes to help advance their project goals through Root Cause’s Fresh Produce Program. Root Causes is an organization started by Duke Medical School students prior to the pandemic that previously provided fresh produce to food-insecure patients at the Duke Outpatient Clinic. But in order to adapt to contactless delivery and new needs due to COVID-19, Root Causes and the Bass team partnered to expand its reach to nearly 150 households in Durham.

Pipeline for Fresh Produce Program, taken from the symposium presentation of Improving Food Security to Increase Resiliency to COVID-19 for Latinx Populations

This expansion was aided immensely by the Duke Campus Farm, which despite the pandemic mobilized to change the produce it grew to be more culturally relevant to the households they were supporting.

In the future, the team hopes to continue to expand their survey data in the Triangle and continue to assess the impact of the Fresh Produce Program.  

Another Bass Connections team broadly addressed the challenges COVID-19 posed to the election process, through three sub-projects focusing on absentee balloting, organizing, and overall voter participation. The symposium presentation for the absentee balloting research was lead by Chase Johnson, Emma Shokeir, and Kathryn Thomas.

To hear more about the work of this Bass Connections team, watch the presentation above.

The 2020 election saw more people than ever relying on absentee voting, either by the one-stop process or by voting through mail. However, this team aimed to address the many voters that are disenfranchised because their votes are rejected due to errors in their ballot. While NC courts ruled that voters are required to be notified if their ballot needs curing, the difficulty of curing one’s ballot often dissuades people from even starting the process, leading to those votes not being counted.

The team utilized the app BallotTrax, a company that the North Carolina State Board of Elections hired to track these ballots. The team then focused on phone banking to increase BallotTrax usage, and then analyzed voter outcomes.

In the future, they hope to analyze the effect that BallotTrax outreach had on voting success, the efficacy of BallotTrax for voters in North Carolina, and the efficiency of North Carolina’s vote-by-mail system compared to other states.

A goal of this symposium for many teams was to ask audience members for suggestions on ways to direct their research further. The beauty of seeing research midway through the process is that it opens the door for collaborative thinking, out-of-the-box ideas, and being open about obstacles and mistakes.

This virtual Symposium is a testament not just to Duke’s collaborative research spirit, which is alive and well despite the pandemic, but to the adaptability of Duke student researchers and faculty. There’s no doubt that these eight Bass Connections Teams, among the many other teams part of the program this year, have been generating relevant and impactful knowledge and will continue to do so.

Post by Meghna Datta

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