Research Projects

Research projects at ZSFG Division of General Internal Medicine

Kirsten Bibbins-Domingo, MD

All of Us Research Program National Sexual and Gender Minority (SGM) Engagement Network
San Francisco General Hospital Foundation
The major goal of this grant is to engage SGM communities in the All Of Us Precision Medicine Initiative.
Role: Principal Investigator

Hypertension Management in Minority and Low Income Populations
NIH NIDDK                                                                              
This proposal seeks to develop effective hypertension control interventions in safety-net settings caring for race/ethnic minority patients with complex co-morbid conditions including chronic kidney disease and diabetes, and to use computer simulations to evaluate these interventions for their population impact on disparities.  This proposal enhances the career development of the PI, while allowing her to develop a rich training environment for junior investigators from a range of disciplines.
Role: Principal Investigator 

SF State BUILD: Enabling Students to Represent in Science
NIH/NIMHD
Goals: Collaborative efforts between UCSF CVP and SFSU to enhance the academic qualifications of the underrepresented minority BUILD scholars and also promote faculty exchanges between the two institutions, thereby transforming both institutions, and strengthening the existing long-term partnership.
Role: Principal Investigator at UCSF

UCSF CTSI NRSA Training Core
NIH-NCATS 
The fundamental goal of the UCSF Clinical and Translational Science Institute TL1 Training Program is to provide pre-doctoral and post-doctoral fellows with the methodological, analytic, leadership, and team science skills required to conduct transformative clinical and translational research relevant to precision health.
Role: Principal Investigator

UCSF Research Implementation Sciences for Equity (RISE)
NIH/NHLBI
Goals: UCSF-RISE will provide outstanding didactic training, research experiences, and on-going research mentoring in ImS for URM faculty and senior fellows focused on cardiovascular or pulmonary disease research, leveraging the considerable expertise in training in ImS here at UCSF. These research skill building activities will be paired with an innovative career development program that includes critical activities of importance for this career stage (including manuscript and grant writing) delivered by successful, NIH-funded investigators who lead this project (including senior URM faculty) and drawing on the broader base of outstanding researchers in cardiovascular and pulmonary diseases at UCSF.
Role: Principal Investigator 

Alicia Fernandez, MD

Making a Difference in Real-World Bioethics Dilemmas
The Greenwall Foundation
The major goal of this project is to identify and resolve the emerging or unanswered bioethics problem in clinical care, biomedical research, public health practice, or public policy.
Role: Principal Investigator

Mentoring in the Context of Improving Care for Latinos with Diabetes
NIH/NIDDK
The major goals of this project are to support the expanded mentoring of early career investigators--from every level of the training pipeline--in clinical and health services research dedicated to improving outcomes for low-income Latinos with diabetes, and also support a research project on determining Latino diabetes patients' role in overcoming language barriers in health care.
Role: Principal Investigator

NIH Building Infrastructure Leading to Diversity (BUILD)
San Francisco State University
The major goals of this project are to establish networks to create opportunities for SF BUILD Scholars to engage in health equity research with diverse faculty at UCSF, and to enhance career development opportunities and collaboration for minority faculty through a cross-institutional forum at both UCSF and SF State.
Role: Co-Principal Investigator

UCSF Research in Implementation Sciences for Equity (RISE)
NIH/NHLBI
The major goals of this project are to train and sustain underrepresented minority (URM) fellows and junior faculty from across the US and Puerto Rico for long-term success in academic careers pursuing innovative research in cardiovascular or pulmonary diseases, and to prepare scholars to conduct innovative research and compete successfully for independent research funding.
Role: Principal Investigator

 

Elaine Khoong, MD

Validating brief screening questions to assess for digital exclusion
NIH/NIA through CADC Pilot
This project will focuses on identifying screening questions to identify if individuals are at risk for digital exclusion regardless of reason. We will ask patients to answer screening survey questions. Then we will interview patients and observe them conducting digital tasks (e.g., searching online, logging into a patient portal) to identify which questions best correlate with adequate device access, Internet access, or digital skills to access digital health tools. We will specifically focus on ensuring screening questions work well for older populations with racial diversity.

Designing a Remote monitoring Intervention for Value & Equity in Hypertension: DRIVE-HTN
NIH/NHLBI
The major goal of this grant is to develop and measure the impact of a team-based home blood pressure (BP) monitoring program, with the goals of developing a sustainable, evidence-based approach to improve hypertension care in safety net systems. Using interviews, focus groups, and direct observations, we will work with patients and clinical teams to co-design a process to collect home blood pressure data and transmit the data to clinical teams for evidence-based management. We will then pilot and evaluate the feasability, implementation, and cost of the co-designed team-based home blood pressure monitoring program.  

Evaluating changes to primary care management and control of type 2 diabetes mellitus among diverse populations after wide-scale telehealth implementation
NIH/NIDDK
The COVID-19 pandemic resulted in rapid conversion of chronic diabetes management from in-person to telehealth (video, phone). Some populations (e.g., older adults, low socioeconomic status (SES)) are more likely to experience barriers to telehealth. Among diverse populations with type 2 diabetes mellitus (T2DM) that receive primary care at UCSF Health or San Francisco Health Network (SFHN), this project aims to use electronic health record (EHR) data and geocoded EHR data to retrospectively: (1) describe how primary care utilization changed for T2DM patients during telehealth implementation; and (2) evaluate how T2DM process and clinical outcomes changed during the period of telehealth and identify clinician and health system processes that impacted clinical outcomes.

Leigh Kimberg, MD

Aspire to Re-Imagine Safety and Equity (ARISE)
HHS Office of Women’s Health (OWH)
The study aims to transform the interpersonal violence (IPV) programs in 17 primary care clinics in the San Francisco Health Network by implementing sustainable collaborative interventions with leading community IPV and legal organizations in order to empower survivors of IPV and, ultimately, reduce IPV. Study outcomes include the impact of ARISE on IPV care measures, patient safety behaviors, other secondary patient outcomes and qualitative patient data about experience with IPV, safety, and healthcare system. 
Role: Principal Investigator

Fears of Disclosure and Misconceptions Regarding Domestic Violence Reporting
University of California Institute for Mexico and the United States (UC MEXUS)
In this study of ED patients, we sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. Specifically, we sought to assess whether ED patients knew of people experiencing DV victimization, whether these people were afraid to disclose DV and seek care, and whether UDLI status was associated with greater fear and more misconceptions about the consequences of DV disclosure to healthcare providers.
Role: Co-Investigator (PI-Dr. Robert Rodriguez)

Margot Kushel, MD

Aging Among the Homeless:  Social Isolation, Function and Institutional Care
NIH/NIA
The major goal of this grant is to establish a cohort of 350 homeless adults aged 50 and older and examine geriatric conditions, health and healthcare outcomes through a life course perspective in order to improve the delivery of clinical services and align policies and programs with the needs of this high risk population.
Role:  Principal Investigator

Community Health (ECROP)
Examining the Consequences of Opioid Restrictions on Patients, Clinical Care, and Community Health
NIH 
We propose to conduct a qualitative study examining the consequences of reductions in opioid prescribing for chronic non-cancer pain (CNCP). The study will recruit CNCP patients with a history of substance use (past or current) who access healthcare in low income, safety-net clinical settings, their primary care clinicians, and community stakeholders. Study results will improve our understanding of the positive and negative consequences of reductions in opioid prescribing on patients, clinical care delivery and community health to inform clinical and policy recommendations.
Role: Co-Principal Investigator

Family-assisted Housing for Older Homeless Adults
NIH/NIA
The major goals of this grant are to use qualitative research methods and ethnography to understand barriers to and facilitators of re-housing older homeless adults (aged 50 and older) with members of their family, via in-depth interviews and ethnographic observations with older homeless adults, family members and key informants
Role:  Co-Principal Investigator

Mentoring Researchers in Aging in Vulnerable Populations
NIH/NIA
Dr. Kushel’s goals for this grant are to (1) Perform rigorous patient oriented research aimed at improving our understanding of aging in vulnerable populations, with a particular focus on older homeless adults; (2) Use her research as a platform for mentoring junior patient-oriented researchers in aging in vulnerable adults.
Role: Principal Investigator

PFS Housing First Initiative
Abode Services
The major goals of this grant are, in a randomized controlled trial, to assess outcomes (housing, health care utilization, use of social services) in chronically homeless adults randomized to permanent supportive housing versus usual care.
Role: Co-Investigator

Courtney Lyles, PhD

Remote monitoring for Equity in Advancing Control of Hypertension (REACH)
The goal of this study is to support patients with hypertension self-management using both home blood pressure monitors and digital messaging programs. We will first engage patients with uncontrolled hypertension in technology training to use home monitors, online portal websites to view their medical record information online, and texting and mobile phone applications. Then we will assess the effectiveness of home blood pressure monitors and enhanced patient-clinician digital communication on blood pressure control during a 12-month intervention. 
Role: Principal Investigator

Improving Diabetes and Depression Self-Management via Adaptive Mobile Messaging (DIAMANTE)
This grant proposal seeks to develop and test a personalized motivational text messaging intervention to improve management of co-morbid diabetes and depression with an emphasis on low-income populations (conducted in both English and Spanish). The findings from this study will aid in the development and dissemination of mobile health tools for chronic illness management in diverse patients.
Role: Multiple Principal Investigator  
                    
Creating Community-Driven, Personalized Health Maps for Patients with Diabetes (MAVEN)
This grant aims to develop and test a personal health library platform for patients with diabetes and prediabetes, harnessing both personal health and healthcare data and location-based mapped data about neighborhood health resources. In this project, we will use design science to create and evaluate a new personal health library platform to strengthen and improve the ways in which low-income individuals and communities of color access and interact with personal health data that better reflect their needs and interests.
Role: Principal Investigator


Developing a Dynamic Toolkit and Evaluating Evolving Needs Among FQHCs Providing Primary Care via Telemedicine During the COVID-19 Pandemic 
Urgent action is required to disseminate vetted telemedicine resources, identify resource gaps, and address evolving challenges faced by safety-net settings across the country during the COVID-19 pandemic. We propose to develop and iterate a dynamic toolkit and evaluate the evolving needs of safety-net clinics providing primary care via telemedicine with the ultimate goal of ensuring vulnerable populations can access telemedicine during and after this pandemic. 
Role: Multiple Principal Investigator        

Population Health Data Initiative (PHDI)
The goal of this initiative is to increase the capacity for population health work and data resources by geocoding patient addresses from electronic health records (EHRs) at UCSF and San Francisco Health Network (SFHN) and facilitating linkage of EHR clinical data to place-based health-relevant data at the neighborhood level. Linkage of EHR clinical data with place-based neighborhood-level data allows investigation of how social factors and environmental factors influence health outcomes. PHDI enables population health research by: providing tools and infrastructure, including curated datasets and documentation of best practices; facilitating research through data consultation and project management support; and contributing to scientific evidence on population health and health equity by conducting analyses on health disparities using EHR and population-level data.
Role: Co-Principal Investigator

Surmounting Obstacles for Low-Income and Vulnerable Populations Everyday Using Health Technology (SOLVE Health Tech)
UCSF S.O.L.V.E. Health Tech is a digital health equity incubator that aims to make digital health products and services more acceptable and usable for patients from groups that have been marginalized and the settings that care for them. It pursues this mission by partnering directly with digital health companies to adapt, test, and evaluate technology to better reach and meet the needs of diverse populations as well as through education, thought leadership, and convenings.
Role: Co-Founder 

Nynikka Palmer, DrPH, MPH

Constructing a Relational Bridge to Achieve High-Quality Prostate Cancer Care for African Americans
National Cancer Institute
This K01 career development award aims to mitigate the perfect storm of complex treatment options and constraints in communication by constructing a relational bridge between low income African American men and high-quality prostate cancer care, using the evidence-based intervention of peer navigation as a means to foster trust and empowerment and optimize patient-centered communication and quality of care.
Role: Principal Investigator

Catalyzing Systematic Stakeholder Engagement between Academic and Community Health Centers for COVID-19 Research
Patient-Centered Outcomes Research Institute
The goal of this Engagement Award is to partner with community health center member organizations from the SFBayCRN, and academic researchers to identify and create infrastructure needed to support stakeholder engagement that catalyzes a health equity focused COVID-19 patient-centered outcomes research and comparative effectiveness research agenda. This project recognizes the essential role of community health centers and patient stakeholders in helping to set COVID-19 research agendas. Project partners include the Family HealthCare Network in Fresno, the BCH-Oakland Federally Qualified Health Center, and the San Francisco Community Clinic Consortium.
Role: Co-Principal Investigator

SF CAN Prostate Cancer Task Force
UCSF Helen Diller Family Comprehensive Cancer Center
The San Francisco Cancer Initiative (SF CAN) is a citywide community collaboration between the people, the City, community groups and health care systems to reduce preventable cancers and poorer outcomes among communities of color. This initiative focuses on the five top cancers that account for almost half of all cases, including breast, prostate, colorectal, liver, and tobacco caused cancers, for the systematic application of epidemiological evidence to reduce the cancer burden and associated inequities. The SF CAN Prostate Cancer Task Force aims to combat prostate cancer disparities through targeted early detection and follow-up of aggressive disease, and institutional health care partnerships that ensure high-quality prostate cancer citywide. We work collectively to support health care providers and engage African American men regarding decisions for the detection and treatment of prostate cancer, to decrease the over-treatment of low-risk disease, and under-treatment of aggressive disease, and to eliminate the disparity in prostate cancer mortality for African Americans.
Role: Co-leader

Center for Aging in Diverse Communities: Ending Health Inequities in Older Adults
National Institute on Aging
The UCSF Center for Aging in Diverse Communities (CADC), an NIA- funded Resource Centers for Minority Aging Research (RCMAR) since 1997, conducts research, training, and mentoring in minority aging and health disparities research. Since 1997, CADC has mentored over 90 minority underrepresented early-career investigators who have made significant contributions to minority aging research. CADC aims to develop a cadre of underrepresented junior investigators for independent research careers in health disparities and minority aging research. 
Role: Co-Investigator/Lead for the Research and Education Component

Urmimala Sarkar, MD

Building an Ambulatory Patient Safety Learning Laboratory for Diverse Populations: The San Francisco Ambulatory Safety CEnter for iNnovaTion (ASCENT)
PHS Agency for Healthcare Research & Quality
In outpatient health care settings like physicians’ offices, there are significant risks to patients’ safety, including delays in diagnosis and treatment which result in disease progression, preventable complications of treatment, and adverse drug events. Few systems exist to recognize and ameliorate such patient safety problems, and the overall aim is to design, develop, test, and evaluate innovative solutions to improve patient safety.
Role: Principal Investigator

Improving Survivorship Care for Diverse Cancer Patients Cared for in Safety-net Settings
NIH NCI
The goal of this mid-career development award is to strengthen Dr. Sarkar’s mentoring of early career researchers focused on cancer survivorship care in safety net settings serving diverse populations. In alignment with mentoring plans, mentored research activities will address gaps in survivorship care through root cause analysis, the role of survivorship care plans for diverse patients living with colorectal, prostate, and breast cancers, and the use of implementation science methods to initiate development of a health information technology-enabled care coordination tool informed by stakeholder input on challenges in post-treatment/ survivorship care.
Role: Principal Investigator

Influencing Cervical Cancer Prevention and Detection Online through Social Media
NIH NCI
This study is a mixed-methods approach to online social media and social networks for enhancing understanding of cervical cancer screening in order to optimize the spread of health messages and behaviors within online social networks.
Role: Principal Investigator

Investigating Failures of Notification and Monitoring in Outpatient Care: Safety Promotion Action Research and Knowledge (SPARK) Network
PHS Agency for Healthcare Research & Quality
The long-term goal of this research is to reduce adverse events and errors in outpatient health care. This project is focused on approaches to measure and characterize adverse events in result notification and ongoing monitoring for high risk health conditions in safety net health care systems that care for diverse patient populations, including low-income and race/ ethnic minority groups. We aim to measure the extent of disparities in patient safety in ambulatory care settings and ways to understand underlying reasons for these disparities.
Role: Principal Investigator           

Patient Safety Network and Web Morbidity and Mortality
PHS Agency for Healthcare Res & Quality
The goal is to maintain excellence of current PSNet and WebM&M websites while focusing on a series of enhancements to existing features and activities.  We seek to disseminate both sites to an broader audience, leveraging additional partnerships and collaborations, as well as new technological capabilities – both through social media and by optimizing the sites to be used on a variety of platforms. 
Role: Co-Investigator

The Health ePeople Resource for Mobilized Research
NIH NIBIB
We seek to create the Health ePeople Resource, a mobilized cohort and infrastructure to carry out research using mobile and digital technology as well as to study mobile health itself. The Resource will develop a cohort of 1,000,000 volunteer participants who have consented to provide data to the resource and participate in research. The Resource will also develop tools for researchers to rapidly conduct research using this cohort or collect new data on an existing cohort.
Role: Co-Investigator

Improving Diabetes and Depression Self-Management via Adaptive Mobile Messaging
PHS Agency for Healthcare Research & Quality
The goal is to use adaptive text messaging to help patients with both depression and diabetes increase their physical activity rates.
Role: Co-Investigator

Dean Schillinger, MD

The Next Frontier in Diabetes Communication: Promoting Health Literacy in the Era of Secure Messaging
NIH NLM 
Limited health literacy places individuals at greater risk of type 2 diabetes and its complications, making limited health literacy a critical clinical and public health problem. As healthcare becomes increasingly dependent on electronic communications, patients with limited health literacy may have difficulty communicating by email with their clinician or understanding the clinician’s emailed replies or instructions. This proposal will use computational linguistics to examine how diabetes patients with a variety of health literacy levels interact with their clinicians via patient portals, will explore whether linguistic gaps between patients and clinicians are associated with diabetes outcomes, and will create a feedback tool to assist clinicians to better accommodate diabetes patients’ communication needs.
Role: Principal Investigator

The HMO Research Network – University of California San Francisco Center for Diabetes Translational Research (CDTR)
NIH NIDDK; Kaiser Foundation Research Institute
The goal is to continue and expand the work of the Health Delivery Systems Center for Diabetes Translational Research, a collaborative partnership between the Kaiser Permanente Northern California’s Division of Research, HealthPartners Institute for Education and Research, Harvard Pilgrim Health Care Institute, and the University of California San Francisco.
Role: Site PI; Director of National Diabetes Safety Net Resource Program

Building an Ambulatory Patient Safety Learning Laboratory for Diverse Populations:The San Francisco Ambulatory Safety CEnter for iNnovaTion (ASCENT)
AHRQ
In outpatient health care settings like physicians’ offices, there are significant risks to patients’ safety, including delays in diagnosis and treatment which result in disease progression, preventable complications of treatment, and adverse drug events. Few systems exist to recognize and ameliorate such patient safety problems, and the overall aim is to design, develop, test, and evaluate innovative solutions to improve patient safety.
Role: Co-Investigator

Diabetes screening and care received by the mentally ill in an integrated system
NIH/NIDDK
The goal of this application: the first step toward attaining the long-term goal is to understand the diabetes monitoring and care received by racially and ethnically diverse populations with severe mental illness in an integrated care delivery system.
Role: Co-Investigator

Health Literacy Systems in the Safety Net: Lessons from Complex Care Management
NIH NINR
To provide an ethnographic description of the interactions, processes, and organizational arrangements of two chronic care programs that contribute to patients’ health literacy, retention in the clinical care system and fulfillment of their social and medical needs. As a result of this work, we will elaborate a conceptual framework linking organizational HL attributes to patient engagement.
Role: Co-Investigator

Implementing The Bigger Picture Campaign into Low-Income High Schools via the CATCH Program
James L Irvine Foundation Impact Fund
Through our CATCH intervention, The Bigger Picture will partner with SFUSD schools and collectively work towards “making heath a shared value." The CATCH intervention aims to improve health equity, build a culture of health among SFUSD participants and promote type 2 diabetes prevention. Our workshop programming and assemblies are rigorously designed to evaluate changes in high school students’ mindsets and expectations towards understanding the social and environmental drivers of type 2 diabetes among youth and youth of color.
Role: Co-Investigator

Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making
NIH NIA
This project will determine the efficacy of a novel, patient-centered, multi-media website called PREPARE. PREPEARE is focused on preparing ethnically diverse, older adults to communicate their wishes with surrogate decision makers and clinicians and to make complex medical decisions over the course of serious and chronic illness. This project will result in a practical advance care planning guide that will be easy-to-use and disseminate and result in diverse, older adults who are prepared for complex medical decision making.
Role: Co-Investigator

Investigating Failures of Notification and Monitoring in Outpatient Care: the Safety Promotion Action Research and Knowedge (SPARK) Network
AHRQ
The overall goals of this proposal are to examine the epidemiology of patient safety in ambulatory care settings that care for diverse, low-income populations as follows; (1) to characterize the incidence and prevalence of specific safety gaps, by race/ ethnicity and language proficiency; (2) to gather in- depth, qualitative evidence about strategies that can improve safety and characterize disparities in patient safety; (3) to pilot-test patient safety monitoring methodologies in a diverse sample of five safety net health care systems; and (4) to develop a measurement and error investigation toolkit for dissemination amongst safety-net health care systems.
Role: Co-Investigator

Testing combinations of population interventions to encourage healthy eating
NIH NIDDK
In Aim 1, we will conduct a prospective evaluation of a population-wide SSB tax in both tax-affected and matched unaffected CA counties. We will identify changes to both beverage and food consumption and purchasing, food substitution patterns, spillover to neighboring areas, effects of marketing, and any regressive economic effects for low-income populations. The longer-term follow-up period enabled by our design will test the hypothesis that a SSB tax produces sustained declines in SSB consumption rather than merely short-term effects followed by a return to pre-tax consumption. Uniquely, we will then test complementarity between the tax and other interventions in Aims 2 and 3. In Aim 2, we will examine the complementarity of the SSB tax with a fruit and vegetable voucher program. Some SSB tax-affected and distant tax-unaffected counties have introduced fresh fruit and vegetable purchasing vouchers, which enable low-income families facing food insecurity to purchase fruits and vegetables at major supermarkets and corner stores in the area, not just at farmer’s markets. We will test the hypothesis, supported by our preliminary data that pairing the purchasing penalty of an SSB tax with a purchasing incentive of a fruit and vegetable voucher improves upon the modest effect of either intervention alone. In Aim 3, we will identify the complementarity between the SSB tax and a workplace SSB purchasing ban, implemented in some workplaces but not others during tax-affected and -unaffected periods.
Role: Co-Investigator

Research Training at the Confluence of Infectious and Non-Communicable Diseases in India
NIH Forgarty Intern’l Center
The goal of the 5-year Global Infectious Diseases (GID) training grant proposal is to establish a research and training program in India focused on the study of the interaction of infectious diseases with non-communicable diseases such as diabetes. Dr. Schillinger will serve on the NCD leadership team.

 

Eleanor Bimla Schwarz, MD

Healthy Moms Study
Prenatal Counseling for Postpartum Health
HRSA Grant
This individual-level randomized trial compares the effects on postpartum health behaviors of providing counseling designed to increase pregnant women's awareness of either: 1. the maternal health benefits of breastfeeding, or 2. the health benefits of smoke-free homes.
Role: Principal Investigator

Hilary Seligman, MD

NOPREN Coordinating Center 
Centers for Disease Control and Prevention
This project primarily involves directing the CDC’s Nutrition and Obesity Policy Research and Evaluation Network (NOPREN). NOPREN is a collaborative, equity-focused applied research network that informs policies and practices designed to improve nutrition and prevent obesity. In addition, this project includes the development of a practical guidance document for health systems, hospitals, insurers and state and local health departments who are developing and evaluating shared food and nutrition security interventions in the community. 
Role: Principal Investigator

Subsidizing Produce in New Moms to Advance Community Health (SPINACH Study)
Robert Wood Johnson Foundation, Healthy Eating Research  
This study examines whether supplementing the existing WIC benefit with fruit and vegetable vouchers for low-income pregnant people can improve birth outcomes, food security, and dietary intake.
Role: Principal Investigator

Vouchers 4 Veggies-EatSF
Multiple funding sources
Vouchers 4 Veggies-EatSF is a healthy food program providing low-income individuals and families with vouchers for free fruits and vegetables or groceries.  EatSF is active in San Francisco and supports implementation in multiple other geographic regions across California and the US.
Role: Founder & PI

Senior Medical Advisor 
Feeding America
This work supports Feeding America’s research agenda related to food insecurity, poverty, nutrition, health and other related social policies, and supports the translation, implementation and dissemination of research and community health and nutrition insights into policy strategies and initiatives.
Role: Principal Investigator

Food and Nutrition Security: A Conceptual Map         
USDA Economic Research Service
For this project we will create a new conceptual model of food and nutrition security based on a detailed and thorough literature review. We will address the question “How do these two phenomena of food security and nutrition security fit together?” 
Role: Principal Investigator 

Designing Food Voucher Programs to Reduce Disparities in Healthy Diets 
NIH/NHBLI
The R01 grant examines how best to design, coordinate and maintain food voucher programs in order to reduce disparities in healthy diets. This multi-center, randomized controlled trial examines strategies for supporting healthy dietary intake using incentive programs and estimates their impact on long-term development of cardiovascular disease. 
Role: Principal Investigator

Impact of SNAP on Health Outcomes in A High-Risk Older Adult Population: A Study to Drive Advocacy Efforts
Archstone Foundation
Using quasi-experimental methods, administrative data and multi-part interviews, this study seeks to examine the extent to which SNAP reduces healthcare utilization and expenditures. It is intended to support efforts to expand or implement policies, systems and programs that support SNAP enrollment among older adults.
Role: Principal Investigator

Gus Schumacher Nutrition Incentive Program ("GusNIP")
USDA through Gretchen Swanson Center for Nutrition, Nutrition Incentive Hub
The goal of this project is to aid the GusNIP Nutrition Incentive Hub with the national evaluation of the numerous GusNIP-funded produce prescription programs (PPR) 
Role: Principal Investigator

LongItudinal Food security Experiments via SuPplemental Assistance with Nutrition for Diabetes (LIFESPAN-D)
Centers for Disease Control and Prevention                 
The goal of this study is to determine the health and cost-related effects of nutrition assistance (SNAP and WIC) on type 2 diabetes outcomes across the lifespan.
Role: Co-Investigator

Food is Medicine: Randomized Trial of Medically Tailored Food Support for Diabetes Health
NIH/NIDDK                                                                                                 
The Changing Health through Food Support for Diabetes (CHEFS-DM) intervention provides 6 months of medically tailored meals and groceries plus nutritional education to low-income adults receiving care from safety-net clinics.  This study will provide timely evidence on the efficacy of medically tailored food support for type 2 diabetes to inform real-world programs and policies, in line with NIH priorities for nutrition research.
Role: Co-Investigator

Testing combinations of population interventions to encourage healthy eating
NIH/NIDDK
We will rigorously assess a rare set of nested natural experiments in in California (CA). We will conduct a prospective evaluation of a population-wide SSB tax in both tax-affected and matched unaffected CA counties, identifying changes to both beverage and food consumption and purchasing, food substitution patterns, spillover to neighboring areas, effects of marketing, and any regressive economic effects for low-income populations; and examine the complementarity of the SSB tax with (a) a fruit and vegetable voucher program and (b) a workplace SSB purchasing ban. We will employ simulation models of obesity, type 2 diabetes, and cardiovascular disease to project the generalizable impact and cost-effectiveness of the interventions for reducing long-term national race/ethnic and socioeconomic disparities.
Role: Co-Investigator


Pilot Study of the Nutrition-Enhanced Wellness for Diabetes Self-Management Program (NEW-DSMP) among Low-Income Adults with Type II Diabetes
NIH/NIDDK
Our goal for this pragmatic, pilot cluster-randomized trial is to test the feasibility, acceptability and preliminary impact of providing 12 weeks of diabetes-healthy food support (i.e. medically-tailored meals and groceries), plus individualized sessions with a registered dietitian, to low-income individuals with T2DM participating in the DSMP, compared to DSMP participation alone. Data from this pilot study will inform the planning of a full-size cluster-randomized trial to test the efficacy of the NEW-DSMP model, with a long-term goal to inform policy debates about the value of implementing medically-tailored food interventions as part of healthcare.
Role: Co-Investigator

Wagahta Semere, MD

Caregiving for Patients with Diabetes in the Era of Online Patient Portals: Findings from the ECLIPPSE Study
NIH/NLM
This project aims to (1) To develop and validate a novel method for analyzing the content of secure messages (SMs) between patients with diabetes and their clinicians, in order to distinguish when a “proxy” (son/daughter, spouse, relative, parent, or other caregiver) communicates on behalf of the patient vs. when the patient self-generates the SM; (2) To characterize the prevalence and distribution of proxy (both formal and informal) SM use within patients’ SMs and examine the socio-demographic, communication and clinical characteristics of proxy versus non-proxy patients; (3) To compare the quantity, intensity, function, and content of SMs written by proxies vs. those of SMs written by non-proxies.
Role: Supplement Candidate                                  

Champion Providers
California H&W Dept of Health Care Services
The Champion Providers initiative builds on the pilot started in 2013 to harnesses the influence, power and respect of health care providers to build healthier communities. The program trains and supports motivated physicians and dentists throughout the state to add their professional influence and experiences to mitigate today's unprecedented obesity epidemic through policy, systems and environmental changes. By connecting physicians and dentists with their local health departments, community coalitions and other organizations, Champion Providers assist in addressing a range of local health concerns, ranging from access to healthy foods, increased opportunities for physical activity and other obesity prevention efforts, especially in low-income communities.
Role: Co-Investigator 

Planning for the Evaluation of Managed Long-Term Services and Support
California H&W Dept of Health Care Services
This project aims to report on the readiness of integrated 20110-2016 dataset to analyze transition into managed Long-Term Services and Support (LTSS) and this policy’s impact on the use of LTSS, acute and subacute services; report on the readiness of the managed care data for analyses of post-MLTSS outcomes comparing those in Cal Medi-Connect and those who are not; report on the compare the change in outcomes from pre- to post-LTSS for Seniors and Persons with Disability (SPD) beneficiaries who enroll in managed LTSS and compare these to the change in outcomes for a comparable time period for beneficiaries who do not enroll in managed LTSS.
Role: Co-Investigator

Leslie Suen, MD

Acceptability Study Evaluating Buprenorphine Rapid Overlap Initiation Protocol Development (ASTEROID)
Agency for Healthcare Research and Quality
The objective of this proposal is to evaluate and enhance a rapid overlap initiation protocol (ROI) for initiating buprenorphine for opioid use disorder treatment, using the COM-B (capability, opportunity, motivation, and behavior) model as a framework to identify barriers and potential targets for intervention for both providers and patients. Our proposal uses a sequential explanatory mixed methods design to first evaluate existing outcomes of the ROI protocol (Aim 1) and to use in-depth interviews (informed by Aim 1 outcome data and the COM-B model) to identify barriers and facilitators to ROI protocol use, along with potential interventions to incorporate in an enhanced ROI protocol (Aim 2).
Role: K12 Scholar

Addiction Care Team SFGH Harm Reduction Program Evaluation (ACT SHaRP)
UCSF Pain and Addiction Research Center Fellowship
We are conducting a mixed-methods study, using electronic medical record (EMR) data and in-depth interviews, to evaluate the implementation of an evidence-based harm reduction program in a hospital setting for patients with substance use disorders (SUD), particularly those requiring acute pain management.
Role: Co-investigator

Vanessa Thompson, MD

Champion Providers
California H&W Dept of Health Care Services
The Champion Providers initiative builds on the pilot started in 2013 to harnesses the influence, power and respect of health care providers to build healthier communities. The program trains and supports motivated physicians and dentists throughout the state to add their professional influence and experiences to mitigate today's unprecedented obesity epidemic through policy, systems and environmental changes. By connecting physicians and dentists with their local health departments, community coalitions and other organizations, Champion Providers assist in addressing a range of local health concerns, ranging from access to healthy foods, increased opportunities for physical activity and other obesity prevention efforts, especially in low-income communities.
Role: Principal Investigator    

Maya Vijayaraghavan, MD

A community-based trial of a smoke-free home intervention in permanent supportive housing for formerly homeless adults. 
The focus of this proposal is on expanding access to voluntary smoke-free homes to formerly homeless residents residing in permanent supportive housing, and examining the impact of this intervention on reducing tobacco-caused disparities. We will conduct a multi-site, community-based cluster-randomized wait-list controlled trial of our multi-faceted smoke-free home intervention among 400 PSH residents residing in 20 permanent supportive housing sites across the San Francisco Bay Area. The primary outcome is voluntary adoption of smoke-free homes at 6-months follow-up and the secondary outcome is tobacco abstinence at 6-months follow-up. We will assess cost and cost-effectiveness of the intervention, and evaluate barriers to adoption and potential for scalability and sustainability. 
Role: Principal Investigator

Randomized trial of a contingency management smoking cessation intervention for homeless adults
The objective of this study is to conduct a pilot randomized controlled trial of a contingency management intervention for smoking cessation among people experiencing homelessness engaged in clinical care the Tom Waddell Urban Health Clinic in San Francisco, CA. We will: (1) adapt a known-efficacious extended contingency management cessation intervention to a novel population and setting, with the ultimate goal of increasing long-term abstinence among homeless adults seeking care in safety net health clinics, (2) develop a corresponding protocol for a randomized controlled trial (RCT), and (3) conduct a pilot RCT with N=90 participants to assess the feasibility and acceptability of the trial. 
Role: Principal Investigator 

The SF CAN Tobacco Thread 1 Task Force  
This project aims to reduce the incidence and mortality from the most common cancers in San Francisco that are likely to be affected by known interventions or better screening, including prostate, breast, liver, colorectal and tobacco-related cancers. In partnership with a community-based pharmacy and three navigation shelters in San Francisco, we will provide on-site access to tobacco cessation counseling and pharmacotherapy for people experiencing homelessness. Participants will receive cessation treatment for 3 months delivered on-site and free of cost or billed to MediCal insurance. We will evaluate behavioral outcomes of reduction in consumption and quit attempts during study duration, and examine whether receipt of on-site cessation services reduce tobacco use among participants in the study. 
Role: Principal Investigator

Integrating tobacco use cessation into Family AIDS Care and Education Services (FACES) in Kisumu, Kenya
This project will evaluate integration of the Guidelines’ interventions into HIV care clinics through the Family AIDS Care & Education Services (FACES). FACES is a 16 years-partnership between the Kenya Medical Research Institute, the University of California San Francisco and the Kisumu County Ministry of Health. We will conduct a cluster randomized controlled trial at 20 FACES-supported clinics, recruiting 580 patients to compare the effectiveness and cost-effectiveness of an intensive (Nicotine Replacement Therapy and Bupropion, 12 sessions of behavioral counseling through in-person and telemedicine approaches (telephone and texts), and provision of a quitline number) versus a brief (one-time counseling plus the quitline number) intervention.
Role: Co-investigator

Strategies for treating tobacco use among high risk, low income smokers
This project develops a community practice-based research collaborative involving San Francisco’s safety-net primary care network and a large community-based behavioral health services provider, with the aim of more effectively addressing smoking in low income populations. We are working with the quality improvement teams within the Population Health Division of the San Francisco Health Network to develop Epic electronic health record (EHR)-related interventions to improve delivery of smoking cessation services to patients seeking primary care in the San Francisco Health Network. We have developed methods to estimate quit attempts and factors associated with quitting among patients seeking primary care in 14 primary care clinics, with a goal to eliminate barriers to receiving cessation services and increase cessation. 
Role: Co-Investigator