Identifying and addressing family-prioritized social drivers of health to improve the long-term health of Black preterm infants

PROJECT SUMMARY/ABSTRACT One in 10 births results in preterm delivery, and preterm birth is a significant source of childhood morbidity, mortality, and healthcare utilization.1 Black families are at highest risk for preterm birth and adverse child health due to structural racism.2-4 Addressing social drivers/determinants of health (SDH) as sequela of structural racism as well as predictors of poor health outcomes can improve pediatric health outcomes.5-7 Several professional organizations recommend addressing social needs in pediatric settings to reduce racial inequities in health outcomes.8-11 However, there is a lack of evidence to inform strategies to effectively address SDH to promote the long-term health of Black preterm infants. Dr. Karvonen's long-term goal is to become an independent researcher who develops, implements, and disseminates SDH interventions that improve the long-term health of Black preterm infants. Centering this population, her overall objectives are to identify the relationships between neighborhood-level SDH, prematurity, and long-term health; identify family-prioritized SDH and related interventions; and evaluate the feasibility and acceptability of a novel intervention that addresses SDH. The central hypothesis of her work is that addressing SDH at birth will improve the positive health and neurodevelopment of Black preterm infants. The rationale is that understanding the critical components of SDH interventions to impact long-term health is crucial for developing an effective, scaled, and evidence-based SDH intervention for this population. To pursue her objectives, Dr. Karvonen will pursue these specific aims: (1) To determine associations between neighborhood-level SDH and long-term health among Black children using extant data from a large, national, longitudinal cohort; (2) To identify family-prioritized SDH and preferred approaches to interventions that address SDH using semi-structured interviews; and (3) To determine the feasibility and acceptability of a novel SDH intervention designed for the general pediatric population among Black preterm infant-caregiver dyads. The proposed work is innovative in its use of (1) a novel outcome, child positive health, in addition to more traditional health outcomes (2) centering the priorities of Black families with preterm infants, and (3) a novel intervention that addresses SDH. It is significant as findings will inform a future intervention specifically designed to address SDH to improve the long-term health of Black children born preterm, a NIMHD priority population. This work exemplifies the NIMHD priorities to "enhance the scientific knowledge base and design interventions to improve health outcomes to reduce and ultimately lead to the elimination of health disparities". To successfully pursue her proposed specific aims, Dr. Karvonen will receive training in advanced statistical methodology, qualitative research, and implementation science through didactic courses and experiential studies at the University of California, San Francisco. She will also be guided by a multidisciplinary mentorship team of leaders with strong expertise across her training goals.