Center for Chronic Disease Reduction and Equity Promotion Across Minnesota (C2DREAM)
C2DREAM aims to research the contribution of structural and interpersonal racism to disparities in chronic disease including cardiovascular disease (CVD) and the related chronic conditions (RCC) of hypertension and obesity.
In Minnesota, where the murder of Mr. George Floyd at the hands of police instigated a local, national, and global reckoning on the pervasiveness of racism, there is an urgent need to understand and ultimately address the ways that racism undermines the well-being of Black, Indigenous, and people of color (BIPOC) communities. The mission of C2DREAM is to reduce disparities in CVD and RCC experienced by BIPOC communities including immigrants and refugees across Minnesota.
C2DREAM's regional partnership of academic institutions and community stakeholders is poised to understand and ultimately address the ways that racism undermines the well-being of BIPOC communities across Minnesota.
Save the Date! May 2023 Health Equity Conference
The C2DREAM Administrative (AD) Core will provide strong, equity-guided governance, administrative, and communications infrastructure; coordinated data collection of innovative measures of racism at multiple levels and shared implementation processes; innovative research assessing the multifactorial relationship between structural and interpersonal racism, intervention efficacy, and chronic disease-related behavior change; innovative programming that connects trainees, researchers, community stakeholders, and policy makers in knowledge sharing and application for change; and equity-oriented rigorous evaluation to assure center impact.
The AD Core will foster C2DREAM’s regional impact in several important ways:
1. Provide the infrastructure, governance, and leadership to ensure that all C2DREAM components operate efficiently across the region.
2. Leverage innovative means to assess racism at multiple levels.
3. Augment activities offered by other Cores to creatively support the productivity of early-stage researchers.
4. Apply robust equity-grounded multimodal evaluation methods to inform flexible adaptation of our approaches and ensure we achieve the Center’s goals, and promote exportation of lessons on the most effective elements for use by other P50 centers.
There is a critical need to support early-stage investigators (ESIs) researching solutions to well-documented disparities in CVD and RCC that disproportionately burden communities identified as Black, Indigenous and people of color (BIPOC). This work requires direct participation from the groups most affected, who are traditionally underrepresented in science and medicine (URSM); unfortunately, URSM investigators often lack institutional resources and structural supports that are critical for success.
To address these needs, the Investigator Development (ID) Core has two primary goals:
1. Administer a pilot grant program that supports and empowers awardees to conduct high-impact research on CVD and RCC among BIPOC communities across Minnesota.
2. Prepare the next generation of investigators to conduct multi-level, multi-disciplinary interventional research to address racism and other social and structural determinants of CVD and RCC disparities.
The ID Core will have impact by creating a rigorous infrastructure designed to promote success of ESIs (including postdoctoral fellows, ESIs and community researchers from other C2DREAM-aligned programs across the region) and improve recruitment and retention of URSM investigators in the scientific workforce addressing chronic disease disparities.
Community engagement is essential for developing, conducting and disseminating research on the prevention, treatment and management of chronic condition disparities in BIPOC communities. To support the success of the goals of C2DREAM a proactive community-engagement infrastructure is needed, co-led by a coalition of expert regional stakeholders, to develop critical and anti-racist community engagement processes and disseminate relevant and actionable information and findings to stakeholders across the region.
The Community Engagement (CE) Core’s overarching goal is to support the activities of C2DREAM by building the strong foundation of critical and anti-racist community engagement practices needed to meaningfully address the drivers of disparities in chronic disease risk and outcomes across BIPOC communities in Minnesota. The CE Core will:
1. Support the activities of C2DREAM by building a regional community and academic Coalition to offer guidance and input on engagement and dissemination.
2. Build a strong foundation of critical and anti-racist community engagement practices academic and community stakeholders.
3. Guide community engaged informed dissemination throughout C2DREAM.
4. Evaluate CE Core activities using RE-AIM.
The CE Core will generate sustained impact by creating an innovative infrastructure for community engagement and dissemination on research on the prevention, treatment and management of cardiovascular disease and the related chronic conditions of hypertension and obesity, particularly in relation to health disparities impacting BIPOC communities.
Healthy Immigrant Community: Mobilizing the power of social networks for cardiovascular risk reduction among Somali and Hispanic persons with overweight and obesity
Immigrants often arrive to Minnesota with healthier cardiovascular risk profiles than the general population, but these health advantages disappear over time, and rates of obesity quickly increase. Accumulation of cardiovascular risk is precipitated, in part, by systemic factors that promote the adoption of unhealthy behaviors after immigration; namely a sedentary lifestyle and consumption of calorie dense foods. Yet few strategies exist to effectively promote health behavior change in immigrant communities, and clinical health promotion programs are often difficult to access or utilize by patients with limited English proficiency.
The objective of Project 1 is to leverage existing social networks for health behavior change relevant to obesity and cardiovascular risk among immigrant populations in Southeast MN. In this project our team proposed to build on the prior success of WellConnect, a robust infrastructure developed by a member of our team for implementing multi-level evidence-based health promotion programs and integrating them within health care systems, tailoring these programs to the needs of immigrant communities. To achieve our objective, Rochester Healthy Community Partnership (RHCP) will test the efficacy of this social network intervention within WellConnect and evaluate its potential dissemination and sustainability.
Project 1 aims to:
1. Assess the efficacy of a social network-informed CBPR-derived health promotion intervention on obesity and other measures of cardiovascular risk in two immigrant communities.
2. Assess the impact on sustainability and uptake outcomes of embedding a social network-informed CBPR-derived intervention within a regional health promotion resource hub.
Project 1's expected product will be a CBPR-derived, social network-informed intervention to reduce cardiovascular risk among two immigrant groups. Project 1 will be the first to evaluate a social network health promotion intervention among immigrant populations. Given that over one million immigrants arrive in the US annually, the potential public health impact of this work is considerable.
Smoking Cessation Outreach for Racial Equity (SCORE): A Pragmatic Trial of Chronic Disease Approaches To Ameliorate Tobacco Related Cardiovascular Disease Health Disparities
Compared with Whites, Black, Indigenous, and people of color (BIPOC) communities in the US experience disproportionate health consequences from tobacco use, particularly commercial cigarettes. Cigarette smoking prevalence rates are higher among certain BIPOC communities. Among people who smoke, those who identify as BIPOC, compared to their White counterparts, experience a greater morbidity and mortality from tobacco-related chronic diseases, especially CVD & RCC. Although there are numerous evidence-based cessation treatments (EBCT) for tobacco cessation, during quit attempts, BIPOC are less likely than Whites to receive and utilize EBCT. Structural and interpersonal racism and discrimination including access to EBCTs may account for their lower utilization among BIPOC patients. Few EBCTs have been specifically developed, rigorously evaluated, or implemented for BIPOC patients.
Project 2 aims to:
1. Conduct a hybrid type 1 implementation-effectiveness RCT to examine the direct effect of AAC+LPO vs. AAC on population-level smoking abstinence at 18 months and treatment utilization among 2,000 BIPOC patients.
2. Examine the moderating effects of structural racism and daily interpersonal discrimination on intervention effectiveness.
3. Use a mixed methods approach to evaluate implementation outcomes of appropriateness, acceptability, and feasibility of AAC and LPO for BIPOC patients.
Wítaya woȟtani k´a čhaǧé š’agya (Dakota) Maamawi Gidani-Mashkawiziimin (Ojibwe)
Working/Braiding Together and Growing Stronger
Urban Native American communities experience significant and persistent disparities in cardiovascular diseases, obesity, hypertension, and their behavioral precursors physical activity and diet. Evidence-based interventions (EBIs) that focus on access to environments and programs that support healthful food and physical activity opportunities have strong potential to reduce and prevent cardiometabolic risk factors such as obesity, and hypertension as well as cardiovascular disease. Missing from previous research is the embedding of EBIs in a broader understanding of Native American context including cultural and community assets such an orientation towards sovereignty and self-determination, as well as a recognition of structural contexts framed by racism and marginalization.
Project 3 aims to:
1. Evaluate the effectiveness of racism-conscious enhanced GTO guidance, tools, training and technical assistance on intervention implementation for after-school physical activity and home visitation healthy eating and physical activity programs, using RE-AIM metrics of program adoption, reach, content fidelity, dose delivered, and dose received.
2. Evaluate contributors of racism-conscious enhanced GTO implementation strategies on implementation outcomes among partnering program leadership and program staff in after-school physical activity and family home visitation programs based on race(ism) adapted CFIR constructs.
Project 3 will use proven effective implementation strategies to build program organizational leadership and program staff implementation capacity to successfully engage urban American Indian families in strengths-based, culturally-centered, evidence-based programs to promote youth physical activity and healthy eating. Sustained program engagement among urban Native American families will promote healthy eating and physical activity behaviors that will reduce future diabetes, obesity and cardiometabolic / cardiovascular disease risk in this highly burdened community.
Community partners in this work include the Native American Community Clinic.
This research center is a partnership between the University of Minnesota Program in Health Disparities Research, the University of Minnesota School of Public Health, Hennepin Healthcare Research Institute, and Mayo Clinic.
Funding supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number P50MD017342.
C2DREAM Principal Investigators
- Jessica Austin, PhD
- Timothy Beebe, PhD
- Kasey Boehmer, PhD, MPH
- LaPrincess C. Brewer, MD, MPH
- Andrew Busch, PhD, LP
- Matthew Chinman, PhD
- Matthew Clark, PhD, LP
- Brooke Cunningham, MD, PhD
- Felicity Enders, PhD, MPH
- Susan Everson-Rose, PhD, MPH
- Steven Fu, MD, MSCE
- Sarah Gollust, PhD
- Patrick Hammett, PhD
- Kristen Jacklin, PhD
- Sandra Japuntich, PhD, LP
- Rhonda Jones-Webb, PhD
- Warren McKinney, PhD
- Jude Mikal, PhD
- David B. Nelson, PhD
- Sean M. Phelan, PhD
- Rebekah J. Pratt, PhD
- Elizabeth Rogers, MD, MAS
- Pravesh Sharma, MD
- Irene G. Sia, MD
- Antony Stately, PhD
- Katherine Diaz Vickery, MD, MSc
- Mark Wieland, MD
- Julian Wolfson, PhD