Emphasis Areas

Drug policies, including youth access to tobacco laws, cigarette taxes, smoke-free air policies, alcohol policy and medical marijuana laws, can have an impact on a variety of health, social and economic outcomes, especially on traditionally marginalized or otherwise vulnerable populations. A number of CHR programs examine and/or effect policy change.
Faculty leads: Amy Paulson, MPH; Patti Kiger, MEd; Paul Harrell, PhD

Marijuana decriminalization and legalization policy changes may have affected race-based disparities in marijuana possession arrests and marijuana use. A CHR study is examining the impact of different features of marijuana policy so that we can make specific policy recommendations based on their real-world impact on youth.
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Substance-use laboratory space at the Community Health and Research division allows for the real-time collection of data related to smoking and the use of e-cigarettes (i.e., "vaping") to better understand the health impact of alternative tobacco use and provide recommendations for policy.
Faculty lead: Paul Harrell, PhD

Using a community engaged-research process, researchers at the Community Health and Research (CHR) division are addressing significant gaps in our understanding of smoke-free housing policy and are providing important guidance on how we can better protect children and other non-smokers in public housing from significant health risks.
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Healthy Alternatives for Little Ones (HALO) is an evidence-based, social-emotional learning curriculum and substance abuse prevention program for children ages 3-6. HALO has been implemented since 2018 in preschool classrooms, child care centers, and virtually across Hampton Roads. The Consortium for Infant and Child Health (CINCH) facilitates teacher training and HALO lessons, provides educational materials and conducts tobacco policy/environmental assessments for community action plan development.
Faculty lead: Sara Rothenberg, MPH

CHR has led multiple community-engaged projects to understand barriers and improve indoor air quality for children with asthma in low-income housing. Caregivers are given supplies and receive education on asthma, the effects of smoking and minimizing exposure to prevent allergic reactions.
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Since 2012, through the Tobacco Use Control Project, the CINCH has consulted with local cities to increase taxes on tobacco products, with revenues used for schools and improving public health.
Faculty lead: Amy Paulson, MPH

CINCH also trains teachers, school nurses and administrators using the American Lung Association’s Asthma 101 booklet and prepares local school nurses through the Asthma and Allergy School Nurse Expert Program to take the National Asthma Certification Exam. 
Faculty lead: Amy Paulson, MPH

In an effort to curb vaping among youth, the Community Health and Research (CHR) division conducted research examining teen e‑cigarette use in order to inform the development of effective countermeasures. In partnership with local teens, an e-cigarette risk communication campaign, was developed and found to be effective in increasing knowledge, changing risk perceptions and reducing intentions to vape. 
Faculty lead: Kelli England

CHR is using implementation science methodology and a community-engaged research process to determine:

• Level of need for vaping prevention and cessation from adolescents in the region
• Available resources for adolescents at different risk tiers (e.g., never-user, experimenter, dependent)
• Gaps and barriers to implementation of vaping prevention and cessation resources

The goal is to work with stakeholders in the community to develop and implement systems to connect adolescents with appropriate, feasible, and acceptable vaping prevention and cessation resources.  Faulty lead:  Kelli England, PhD

Using qualitative and quantitative methods, researchers in the division are developing e‑cigarette measures, including an expectancy measure for e-cigarettes. Expectancies are associated with initiation and maintenance of substances. This research involves focus groups, qualitative analysis, input from an expert panel, survey administration and analysis using Confirmatory Factor Analysis and Item Response Theory. Populations studied include teenagers and college students.   Faculty lead: Paul Harrell, PhD

Motor vehicle crashes are the leading cause of death for children over age 5. Our work in this area blends psychological, public health and risk communication principles to devise novel approaches to motivate behavior change among hard-to-change populations.

We have worked with national and state agencies to examine various messaging approaches in child passenger safety, to provide recommendations and workshops for improved messaging to the public and to provide continuing education for professionals.
Faculty lead: Kelli England, PhD

In response to the low booster-seat use, we studied the use of health risk messages in booster seat campaigns. The resulting Boost ‘em in the Back Seat video conveys the power of crash forces to motivate parents to use booster seats and back seats for older children. The research-supported video and its companion website has had more than 22 million views in only its first year of release. 
Faculty lead: Kelli England, PhD

Car Safety Now uses a social marketing approach and houses research-supported programs in free downloadable toolkits. Our online and community-engaged efforts target not only parents, but also teachers and health professionals who may use these programs in their work with families. Car Safety Now encompasses the Boost ‘em in the Back Seat program as well as our other empirically supported school-based programs for tweens (Make it Click) and teens (In Control).
Faculty lead: Kelli England, PhD

Our division has a history of implementing and evaluating young driver risk-reduction training programs in military, school and courtroom settings, with a particular focus on applying alcohol harm-reduction strategies to DUI prevention.
Faculty lead: Kelli England, PhD

Eastern Shore Healthy Communities (ESHC) addresses obesity and resulting chronic diseases through a multi-sector leadership team focused on policy, systems and environmental change. This network addresses obesity through a "livable communities" approach that emphasizes the importance of place and a guiding principle that health begins in the community. ESHC initiatives include student BMI data collection, a youth leadership academy and healthy restaurant initiatives.
Faculty lead: Patti Kiger, MEd

The Community Health and Research division is developing interventions to prevent diabetes in Portsmouth with initial focus on high-risk groups, including food insecure populations and food bank clients. One focus area is community engagement in the Cradock neighborhood, a diabetes hot spot. A community needs assessment, including Photovoice methods, identifies Cradock resident perceptions of healthy lifestyle assets and barriers. This analysis will be used to develop a list of priority needs for interventions, programs and economic development.
Faculty lead: Amy Paulson, MPH

Healthy Kids builds upon prior initiatives, expanding to an early childhood nutrition focus, addressing a need for breastfeeding support for working moms and promoting optimal nutrition from infancy through preschool. The initiative will work with early care and education centers (ECEs) to encourage healthy food and beverage and physical activity policies. Healthy Kids also engages regional ECEs to complete nutrition/physical activity policy and environmental assessments and implement policy changes to promote complete childhood nutrition in early care settings. A multimedia campaign will promote the Healthy Kids Initiative and its activities.
Faculty lead: Sara Rothenberg, MPH

There has been an upsurge in abuse of synthetic (club) drugs in China, the U.S. and elsewhere internationally. Unlike heroin and opium, synthetic drugs often stimulate sexual activities and contribute to unsafe sexual practices and STIs.

In an NIH-funded R01 grant (PI: Dr. XIushi Yang, Old Dominion University), a team of interdisciplinary  researchers are studying causes and   consequences of synthetic drug abuse in adult population in China.  The objectives are to:

1. Develop a model of causes and health consequences of synthetic drug abuse.
2. Recruit drug users and non-users to test the model, and Identify effective interventions.
3. Analyze the longitudinal mixed methods data to test the conceptual model to enhance our understanding of causes and health consequences of synthetic drug abuse and to identify focal points for effective interventions. 

The overarching hypotheses are first, that differences in intrapersonal and interpersonal risk/protective factors, interacting with community contextual characteristics, explain why some people use drugs and/or have risky sex while others do not; and second, that neuro-behavioral effects of synthetic drugs (on state/mood), interacting with unique synthetic drug-use settings, such as entertainment venues or group gatherings, render users vulnerable to unsafe sex and STIs.

Findings will be used to support the design of multicomponent interventions for the simultaneous reduction of drug use and STIs in China and beyond.  Faculty lead: Tracy Fu, PhD

Hampton Roads has one of the highest rates of SIDS in the country. The Community Health and Research division is exploring why this is true and what can be done about it. Unsafe sleep practices, such as placing babies on their stomachs, having items in cribs and co-sleeping, contribute to infant suffocation. A qualitative study is asking caregivers and home visitation staff about safe sleep knowledge, experiences and behaviors.
Faculty lead: Tracy Fu, PhD

The Consortium for Infant and Child Health (CINCH) promotes breastfeeding in two ways. Business Case for Breastfeeding builds on a community implementation model that provides assistance to implement employer-based policy and environmental changes supporting lactation in the workplace. To date, 20 workplaces have made changes, potentially impacting more than 10,000 female employees. 

Breastfeeding Welcome Here helps create safe, supportive breastfeeding environments to decrease stigma and shift social norms for mothers nursing in public places; CINCH works with communities to facilitate compliance with new state legislation.
Faculty lead: Amy Paulson, MPH

#757Breastfeeds is a collective of community members and stakeholders working to build a supportive community for human milk feeding in Hampton Roads through collaboration, education, and advocacy. #757Breastfeeds is committed to promoting equity through systems changes, reducing racial disparities in breastfeeding, and improving breastfeeding support for all families.  Faculty lead: Sara Rothenberg, MPH

African Americans and teen mothers are particularly at risk for poor birth outcomes. The Loving Steps program supports community health workers and care coordination through home visits, providing parent education and helping connect moms with community services. Moms are screened for medical, nutritional, social and economic risks and work with staff to develop a care plan. Mentoring support is provided to mothers until the baby is 2 years old. Faculty lead: Amy Paulson, MPH

Using national and state birth outcomes datasets, division faculty, in partnership with Public Health practicum students, examine such issues as racial disparities in safe sleep practices and breastfeeding, maternal smoking, relationships between knowledge of maternal-child health services and birth outcomes, association between pregnancy intention and breastfeeding, and birth outcomes in teen mothers across the U.S.
Faculty lead: Tracy Fu, PhD

Minus 9 to 5 is a network of cross-sector stakeholders from education, medical, childcare, business, nonprofit, philanthropic and local and state government sectors. Together, we are committed to creating an impact for children and their families from conception to kindergarten. Ensuring that each family in Hampton Roads will be equipped and supported to raise children who are healthy, thriving and ready to learn is our vision. By aligning and coordinating the many programs and services that serve young children and their families, Minus 9 to 5 unites a variety of community stakeholders dedicated to improving the lives of our region’s youngest residents and their families.  https://vimeo.com/349062744 
Faculty lead: Jane Elyce Glasgow, PhD

Although the Back to Sleep campaign (currently called “Safe to Sleep”) has led to a significant reduction in infant mortality over the past two decades, sudden infant death syndrome (SIDS) is still the leading cause of death in infants aged 1 month to 1 year in the United States, with an estimated number of 3,500 infants dying yearly from SIDS and other unsafe sleep environment-related causes.  Sleep-related death is the second leading cause of infant mortality in Eastern Virginia, with over 139 infant deaths being reported in 2019 alone, accounting for 6.27 per 1000 live births.  

The Community Health and Research division is exploring the driving forces behind SIDS in the region, using mixed method research to understand: 1) the patterns of infant sleep practices and disparities across sub-populations in the communities; (2) the caretakers’ perceptions about risk/safety related to infant sleep, attitudes about co-sleeping and bed-sharing with infants, infant sleep positions, 3) the availability of and utilization of infant sleep-related products by families. Findings are used to inform the design and implementation of  evidence based intervention for the reduction of SIDS and social/racial disparities.    Faculty lead: Tracy Fu, PhD

Using national and state birth outcomes datasets, Community Health and Research Division faculty examine the patterns and disparities in key maternal and child health issues affecting US populations in partnership with the Public Health practicum students at the EVMS School of Health Professions and the medical students at the Eastern Virginia Medical School.  A range of secondary data analysis has been conducted to examine such issues as racial disparities in safe sleep practices, and breastfeeding, maternal smoking, relationships between knowledge of maternal-child health services and birth outcomes, contraceptive use,  pregnancy intention, and other factors associated with birth outcomes and health disparities across subpopulation by age, race/ethnicity and socio-economic status, in the U.S.  Faculty lead: Tracy Fu, PhD

At the Community Health and Research division, we focus on reducing health disparities experienced across populations. We recognize that much of our health is determined not just by lifestyle choices, but by our environments, including where we live, learn, work and play.

The Consortium for Infant and Child Health (CINCH) is acutely focused on reducing health inequities. The Disparities for Women of Color in Pregnancy & Motherhood Task Force is working to reduce maternal morbidity and mortality disparities for women of color by increasing and promoting equality, advocacy, provider accountability, and system changes in the healthcare setting. Other CINCH initiatives and programs, including #757Breastfeeds, Loving Steps, and COVID-19 response also seek to reveal, challenge, and address health inequities in our community.  Faculty leads: Amy Paulson, MPH; Sara Rothenberg, MPH

Minus 9 to 5 will measure the following indicators of children’s health, thriving, and readiness to learn; we seek to address health disparities that exist (and vary) in the five Southside cities in Hampton Roads by tracking metrics related to the nine desired outcomes that we strive to impact below:

• Increase participation in early prenatal care
• Increase number of babies born at healthy birth weights
• Decrease infant mortality rates in the first year of life
• Increase participation in home visiting services
• Increase children immunized on-schedule
• Increase children receiving well-child visits
• Increase children receiving developmental screenings
• Increase kindergarten readiness as measured by the Kindergarten PALS
• Decrease number of children retained in kindergarten

The COVID-19 pandemic has disproportionately impacted low-income communities of color. An NIH-funded study is examining how widespread mistrust of information about COVID-19 has contributed to low compliance with public health guidance in these communities. Researchers are working with a regional community advisory board comprised of residents in low-income housing to collaboratively develop community-informed strategies to address resident concerns about COVID-19 vaccination and to make public health guidance more relevant to their needs.

The Community Inclusion and Health Equity (CIHE) Initiative collaborates with the Office of Diversity and Inclusion to improve health equity across Hampton Roads by facilitating community engagement and feedback in the areas of research, education, clinical care and administration at Eastern Virginia Medical School. 

The CIHE Initiative aims to expand institution-wide community engagement efforts; develop and expand infrastructure; develop and provide training and technical assistance to EVMS faculty, staff and students; and develop and research new methods to engage and serve under-resourced communities in Southeastern Virginia.  Faculty leads:  Mekbib Gemeda

The Community Health and Research division is developing interventions to prevent diabetes in Portsmouth with initial focus on high-risk groups, including food insecure populations and food bank clients. One focus area is community engagement in the Cradock neighborhood, a diabetes hot spot. A community needs assessment, including Photovoice methods, identifies Cradock resident perceptions of healthy lifestyle assets and barriers. This analysis will be used to develop a list of priority needs for interventions, programs and economic development.     Faculty lead: Amy Paulson, MPH

Comprehensive Sex Health Education for School-Age YouthCities (e.g. Norfolk and Portsmouth) in Hampton Roads reported some of the highest teen pregnancy and sexually transmitted infections (STIs) among youth in the Commonwealth of Virginia.  Access to comprehensive sexual education is limited due to a range of social, economic, cultural and structural barriers.  Abstinence-only education has been the primary focus of school-based sexual education.

With funding support from the Virginia Department of Health (VDH)/Health Resources and Services Administration (HRSA), our faculty partner with the Norfolk Public Schools (NPS) and other community partners to implement Get Real, a comprehensive sexual education program aimed at reducing teen pregnancy rate and improving sexual health outcomes among school-age youth.  The program focuses on three objectives: 1) Reduce incidences of teen pregnancies through implementing a comprehensive sexual education intervention among middle school and high school age youth; 2) Nurture a cohort of high-performing health educators and trainers in Norfolk via sexual education capability-building trainings and mentoring to ensure long-term program sustainability; 3) Collect data to inform evidence-based program monitoring and evaluation to support future program scale-up for bigger and long-term impacts.  Faculty lead:  Tracy Fu, PhD

Asian American and Pacific Islanders (AAPIs) have been stereotyped as model minorities over the past decades.  It is largely ignored that AAPIs comprise subgroups of people who are culturally and economically diverse.  And a substantial population of AAPIs are linguistically isolated and have experienced significant social and health disparities.  The lack of disaggregated data has contributed to the pervasive stereotype of Asian Americans as being healthier, which has systemically affected the provision of health care to AAPIs, and have further aggravated health disparities in AAPIs.

In collaboration with the New York University’s Center of the Study of Asian American Health (NYU-CSAAH), a Community Health Resources and Needs Assessment (CHRNA) study led by Cynthia C. Romero, M.D. (PI) at the Brock Institute and Dr. Tracy Fu (Co-PI) addresses tackle the health disparities in APPIs with three objectives: 1) to understand specific health challenges in AAPIs in Eastern Virginia through collecting mixed-methods data on various health topics; 2) to gather community level data to understand health issues, priorities, and concerns of AAPI communities; 3) to understand the driving forces and mechanisms of health disparities through in-depth interviews with  community stakeholders.  The study uses a community-based participatory approach to ensure meaningful reach into these underserved communities, the development of culturally and linguistically appropriate tailored data collection instruments and methods to inform evidence-based program services for AAPI in Eastern Virginia Region.  Faculty lead:  Tracy Fu, PhD