Center for Health Outcomes and Population Research CoBRE

Leverage Points for Equitable Systemic Change to Reduce Alcohol Exposed Pregnancy
There is a great need for higher quality alcohol and substance exposed pregnancy (ASEP) reduction programs that account for the constellation of interpersonal, intrapersonal and community-level contributors. Such programs are particularly important for addressing ASEP-related health disparities within at-risk communities, such as American Indian women. This proposal utilizes community-based system dynamics simulated models to test and discern high-impact areas for intervention and best strategies for translating these findings into action-based systematic change.

Influence of Behavioral Economics Techniques on Medical Decision Making
这项研究的目的是通过调查医疗决策者来检验医疗决策中的行为经济学。具体来说，我们将测试一个假设，即通过各种经济技术改变选择架构(一个决定如何呈现)将增加积极的(更好的结果，更低的成本)医疗决策。

Momentary Relationships between Stress and Weight Regulation Behaviors after Bariatric Surgery
Obesity has become a worldwide epidemic, with especially high prevalence in rural areas including North Dakota. While bariatric surgery is an effective treatment for severe obesity, the course of long-term weight loss is variable. Such evidence underscores the need to identify and target the processes that may impede weight loss and maintenance in daily life. Stress is a dynamic construct that may elevate risk for problematic eating and physical inactivity by reducing individuals’ ability to engage in effective self-regulation.

This study will use ambulatory assessment methods to examine a state based model of problematic energy balance behaviors (i.e., loss of control eating, physical inactivity) among postsurgical bariatric patients. This model posits that momentary increases in stress will lead to reduced inhibitory control; in turn, these states of disinhibition will increase the likelihood of engaging in behaviors that impede weight loss (i.e., increased loss of control eating, decreased physical activity, and increased sedentary behavior). Further, to examine these processes specifically in a population that is at higher risk for poor weight-related health outcomes, this study will recruit postsurgical bariatric patients from Sanford Health, which is the largest rural not-for-profit health care organization in the U.S., operating in some of the most remote/frontier regions of the U.S.

Polygenic risk score phenome-wide association study to identify novel associations
This study aims to develop novel methods to systematically identify the pleiotropic effects of coronary heart disease (CHD) and Breast Cancer polygenic risk scores (PRS) on all other phenotypes in the linked electronic medical record (EMR). By doing so, it can also identify patients who may be at higher risk for developing undiagnosed CHD and/or breast cancer.

An Exploration of Rural-Urban Disparities in Colorectal Cancer Care in North Dakota and South Dakota

Colorectal cancer (CRC) is the second-leading cause of cancer mortality in the United States, despite being highly preventable, detectable, and treatable. Over the last decade, CRC incidence rates have decreased by 30% in the United States. North Dakota is in the lowest quartile for CRC screening and highest quartile for CRC incidence. While South Dakota has been faring better with screening, it has worse CRC outcomes with mortality, which may conversely be due to limited access to subspecialty care. We hypothesize that there are spatial/geographic and aspatial/socioeconomic disparities in access to care measures that impact CRC outcomes differently in these two rural Northern Plains states.

利用一个概念框架来推进医疗保健系统内的差异研究，我们的第一个目标将研究诊断和筛查年龄对达科他州癌症发病率的影响。我们的第二个目标将侧重于利用结肠镜检查和手术服务的空间可达性的多层次建模，并考虑旅行障碍、提供者能力、人口密度和社会经济因素，检测和理解农村CRC的地理差异。我们的第三个目标将通过对北达科他州和南达科他州热点县(CRC发病率高)和非热点县居民的态度、偏好和信念的问卷分析，来表征空间和空间障碍的相对重要性。我们预见，这些发现将使我们更好地了解和解决城乡儿童权利公约死亡率的差异，为今后制定干预措施以减少这些差异提供依据。