I bring a multi-disciplinary research approach, setting forth a new path to explore how social factors shape life for survivors of chronic disease.
I bring a multi-disciplinary research approach, setting forth a new path to explore how social factors shape life for survivors of chronic disease.
Guaranteed income (GI) initiatives have the potential to improve health outcomes and reduce health disparities; however, few existing initiatives have assessed health outcomes or social determinants of health, and none have assessed impacts on health disparities. In this application, we propose to develop a framework for what health, social determinants of health, and health disparity indicators might be addressed in a GI pilot and what sources of data might be available for those assessments.
Sponsor: Johns Hopkins Urban Health Institute
This study uses the nation’s largest pharmaceutical claims database to assess the frequency with which patients choose not to pay for PrEP prescriptions at the pharmacy point-of-sale, known as a prescription reversal. The results of this first ever study of PrEP prescription reversals will guide who to target for subsequent R series intervention grants focused on increasing retention in PrEP care and can ultimately inform federal safety net programs, industry sponsored medication assistance programs.
Sponsor: NIH/ National Institute of Nursing Research (NINR) R21NR018387
Although pre-exposure prophylaxis (PrEP) is effective in preventing HIV, high out-of-pocket costs (i.e., co-pays, deductibles, and co-insurance) may prohibit uptake of the intervention. This study evaluates the extent to which out-of-pocket costs may limit PrEP uptake. The results of this study will provide insight for public health programs as well as for development of future interventions that address cost as a barrier to PrEP uptake.
Sponsor: NIH/National Institute of Mental Health 1R21MH118019-01
Our goal is to elucidate the pathways through which county-level structural racism influences hypertension and its risk factors among 30,000+ Black and White participants in counties across the US from the REasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort. Building on our research using our novel multi-domain measure of structural racism, this multilevel analysis will quantify the contribution of structural racism to hypertension risk factors, morbidity, and severity, and estimate hypertension health care costs that could be saved if structural racism was eliminated.
Sponsor: NIH/National Heart Lung and Blood Institute (NHLBI) R01HL164116
Using data from a scoping review and primary data collection with key informant interviewees and clients of formers cash transfer programs in Baltimore, we will develop a person-centered and evidence-informed framework of guaranteed income is linked to health and health equity.
This study uses the nation’s largest pharmaceutical claims database to assess the frequency with which patients choose not to pay for PrEP prescriptions at the pharmacy point-of-sale, known as a prescription reversal. The results of this first ever study of PrEP prescription reversals will guide who to target for subsequent R series intervention grants focused on increasing retention in PrEP care and can ultimately inform federal safety net programs, industry sponsored medication assistance programs.
Sponsor: NIH/ National Institute of Nursing Research (NINR) R21NR018387
Disparities in breast cancer screening, risk, and mortality have been found both in studies of sexual minority women and studies of racial minority women. Data from both sexual minority women and cisgender Black women (i.e. female at birth who identifies as a woman) indicate lower use of timely screening mammography, despite higher risk of breast cancer for sexual minority women than heterosexual women and higher breast cancer mortality rates for Black than White women. This mixed-methods study investigates breast cancer screening behaviors (i.e. mammography) and follow-up (i.e. ultrasound or clinic visit) after abnormal results for Black sexual minority women.
Sponsor: Faculty Innovation Fund
Social capital, a characteristic of a collective, has been associated with better health for individuals. This dissertation work explored the extent to which social capital was associated with cancer preventive behaviors for African-Americans in Philadelphia, and whether or not African-American communities had unique social capital structures compare to other race groups. This study incorporated propensity scores, geocoding, and multi-level modelling.
Sponsor: NIH/National Cancer Institute (NCI) 1F31CA136236-01
Although pre-exposure prophylaxis (PrEP) is effective in preventing HIV, high out-of-pocket costs (i.e., co-pays, deductibles, and co-insurance) may prohibit uptake of the intervention. This study evaluates the extent to which out-of-pocket costs may limit PrEP uptake. The results of this study will provide insight for public health programs as well as for development of future interventions that address cost as a barrier to PrEP uptake.
Sponsor: NIH/National Institute of Mental Health 1R21MH118019-01
Upper body breast-cancer related lymphedema (BCRL) is a persistent adverse outcome of cancer treatment that affects the physical health and quality of life of up to 1 in 3 of the 2.9 million breast cancer survivors in the US. For those with BCRL, known predictors of progression include BMI, type of surgery and radiation treatment, all of which are associated with social factors. However, no studies have explored the association of race/ethnicity, geography or other social and environmental factors with BCRL progression. The purpose of this study is to explore the relationship between macro- (neighborhood) and micro-level (individual) social and environmental risk factors for the persistent adverse effects of cancer treatment, and the costs they pose, using the example of breast cancer survivors who have BCRL as a persistent adverse effect of breast cancer surgery.
Venezuela has very low rates of breast cancer, but there is little research explaining the low rates. This independent mixed methods research project focused on perceptions of breast cancer preventive behaviors by Venezuelan women. Focus groups and surveys unveiled that Venezuelan women in the sample did not have confidence that self-breast exams (which were still advocated at that time) were an effective mode of early detection for breast cancer.
Sponsor: William J. Fulbright Foundation/ IIE
Dean, Lorraine T & Doshi, Jalpa A. “Preventive care is under threat: PrEP now or pay later” The Hill. 20 July 2024. https://thehill.com/opinion/healthcare/4780432-braidwood-prep-hiv-preventative-care/
Egan, John, “Bad credit can affect your mental and physical health.” Yahoo News. 24 April 2023. https://finance.yahoo.com/news/bad-credit-affect-mental-physical-110052560.html?guccounter=1
Kast, Sheila. “On the Record: Baltimore tests a guaranteed income for 200 young parents.” NPR/WYPR. 18 May 2022. https://www.wypr.org/show/on-the-record/2022-05-18/baltimore-tests-a-guaranteed-income-for-200-young-parents
Rubin, Rita. “Distrust In Health-Care System Might Prevent Breast Cancer Patients From Getting Recommended Care” com. 1 December 2017. https://www.forbes.com/sites/ritarubin/2017/11/30/distrust-in-health-care-system-might-prevent-breast-cancer-patients-from-getting-recommended-care/#43861c2f3100
Lorraine T. Dean, ScD
Dr Dean Lab, LLC
Baltimore, MD 21205
Email: drltdean@gmail.com