Each year, The Graduate School honors graduate students in programs throughout our University for their powerful discoveries that contribute to a better future for people and communities in North Carolina. We’re pleased to present 11 Impact Awards for 2022 — and to share the honorees’ own descriptions of their research projects.
“The Centers for Disease Control and Prevention (CDC) is a trusted source for public health information. However, during the COVID-19 pandemic, their guidance documents were too complex to be read and understood by the 21 percent of adults in North Carolina who read at or below basic reading levels, including approximately 70,000 adults with intellectual and developmental disabilities (IDD). Given that people with IDD are up to eight times more likely to die from COVID-19 than those without IDD, there was a pressing need to make CDC COVID-19 guidance documents more accessible.
The purpose of the project was to produce texts that were accessible to adults with low literacy skills, including adults with IDD. As part of this project, my team and I worked to create guidelines to make CDC documents easier to understand, which we applied to 25 of their documents. These documents have been downloaded more than 650,000 times since the end of 2020.
The results of this project had an immediate positive impact on adults with basic reading skills in North Carolina, including those with IDD, by providing them with urgently needed access to guidance that can help them remain safe during the COVID-19 pandemic. The project will continue to have an impact as the CDC integrates our guidelines into their communications.”
“As the cost of cancer care increases, over half of patients with cancer report cancer-related financial hardship, termed “financial toxicity.” Associated with worse clinical outcomes, financial toxicity threatens to limit decades of advancement in cancer care and exacerbate existing health inequities if left unaddressed. Promising research has pointed to financial navigation as an evidence-based practice to reduce financial toxicity by systematically identifying and addressing the financial needs of patients and their caregivers.
Prior to the implementation of financial navigation in rural and non-rural oncology practices across North Carolina, it is critical to understand how oncology care practices currently address financial concerns to inform intervention adaptation. Through qualitative interviewing and process mapping, we described the processes in place for identifying and addressing patient financial needs across ten diverse practices, comparing practices in rural and non-rural settings. Additionally, we synthesized stakeholder perspectives on barriers and facilitators to addressing patient financial needs within current workflows.
The results from this analysis point to several key opportunities for process improvement through financial navigation, such as remediating disconnects in referral pathways, defining roles among staff, and documenting available resources. Process mapping also engaged stakeholders in the visualization of existing procedures and workflows prior to intervention implementation. The findings from this analysis, as well as the relationships developed with stakeholders, are now supporting the implementation and evaluation of a two-year financial navigation program at each site.”
“Inorganic arsenic (iAs) is a toxic chemical element naturally existing in the environment. Globally, at least 140 million people are exposed to iAs at harmful levels through contaminated drinking water. This includes North Carolinians, where more than two million residents rely on private wells that aren’t regulated or regularly tested by governing officials. Health-protective limits for iAs in drinking water are established at 10 parts-per-billion (ppb). However, in 2012, our lab found that more than 1,400 of 63,000 wells exceeded this limit.
Exposure to iAs during pregnancy is linked to lower infant birthweight, and in 2019, one in 11 babies were born with low birthweight in our state—and contamination of drinking water may be a contributing factor. Fortunately, iAs is removed from the body through a process influenced by diet. Promising dietary interventions for iAs exposure have been tested in adults but are understudied in how that might affect birth outcomes.
My research seeks to close this gap. So far, my findings suggest there is a potential protective effect from vitamin B12 for pregnant people. This work could improve the dietary recommendations made to pregnant women, especially those relying on private well water in North Carolina.”
“Despite a global pandemic that forced millions of people to stay at home in 2020, North Carolina still experienced a significant increase in the number of fatal motor vehicle crashes last year, with at least 1,650 people losing their lives. This highlights an unfortunate trend in recent years where the number of crash-related injuries and fatalities on state roads has gone up. Adverse weather conditions—such as snow, rain, and fog—can contribute to someone’s risk of being in a motor vehicle crash. Still, little is known about how a driver's risk of experiencing a crash is influenced by inclement weather or how that risk differs across rural and urban regions of our state.
Our changing climate further magnifies the importance of this issue. In 2018, towns across North Carolina shattered rainfall records. Experts project that the southeastern United States will continue to experience significant increases in the frequency and intensity of heavy precipitation events over the next century. Therefore, it is critically important to understand how precipitation events influence how often and how severe motor vehicle crashes can be in our state.
My research directly addresses these issues by using nearly 20 years of historical car crash records, coupled with precipitation data, to calculate car crash risk estimates for all 100 counties across our state. Ultimately, as one of the fastest-growing regions in the country and as the changing climate increases the risk for extreme precipitation events in the future, I hope that this project will provide meaningful results for improving driver safety in North Carolina for years to come.”
“North Carolina’s tobacco industry has historically been very influential in the state’s economy and politics. North Carolina also has the second-highest rate of youth vaping in the country, with 35.5 percent of high school students who are current e-cigarette users. Therefore, research investigating the health effects of vaping is critical for North Carolinians. My research addresses critical knowledge gaps in the field of e-cigarette toxicology and informs multiple key groups: clinicians, about health effects of e-cigarette exposure; regulatory bodies, about the public health impacts of e-cigarette use; and the public, about the potential risks of e-cigarette use.
I have participated in outreach efforts to disseminate e-cigarette science to youth in North Carolina through the development of high school biology lessons in partnership with the Community Engagement Core, part of the UNC Gillings School of Global Public Health. As part of this lesson development, I have engaged with classrooms and teachers across the state, breaking down the barriers between the scientific research community and relevant stakeholders to address this important public health challenge. In addition, I developed a clinical questionnaire to facilitate conversations around vaping in primary care clinics in collaboration with the Mountain Area Health Education Center in Asheville.
Altogether, my research results and engagement with the broader community will have lasting impacts on many North Carolinians through expanding scientific knowledge about the effects of e-cigarettes and effectively communicating this science to the public.”
“An estimated 1.5 million North Carolinians live with a mental illness, but a national mental health workforce shortage has limited access to mental health care. In particular, there is a significant shortage of mental health providers who can prescribe psychotropic medications. Some states, such as Louisiana and New Mexico, have attempted to address this by implementing policies where psychologists with additional training can become licensed to prescribe these medications.
My study answers the question: How might implementing a similar policy in North Carolina affect unmet need for mental health prescribing in our state? To answer this question, I used state-level data on mental illness, mental health treatment, and available mental health providers. I examined how that unmet need might be reduced based on a theoretical policy which would allow psychologists to become allowed to prescribe medication. We estimate that 61 percent of mental health prescribing need in North Carolina is currently unmet. Our results suggest that if psychologists were to be granted prescriptive authority, unmet need for mental health prescribing could be reduced by 3.5 percent if only five percent of psychologists became licensed to prescribe. That gap would be reduced by 13.8 percent if 20 percent of psychologists became licensed to prescribe.
This research has significant policy implications as North Carolina seeks to address its mental health workforce shortage. Psychologists already outnumber psychiatrists in North Carolina. Creating a path for psychologists to become licensed prescribers creates the potential for a rapid increase in access to much-needed care. Additionally, increasing access to mental health services could help achieve the Healthy North Carolina 2030 goal of reducing the state suicide rate as put forward by the North Carolina Institute of Medicine.”
“The Cape Fear watershed region is home to more than two million North Carolinians. Due to the prevalence of industry along the watershed, per- and polyfluoroalkyl substances (PFAS), otherwise known as forever chemicals, now contaminate the watershed. The Environmental Protection Agency (EPA) has set a health advisory limit of 70 parts per trillion (ppt) of exposure to two PFAS known to cause adverse health effects. However, PFAS have been found at a total concentration of over 250 ppt in Pittsboro, North Carolina and 600 ppt in Fayetteville, North Carolina. A recent study of Wilmington, North Carolina residents’ blood serum found significant levels of PFAS in 99 percent of samples.
Motivated by the lack of a way to reduce the level of PFAS in the water, we’ve used chemistry to develop a technology that we call Ionic Fluorogels. These Ionic Fluorogels remove a variety of PFAS from water, including water collected at treatment plants in the Haw and Cape Fear watersheds. We designed Ionic Fluorogels to be easy to implement both at treatment plants and in the home. Furthermore, we designed Ionic Fluorogels by intentionally working with materials that do not exacerbate PFAS contamination or environmental concerns. Ionic Fluorogels demonstrate considerable promise in affecting quality of water, and we’re working to continue more pilot tests in our state.”
“Coastal and estuarine habitats in North Carolina are home to a rich number of recreationally and commercially important fish species. Despite the economic and cultural importance of many of these species to North Carolina coastal communities, their effective management and conservation has been hampered by a lack of information on fish movement and habitat use. This is, in part, due to the complex and lengthy offshore migrations that many fishes undertake, leaving inshore waters during cooler months and migrating to largely unknown offshore areas.
Considering these challenges, novel, innovative methodologies for tracking fish are becoming increasingly recognized as an important solution. I used newly available satellite-tracking technology and developed a method for tracking the offshore movements of a popular North Carolina fish, the sheepshead. I collected previously unobtainable data about the sheepshead. The data collected directly addresses a key research gap identified by the N.C. Division of Marine Fisheries as being of high priority for the management, protection, and enhancement of marine resources in North Carolina.
This data will play a key role in safeguarding the long-term viability of the fish population and the prosperity of the local communities and fisheries it supports. Additionally, this new research method is widely applicable to many other understudied and economically important fishes in North Carolina and beyond.”
“On November 3, 1979, in Greensboro, North Carolina, approximately fifty members of the Communist Workers’ Party gathered for a protest march against escalating white power activity in the Triad. Before the marchers set off on their route, a caravan of Knights of the Ku Klux Klan and American Nazi Party members drove through a neighborhood and opened fire on the group, killing five of the protestors in what is now colloquially referred to as the Greensboro Massacre. The caravan, a loose yet coordinated alliance of white nationalist organizers across the state, called themselves the United Racist Front.
My research argues that the Greensboro Massacre, a turning point for white power organizing in the United States, depended on the long-term efforts of a large community network made possible by the work of women involved in the United Racist Front. I propose historical study and analysis of white power movements that include the full scope and range of organizing labor within white power groups that includes the essential work of feminized labor in developing and sustaining coordinated efforts across the state and country. Specifically, my thesis demonstrates that understanding the shift in white power organizing that occurs in the late 1970s and early 1980s in North Carolina is critical in understanding the contemporary histories and tensions of North Carolina and the rest of the nation.”
“My research addresses environmental racism perpetuated by polluting industries in communities of color. The Anderson community is a predominantly Black community located in Caswell County, North Carolina, and is also the home of Thomas Day, the lauded and well-respected Black furniture maker. This community has been selected as the proposed site of an asphalt plant. Many residents live within a quarter mile of the proposed facility, and they are concerned that the polluting plant will negatively impact their health, as the community already experiences many health issues which are compounded by COVID-19. Available studies report an association between asphalt plant pollutants and negative health outcomes.
Working in partnership with the Anderson Community Group and the Environmental Justice Action Research Clinic at Carolina, we conducted a health assessment to document the health status and environmental quality of this community. Our health assessment found that 77 percent of Anderson residents have a formally diagnosed chronic illness and 48 percent report three or more illnesses. Additionally, various health outcomes are significantly more prevalent in Anderson compared to state averages, including asthma, lung disease, Type 2 diabetes, and high blood pressure.
Our findings suggest that this community requires protection from the effects of polluting industries and their facilities. By sharing our findings, which underscore the need for environmental justice, we hope to prevent rural communities of color in North Carolina from experiencing environmental racism.”
“In North Carolina, 54 percent of all pregnancies are unintended. More than a quarter of those unintended pregnancies resulted in abortions, which can result in both economic and emotional burdens. Many women avoid using available and effective contraceptives because of the real and/or perceived side-effects associated with existing hormonal methods. In a recent study among adolescents in North Carolina, only three percent initiated the use of long-acting reversible contraceptives such as hormonal intrauterine devices (IUD). Unsurprisingly, half of the adolescent IUD users had the device removed within the first year, highlighting an unmet need for safe and effective non-hormonal contraceptives.
There has been only one new product in non-hormonal contraception for more than three decades, and existing non-hormonal products (copper-IUD and detergents) are fraught with serious side effects. This motivated us to pursue the use of naturally occurring sperm-binding monoclonal antibodies (mAbs) to enable effective non-hormonal contraception for women. We engineered a panel of ultra-potent sperm-binding mAbs that are highly stable and subsequently formulated into a mAb-contraceptive film that effectively eliminated progressively motile sperm in sheep within two minutes.
Altogether, our work represents a new strategy of non-hormonal contraception that could prevent emotional and financial distress for women of North Carolina by averting unintended pregnancies. We are currently advancing the first contraceptive mAbs into human clinical trials as well as developing the intravaginal ring format to provide long-term contraception.”