Chantele Mitchell-Miland

Introduction: The purpose of this research was to understand perceptions and experiences of inclusion among underrepresented early-career biomedical researchers (postdoctoral fellows and early-career faculty) enrolled in the Building Up study. Because inclusion is vital to job satisfaction and engagement, our goal was to shed light on aspects of and barriers to inclusion within the academic workforce. Methods: We used qualitative interviews to assess workplace experiences of 25 underrepresented postdoctoral fellows and early-career faculty including: their daily work experiences; sense of the workplace culture within the institutions; experiences with microaggressions, racism, and discrimination; and whether the diversity, equity, and inclusion (DEI) policies and practices at their institution enhanced their experiences. Using qualitative methods, we identified themes that highlighted high-level characteristics of inclusion. Results: Four distinct themes were identified: (1) participants appreciated the flexibility, versatility, and sense of fulfillment of their positions which enhanced feelings of inclusion; (2) greater psychological safety led to a greater sense of belonging to a research community; (3) participants had varied experiences of inclusion in the presence of microaggressions, racism, and discrimination; and (4) access to opportunities and resources increased feelings of value within the workplace. Discussion: Our findings provide new insight into how inclusion is experienced within the institution among underrepresented early-career biomedical researchers. This research points to specific approaches that could be used to enhance experiences of inclusion and to address barriers. More research is needed to understand how to accomplish a balance between the two, so that perceptions of inclusion outweigh negative experiences.

Background: In previous efforts, health-related quality of life (HRQoL) improved for individuals at high risk of type 2 diabetes and cardiovascular disease after participation in community-based lifestyle interventions (LI) with a moderate-to-vigorous physical activity (MVPA) movement goal. Purpose: It is unknown whether HRQoL improves with LI when the primary movement goal is to reduce sedentary behavior. HRQoL changes were examined among adults with overweight and prediabetes and/or metabolic syndrome randomized to a 12-month Diabetes Prevention Program-based Group Lifestyle Balance (DPP-GLB) community LI work with goals of weight-loss and either increasing MVPA (DPP-GLB) or reducing sedentary time (GLB-SED). Methods: Study participants (N = 269) completed the Euroqol 5 dimension 3 long (EQ5D-3L index and EuroQol Visual Analog Scale (EQVAS)—visual analog scale) at baseline, and 6 and 12 months. Paired t-tests were used to evaluate pre-to-post-intervention changes by arm. Results: Mean EQVAS improvements for the GLB-SED arm at 6 and 12 months were +5.6 (SE = 1.3; P < .0001) and +4.6 (SE = 1.4; P = .0006), respectively. Similar mean EQVAS improvements were reported for the DPP-GLB arm; +5.9 (SE = 1.2; P < .0001) and +4.9 (SE = 1.2; P = .0001) at 6 and 12 months, respectively. Mean EQ5D index improvements were significant in the GLB-SED arm [6 months: +0.03 (SE = 0.01; P = .004); and 12 months: +0.04 (SE = 0.01; P = .006)], but not in the DPP-GLB arm. Conclusions: Participation in community LI with a primary movement goal to reduce sedentary behavior improved HRQoL at least as well as traditional LI focused more on MVPA improvement, supporting an alternate intervention strategy for those who can’t or won’t engage in MVPA as the primary movement goal.

Introduction: Social unrest tied to racism negatively impacted half of NIH-funded extramural researchers underrepresented (UR) in science. UR early-career scientists encounter more challenges in their research careers, but the impact of social unrest due to systemic racism in this group is unclear. We used mixed methods to describe the impact of social unrest due to systemic racism on mentoring relationships, research, and psychological well-being in UR post-doctoral fellows and early-career faculty. Methods: This is a cross-sectional analysis of data collected in September 2021–January 2022 from 144 UR early-career researchers from 25 academic medical centers in the Building Up Trial. The primary outcomes were agreement on five-point Likert scales with social unrest impact statements (e.g., “I experienced psychological distress due to events of social unrest regarding systemic racism”). Thematic analysis was conducted on responses to one open-ended question assessing how social unrest regarding systemic racism affected participants. Results: Most participants were female (80%), non-Hispanic Black (35%), or Hispanic (40%). Over half of participants (57%) experienced psychological distress as a result of social unrest due to systemic racism. Participants described direct and indirect discrimination and isolation from other persons of color at their institutions. Twice as many participants felt their mentoring relationships were positively (21%) versus negatively (11%) impacted by social unrest due to systemic racism. Conclusions: Experiences with racial bias and discrimination impact the career and well-being of UR early-career researchers. Mentoring relationships and institutional support play an important role in buffering the negative impact of racial injustice for this population.

Background: Serious mental illness (SMI) affects 4.6% of the American population. While treatments are available, adherence to specific regimens is often suboptimal. Multiple organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have called for more options that improve accessibility and engagement to treatment among individuals with SMI. This study protocol answers such calls by testing the effectiveness of peer specialists—individuals with SMI trained to use their experience to help others with SMI—in delivering social skills training (SST) and cognitive behavioral social skills training (CBSST), evidence-based treatments effective at engaging individuals with SMI to make behavioral and cognitive changes. Peer specialists have been shown to be adept at engaging those with SMI in treatment; however, their ability to deliver these structured treatments is unknown. Methods: This study is a randomized, hybrid 1, research assistant-blinded, superiority trial. A total of 252 veterans with SMI will be recruited and randomized to one of three arms: CBSST-Peer vs. SST-Peer vs. treatment as usual. Participants randomized to CBSST-Peer or SST-Peer will participate in a 20-week group-based intervention that meets weekly for a 60-min class. All participants will complete 4 study assessments at baseline, 10 weeks, 20 weeks, and 32 weeks. A multidimensional battery of functional outcomes will be used with the Independent Living Skills Survey (ILSS) as the primary outcome measure. Post-study completion, veterans who participated in the CBSST-Peer or SST-Peer arms will randomly be invited to participate in focus groups, and peer specialists will complete interviews to further assess the effectiveness of each intervention. Discussion: Improving care and outcomes for individuals with SMI is a national priority. To improve care, it is imperative to think about new ways to improve engagement and accessibility to care. This study provides an innovative solution to this problem by evaluating how two different types of treatment, delivered by peer specialists, compare to usual care. The results of the study will allow for the expansion of treatment options that improve access and engagement among veterans with SMI.

Background: The behavioral model of health service use identified health needs, service preferences (predispositions), and service availability (enabling factors) as important predictors, but research has not conceptualized consistently each type of influence nor identified their separate effects on use of substance abuse and mental health services or their value in predicting service outcomes. Objectives: To test hypotheses predicting use of substance abuse and mental health services and residential stability and evaluate peer specialists’ impact. Research Design: Randomized trial of peer support added to standard case management in VA-supported housing program (Housing and Urban Development-VA Supportive Housing program). Subjects: One hundred sixty-six dually diagnosed Veterans in Housing and Urban Development-VA Supportive Housing program in 2 cities. Measures: Average VA service episodes for substance abuse and mental illness; residential instability; preferences for alcohol, drug, and psychological services; extent of alcohol, drug, and psychological problems; availability of a peer specialist. Results: Self-assessed health needs, mediated by service preferences, and assignment to a peer specialist predicted use of VA behavioral health services and residential stability, as did chronic medical problems, sex, and race. Conclusions: The behavioral model identifies major predictors of health service use and residential stability, but must recognize the mediating role of service preferences, the differing effects of alcohol and drug use, the unique influences of social background, and the importance of clinical judgment in needs assessment. Service availability and residential stability can be increased by proactive efforts involving peer specialists even in a health care system that provides services without a financial barrier.