Diversity Supplement –  Whose Depression Are We Measuring?: Considering the role of place on Black women’s depression outcomes

Grant Details

Title: Whose Depression Are We Measuring?: Considering the role of place on Black women’s depression outcomes
Funder: NIMH
Grant Number: 3U19MH121738-05S1 (supplement under the main MHRN cooperative agreement)
Grant Period: 07/01/2023 – 06/30/2024
Narrative:
There are several gaps in knowledge about Black women and mental health. In this proposed supplement, Wilson will explore how social determinants of health related to location affect how Black women express depression and distress. This supplement is designed to enhance Dr. Wilson’s overall career as a mental health disparity researcher and strengthen her profile as a candidate for future NIMH funding opportunities.
Lead Site:
Overall PI: KPGA (Project lead/site PI Kanetha Wilson)
Additional Sites Participating in the Study:
Kaiser Permanente Washington, Seattle, Washington
Johns Hopkins, Baltimore, Maryland
University of California, Los Angeles, Los Angeles, California
Investigators:
Kanetha Wilson, PhD (Project PI)
Courtney McCraken, PhD
Gregory Simon, MD MPH
Robert Penfold, PhD
Roland Thorpe, Jr., PhD MS
Courtney Thomas-Tobin, PhD
Funder Contacts
Program Official: Michael Freed
Grants Management Official: Julie Bergerud
Awarded Budget (Total Cost)
 $217,372
Documents

Funding Announcement
Specific Aims
Research Plan
Notice of Award
Personnel Contact List pending-link to Airtable
Current Status
Pending
Summary of findings
Not yet available
Publications
None

Understanding Structural Social Determinants of Suicidal Trajectories

Grant Details

Title: Understanding Structural Social Determinants of Suicidal Trajectories

Funder: American Foundation for Suicide Prevention, Inc.

Grant Number: YIG-2-133-22

Grant Period: 11/01/2023 – 10/31/2025

Narrative: 

Suicide is the second leading cause of death among U.S. adolescents and young adults aged 10 to 34. Racial/ethnic disparities in suicidal behaviors among youth and young adults in the US have emerged in recent years. Structural social determinants of health (SSDoH) are critical to understanding the impact of structural racism on suicide risks as they reflect systematic stressors that burden minorities. Yet, the longitudinal effects (and mechanisms) of the multidimensional structural social determinants on the disparities in suicidal trajectories (i.e., changes in suicidal ideation/attempts over the life course) are less clear. Few studies have examined disparity-related mediation pathways through stress (e.g., depression) and networks (e.g., parental closeness) to suicidal trajectories by race/ethnicity.  

We propose to leverage a cohort study of a nationally representative sample of 9421 respondents from Waves I-V National Longitudinal Study of Adolescent to Adult Health (1994-2018), with substantial diversity in race, and neighborhood and socioeconomic status, recruited in 7-12th grade across the U.S. and followed up five times through young adulthood (ages ~42) with over 80% response rates per wave, to innovatively study where, why, and to whom intra-neighborhood differences in SSDoH influence the incidence and persistence of suicidal ideation and suicide attempts. We will link SSDoH data of neighborhood physical, healthcare, social, education, and economic contexts to each participant’s residential and school neighborhoods. We will also innovatively assess confounding via individual-level factors known or hypothesized to influence suicidal behaviors, including social networks, mental illness, and access/quality of healthcare, and then construct SSDoH typologies that will directly inform policy. Our central hypothesis is that living in high-risk SSDoH increases suicidal behaviors concurrently and longitudinally, particularly in racial/ethnic minorities. We will produce findings of direct relevance to public health, city planning, and design decisions around temperature-reducing, healthcare-producing, and social cohesion-promoting interventions, greening, tree planting, and building construction. Our aims are:

 Aim 1: Intensively characterize SSDoH and their associations with suicidal trajectories of >9,000 longitudinally followed adolescents till their young adulthood.

Aim 2: Apply novel latent variable techniques to physical and social environment data to identify SSDoH typologies related to suicidal trajectories that are relevant to city planners.

Aim 3: Identify mediators (e.g., social networks, depressive symptoms) and moderators (e.g., health care access) of the impact of SSDoH and suicidal trajectories to advance future research and inform policies.

The emerging concerns on social risks underscores that investment in research on the multidimensional SSDoH on suicide risks is critical, timely, and can produce real-world changes with population-level benefits. We will produce innovative findings with direct health policy implications and clear and downstream interventions that improve health. We have previously conducted large-scale longitudinal studies and have collaborated with policymakers to leverage our science in improving health for local communities, making us well-situated to complete the proposed project.

Findings of our study will support an NIMH R01 application to further identify place-based suicide prevention. Focusing on SSDoH over the life course provides a unique and timely opportunity to unravel the impact of structural racism that systematically burdens racial/ethnic minorities.

  • Lead Site:
    • Overall PI: Cornell (Project lead/site PI Ridout)
  • Participating Sites/Subcontractors:
  • Funder Contacts
    • Program Official:
    • Grants Management Official:
  • Awarded Budget
    • $

Current Status

Summary of Findings

Publications

Computational Strategies to Tailor Existing Interventions for First Major Depressive Episodes to Inform and Test Personalized Interventions

Grant Details

Title: Computational Strategies to Tailor Existing Interventions for First Major Depressive Episodes to Inform and Test Personalized Interventions

Funder: NIMH

Grant Number: 1R01MH132973-01

Grant Period: 07/19/2023 – 03/31/2028

Narrative:

  • Lead Site:
    • Overall PI: KPNC (Project lead/site PI Kathyrn Ridout)
  • Participating Sites/Subcontractors:
  • Funder Contacts
    • Program Official: Matthew Rudorfer
    • Grants Management Official:
  • Awarded B
    • $812,514

Current Status

Summary of Findings

Publications

Pilot Testing Implementation of Suicide Risk Prediction Algorithms to Support Suicide Prevention in Primary Care

Grant Details

Title: Pilot Testing Implementation of Suicide Risk Prediction Algorithms to Support Suicide Prevention in Primary Care

Funder: NIMH

Grant Number: 1R34MH132829-01 

Grant Period: 07/07/2023 – 04/30/2024

Narrative: Suicide is one of the main drivers of increased mortality attributed to “diseases of despair” in the U.S. Suicide risk prediction algorithms have potential to vastly improve identification of individuals at high risk of suicide, but there is very little evidence to guide routine use of this powerful technology in primary care. Project deliverables will include clinical decision support tools designed to support use of suicide risk predictive analytics in primary care, that can be potentially scaled nationwide, and lay a foundation for future evaluation of the effectiveness of implementation for preventing suicide attempts and deaths.

  • Lead Site:
    • Overall PI: KPWA (Project lead/site PI Julie Richards)
  • Participating Sites/Subcontractors:
    • KPCO (PI Jenn Boggs)
    • University of Washington (PI Katherine Comtois)
  • Funder Contacts
    • Program Official: Victor Lushin
    • Grants Management Official: Christine Clarkson
  • Awarded Budget (Total Cost)
    • $256,413

Current Status

Summary of Findings

Publications

None

INSPIRED: INtegrating Social determinants and Policy In REducing Disparities

Grant Details:

Funder: NIMH (MHRN III Feasibility Pilot Program)

Grant Number: U19MH121738

Project Period: 7/1/2023 – 6/30/2024

Narrative:

Background:  US children experienced up to 200% increases in stress, depression, 130% in suicidal ideation and suicide attempts (SI/SA); and the highest pediatric suicide rates, compared to the pre-COVID period. Black and Hispanic youth, females, and low-income families are especially at risk. Our research, along with others’ found that food insecurity, as a vital social determinant of health (SDoH), can worsen child mental health. In response, the federal, state, and local governments have expanded and added flexibility to ongoing public policies (e.g., food assistance, unemployment) and initiated new pandemic-related policies. Addressing SDoH, especially by leveraging policies, is key to reducing mental health disparities. However, most research focused on individual SDoH (e.g., negative life events) and cross-sectional design, ignoring structural SDoH at the population level and in the long term. We propose INSPIRED: INtegrating Social determinants and Policy In REducing Disparities in youth suicide, to fill the gap and bring a richly linked external database on multilevel SDoH and policies (by local, county, and state) to electronic health records (EHR) in MHRN.

Research Questions:

1.    What are the relationships between population-level SDoH and youth suicide (SI/SA)?

2.    How do pandemic-era policies (containment, health, economy, food, housing) affect youth suicide?

3.    Whether the associations between SDoH, policy, and youth suicide vary by race, ethnicity, and sex?

Methods: 

To address these research questions, we will:

●     Study Cohort: Youth ages 10-25 years old on the day of visiting INSIGHTS (n>11 million), before Dec 2023. We have geocoded data by 5-digit, 9-digit, city/state, NYC patients > borough & neighborhood tracking since 2010 and moving forward. This cohort has geographic heterogeneity (figure on the right) across the NY State to allow linkages and feasibilities. Demographically, it is also diverse (11% 0-19 yrs old, 34% 20-44 yrs old, 37% White, 13% Black, 14% Hispanic). In NYC, 28% are from Bronx and 26% from Manhattan.

●     Measures: Outcomes SI/SA (diagnoses codes); Exposures 1) SDoH (AHRQ SDoH databases, primary data collection tailored to climate change [from the Environmental Protection Agency]), to food insecurity [from Feeding American]), to childcare [from Child Opportunity Index]), 2) COVID-19 policy (e.g., U.S. COVID-19 County Policy Database, OxCGRT/USA COVID-19 policy database), 3) Pre-COVID policy (e.g., Supplemental Nutrition Assistance Program [SNAP]), 4) demographic characteristics (sex, race, ethnicity).

●     Statistical Analysis: 1) Link SDoH and policy data to MHRN-INSIGHTS Cohorts, 2) Examine associations between population-level SDoH, policies, and SI/SA, adjusting for covariates, 3) Use causal models (e.g., instrumental variables, differences-in-difference) to assess the impact of policies on youth suicide, 4) For each step, we will address health disparities by conducting subgroup analysis to examine differences by sex, race, ethnicity, age, and site characteristics. 5) We will conduct several sensitivity analyses, including specifying youth with multiple suicide-related visits, applying false-discovery rates to adjust multiple group comparisons, and different methods of dealing with missing data (e.g., listwise, multiple imputations).

Connections to Previous MHRN Projects: Our proposed research builds on previous MHRN projects, such as addressing social risks and studies on individual-level SDoH.13 We will leverage the expertise and data resources from these projects to enhance the rigor and impact of our study. In conclusion, our INSPIRED project will contribute valuable insights into the complex relationships between SDoH, policy, and youth suicide, with a focus on reducing disparities. Our findings will inform policy interventions and improve mental health care delivery for youth populations at risk for suicidal behaviors. Our prior studies on SDoH, Policy, and mental health (see References) further enhance the feasibility of achieving the goals in 1 year.

Planned Products: 1) A comprehensive SDoH and policy database will be developed and prepared to be linked to MHRN, serving as a valuable resource for future researchers. 2) two papers, one for the associations between SDoH and suicidal behaviors, another for causal evidence on the impact of state-level pandemic-era policies on youth suicide, 3) A policy brief, offering actionable recommendations for policymakers to mitigate suicide disparities among vulnerable youth groups, with the goal to inform effective policy, 4) use results as preliminary data to submit >1 R01 NIMH application in the project period.

Lead Site: Cornell(PI Yunyu Xiao)

Participating Sites: INSIGHTS (future use of MHRN VDM).

Current Status:

Summary of Findings:

Publications:

Employing a Stepped-Wedge Design to Implement an Evidence-Based Psychotherapy for PTSD in Six Large, Diverse Health Care Systems

Grant Details

Funder: PCORI

Grant Number:

Project Period: 2022 – 2025

  • Lead Sites:
    • Yale (co-PI Joan Cook) and KPHI (co-PI Vanessa Simiola)
  • Participating Sites:
    • Henry Ford Health System (co-I Lisa Matero)
    • Kaiser Permanente Northwest (co-I Frances Lynch)
    • Kaiser Permanente Georgia (co-Is Ashli Owen-Smith, Kanetha Wilson, Courtney McCracken)
    • Essentia Health (co-I Melissa Harry)
    • Baylor Scott & White Health (co-I Katherine Sanchez)

Brief Narrative: Written Exposure Therapy (WET) is a five-session exposure-based EBP for PTSD that was efficacious in randomized controlled trials for treating PTSD from different types of traumas. In addition to PCORI’s recognition, WET is recommended as a first-line treatment by the Department of Veteran Affairs (VA) and the Department of Defense (DoD). In two recent trials, WET was non-inferior to the more time-intensive, gold-standard EBP, Cognitive Processing Therapy. Thus, WET seems to meet the need for alternative PTSD treatments that are brief, with little dropout, and require less clinical training. Indeed, WET’s brevity and tolerability make it an ideal first-level intervention, appealing to patients who have opted not to seek out more time- and therapist-intensive EBPs. WET addresses significant barriers to other EBPs for PTSD at the patient, provider, and system levels.

The project will employ a stepped wedge design to implement WET in six, large, diverse, integrated, civilian health care systems across the United States— Kaiser Permanente (KP) Hawaii, Henry Ford Health System, Kaiser Permanente Northwest, Kaiser Permanente Georgia, Essentia Health, and Baylor Scott & White Health — with all sites receiving the intervention during the project period. The healthcare systems are members of the Mental Health Research Network (MHRN), a consortium of 14 research centers. Sites will be assigned to one of two implementation groups. Every site will receive WET training, consultation, and multi-component implementation strategies, promoting equity and advancing the field of implementation science.

The specific aims of this project are to:

  1. Employ multi-component implementation strategies to help mental health providers implement WET for their PTSD patients in mental health settings in six health care systems.
  2. Use Consolidated Framework for Implementation Research (CFIR) to understand the determinants and process of implementation.
  3. Utilize RE-AIM framework to evaluate implementation outcomes for mental health providers and patients.

Improving Suicide Risk Prediction with Social Determinants Data

Grant Details

Funder: NIMH

Grant Number: R56MH125794-01A1

Grant Period: 1/1/2022 – 12/31/2022

Brief Narrative: Suicide accounted for 47,511 deaths in the United States in 2019 and the suicide rate has increased by 39% since 1999. Suicide prevention is an NIMH research priority. Recent research in estimating machine learning algorithms to predict suicide risk has been tremendously successful. The models have been implemented as part of routine prevention programs in health systems such as Kaiser Permanente Washington, HealthPartners, and the Veterans Health Administration. Despite these successes, existing models have important shortcomings. A significant proportion of suicides followed healthcare visits where the predicted risk was low (and where an intervention might have taken place otherwise). The models do not currently include any information about social determinants of suicide (e.g., living alone, financial stress) or negative life events (NLE), such as divorce, bankruptcy, and criminal arrest. Adding social determinants data and NLE data to models may improve predictive accuracy. The specific aims of this study are: (1) expand and enhance the risk prediction dataset with over 1500 date-stamped variables describing social determinants of suicide risk and NLE; (2) construct and evaluate suicide risk prediction models using social determinants and NLE data alone; (3) construct and evaluate suicide risk prediction models using social determinants, NLE and healthcare data together and estimate interaction terms between social determinants, NLE, and healthcare predictors. An example would be “depression diagnosis” interacted with “divorce filing in last 30 days”. This will be the first large scale study to incorporate individual-level, date-stamped measures of social determinants and NLE into machine learning suicide risk prediction models. Upon successful completion of this study we expect to know how much incorporating these new data contributes to the accuracy of suicide risk prediction models. This will be an important next step towards implementing better suicide prevention programs and reducing overall suicide rates.

Lead Site: KPWA (PI Rob Penfold)

Participating Sites: N/A

Current Status

We fielded the discrete choice experiment in mid-October 2022. Planned recruitment is 720.

Summary of Findings

Publications

Mindfulness-based cognitive therapy for prevention of perinatal depression

Grant Details

Funder: NIMH

Grant Number: R34MH083866

Grant Period: 9/17/2008 – 7/31/2012

Brief Narrative: This study will investigate the feasibility, safety, acceptability, and preliminary efficacy of a brief, group intervention designed to prevent perinatal depression (PD). We will develop and evaluate a behavioral preventive intervention based on Mindfulness-Based Cognitive Therapy (MBCT), which has been found to significantly reduce rates of relapse of recurrent depression among general adult samples and has high relevance to the prevention of PD. MBCT is non-pharmacological, offers an alternative to traditional one-on-one care models, and is based on a clear conceptual and empirical relationship between the specific intervention strategies and the most robust risk factor for perinatal depression, namely depressive history. The project will involve 3 phases, implemented in 2 obstetric settings: 1) conceptualizing the intervention based on theory and empirical research (MBCT for perinatal depression; MBCT-PD), 2) developing and standardizing MBCT-PD, and 3) pilot testing its efficacy in preventing relapse and recurrence among perinatal women with histories of depression. Phase 1 work is already under way. In Phase 2, we propose an open-trial to develop the MBCT-PD program (N=20). Based on an iterative process, we will finalize a participant- and expert informed manual for MBCT-PD that is sensitive and specific to the developmental factors associated with PD. In Phase 3, we propose to test MBCT-PD in a pilot randomized controlled trial comparing MBCT-PD to Treatment-as-Usual (TAU) (N=160). We will test the primary hypothesis that participants receiving MBCT-PD will experience improved depressive outcomes compared to participants receiving TAU, including testing group differences in rates of relapse/recurrence and exploring group differences in depressive symptom severity. We will also explore group differences in secondary outcomes, including anxiety and stress and obstetrical complications, and will explore potential moderators and mediators of depression outcomes. Finally, we will train and evaluate the ability of behavioral health care providers to administer the MBCT-PD program with fidelity. Given the negative and enduring consequences of untreated perinatal depression for women and their children, low rates of treatment seeking, and concerns associated with pharmacological approaches, the development and ongoing investigation of MBCT-PD may have significant benefits for women, children, and society at large

Lead Site: University of Colorado (PI Sona Dimidjian)

Participating Sites: KPCO, Emory University

Current Status

Summary of Findings

Publications

  1. Dimidjian, Sona; Goodman, Sherryl H; Felder, Jennifer N; Gallop, Robert; Brown, Amanda P; Beck, Arne. Staying Well during Pregnancy and the Postpartum: A Pilot Randomized Trial of Mindfulness Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence. Journal of consulting and clinical psychology 2016 Feb; 84 (2) 134-45          
  2. Dimidjian, Sona; Segal, Zindel V. Prospects for a clinical science of mindfulness-based intervention. The American psychologist 2015 Oct; 70 (7) 593-620       
  3. Dimidjian, Sona; Goodman, Sherryl H; Felder, Jennifer N; Gallop, Robert; Brown, Amanda P; Beck, Arne. An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Archives of women’s mental health 2015 Feb; 18 (1) 85-94         
  4. Goodman, Sherryl H; Dimidjian, Sona. The developmental psychopathology of perinatal depression: implications for psychosocial treatment development and delivery in pregnancy. Canadian journal of psychiatry. Revue canadienne de psychiatrie 2012 Sep; 57 (9) 530-6

Trans-America Consortium of the Health Care Systems Research Network for the All of Us Research Program

Grant Details

Funder: NIH Office of the Director

Grant Number: OT2OD026550

Grant Period: 1/4/2018 – 3/31/2023

Narrative:

Lead Site: HFHS (co-PIs Christine Johnson and Brian Ahmedani)

Participating Sites:

Current Status:

Ongoing recruitment, enrollment and retention of 100,000 participants and members.

Summary of Findings:

Publications:

Cronin, R.M., Jerome, R.N., Mapes, B.M., Andrade, R., Johnston, R., Ayala, J., Schlundt, D., Bonnet, K.R., Kripalani, S., Goggins, K., Wallston, K.A., Couper, M.P., Elliott, M.R., Harris, P.A., Begale, M.A., Munoz, F.A., Lopez-Class, M., Cella, D., Condon, D.M., AuYoung, M., Mazor, K.M., Mikita, S., Manganiello, M., Borselli, N., Fowler, S.L., Rutter, J.L., Denny, J.C., Karlson, E.W., Ahmedani, B.K., O’Donnell, C.J. Vanderbilt University Medical Center Pilot Team, and the Participant Provided Information Committee. (2019). Development of the Initial Surveys for the All of Us Research Program. Epidemiology, 30(4), 597-608.. doi: 10.1097/EDE.0000000000001028. PMID: 31045611. 

Ramirez AH, Sulieman L, Schlueter DJ, Halvorson A, Qian J, Ratsimbazafy F, Loperena R, Mayo K, Basford M, Deflaux N, Muthuraman KN, Natarajan K, Kho A, Xu H, Wilkins C, Anton-Culver H, Boerwinkle E, Cicek M, Clark CR, Cohn E, Ohno-Machado L, Schully SD, Ahmedani BK, Argos M, Cronin RM, O’Donnell C, Fouad M, Goldstein DB, Greenland P, Hebbring SJ, Karlson EW, Khatri P, Korf B, Smoller JW, Sodeke S, Wilbanks J, Hentges J, Mockrin S, Lunt C, Devaney SA, Gebo K, Denny JC, Carroll RJ, Glazer D, Harris PA, Hripcsak G, Philippakis A, Roden DM; All of Us Research Program. (2022). The All of Us Research Program: Data quality, utility, and diversity. Patterns (N Y); 3(8), 100570. doi: 10.1016/j.patter.2022.100570. PMID: 36033590.

Cronin, R.M., Halvorson, A.E., Springer, C., Feng, X., Sulieman, L., Loperena-Cortes, R., Mayo, K., Carroll, R.J., Chen, Q., Ahmedani, B.K., Karnes, J., Korf, B., O’Donnell, C.J., Qian, J., Ramirez, A.H., All of Us Research Program Investigators.  (2021). Comparison of Family Health History in Surveys versus Electronic Health Records in the All of Us Research Program. Journal of the American Medical Informatics Association, 28(4):695-703. doi: 10.1093/jamia/ocaa315. PMID: 33404595. 

Treatment Initiation for New Episodes of Depression in Pregnant Women

Grant Details

Funder: NICHHD

Grant Number: R01HD100579

Grant Period: 5/6/2021 – 3/31/2026

Narrative: Up to 12% of pregnant women have a new episode of depression, ie, an incident or recurrent depressive episode with symptom onset during pregnancy. Effects of untreated antenatal depression include unhealthy maternal behaviors (eg, diminished self-care, smoking, substance use, self-harm) and emotional and behavioral problems in offspring. Antenatal depression or elevated depression scores, identified by screening instruments, increase the risk of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) birth, and are associated with breastfeeding discontinuation before 3 months postpartum. In-person psychotherapy and antidepressant medication improve depression symptoms in many with depression, yet <50% of pregnant women with new episodes of depression initiate these treatments. Although some barriers to initiating antidepressants and psychotherapy are known, other factors have not been well described, especially after accounting for depression severity. Furthermore, the impact of antidepressants and psychotherapy on perinatal outcomes, including PTB, LBW, SGA, and breastfeeding continuation among pregnant women with new episodes of depression after accounting for confounding by depression severity is unknown. Given the importance of factors influencing the decision to initiate antidepressant or psychotherapy treatment during pregnancy and the need for further evidence on the perinatal risks and benefits associated with antidepressant use and psychotherapy in pregnant women, the goal of this study is to identify predictors and perinatal effects of psychotherapy and antidepressant use for new episodes of depression during pregnancy while accounting for depression severity. We will conduct this study in a racially and ethnically diverse multi- site population using electronic health data, enriched with survey data from a subset of women. Among pregnant women with new episodes of depression, we will evaluate factors that influence the propensity to initiate psychotherapy or antidepressants; accounting for these is crucial when studying treatment effects. We will describe patterns of use of alternative depression management approaches (eg, Internet- based psychotherapy, peer support groups, and complementary and alternative medicine) and will evaluate whether initiation of psychotherapy or antidepressants is associated with these practices while accounting for depression severity. We will quantify the impact of psychotherapy and antidepressants (including dose, timing, and duration of use) on PTB, LBW, SGA, and breastfeeding continuation accounting for the propensity to initiate psychotherapy or antidepressants and depression severity. We are uniquely positioned to overcome limitations of confounding and small size in prior studies given our data on depression severity and maternal comorbidity for more than 8,000 pregnant women. Our study will be informative for understanding the mental health interventions utilized by pregnant women with depression and will inform decision making on optimal depression management during pregnancy.

  • Lead site:
    • HPI (PI Kristin Palmsten)
  • Participating Sites:
    • HFHS
    • KPHI
    • KPNC
    • KPSC

Current Status:

We are currently conducting the first aim of the study, which is a survey among people with new episodes of depression during pregnancy. We aim to learn about the treatments and strategies participants used to manage new episodes of depression during pregnancy, how they are supported by others, and how they feed their new babies. The survey also asks about childhood and life experiences.  We completed a pilot survey at HealthPartners this spring and we are launching the survey across all sites this fall.

Summary of Findings:

None yet

Publications:

None yet