Lown Scholars’ Projects

Ongoing Projects

PI: Cecilia Anza Ramírez

Institution: CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia, Peru
Title:  Advancing Understanding of Treatment Burden in Multimorbidity: A Latin American Perspective Focused on Hypertension
Budget: $37,662
Start date: TBD
End date: TBD
Co-investigators: Vilma Irazola, Omar Bello-Chavolla, J. Jaime Miranda 
Mentors: Goodarz Danaei, Jaime Miranda

Hypertension, one of the main risk factors for cardiovascular diseases (CVD), affects more than 30% of the adult population worldwide, and Latin America is not an exception to this concerning pattern. Optimal treatment and control of hypertension are crucial in reducing CVD burden. Adequate management of hypertension has been associated with a significant decrease in the risk of myocardial infarction and cardiovascular events. However, this is not occurring as effectively as desired in Latin America, where we observe low proportions of individuals receiving proper treatment, and even among those who are treated, there are alarmingly low rates of optimal control. Therefore, our overarching goal is to advance the understanding of BoT in patients with hypertension living with multimorbidity in Argentina, Peru, and Mexico.

This project is an international team-based collaboration between Lown Scholars to measure BoT in patients with hypertension living with multimorbidity in Argentina, Peru, and Mexico. Vilma Irazola, Omar Bello-Chavolla, and J. Jaime Miranda are co-principal investigators.

PI: Omar Bello-Chavolla

Institution:  National Institute of Geriatrics in Mexico City, Mexico
Title: Characterizing Heterogeneity in Fatal Cardiovascular Disease Risk Among Mexican Adults with Type 2 Diabetes: A Data-driven Approach to Cardiovascular Disease Prevention
Budget: $13,500
Start date: TBD
End date: TBD
Co-investigators: Carlos Alberto Fermín Martínez,  Neftali Eduardo Antonio Villa, Jerónimo Perezalonso Espinosa, Daniel Ramírez García
Mentors: Goodarz Danaei, Dalia Stern

Cardiovascular disease (CVD) is the leading cause of mortality and disability in Mexico. Type 2 diabetes, which is highly prevalent in Mexico, is a key accelerant of CVD and the importance of multi-risk factor management to reduce CVD burden in people with type 2 diabetes is well established. However, accumulating evidence on the heterogeneity of CVD risk among people with type 2 diabetes suggests that current tools for the early identification of people at the highest risk of CVD could be refined by the incorporation of more nuanced, population-specific risk factor which also considers the heterogeneity of clinical phenotypes in diabetes. The overall goal of this research proposal is to develop a model to estimate CVD risk among Mexican adults and to assess whether diabetes subgroup classifications improve estimation of CVD risk in diabetes.

2024 Lown Scholar Neftali Antonio-Villa will be a research investigator.

PI: Julius Mwita

Institution: University of Botswana, Botswana 
Title: The Practicability of Streptococcal Rapid Antigen Testing in Children with Pharyngitis in Low-resource Sub-Saharan Countries
Budget: $55,006
Start date: TBD
End date: TBD
Co-investigators: Tiny Masupe, Pilly Chillo, Frederick Wekesa
Mentors: Marina Njelekela, Murray Mittleman

It has been nearly 20 years since the World Heart Federation endorsed a goal of achieving a 25% reduction in premature deaths from acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among individuals aged <25 years by 2025. Yet, RHD has remained the most common acquired cardiovascular cause of morbidity and mortality in children and young adults <25 years in developing countries in young people. RHD is a sequel of ARF, which occurs as an autoimmune response to Group A Streptococcal (GAS) pharyngitis and skin infection in susceptible hosts. Successful antibiotic treatment of GAS pharyngitis relies on accurately assessing GAS infection through clinical evaluation and microbiological confirmation. The introduction of non-culture-based rapid antigen-detection tests (RADT)has allowed the detection of GAS directly from throat swabs with a quick turnaround time (10-15 minutes). This study aims to assess the utility of RADTs in low-resource settings and explore the practicality of RADT for GAS in primary care settings.

This project is an international team-based collaboration between Lown Scholars; research will take place in Botswana, Tanzania, and Kenya. Lown Scholars Pilly Chillo and Frederick Wekesa are co-investigators.

PI: Ana Abreu

Institution: Instituto Nacional de Salud Pública, Mexico
Title: Potential impact of salt reformulation programs in processed foods in Mexico: a modeling study
Budget: $33,383
Start date: 6/1/22
End date: 9/30/23
Co-investigators: Josiemer Mattei, Tonatiuh Barrientos-Gutiérrez, Juan Rivera
Mentors: Josiemer Mattei, Tonatiuh Barrientos-Gutiérrez 

Cardiovascular disease is the first cause of death in Mexico; 52% of CVD deaths in the country are attributable to high blood pressure and 34% to dietary risks. Sodium intake increases high blood pressure and the risk of CVD. The Mexican government is interested in salt reduction programs, but no steps have been undertaken to implement a long-term salt reformulation program. While many modeling studies have addressed the future impact of sodium reduction, no studies have focused on which processed foods should be targeted to achieve the proposed salt reductions. This study aims to identify the range of sodium reductions on multiple processed foods worldwide and estimate the cost-effectiveness of establishing a mandatory law to set maximum limits of sodium content in processed foods. The results may further support salt reductions in Mexico towards the goal of reducing hypertension and CVD. 

PI: Aswathy Sreedevi

Institution: Amrita Institute of Medical Sciences, India
Title: Effectiveness of a ‘tobacco smoke free home’ intervention in partnership with women’s self help groups in the slums of Kochi corporation, Kerala: A cluster randomized trial
Budget: $49,590
Start date: 6/30/21
End date: 12/31/23
Co-investigators: Sobha George, Arathi Sekhar, Vijaya Kumar, Jaideep Menon
Mentor: Jon Rohde

In Kochi corporation, cardiovascular health issues are the third most common cause of morbidity. About 21% of its population now live in slum areas with high occupancy rates where smoking within the home can result in high second-hand exposure. An initial experience with an initiative of “Quit Tobacco international activities” suggested that “tobacco smoke free homes initiatives” are feasible. This study aims to determine the effectiveness of a “smoke free home” intervention in partnership with women’s self-help groups in the slums of Kochi corporation, Kerala.

PI: Natalia Oli

Institution: Kathmandu Medical College, Nepal
Title: Formative research to evaluate customers’ awareness and policy implementation gaps in nutritional labeling of packaged food in Nepal
Budget: $21,906
Start date: 8/1/22
End date: 2/29/24
Co-investigators: Abhinav Vaidya, Uma Koirala, Archana Shrestha
Mentors: Eric Rimm, Abhinav Vaidya 

Nutrition transition contributes to increasing burden of non-communicable diseases (NCDs) in low-and middle-income countries, such as Nepal. Nutrition labels are a major instrument to help consumers make positive, healthy food choices and therefore to improve their food literacy. Nepal has limited health promotion campaigns to address food literacy and food purchasing behavior through improvement of awareness of nutrition labeling. There is also a lack of data regarding food labeling literacy among the customers in Nepal. To address these gaps, this study aims to carry out formative research to explore food labeling implementation gaps in Nepal and assess nutritional literacy and food buying behavior among customers of Lalitpur district. 

PI: GK Mini

Institution: Centre for Environment and Development, India
Title: Behavioral intervention for cardiovascular risk factor reduction among Policemen in Kerala, India: A feasibility study
Budget: $20,460
Start date: 7/1/22
End date: 
Co-investigators: Chitra Venkateswaran, K Rajasekharan Nayar, Malu Mohan, Anand Marthanda Pillai, DS Sabida Das
Mentors: Vilma Irazola, Aswathy Sreedevi 

The effectiveness of behavioral interventions in delaying or preventing cardiovascular diseases (CVD) is currently well established in many high-income countries, but these interventions need to be culturally adapted and implemented to a real-world setting in low- and middle-income countries like India. Furthermore, not much is known about the implementation and scale-up of such programs for special occupational groups like law enforcement officers. Studies show that police officials are at greater risk for cardiovascular diseases compared to the general population. This feasibility study proposes to evaluate whether a behavioral intervention based on the Health Belief Model (HBM) can reduce modifiable risk factors of CVD through psychological and behavioral changes in policemen in Thiruvananthapuram district of Kerala state, India. 

PI: Mahdi Mahdavi

Institution: Tehran University of Medical Sciences, Iran
Title: Cost-effectiveness analysis of intensive blood pressure control to enhance the Universal Health
Coverage of hypertension in Iran
Budget: $9,998
Start date: 7/15/21
End date:
Co-investigator: Mahboubeh Parsaeia
Mentors: Goodarz Danaei, Ankur Pandya

The SPRINT trial supports that aggressive blood pressure treatment target (less than 120 mm Hg) compared with the standard treatment target (less than 140 mm Hg) significantly reduces CVD events and all-cause mortality among individuals at high risk for CVD but without diabetes.  However, lowering the blood pressure target to 130/80 mm Hg based on the2017 ACC/AHA sharply increases the prevalence of hypertension in Iran. This raises the question of whether the health gains produced by lowering the blood pressure target are worth the costs, and whether the aggressive treatment target is more cost-effective than the standard target in Iran. To answer this question, this study will consist of a model-based cost-effectiveness analysis, comparing costs and health gains of pharmacological therapy for different subpopulations based on the standard vs. aggressive treatment targets.

PI: Indah Suci Widyahening

Institution: Universitas Indonesia, Indonesia
Title: The effect of a school-based nutrition intervention to promote healthy eating behaviour among adolescents in Indonesia: A cluster randomized pilot study
Budget: $48,168
Start date: 9/1/21
End date:
Co-investigators: Luh Ade Ari Wiradnyani, Judhiastuty Februhartanty, Ahmad Thohir
Mentors: Sarah Bleich, Sudha Ramalingam

In the last decade, the significant increase in childhood and adolescent obesity has contributed to the tripling of malnutrition rates in Indonesia.  The overall goal of the study is to assess the feasibility and effect of a school-based nutrition intervention program, called the “Nutrition Goes to School” (NGTS), which seeks to improve diet and physical activities as part of the prevention and management of obesity among adolescents in urban Indonesia. A cluster randomized controlled pilot trial will be conducted to inform the design of a future effectiveness trial. 

PI: Sudha Ramalingam

Institution: PSG Institute of Medical Sciences and Research, India
Title: Design, implementation, and evaluation of a comprehensive school based intervention for prevention of cardiometabolic risk factors among adolescents in rural schools at Coimbatore, India (PRANA: Prevention through Nutrition and Activity): A pilot study
Budget: $24,944
Start date: 6/1/20
End date:
Mentors: Joseph Brain, Nancy Long Seiber

Among the Indian states, Tamilnadu ranks first in ischemic heart disease and second in diabetes mellitus, requiring urgent action. With about 25% of the population being adolescents, there is also a rise in the cardiometabolic risk factors in this age group. The existing national programs, such as the School Health Program, National Program for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke, and the Rashtriya Kishor Sawstya Karyakram, focus on undernutrition, menstrual hygiene and substance abuse and not on NCDs, resulting in a large void of prevention. This study seeks to prevent the adult onset of cardiometabolic diseases by designing, implementing, and evaluating the effectiveness of a comprehensive school-based intervention program among adolescents aged 10-18 years in the rural area of Coimbatore, India.

PI: Chitra Venkateswaran

Institution: Believers Church Medical College Hospital, India
Title: Assessment of a psychological intervention by community health volunteers for hypertension in rural settings in Alappuzha in Kerala: A pilot study
Budget: $19,112
Start date: TBD
End date: TBD
Co-investigators: Alice David, Jaico Katadiyil Paulose,  Geethu Mathew, Poornima Sunder
Mentors: Goodarz Danaei, Karestan Koenan, Sairu Philip

Psychological stress can contribute to the development of hypertension and psychological treatment can reduce blood pressure (BP), but evidence is not conclusive. A psychological intervention in primary care setting in India, Health Activity Program (HAP), has been found to be effective for depression when delivered by lay counselors.  This pilot study proposes to evaluate whether the psychological intervention (HAP) delivered by community volunteers can reduce blood pressure in patients with hypertension in a rural setting (Muhamma) a village in Alappuzha, in Southern Kerala, India.

Completed Projects

PI: Garima Kapila

Institution: Swasth Foundation, India
Title: An innovative, integrated primary care intervention for hypertension control in India: A
feasibility assessment study
Budget: $20,002
Start date: 9/1/21
End date: 3/31/23
Co-investigator: Shailender Swaminathan
Mentors: Goodarz Danaei, Aswathy Sreedevi

Despite extensive knowledge on prevention and control of hypertension, the strongest modifiable cardiovascular disease (CVD) risk factor, its incidence and prevalence continue to rise in India. Recognizing the importance of comprehensive primary care addressing non-communicable diseases, the Indian government has launched several policies and programs such as Ayushman Bharat. However, a gap remains from pharmacological and lifestyle interventions working in silos, and a lack  collaboration between healthcare providers using modern sciences and those using traditional therapeutic disciplines. The goal of this study is to assess the feasibility of an integrative, protocol-based primary care intervention for significant hypertension control.

PI: Rosana Poggio, Victor Dourado

Institution:  Institute for Clinical Effectiveness and Health Policy, Argentina
Title: Physical Activity and Fitness Team: Long-term impact of the COVID-19 pandemic on physical activity and cardiorespiratory fitness in developing countries: The PA&FIT-Network Online Survey
Budget: $30,034
Start date: 6/1/22
End date: 5/31/23
Co-investigators: Ghada El-Hajj Fuleihan, Laila Al-Shaar, Indah Widyahening, Fredirick Mashili, Ricardo Peña Silva, Shifalika Goenka, Isabel Pereira, Sandra Lopez Arana 

In March 2020, the World Health Organization (WHO) classified the infection of the coronavirus (SARSCoV2; COVID-19) as a global pandemic. To control the virus spread, many countries imposed important restrictions such as closures of business establishments, public parks, gyms or sport facilities, in addition to limited access to public transportation. While these measures helped to control further transmission of the virus, they also fostered undesirable lifestyle changes such as reduction in levels of physical activity (PA), higher intake of alcohol and unhealthy food which have adversely impacted physical and mental health and mental wellbeing since increased levels of stress, anxiety, and depression were described during this period.  This study aims to explore changes in physical activity, estimated cardiorespiratory fitness (VO2max), risk factors status and food intake between pre-COVID-19 pandemic and current time among the adult population of India, Indonesia, Tanzania, Lebanon, Brazil, Colombia, Uruguay, and Argentina. It also aims to explore how these changes are associated with the current mental wellbeing of participants by assessing their anxiety and depression symptoms. 

PI: Ricardo Peña Silva

Institution: Universidad de los Andes, Colombia
 Impact of a patient-targeted MOOC on cardiovascular health outcomes and health literacy of patients with hypertension in Colombia
Budget: $39,779, with $15,000 funded by the Lown Scholars Program
Start date: 6/1/19
End date: 9/30/22
Co-investigators: Rima Rudd, Carlos Mendivil, Luis Jorge Hernandez, Jovana Ocampo, Conecta-TE, Margaret Raba
Mentor: Rima Rudd

It is expected that in 2025, almost three quarters of patients with hypertension and/or cardiovascular disease will live in developing countries. Addressing disparities is a critical component of management strategies for chronic diseases, as there is evidence shows that level of education and health literacy are associated with poorer control of hypertension. Based on recommendation by the National Academy of Sciences, the significance of this project is to improve health outcomes on a broad scale by improving health literacy and incorporating adequate teaching materials and strategies that target particular patient needs. This study aims to develop a patient-targeted massive open online course (MOOC) in cardiovascular health, guided by health literacy data from patients with cardiovascular disease. A small group of patients are planned to pilot the MOOC in a subnet of hospitals in Bogotá, and the study plans to explore their experience.

PI: Abhinav Vaidya

Institution: Kathmandu Medical College, Nepal
Title: Formative research to inform a community-based CVD prevention intervention among urban poor in Kathmandu, Nepal
Budget: $22,821
Start date: 4/1/20
End date: 12/31/22
Co-investigator: Natalia Oli
Mentor: Lindsay Jaacks

Cardiovascular diseases  and their behavioral risk factors such as tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol are emerging public health problems in Nepal. Most of the focus, however, has been on hospital-centric curative services for CVDs, rather than on primary prevention. Our recent CVD-focused community-based interventions in Nepal have yielded success in terms of improving the knowledge and perceptions of mothers, and improving cascade of care of diabetes management through involvement of community health volunteers. This study aimed to conduct formative research to inform the design and implementation of a community-based CVD prevention intervention in the Sinamangal-Minbhawan squatter area.

PI: Natasha Sobers

Institution: The George Alleyne Chronic Disease Research Center, Caribbean Institute for Health Research, Barbados
Title: Assessing effectiveness of a chronic disease self-management program in faith-based organizations in Barbados: A cluster randomized clinical trial
Budget: $15,000
Start date: 6/1/20
End date: 11/30/22
Co-investigators: Trevor Ferguson, Ian Hambleton, Saria Hassan, Simon Anderson
Mentor: Trevor Ferguson

In Barbados, levels of hypertension (40.7%) are high and account for the highest proportion of deaths due to cardiovascular and noncommunicable diseases (NCDs). The financial implications of the high and increasing prevalence are grave especially in Barbados, which in 2018, was among the top five most indebted nations in the world. Tackling NCDs requires a multi-level approach involving the health system, providers and the individual. This study sought to evaluate the effectiveness and cultural appropriateness of a hypertension self-management program including lifestyle workshops, self-monitoring training, and tools to enhance medication adherence, in a small island developing state with a high burden of NCDs.

PI: Bruce Twinamasiko

Institution: Church of Uganda Kisiizi Hospital, Uganda
Title: Effect of a community health worker led intervention to control high blood pressure in south western Uganda: a pilot pragmatic cluster randomized trial
Budget: $15,000
Start date: 8/1/20
End date: 7/31/22
Co-investigators: Samson Okello, Edson Mutahi, Eleanor Kengoma
Mentor: Samson Okello

In Uganda, the prevalence of hypertension is 26%, and only 26.7% of patients have controlled high blood pressure. Poor blood pressure control is increasing despite the availability of effective medications. Blood pressure control is much more complicated by scarcity of health professionals in most parts of the country, and up to one third of doctors leave the country in search of better jobs. This study aimed to test whether a comprehensive intervention program including community health workers, physician training, and text messaging will improve high blood pressure control among hypertensive patients attending hypertension clinics in southwestern Uganda.

PI: Pilly Chillo

Institution: Muhimbili University Of Health And Allied Science, Tanzania
Title: Assessing feasibility and acceptability of a school-based rheumatic heart disease (RHD) control program in Manyara Region, Tanzania
Budget: $15,000
Start date: 6/1/20
End date: 5/31/22
Co-investigator: Marina Njelekela
Mentor: Vanessa Kerry

Rheumatic heart disease (RHD) accounts for approximately 275,000 deaths annually, and although almost eradicated in developed countries, RHD continues to affect many children and young adults in Sub Saharan African countries, including Tanzania. RHD can largely be prevented when appropriate control programs are implemented focusing on community awareness, appropriate diagnosis and treatment of its cause, namely Group A beta haemolytic Streptococcus (GAS) sore throat infection as well as proper management of Acute Rheumatic Fever. Since the most vulnerable populations for GAS throat infections are children, there is strong potential for RHD control programs to be successful when targeting primary schools, improving the reach of primary and secondary prevention as well as case detection of RHD. This study aimed to assess the feasibility and acceptability of a school-based RHD control program in Manyara Region using the World Heart Federations’s RHD control toolkit.

PI: Prajjwal Pyakurel

Institution: BP Koirala Institute of Health Science, Nepal
Title: Worksite intervention study to prevent diabetes in Nepal
Budget: $39,312
Start date: 9/1/17
End date: 2/28/22
Co-investigators: Archana Shrestha,  Biraj Man Karmacharya, Hyam Sundar Budhathoki
Mentor: Donna Spiegelman

This study attempted to measure the effectiveness of a six-month intervention to provide healthier food options in a worksite cafeteria on diabetes risk and to measure the effectiveness of an individual-level lifestyle education on the risk of diabetes.

PI: Juan Pablo Gonzalez-Rivas

Institution: Foundation for Public Health and Epidemiology Research in Venezuela (FISPEVen), Venezuela
Title: Hybridized three steps (HITS) intervention to prevent diabetes in Venezuela: HITS diabetes with prevention, an EVESCAM lifestyle intervention study
Budget: $39,038
Start date: 3/1/20
End date: 2/28/22
Co-investigator: Ramfis Nieto-Martinez
Mentor: Ramfis Nieto-Martinez

In Venezuela, cardiovascular disease is responsible for 30.5% of all deaths, increasing by 8.3% since 2007 to 2017. The prevalence of cardiometabolic risk factors in the country is also increasing. Through the VENMOLS and EVASCAM surveys, it has been estimated that 1.7 million adults could advance to type 2 diabetes (T2D) in the next three to five years. In previous studies, lifestyle interventions only showed a pooled mean weight loss 1.57 kg higher than standard care, demonstrating the large difficulties in weight loss of participants at community levels. This study aimed to improve the effectiveness of T2D prevention programs through a transculturalization process incorporating multiple validated components and by extension, positively impact T2D incidence, prevalence, quality of life, and health care costs.

PI: Eleonora d’Orsi

Institution: Universidade Federal de Santa Catarina, Brazil
 Workshops of digital inclusion as a tool to promote healthy lifestyle among digitally illiterate patients with diabetes or hypertension living in Florianopolis, south Brazil
Budget: $14,999
Start date: 12/1/19
End date: 12/31/21
Co-investigators: Marcia Scazufca, André Junqueira Xavier, Anna Quialheiro da Silva, Thamara Huevler Figueiro
Mentor: Marcia Scazufca

Cardiovascular disease in the leading cause of death in Brazil, accounting for 29.1% of total deaths in the country in 2016. There is emerging evidence that internet-based interventions may reduce cardiovascular risk, making the digital inclusion of socioeconomic groups with lower access to internet a possible low-cost strategy to reduce cardiovascular risk factors. The specific aims of this study were to adapt an existing digital inclusion program for digitally illiterate hypertension and/or diabetes primary care users, estimate the feasibility of the digital inclusion program in one primary health care center, and estimate the effect of the program in cardiovascular health, mental health, and quality of life of the participants.

PI: Frederick Wekesah

Institution: African Population and Health Research Center, Kenya
Title: Investigating the role of sugar-sweetened beverages in and perceptions towards childhood obesity in the slums of Nairobi
Budget: $38,841
Start date: 3/1/20
End date: 12/31/21
Co-investigators: Steven Gortmaker, Shukri Mohamed, Martin Kavao, Gershim Asiki
Mentor: Steven Gortmaker

Childhood obesity is an emerging public health issue in Kenya. Research on childhood obesity related to diet and physical activity has been conducted in some populations in Kenya, but no data exists on the double burden of childhood malnutrition, and on the consumption of sugar-sweetened beverages, and its association with childhood obesity and/or childhood undernutrition. This mixed-methods study investigated the factors associated with childhood malnutrition, and childhood obesity in the slums of Nairobi, and aimed to highlight the link between sugar-sweetened beverages on excessive weight gain and childhood obesity. This study also sought to identify and isolate potential barriers or facilitators in addressing childhood malnutrition in this community.

PI: Paula Margozzini

Institution:  Pontificia Universidad Católica de Chile, Medical School, Chile
Title: Reductive validity of chronic disease multimorbidity-based risk stratification in Chile: Cohort analysis using a national health survey, ENS 2010
Budget: $14,882
Start date: 3/31/20
End date: 11/30/21
Co-investigators: Alvaro Passi, Samanta Anriquez
Mentor: Goodarz Danaei

In Chile, 70% of the over-14-year-old population has chronic disease multi-morbidity (MM). People who live with 5 or more chronic diseases has increased from 11.9% to 17.5 % between 2010 and 2017 national health surveys. The Ministry of Health (MINSAL) recently proposed a national shift to a new MM-based chronic care mode, which included a new definition of MM strata. However, its capacity to predict important and costly events like hospitalizations and deaths that are amenable with primary care is not known. This study sought to contribute to a gap of knowledge using newly available and nationally representative data through cohort analysis of linked death certificates and hospital discharge data associated to the 2010 National Health Survey (Encuesta Nacional de Salud, ENS 2010). The general aim was to estimate the predictive validity of the simpler stratification definition that MINSAL wants to implement.

PI: Ghada El-Hajj Fuleihan

Institution: American University of Beirut, Lebanon
Lifestyle and environmental determinants of maternal and offspring obesity
Budget: $15,000 funded by the Lown Scholars Program
Start date: 4/1/19
End date: 3/31/21
Co-investigators: Najat Saliba, Carla Makhlouf Obermyer, Anwar Nassar, Marlene Chakhtoura, Ziyad Mahfoud
Mentor: Wafaie Fawzi

WHO reports that cardiovascular disease and cancer are the leading causes of mortality in Lebanon, with rates of 47% and 22%. There is also evidence from Western studies that prenatal exposure to maternal smoking is a major precursor of adverse health outcomes in the offspring, though data for risk factors to cardiovascular diseases in the Middle East is lacking. This study sought to validate environmental pollutant measurements and lifestyle assessment instruments (dietary and activity questionnaires) to be used postpartum, and to explore the impact of environmental pollutants on the obesity phenotype in mother-offspring pairs. Thus far, data on exposure to pollution of mother-infant pairs was collected and will be analyzed during the next project phase.

PI: Marcia Scazufca

Institution: Institute of Psychiatry, University of São Paulo, Brazil
Title: Cluster randomized controlled trial to lower blood pressure among old adults with hypertension and depression within the Family Health Strategy in São Paulo, Brazil
Budget: $9,250
Start date: 3/1/18
End date: 2/28/21
Co-investigator: Roopen Araya
Mentor: Goodarz Danaei

This study aimed to test whether behavioral activation would improve control of raised blood pressure among older adults with depression registered with the Family Health Program (primary care) in São Paulo, Brazil compared with enhanced usual care. The recruitment of participants and the delivery of the psychosocial intervention began in May 2019. Due to the COVID-19 pandemic in Brazil, activities that included face-to-face contact with the elderly participants were halted in March 2020; eight- and 12-months follow-up assessments were conducted by phone for those already included in the study.

PI: Trevor Ferguson

Institution: Caribbean Institute for Health Research (formerly Tropical Medicine Research Institute), The University of the West Indies, Jamaica
Title: Cardiovascular health in urban poor and middle income communities in Jamaica: Impact of psychosocial stress, social networks, and social support
Budget: $49,988
Start date: 9/1/17
End date: 12/31/20
Co-investigators: Novie Younger-Coleman, Ishtar Govia, Rainford Wilks, David Williams, Marshall Tulloch-Reid
Mentor: David Williams

Ideal cardiovascular health (ICH) is associated with greater longevity and reduced morbidity, but no research on ICH has been conducted in Jamaica. This study aimed to estimate the prevalence of ICH in urban Jamaica and to evaluate associations between ICH and community, household, and individual socioeconomic status (SES). Using data from the third Jamaica Health and Lifestyle Survey, (JHLS-III), two phases of analysis were conducted on a variety of socioeconomic and psychosocial variables. Living in poorer communities was associated with lower odds of ICH-5 among men in Jamaica. The association between education level and ICH-5 differed in men and women.

PI: Alfa Muhihi

Institution: Management and Development for Health (MDH), Tanzania
Title: Assessing effects of community health workers interventions for reduction of blood pressure among adults in Morogoro, Tanzania: A demonstration study
Budget: $38,740
Start date: 3/1/19
End date: 9/30/20
Co-investigators: David Urassa, Emmy Metta, Deodatus Kakoko
Mentor: Marina Njelekela

This study sought to determine baseline prevalence and determinants of hypertension among adults in Morogoro, Tanzania and to determine effects of interventions involving community health workers (CHWs) on reduction of blood pressure among hypertensive adults in Morogoro, as well as explore the perceived quality and acceptability of such interventions. Through a cross-sectional survey conducted as part of the cluster randomized controlled study of CHW interventions for reduction of blood pressure in a randomly selected sample of young and middle-aged populations in rural Morogoro, it was determined that there is high prevalence of hypertension with low rates of awareness, treatment, and control among young and middle-aged adults in rural Tanzania.

PI: Dalia Stern

Institution: National Institute of Public Health, Mexico
Title: Acceptability, feasibility and effectiveness of a worksite intervention to reduce cardiometabolic risk in Mexico
Budget: $56,050.81 with $12,962.86 awarded by the Lown Program
Start date: 3/1/18
End date: 9/30/20
Co-investigator: Ruy-López Ridaura
Mentors: Donna Spiegelman, Josiemer Mattei

Worksite-based nutrition interventions can serve as access points to facilitate healthy eating and translate existing knowledge of cardiometabolic disease prevention. This study explored perceptions, facilitators, and barriers for healthy eating in a cafeteria at a large worksite in Mexico City. Through an exploratory qualitative study in a large department store, it was discovered that major barriers to healthy eating included unavailability of healthy foods, unpleasant taste of food, and preference for fatty foods and meat. For lower-wage workers, affordability was a major concern. Other barriers included lack of time to eat work and long working hours.

PI: Ramfis Nieto-Martinez

Institution: Foundation for Public Health and Epidemiology Research in Venezuela (FISPEVen); Venezuelan Society of Internal Medicine (SVMI), Venezuela
Title: Effect of socioeconomic status on cardiometabolic risk during the Venezuelan humanitarian crisis: EVESCAM cohort study
Budget: $23, 501
Start Date: 4/1/18
End Date: 7/31/20
Co-investigators: Juan P. González-Rivas, Eunice Ugel, Maritza Durán, Maria Ines Marulanda, Hermes Florez, Jeffrey I. Mechanick
Mentors: Goodarz Danaei

This study examined recent changes in CVD risk in each socioeconomic status during the current economic and political crisis in Venezuela. The team used data from a sample of 1,257 participants from the cross-sectional version of the EVESCAM to assess the change between 2015/2017 and 2018/2019 in 10-year fatal CVD risk across different socioeconomic strata and examined changes in specific CVD risk factors in the same population. Data analysis is ongoing.

PI: Seyed Hesameddin Abbasi

Institution: Tehran Heart Center, Tehran University of Medical Sciences, Iran
Title: Association between socioeconomic factors and major adverse cardiac events (MACE) in patients with premature coronary artery disease in Iran
Budget: $100,000 with $10,000 awarded by the Lown Program
Start Date: 11/1/17
End Date: 6/30/20
Co-Investigators: Seyed Ebrahim Kassaian, Saeed Sadeghian, Masoumeh Lotfi, Arash Jalali, Tahereh Davarpasand
Mentor: Murray Mittleman

This study explored the association between socioeconomic factors (including level of education, employment/unemployment status, household income, and gender) and major adverse cardiac events in patients with premature coronary artery disease (those occurring in the fourth and fifth decade of life) in Iran. By interviewing over 800 patients with early-onset coronary artery disease referred to Tehran Heart Center Hospital, the study found that sex and educational level play significant role in patients’ outcomes. The study also established a multidisciplinary premature coronary artery disease clinic.

PI: Rosana Poggio 

Institution:  Institute for Clinical Effectiveness (IECS), Argentina
Title: An innovative approach to improve quality of care for cardiovascular disease risk factors management in poor urban settings: A feasibility study in Argentina
Budget: $46,008
Start date: 3/1/19
End date: 2/28/20
Co-investigators: Laura Gutierrez, Vilma Irazola
Mentor: Vilma Irazola

Argentina is the highest contributor to cardiovascular disease burden in South Latin America; at the same time, 36% of the population is uninsured and is constituted mainly of the poorest. Through a non-controlled feasibility study using a mixed methods approach, this study evaluated the feasibility of a CHW-led intervention to improve detection and risk factors management in the uninsured poor population with moderate or high CVD risk in Argentina. The proposed CHW-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina.

PI: Rakesh Suseela

Institution: Amrita Institute of Medical Sciences, India
Title: Effectiveness of a community-based education and peer support led by women self-help group members in improving the control of hypertension: an implementation research in urban slums of Kochi city, Kerala, India
Budget: $58,275, with $37,315 awarded by the Lown Program
Start Date: 3/1/18
End Date: 12/31/19
Co-investigators: Menon J, Aswathy S, Teena MJ, Sobha George
Mentors: Goodarz Danaei, Rajani Ved, Donna Spiegelman

This study assessed the effectiveness of a community-based education and peer support led by women self-help group members in reducing systolic blood pressure among people with hypertension in urban slums of Kochi, Kerala, India. Through consultation meetings with self-help groups, local government leaders, and participant groups, a study was designed and data collected by trained self-help group volunteers in twenty slums; community interventions followed and data analysis is ongoing. The project resulted in demand generation for better hypertension control, improved awareness, improved early detection, and improvement in positive life styles and overall blood pressure reduction in the intervention area.

PI: Devaki Nambiar

Institution: The George Institute for Global Health, Delhi, India
Title: Assessing coverage, inequalities, and frontline provider workflows for hypertension and diabetes screening, treatment, and follow-up in two Indian states
Budget: $64,008 with $49,099 awarded by the Lown Program
Start date: 3/1/18
End date: 10/31/19
Co-investigator: Rajani Ved
Richard Cash

This study assessed the coverage of screening, treatment, and follow-up for hypertension and diabetes by frontline health workers in two Indian states (Delhi and Himachal Pradesh) to determine inequalities in screening, treatment, and follow-up coverage by gender, poverty and caste status at facility level across two states and to characterize the workflow of frontline health workers undertaking screening, treatment and follow-up monitoring for hypertension and diabetes in these two states. The study is now embedded within the national program and will assist with state and district level decision-making to improve the delivery of CVD-related services, and engage frontline health workers in quality appraisal and equity analysis of data gathered by them.

PI: Davood Khalili

Institution: Research Institute for Endocrine Sciences in Shahid Beheshti University of Medical Sciences, Tehran, Iran
Title: Cost-effectiveness of risk-based prevention in primary health care setting in rural and urban areas in Iran: from prediction to action (PredAction project)
Budget: $10,118
Start date: 4/15/18
End date: 4/14/19
Co-investigator: Noushin Fahimfar
Mentor: Goodarz Danaei

This study aimed to determine the clinical usefulness of the risk-based interventions for CVD prevention in urban and rural areas of Iran. Specifically, the study assessed the acceptability and preferences for treatment threshold among service users and healthcare providers in urban and rural populations by using the knowledge, attitude and practice (KAP) study and Treatment Trade-Off Method (TTM) used in shared decision making in order to determine the clinical usefulness of the Globorisk prediction model in different preferred risk thresholds for treatment by calculating the “net benefit.”

PI: Okechukwu Ogah

Institution: Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
Title: A study to explore the cardiovascular disease risk factors profile and burden of cardiovascular diseases in urban slums of Aba, Abia State, Nigeria
Budget: $13,000
Start date: 1/1/17
End date: 4/31/18
Co-investigators: Innocent Chukwuonye, Ijeoma Nduka
Mentors: Goodarz Danaei

This study aimed to determine the prevalence of CVD risk factors such as hypertension, diabetes mellitus, dyslipidemia, obesity and overweight, cigarette smoking, alcohol abuse and physical activity in slums in Aba, Nigeria. It also examined the knowledge, attitude, and health-seeking behavior of inhabitants of these slums on CVD risk factors and compared this population with high-income segment of the population based on a study in the same state by Ogah et al.

PI: Vilma Irazola

Institution: South American Center of Excellence for Cardiovascular Health at the Institute for Clinical Effectiveness and Health Policy, Argentina
Title: Assessing the interaction between built environment and cardiometabolic risk factors: Its role on health disparities
Budget: $40,000
Start Date: 3/1/17
End Date: 2/28/18
Co-investigators: Adolfo Rubinstein, Natalia Elorriaga, Luz Gibbons, María Calderón
Mentor: Marcia Castro

This study evaluated the influence of Built Environments on health-related behaviors and cardiometabolic outcomes in the Southern Cone of Latin America, focusing on urban poor and health disparities. Food and physical activity environment and its relationship with socioeconomic status factors in four communities in Argentina, Chile and Uruguay were examined and the association between characteristics of the built environment and physical activity and diet and cardiometabolic conditions (hypertension, diabetes and obesity) were quantified in adults 40-80 years old in the four communities. The study also explored the agreement between perceived and objectively measured built environment, and their association with physical activity, diet, obesity and diabetes in the four communities.