Efficacy Assessment of Deployment of Phone-Based Glucose Test Strips for Prediabetes Awareness

Investigators
Jason Hoffman, Allen School of Computer Science & Engineering
Lorena Alarcon Casas-Wright, Department of Medicine
Shwetak Patel, Allen School of Computer Science & Engineering and Department of Electrical & Computer Engineering

Project abstract
Prediabetes affects millions of Americans, yet over 80% of those with the condition are unaware of their status. Current screening methods are often cost-prohibitive or clinic-dependent, creating significant barriers to early detection and subsequent intervention. This project validates GlucoScreen-C, an ultra-low-cost, smartphone-based test strip that connects directly to a user鈥檚 smartphone, transforming the device into a high-accuracy medical reader without the need for standalone hardware.

In a new interdisciplinary collaboration between the 糖心少女Computer Science and 糖心少女Medicine鈥檚 Endocrinology Department, this pilot study will deploy GlucoScreen-C in an at-home model for follow up for some patients. By sending participants home with a set of test strips compatible with their smartphones, we aim to improve outcomes for individuals who do not traditionally visit physical clinics, effectively extending the reach of existing mobile screening efforts. This project addresses the population health pillars of human health and social equity by bringing essential screening to underserved and rural communities in Washington. The success of this deployment validation will provide the proof of efficacy needed to launch this technology as a scalable solution for population-level prediabetes awareness.

Evaluating Wildfire Threats to Drinking Water Systems in Yakima Valley to Inform Intervention Development and Mitigate Public Health Risks

Investigators
Katya Cherukumilli, Department of Human Centered Design & Engineering
Susan Carpenter, Department of Human Centered Design & Engineering
Catherine Karr, Department of Environmental & Occupational Health Sciences
Christine Loftus, Department of Environmental & Occupational Health Sciences
Jessica L. Black, Heritage University
Stephanie Hung, Department of Human Centered Design & Engineering
Allison Sherris, Department of Environmental & Occupational Health Sciences

Project abstract
Wildfires increasingly threaten drinking water quality across the U.S. by introducing heavy metals, nutrients, and volatile organic compounds through ash deposition, soil erosion and reduced natural filtration. In Washington State’s Yakima Valley, the 2024 Retreat and 2025 Wildcat fires burned over 60,000 acres near watersheds supplying drinking water to over 200,000 residents, yet their impact on water quality has not been studied. This region already faces elevated exposure to agricultural contaminants including nitrates and pesticides, creating the potential for compounding health risks鈥攑articularly for vulnerable populations such as pregnant women and children.

We propose to evaluate wildfire impacts on Yakima Valley’s drinking water. In Aim 1, we will assess changes in heavy metals, nutrients and water quality parameters pre- and post-fires by analyzing existing surface water quality datasets from USGS and Washington Department of Ecology, along with new field measurements of surface water, sediment, and soil across the Naches River watershed. In Aim 2, we will leverage EPA data and interview water utility operators to evaluate impacts of wildfires on the City of Yakima鈥檚 drinking water quality. In Aim 3, we will compare Aims 1 and 2 findings against federal and state regulatory standards to estimate residents’ potential contaminant exposure risk and inform mitigation strategies.

We will partner with Heritage University, a minority-serving educational institution, to engage local students in research and design of public materials for communicating results. Findings will fill a critical evidence gap and guide enhanced monitoring, treatment and intervention strategies for wildfire-impacted water systems.

Improving Access to Serious Cardiac Illness Care in the WWAMI Region: A Community-Engaged Mixed Methods Study

Investigators
Erin Blakeney, Department of Biobehavioral Nursing and Health Informatics
Jill Steiner, Department of Medicine
WWAMI Voices Community Advisory Board
Salpy Pamboukian, Department of Medicine
James Sibley, Clinical Informatics Research Group
Warren Szewczyk, Department of Biobehavioral Nursing and Health Informatics

Project abstract
The 糖心少女 (UW) is the largest provider of advanced therapies for serious cardiac illness (SCI; e.g., advanced heart failure (AHF), adult congenital heart disease (ACHD)) in the WWAMI region (Washington, Wyoming, Alaska, Montana, Idaho) and one of only two such centers. Because many SCI patients must travel long distances to Seattle for care, extended journeys that span days or even months are common. This creates a regional population鈥慼ealth challenge for patients and health systems alike.

In recognition of these challenges, in 2025, with Population Health Initiative Tier 1 support, we formed the 鈥淲WAMI Voices鈥� Community Advisory Board to foster community-engaged research and improve SCI care access, experience, and outcomes.

Our Tier 2 project builds on this partnership. Using mixed methods, we will evaluate the current SCI care referral process at 糖心少女from both administrative and patient/clinician perspectives. Our aims are to:

1. Assess key SCI referral process鈥� and patient鈥憃riented outcomes, including modifiable areas for improvement; and,
2. Characterize the SCI referral and orientation experience across inpatient and outpatient settings through policy and document review, followed by interviews with patients and clinicians.

These aims align with WWAMI Voices priorities, including supporting families during hospitalization and addressing geographic variation, as well as the Population Health pillars of human health and social and economic equity.

This will be WWAMI Voices鈥� first community鈥慹ngaged research project, yielding preliminary data for future work. Findings are expected to inform near鈥憈erm grants, broaden engagement with SCI patients and providers and support the co鈥慸evelopment of a referral鈥憃ptimization intervention.

Co-designing a culturally responsive vaccine communication intervention with caregivers and community-based organizations to increase childhood vaccine uptake among East African children

A portion of the funding for this award came via a partnership with the , which seeks to enhance the UW鈥檚 global engagement and reach.

Investigators
Michelle Shin, Department of Child, Family, and Population Health Nursing
Ahmed Ali, Somali Health Board and Department of Global Health
Alyssa M Caucci, Neighborcare Health Administration
Najma Osman, Somali Health Board
Ramla Abdi, School of Public Health and Neighborcare
Aynalem Sisay, School of Nursing

Project abstract
Resurgence of measles, mumps, rubella, and varicella (MMRV)鈥攚ith 2025 marking the highest number of measles cases in 33 years and an ongoing outbreak in 2026鈥攑oses a significant population health threat in Washington. East African (EA) communities, including Somali, Eritrean, and Ethiopian populations, face disproportionately high risk due to low MMRV vaccination rates driven by misinformation and systemic barriers. Neighborcare, a community health clinic, and Dr. Shin have identified that EA patients under age two have 60鈥�69% lower odds of receiving at least one MMRV vaccine dose compared to peers. Providers and staff emphasized the need to collaborate with EA caregivers and community leaders 鈥渂eyond the clinic walls鈥� to address fears related to autism and concerns about gelatin in vaccines, but reported limited capacity to build meaningful partnerships.

To address these challenges, Neighborcare (CHC; Ms. Caucci), the Somali Health Board (CBO; Dr. Ali), and Dr. Shin propose a tripartite partnership to develop a community-informed intervention using Intervention Mapping. The project will:

1. Conduct a community-engaged needs assessment with a multi-level community advisory board (CAB) to identify determinants of MMRV vaccination among EA communities; and,
2. Co-design a theory-informed, culturally responsive vaccine communication intervention and implementation plan in collaboration with the CAB.

This project will generate two proofs-of-concept aligned with the Population Health pillars: (1) a community- and theory-informed intervention to increase MMRV vaccination (human health), and (2) a scalable CHC鈥揅BO鈥揳cademic partnership model that embeds culturally responsive strategies into clinical and community settings (social and economic equity). The work will provide preliminary data to support future large-scale trials evaluating the intervention鈥檚 effectiveness and real-world implementation, advancing health equity.

Integrating end-user needs and perspectives in the measurement of young adult climate change distress

Investigators
Jessica Acolin, Department of Psychiatry & Behavioral Sciences
Sonya Jampel, Public Health 鈥� Seattle & King County
Jennifer Atkinson, Interdisciplinary Arts & Sciences (糖心少女Bothell)
McKenna Parnes, Department of Psychiatry & Behavioral Sciences
Jason Kilmer, Department of Psychiatry & Behavioral Sciences
Brittney Hultgren, Department of Psychiatry & Behavioral Sciences

Project summary
This project performed pilot work to support the development of a brief Climate Distress Questionnaire (CDQ) suitable for measuring climate change distress in epidemiologic surveys. This work represents a foundational step towards facilitating future research on the public health burden and health impacts of climate distress which are currently understudied.

The project occurred over three stages. First, we conducted post-hoc qualitative analysis of a series of meetings with key informants from local public health jurisdictions to identify practitioner demands of climate distress measurement to support public health. Second, we conducted qualitative focus groups with end-users of the proposed CDQ. This work consolidated and reconciled differing disciplinary perspectives on climate distress, identified multi-sectoral demands for climate distress measurement and explored priorities for future work across fields. Participants included environmental epidemiologists, mental health clinicians, public health professionals and community-based key informants. Additional interviews with survey administrators explored the logistic demands regarding the development of epidemiologic surveys and the inclusion of novel measures.

Across disciplinary perspectives, overall consensus highlighted the complex nature of climate distress. Consistent with prior work, respondents described the contributions of individual exposure to extreme weather, social norms, behavioral change and sociopolitical climate to climate distress. Novel findings regarding climate distress measurement included the need for brevity, alignment with existing programs and acceptability by respondents. Respondents also noted the need for future work to address and overcome barriers in order to advance public health, including polarization regarding the term 鈥渃limate change,鈥� competing demands for limited funds and institutional inertia. Innovative findings regarding future directions for climate distress work also emerged.

This work resulted in a preliminary list of approximately 30 items to measure climate distress among young adults, selected to capture conceptually relevant aspects of climate distress while meeting the demands of cross-sectoral end-users. These items provided the foundation for the third stage: qualitative pre-testing of items with young adults to ensure that young adults perceived items were relevant, clear and easy to understand. A series of focus groups with 20 young adults recruited nationally reduced the preliminary list to 15 items.

Using remaining pilot funds, we have extended project aims to include quantitative psychometric testing of the remaining 15 items. Data collection is ongoing and will include a national sample of young adult college students. Preliminary findings were presented at the Oregon Public Health Association Annual Conference, the Washington State Public Health Association Conference, the American Public Health Association Annual Conference and the American Meteorological Society Annual Meeting. Two research manuscripts summarizing these findings are being prepared for submission to peer reviewed journals.

Identity safety in medicine: a qualitative study to elicit patient perspectives and develop a framework to apply in clinical settings and research

Investigators
Brian Wood, Department of Medicine
Justin Bullock, Department of Medicine
Crystal Brown, Department of Medicine
Reggie Casanova-Perez, Department of Biomedical Informatics and Medical Education

Project summary
The principal aim of our project is to gain a better understanding of patient perspectives on identity safety in healthcare, which we hope will contribute to development of strategies to help individuals feel safe during medical encounters, feel that they can be their true authentic selves with medical staff and feel that they can discuss difficult issues or share sensitive information which will improve the quality of their healthcare. We are accomplishing this through a qualitative study in which we enrolled people with HIV at clinical sites with varied geopolitical environments (sites from a major metropolitan area in Washington, a more mid-size city in Washington, a mid-size city in Montana and a lower population area of Idaho).

We enrolled individuals with HIV because of a relatively high rate of stigma around HIV plus relatively frequent occurrence of intersectionality with other stigmatized conditions such as mental health issues, substance use, incarceration and others. A secondary aim of the study is to create a framework for understanding and studying identity safety in healthcare which will benefit future research efforts.

We feel that we have had a high degree of success with this study. During the grant period we were able to accomplish the following:

• Completed the IRB review and approval process
• Completed a successful community advisory board meeting during which we gained insights and input from 10 community members who gave feedback on our study goals and methods (including recruitment strategy and interview plans)
• Our study team reviewed, revised and finalized the interview guide and focused on integrating advice and feedback from the community advisory board meeting
• We recruited at all planned clinical sites via study flyers and assistance of staff at those clinics who helped distribute flyers and disseminate information about the study
• We successfully completed a total of 17 qualitative interviews (12 participants from Washington, 4 participants from Idaho and 1 participant from Montana) and feel that we reached a relatively diverse group of participants and gathered rich and valuable input from the interviews
• Volunteers who completed interviews were given Tango gift cards as a thank you for their time and participation
• We have uploaded all interview audio recordings to Rev, developed a code book for analysis and are actively working on coding the transcripts

Although the grant period has ended, the study team will continue to code the transcripts and then will move to analyzing the data, developing a manuscript and developing other tools that can be informative to clinics and providers to help promote feelings of safety for patients during medical encounters.

Exploring the Impact of Communication Styles in Health Chatbot using Large Language Models to Support Family Caregivers from Multicultural backgrounds

Investigators
Elina Hwang, Foster School of Business
Stephanie Lee, Foster School of Business
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Rebekah Baik, Foster School of Business
Weichao Yuwen, School of Nursing & Healthcare Leadership (糖心少女Tacoma)

Project summary
Recent advancements in generative large language models (LLMs) have opened up significant opportunities for AI-based chatbots in the healthcare sector. However, there are ongoing concerns regarding their cultural sensitivity. It remains uncertain whether these chatbots can grasp the nuanced cultural differences that are essential for effective communication in healthcare, where building rapport is crucial for patient compliance, satisfaction and overall outcomes. Our project aims to establish a foundation for developing health chatbots that can adapt to various cultural communication styles.

Our study had two aims. First, we aimed to conduct a comprehensive literature review on cultural preferences in communication styles, specifically within healthcare. This review will help identify factors that can assist in adapting AI-based chatbots to be more culturally sensitive (Aim 1). Second, we proposed to develop prototypes of AI-based therapy bots that incorporate a variety of communication styles and gather feedback from participants of diverse racial and ethnic backgrounds (Aim 2). We expect these findings to enhance the cultural sensitivity and effectiveness of therapy chatbots for patients from various backgrounds. To achieve our goals, we have assembled an interdisciplinary team of faculty and doctoral students from the business school, the school of medicine, the college of arts and sciences (department of communication) and the school of nursing and healthcare leadership.

Our team has satisfactorily completed both aims. For Aim 1, we conducted a thorough literature review on health communication styles, drawing from various fields, including communication, psychology, anthropology, linguistics, human-computer interaction (HCI) and computer science. From this review, we identified four communication style dimensions that could influence the effectiveness of AI-based chatbots designed for caregivers from diverse cultural backgrounds. These dimensions are authoritative, sentimental, informal and concise.

For Aim 2, we developed prototypes of therapy chatbots and evaluated their effectiveness. Based on the communication styles identified in Aim 1, our team created several chatbot prototypes that incorporate these different styles. We utilized a multi-agent system with large language models (LLMs) and Langchain to engineer prompts tailored for each communication style. We validated these prototypes through a controlled experiment, where we assessed human subjects’ evaluations of the chatbots’ communication styles. The experiment demonstrated that the prototypes successfully produced noticeable differences in communication styles, with the adapted responses receiving significantly higher ratings for style-specific characteristics compared to the unadapted responses. Furthermore, we validated these prototypes using dictionary-based measures of linguistic markers, specifically the Linguistic Inquiry and Word Count (LIWC 2024). These results indicate that LLM-based therapeutic chatbots can be effectively tailored to exhibit distinct communication styles, establishing an essential foundation for the current proposed study. Our paper summarizing the findings from this Tier 1 project has been accepted to CHI 2025 as Late-Breaking Work.

Clinical and structural approaches to addressing substance use disorder in HIV care in Zimbabwe: Formative work

Investigators
Helen Jack, Department of Medicine
Malinda Kaiyo-Utete, University of Zimbabwe
Theresa Matson, Kaiser Permanente Washington Health Research Institute
Kudakwashe Takarinda, OPHID
Emily Williams, Department of Health Systems and Population health

Project summary
The aims of this study are to validate 1) a single-item substance use disorder screening tool (1) and 2) the AUDIT-C, a 3-item alcohol use disorder screening tool (2) against a clinical interview (CIDI diagnostic interview) (3) in a sample of 1064 patients in HIV care in Zimbabwe. This study will also provide the first prevalence estimate of alcohol and substance use in HIV care and one of the first prevalence estimates in the country overall. This is a collaborative project between the Organization for Public Health and Development (OPHID), a Zimbabwean non-profit organization and 糖心少女 (UW). Data collection for this study took place in Bulawayo and Gwanda districts in southern Zimbabwe. The overall study was supported by the 糖心少女Behavioral Research Center for HIV (BIRCH); the 糖心少女Addictions, Drug and Alcohol Institute (ADAI); and the 糖心少女Population Health Initiative (PHI). PHI specifically supported expansion of the study to include the single-item SUD screening tool.

The study took place in 8 HIV clinics in Bulawayo (urban) and Gwanda (rural) districts. People living with HIV presenting for care were randomly selected to participate in the study. A trained data collector administered a sociodemographic questionnaire, the full AUDIT (of which the AUDIT-C is the first 3 questions) and the single-item substance use screening tool to people who consented to participate. The participants then met with a nurse who administered a structured clinical diagnostic interview (the CIDI) for alcohol and substance use disorders then completed timeline followback, a standardized method for eliciting the number of standard drinks that someone has consumed in the past 30 days. In preparation for future work, we asked participants with alcohol or substance use disorder what types of treatment they would find most helpful. During analysis, receiver operator curves and areas under the curve were created for the alcohol and substance use screening tools, comparing their performance to the diagnostic interview and the sensitivity and specificity at each threshold was calculated.

We enrolled 1064 people living with HIV in the study, the a priori target sample size. The sample was 62% female, 36.1% were between the ages of 18 and 40 and 64.0% had a secondary school level of education. 40.7% of the sample stated that they 鈥渙ften鈥� or 鈥渁lways鈥� lacked resources for basic necessities such as housing or food in the past 12 months. We found a high prevalence of alcohol use disorder based on the diagnostic instrument with prevalence twice as high among males compared to females. We found a markedly lower prevalence of substance use disorder and the most common substance used was cannabis. The AUDIT-C had excellent performance for predicting alcohol use disorder and the single-item substance use screen had good performance. The vast majority of people with alcohol or substance use disorder wanted to reduce their use and the treatment that they thought would help the most was having a job or other income-generating activity. Of more standard substance use treatments, counseling from a lay health worker or psychologist were most commonly endorsed and there was less interest in counseling from a peer.

A community co-led epidemiologic study of methamphetamine use patterns and associated factors among cisgender men and transgender people who have sex with men

Investigators
Matthew R. Golden, Department of Medicine
Christopher Archiopoli, Strength Over Speed
Mike Barry, Department of Epidemiology
Jack Harlan, Peer Seattle
Barbra A. Richardson, Department of Biostatistics

Project summary
In this research, we aimed to recruit cisgender men and transgender people who have sex with males (CMTSM, N >2,500) for a web-based biobehavioral survey previously developed by our research team. Our scientific aims were to (1) identify methamphetamine (meth) use classes (e.g. experience types) in this population and (2) compare characteristics of these groups to one another. The public health significance and expected impact of this research was to understand the diversity of meth use in this population and discern which characteristics are associated with the most morbid manifestations of meth use. Additionally, this work was guided by Community-Based Participatory Research principals and included a formal partnership with the Strength Over Speed (SOS) program of Peer Seattle. We proposed hosting two public meetings with the SOS group for the research team to receive input at various stages of the study from CMTSM who use meth in the Seattle Area.

Results and findings for Aim 1: From June-November 2024, the survey was attempted 2,579 times. Among these, 1,720 complete deduplicated surveys comprised the analytic sample. In this sample, 428 (25%) reported ever using meth. Among those who ever used meth, 403 (94%) provided sufficient data to be included in a stimulant use disorder (StUD) and meth-related adverse outcomes (MRAO) analysis (i.e. the meth use class analysis). In this sample, 269 (67%) reported evidence of developing StUD/MRAO. On average, CMTSM developed the first evidence of StUD/MRAO 6 years following first meth use. The most common manifestations of StUD/MRAO among those who developed it were disruptions in relationship/school/work (50%) and requiring medical attention due to meth use (20%). We estimated a 13% lifetime prevalence of StUD/MRAO in the CMTSM population.

Results and findings for Aim 2: CMTSM who ever used meth were more likely than those who did not to (1) be living with HIV (2) have experienced housing instability/homelessness and (3) have ever exchanged sex for money, drugs or a place to stay. CMTSM who developed evidence of StUD/MRAO were more likely than other CMTSM who used meth to (1) have received an HIV diagnosis (2) have experienced >1 of housing instability/homelessness, sex exchange or inability to meet basic needs. We held two community meetings at SOS; these were well-attended and supported the development of analyses and the interpretation of our findings.

Paid Family Leave and Parent Mental Health: Evidence from Administrative Data

Investigators
Tom Lindman, Evans School of Public Policy & Governance
Anirban Basu, School of Pharmacy
Anjum Hajat, Department of Epidemiology
Heather D. Hill, Evans School of Public Policy & Governance
Jessica Jones-Smith, Department of Health Systems and Population Health

Project summary
Research indicates that when workers have paid time off to care for themselves and others, they have more stable economic circumstances and improved physical health (Bartel et al. 2023). However, less is known about the effect of access to paid leave on mental health particularly among parents using leave around a birth. Although recent studies on U.S. state-level paid leave programs find reductions in mental distress for new parents, these studies compare mothers in states with and without paid leave programs, an approach that can be biased by unobserved differences between states (Bullinger 2019; Doran et al. 2020; Irish et al. 2021). In addition, all studies in the U.S. use self-reported mental health outcomes that are not closely linked to specific conditions or mental health care. Using data from the Washington Paid Family and Medical Leave Program (WA PFML) linked with insurance claims from the Washington All Payer Claims Database (APCD), we evaluated the impact of paid leave on the likelihood of birthing parents submitting insurance claims related to depression and anxiety following the birth of a child. Our study leverages a plausibly random feature of eligibility rules鈥攖he program work-hour eligibility requirement鈥攗sing regression discontinuity designs. We separately estimate the impact of paid leave on parents submitting insurance claims related to (1) depression and (2) anxiety in the calendar quarter following paid leave use.

Results suggest that access to Washington鈥檚 Paid Family and Medical Leave program reduces the likelihood of birthing parents submitting medical claims for depression by approximately 26.5% (-3.18 percentage points, SE 1.30) with much larger impacts in the treatment-on-the-treated analysis focused on leave users. We do not find statistically significant impacts on anxiety diagnoses. Our sample of working parents has low earnings and high rates of Medicaid use, suggesting that state paid leave programs positively affect the mental health among working parents with low incomes and/or unstable employment. This study is the first in the U.S. to evaluate paid leave鈥檚 impact on measures of mental health care or diagnosis and speaks directly to the efficacy of state paid leave programs at supporting the mental health of working parents.

Ensuring Equality: Language Access in Civil Protection Orders

Investigators
N. Jeanie Santaularia, Department of Epidemiology,
Alice M. Ellyson, Department of Pediatrics
Avanti Adhia, Department of Child, Family, and Population Health Nursing
Leticia Figueroa, King County Prosecuting Attorney鈥檚 Office

Project summary
Over 50% of women experience some form of interpersonal violence (e.g. domestic violence, sexual assault, harassment) in their lifetime. A civil protection order (CPO) is one critical intervention to support victim-survivors. CPOs are legal remedies meant to reduce the risk of threat and harm to a victim-survivor; however, equitable access to CPOs is limited. Individuals can encounter language barriers inhibiting effective communication at many points in their help-seeking and CPO process. The overall goal of our Tier 1 project was to describe language access challenges in CPO processes across counties in Washington State. The aims were to: (1) characterize language access of written materials (e.g. webpages) required to file and receive a CPO for interpersonal violence and (2) assess language access in verbal settings (e.g. interpretation services in hearings) using court observations.

We worked closely with our community partners at the King County Prosecuting Attorney鈥檚 Office and Washington Administrative Office of the Courts to receive input and feedback on all aspects of the project. We had two graduate students assisting on the project: an MPH student in Epidemiology and a PhD student in Health Services. We met weekly as a research team to check in and make progress.

Aim 1: We created a data abstraction tool, piloted the tool with a small number of counties, double coded a subset of counties with the tool (i.e. had two independent coders code the same webpages using the tool and comparing coding) and collected data from all county webpages. We systematically collected data to evaluate search results and webpage resource availability across the 38 counties with CPO webpages for the six most commonly spoken languages in the state other than English (Spanish, Russian, Chinese, Korean, Vietnamese and Tagalog/Filipino) to better understand the resources available to English language learners. We conducted web searches to assess whether two search terms (鈥減rotection order鈥� and 鈥渞estraining order鈥�) directed individuals to a county CPO webpage and assessed the translation availability and features of these CPO webpages. Across the six languages, the search term 鈥減rotection order鈥� returned the county鈥檚 CPO webpage for 3鈥�79% of counties and 鈥渞estraining order鈥� for 0鈥�76% of counties. Between 53%鈥�63% of county CPO webpages had a translation option available where Spanish was the most common and Chinese the least common. Most webpages used Google Translate and while over half of county CPO webpages offered a translation option, many elements (e.g. instructional PDFs, links, images) did not translate. We identified several possible solutions to these language access gaps, such as linking to translated versions of documents from the Washington State Administrative Office of the Courts website, embedding non-English search terms into webpages鈥� HTML code and using human translations or verifying quality of automatic translations.

Aim 2: We gained access to CPO hearings in King County that had language access needs and created a standardized data abstraction tool. We conducted court observations (n=50) by joining hearings via Zoom or accessing digital recordings of hearings held between December 2024 and March 2025. Hearings were eligible if they involved first-time cases and an interpreter was requested for at least one party. Our data abstraction tool included a mix of closed- and open-ended fields and had measures on hearing and CPO type, petitioner and respondent presence, interpretation requests and presence, hearing outcome, victim advocate presence, lawyer presence, judicial officer type, behavior and actions. Interpretation quality was assessed for a subset of Spanish interpreter cases observed by a native Spanish speaker on our team. Among the 50 CPO hearings, 38% resulted in a granted CPO, 36% in a continuance, 12% in a dismissal, 8% in a denial. An interpreter was requested for the petitioner in 89% of cases and present when requested in 92% of cases. A total of thirteen different languages were requested with Spanish being the most common. While 68% of hearings included an opening statement by the commissioner, not all opening statements were interpreted (83%). In open text fields, observers noted that there were hearings where evidence was not being considered due to lack of interpretation. Approximately 40% of hearings had an advocate present for the petitioner, 11% had a lawyer present for the petitioner and 23% had a lawyer present for the respondent. Overall, these exploratory analyses of observations of CPO hearings in King County, the most well-resourced county in the state, highlighted opportunities for improving language access in CPO hearings to ensure survivors of interpersonal violence are able to receive adequate legal protection.

Dissemination: We have disseminated our findings in several ways. First, we submitted a manuscript summarizing the Aim 1 findings on language access in CPO webpages to a peer-reviewed journal. We presented to the Washington Domestic & Sexual Violence Committee and the broader Washington State Supreme Court Gender and Justice Commission where members of the Interpreter and Language Access Commission were also invited. These commissions include relevant partners from across the state (e.g. judicial officers, court administrators) who were interested in our empirical findings.

Exploring stakeholder perspectives on the use of controversial datasets in population health research

Investigators
Stephanie M. Fullerton, Department of Bioethics & Humanities
Sarah C. Nelson, Department of Biostatistics
Jacklyn Dahlquist, Department of Bioethics & Humanities
Stephanie M. Gogarten, Department of Biostatistics

Project summary
The aims of this pilot project were to (1) perform a scoping literature review to identify relevant scientific and scholarly discussions of use of a controversial dataset (the Human Genome Diversity Project, or HGDP) in population health research and (2) conduct qualitative interviews with key informants knowledgeable about the historic and/or current relevance of HGDP data for population health research and which communities may be impacted by its ongoing use.

For Aim 1, we completed the literature review and are now preparing a manuscript for publication. Our review was based in reverse citation searches of six key HGDP resource papers, identifying 1,848 manuscripts published since 2010 (as publications prior to 2010 were analyzed in a previous publication). We manually screened abstracts then full text to exclude 631 publications that were either not primary research reports (e.g. commentaries and reviews) or did not directly use the HGDP data. The final collection of 1,217 articles was then assigned to one of four categories of HGDP research use: health-related study, non-health related phenotype, no phenotype (e.g. population genetics study) or methods development. Relevant metadata, including dates of publication, geographic locations of study authors and funding source, has also been extracted and is being analyzed for the planned manuscript. A primary finding from this analysis is that the HGDP data continue to be widely used largely by investigators located in the United States or Europe and despite early controversies surrounding the project. Most published uses were in the realm of population genetics and evolutionary biology, in line with the original goals of the project. We also observed both health-related and commercial uses of the data, which were not anticipated at the time the sample collection was established. Importantly, because HGDP data are also embedded in several prominent databases and other resources without full attribution, we believe this review captures only a fraction of all secondary uses of those data.

For Aim 2, we completed Zoom-based interviews with a sample of bioinformaticians, geneticists, Indigenous scientists, social scientists and historians about the current utility of and potential concerns regarding ongoing use of the HGDP data. To identify key informants for recruitment, we began with social scientists and researchers who had written about the HGDP or used HGDP in their work (including from our Aim 1 literature review); we then used snowball sampling to identify others with related interests and experiences. In total, we successfully recruited 20 and spoke with 18 different scholars based in the United States, United Kingdom or Latin America. These interviews, which were primed by a brief introduction to the findings of the Aim 1 literature review, focused on key informants鈥� understandings of the early history of the project, their thoughts on the benefits and risks involved in ongoing uses and ended by soliciting responses to the currently hypothetical possibility of researcher engagement with the Indigenous and other communities whose members contributed data to the project. All interviews were recorded with permission, transcribed and redacted. We are now in the process of qualitatively analyzing the transcripts and plan to summarize our findings in peer reviewed publications and at professional meetings. A preliminary finding is the striking heterogeneity of views among the different stakeholders we interviewed and varying familiarity with the history and early controversies of the HGDP collection. While some regard the data as fundamentally unique and of high scientific utility, others suggested that donor communities could hold concerns about the ongoing use of their members鈥� information particularly so many decades after sample collection. Most regarded the possibility of community engagement as practically infeasible or undesirable.

Building and evaluating AI-augmented treatment support for individuals with tuberculosis

Investigators
Martine De Cock, School of Engineering and Technology (糖心少女Tacoma)
Sarah Iribarren, Department of Biobehavioral Nursing and Health Informatics
Fernando Rubinstein, Institute for Clinical Effectiveness and Health Policy
Daniil Filienko, School of Engineering & Technology (糖心少女Tacoma)
Weichao Yuwen, School of Nursing & Healthcare Leadership (糖心少女Tacoma)

Project summary
Tuberculosis (TB) remains one of the world鈥檚 deadliest diseases, killing three people per minute. Each year an estimated 10.6 million people develop TB and 1.5 million die from this curable disease. A critical challenge to meeting the World Health Organization鈥檚 targets to end TB is ensuring patients鈥� adherence to the 6 to 9-month treatment regimen. Innovative patient-centered approaches are needed to empower individuals with TB and frontline healthcare workers to meet the end TB goals. The TB Treatment Support Tools (TB-TST) intervention, iteratively developed by a 糖心少女team with patients and clinical partners, combines a Spanish-language mobile application for patient-centered support, monitoring and communication with a drug metabolite test. While helpful, following up on patients through Digital Adherence Technologies (DATs) still requires significant human involvement from healthcare providers. A pragmatic clinical trial across four public hospitals in Argentina demonstrated TB-TST鈥檚 effectiveness but challenges such as 24/7 support needs and workforce burden highlighted the need for further innovation.

Large Language Models (LLMs), a new kind of powerful AI model such as the GPT series from OpenAI, offer a promising advancement to scale patient support and reduce provider workload. They can answer medical questions, provide treatment guidance and enhance patient engagement, potentially transforming TB care delivery. Yet, no Spanish-language chatbots have been developed specifically for TB treatment support. In this pilot project (1) we developed an LLM-powered TB treatment support AI agent based on pragmatic clinical trial data of the TB-TST intervention tool and patient needs and (2) we evaluated the AI agent in terms of linguistic appropriateness, empathy, medical accuracy and privacy.

AI agent development. We iteratively developed a series of GPT-based conversational models designed to be deployed as human-supervised treatment supporters for Spanish-speaking individuals with TB. These models can answer questions such as 鈥淒o I take all of the pills together or some in the morning and some in the evening?鈥� or 鈥淚s it normal to continue having night sweats?鈥� The models were created using different prompt engineering techniques, few-shot learning and Retrieval Augmented Generation (RAG). To enhance domain-specific responses, we integrated publicly available TB guidelines and medication suggestions including from the WHO and the CDC; previous TB trial messages; and manually crafted dialogue samples mimicking real conversations to be used by the model. To safeguard patient privacy, we applied differentially private text sanitization to trial messages used in few-shot prompts. We also developed a multi-agent classification sequence in which the first LLM agent uses a classification prompt to identify whether a user query is empathy-seeking or information-heavy based on examples curated by clinical experts. Queries classified as empathy-seeking are directed to an empathy-optimized agent while information-heavy queries are routed to a fact-focused RAG agent. This modular setup enables the system to provide context-appropriate responses while leveraging the strengths of each specialized agent.

AI agent evaluation. A considerable amount of effort went into assessing the quality of the developed models. We created rubrics to evaluate the conversational agents in terms of linguistic appropriateness, empathy and medical accuracy. After multiple rounds of internal evaluation with our bilingual research team (physician, Argentinian researcher, nurses) we selected the top-performing models for external evaluation by ten Spanish-speaking TB experts. Using predefined patient personas and common queries identified in the clinical trial, evaluators engaged in structured chatbot interactions and assessed performance across nine dimensions based on the QUEST framework for human evaluations of LLMs (Quality of Information, Understanding and Reasoning, Expression Style and Persona, Safety and Harm and Trust and Confidence) (rated 1鈥�5 with 5 = highest). Empathy was rated separately (0鈥�2 scale). Qualitative feedback was analyzed thematically.

Findings demonstrated the feasibility of LLM-powered chatbots for TB treatment support, with all three top-performing models scoring 鈮�4 across evaluation dimensions. The FS model had the highest overall rating (4.81, SD 0.47) and empathy score (1.82, SD 0.49). Key challenges included overly technical language, difficulty distinguishing between latent and active TB and occasional incomplete responses.

Assessing readiness for newborn pulse oximetry screening in Northern Ghana

Investigators
Nelangi Pinto, Department of Pediatrics
Kristin Beima-Sofie, Department of Global Health
Alhassan Abdul-Mumin, Tamale Teaching Hospital
Donna Denno, Departments of Pediatrics and Global Health
Abdulai Abubakari, University for Development Studies
Rafiuk Cosmos Yakubu, University for Development Studies

Project summary
The goal of this project was to conduct a mixed methods assessment grounded to inform community co-designed implementation of newborn pulse oximetry screening (POS) in the Northern Region of Ghana. Our specific aims were: 1) to assess the current healthcare organizational capacity in the Northern Region for newborn POS and cascade care for positive screens and 2) to explore POS acceptability, appropriateness and feasibility across facility levels and use our findings to co-develop/adapt interview guides and site assessments for use across the Northern Region.

We collected abstracted high level health care data and completed detailed facility surveys at 17 health facilities in Northern Ghana (Table 1). This included 1 teaching/referral hospital, 1 regional hospital, 14 district hospitals and 2 primary health centres. We elicited important data regarding capacity for POS implementation including the availability and use of neonatal pulse oximetry in almost all health facilities except for one maternity home. Pulse oximetry for neonates was not universal but used as needed and all but 2 facilities had oxygen available for neonates if required. In general results showed a high level of resource capacity for POS screening but not for downstream testing for positive results. Most facilities also had the capacity for specialty consultation with pediatric cardiologists and transfers though transportation was a constrained resource with most relying on a combination of ambulance and private car transfers.

We performed focus groups and key informant interviews with providers and staff from 4 health facilities representing all levels of care in Northern Ghana (teaching hospital, regional hospital, district hospital and primary health center/maternity home). Between 3/25 and 5/25 we conducted 13 individual interviews and 4 focus group discussions (FGDs) with healthcare providers (N=42: RNs=17, midwives=15, doctors=8, administrators=2). Interviews and FGDs lasted an average of 47 minutes, were conducted in English and transcribed for analysis. Transcripts were analyzed using a thematic analysis approach to characterize current newborn assessment processes and identify key influences on acceptability and feasibility of future POS implementation. Preliminary analysis results identified that providers are highly motivated to implement interventions that improve neonatal mortality but work in busy clinics, lack access to clinical specialists, rely on personal communication networks to facilitate referrals of high-risk patients and face challenges navigating patients鈥� needs and preferences when providing neonatal care. Overall, providers found POS acceptable and were enthusiastic about the potential for POS to improve infant outcomes, believed the intervention was effective and that there would be motivation to adopt POS if training was well conducted and providers saw a positive impact on infant morbidity and mortality. Providers also believed POS was feasible to implement because it was non-invasive, quick to perform and would be easy to train providers on results interpretation. Providers identified challenges affecting their beliefs about feasibility including lack of access to pulse oximeters, overcrowding in labor and delivery settings, staff resistance to change and new procedures and high rates of staff turnover. Participants specifically noted concerns about future pulse oximeter availability and functionality if initial access were contingent on research study investment rather than broader national policies or guidelines. Providers also expressed concerns that limited POS acceptability included how to deal with positive screening results when the recommended treatment or follow-up diagnostics were not available or were not acceptable because of high costs. To ensure successful POS implementation, providers recommended engagement of leadership at national and local levels, repeated sensitization and training of all staff and integration of POS screening into already existing neonatal care guidelines and standardized neonatal assessment forms.

Sembrando Salud: Designing Healthy Eating Futures for Latinx Adolescents

Investigators
Carla Castillo, Department of Human Centered Design & Engineering
Sean Munson, Department of Human Centered Design & Engineering
Julie Kientz, Professor, Department of Human Centered Design & Engineering
Pia Chaparro, Department of Health Systems and Population Health

Project summary
Adolescence is a pivotal period when teens develop eating agency鈥攖he ability to make and carry out independent food choices鈥攁nd eating patterns formed during this stage can carry into adulthood. Teens鈥� food choices are shaped by their environments (e.g. home and school), social influences (e.g. peers and family), cultural context, food availability and family routines. This transition period is especially important to understand among Latinx adolescents as Latinx communities experience higher risk of obesity and diet-related conditions (e.g. type 2 diabetes). Despite this importance, limited research examines how Latinx adolescents experience food decision-making as they gain autonomy, particularly in rural contexts. This project aimed to (1) understand how Latinx adolescents in rural Washington, specifically Lower Yakima Valley, experience food choices as they gain autonomy (Aim 1) and (2) engage teens, caregivers and community partners in co-design to identify challenges and opportunities that could inform community-informed interventions that reflect their needs and contexts (Aim 2). We engaged 7 caregiver鈥搕een dyads and 5 teens participating independently, recruited through schools and community organizations. We also engaged 5 community partners from community- and school-based organizations, including family-serving, healthcare, youth and school district settings in roles such as registered dietitian and program coordinator.

For Aim 1, we conducted food diaries and in-depth interviews with teens and caregivers. Teens shared their eating experiences, goals and influences on food choices and reflected on their diary entries. Some teens described goals related to healthier eating while others focused on weight-related goals; a few used tracking apps to support these goals. Mapping teens鈥� responses to the social ecological model, we found that at the individual level, teens鈥� eating was influenced by food preferences, cravings, perceptions and relationships with food (e.g. body image concerns or disordered eating), dietary sensitivities (e.g. lactose intolerance) and physical reactions (e.g. nausea). At the family level, influences included specific family members, home food availability, social gatherings (e.g. parties) and growing their own fruits and vegetables. At the community level, influences included school food and nearby grocery stores as well as broader factors such as money, friends and social media. While influences varied by teen, social media and school food were most often described as barriers to eating in desired ways.

For Aim 2, we held co-design sessions with teens, caregivers and community partners. In teen sessions, participants generated individual ideas for addressing challenges they experience, including meal planning, portion control and improving access to healthier foods. Teens with eating challenges (e.g. eating disorders or difficult relationships with food) described solutions such as supportive eating settings, food diaries, meal planning and counseling. In these same sessions, teens emphasized parental support that felt helpful鈥攁utonomy, validation, emotional support and privacy鈥攁nd expressed resistance to control, judgment, comparison and sharing their experiences without consent. We also held individual caregiver co-design sessions in which caregivers discussed their teens鈥� eating patterns and food preferences and ways they support them. Caregivers additionally discussed school-based supports, including creating space for food gardens and communicating concerns to schools about food quality. Community partners reviewed ideas from these sessions and shared insights from their experience in the area, including existing family programs and implementation challenges. A registered dietitian in a school district talked about the challenge of meeting nutrition standards while still serving food that students want to eat. In a final survey, participants rated the helpfulness of generated ideas and selected among five program concepts: (1) food education, (2) cooking and meal skills, (3) strengthening caregiver鈥搕een relationships around food, (4) a teen food support group and (5) a food-support app. Teens most often selected the app and cooking/meal skills while caregivers most often selected cooking/meal skills and food education; across both groups, some participants also selected the caregiver鈥搕een relationships program. These preferences clarify where teens and caregivers see the most useful support and can guide future intervention design.

While this work focuses on improving teen eating, it is also important to highlight teens鈥� experiences with school food in Lower Yakima Valley. Teens frequently described concerns about school food quality, particularly food that seemed expired. Survey responses echoed these experiences, with over half of teens reporting encountering expired-seeming school food in the past three months, including some who reported it happening more than once. These experiences may influence eating behavior as many teens reported avoiding school food at least sometimes due to worry about expiration. When faced with questionable food, teens most often threw it away or stopped eating rather than asking staff for a replacement, suggesting limited perceived options for addressing the issue. One teen shared, 鈥淪ometimes the milk is sour or slightly chunky, but I still drink it anyways; however, I usually eat around fruits and other food that seems rotten or expired.鈥� These findings point to a concrete opportunity for schools to address food quality concerns and support safe eating environments for teens.

Building Reparative Connections and Community Health Strategies across Sites Impacted by Nuclear Weapons Development

Investigators
Sasha Su-Ling Welland, Department of Gender, Women & Sexuality Studies
Holly M. Barker, Department of Anthropology

Project summary
This project advanced collaborative research about the environmental and health impacts of nuclearism on frontline communities created through weapons development and testing, mining and manufacturing and waste (mis)management. From March 5鈥�7, 2025, we held a workshop for current and future leaders from impacted communities to discuss their experiences, develop trust and gauge interest in potential collaboration. Workshop participants traveled to 糖心少女from Majuro (Marshall Islands), Yakama Nation, Livermore CA, Portland OR, Minneapolis MN, Lacey WA and Seattle to connect, learn, think and brainstorm together.

In addition to the project PIs, the group members included:

• Community leaders addressing environmental health and restoration: Laurene Contreras (Yakama Nation Environmental Restoration & Waste Management), Moriana Phillips (Republic of Marshall Islands Environmental Protection Agency) and Lyla Lemari (Marshall Islands researcher at Lawrence Livermore National Laboratory)
• Graduate students and public health leaders: Johnny Buck (Wanapum/Yakama, Human Centered Design & Engineering) and Leimamo Wase (Marshall Islands, Anthropology)
• Undergraduate researchers and leaders: Torin Burns and Anika Palep (糖心少女Students for Nuclear Justice)
• Artists: Lauren Iida (Japanese American public artist, WA State Arts Commission) and Johnny Buck (Wanapum/Yakama)
• Non-profit organization managers and strategists: Liz Mattson and Miya Burke (Hanford Challenge)
• Published scholar and community leader: Michael Buck (Wanapum/Yakama)

A loosely structured agenda gave people time for discussions within and across smaller groups with an emphasis on establishing trust, gaining local knowledge about sites and communities siloed from one another by government secrecy and identifying opportunities for future collaboration. The group鈥檚 intergenerational composition reflects the importance of connecting the next generation of community leaders, especially students enrolled at UW, with knowledge holders from their communities as essential aspects of their learning. The proposal for this project stressed the importance of relationship-building as a critical component of growing and extending conditions for community-directed change; and the workshop achieved that goal by bringing impacted Marshallese, Yakama and Wanapum community members together for the first time to reflect upon a shared history of nuclear harm and dispossession from land, water and cultural resources. Our findings align with Indigenous research methods that emphasize the importance of relationship building rather than extractive knowledge as an essential foundation for learning and possibility.

Without question, the major result to emerge from this workshop was the creation of a new and extremely close 鈥渘uclear family,鈥� a term we coined to identify ourselves in a familial way. Our group hypothesizes that we were able to build a sense of family in just a few short days because of familiarity with and similarity between the issues experienced in 鈥渒in鈥� communities, including removal from the land and waters of home, high incidences of cancer, long-term environmental contamination and complexity and intractability of interactions with governmental agencies. We arrived as individuals committed to community-led efforts to address nuclear justice but we left feeling and behaving like a family. The result, which exceeded every expectation for this workshop, was seeing that a group of people with vastly different ages, languages, knowledges and geographies could unite quickly and deeply over shared interests. This result supports our understanding about the nuclear realm: that the strongest possible defense system to nuclear violence is building community that centers care and concern for one another, for our relations to land, plants and animals and to the future.

Another key finding is awareness about the many similarities among frontline communities and how cathartic and healing it felt to share the pain with people who understood and could relate to it, including the profound grief of losing beloved family members and community leaders. The project鈥檚 model for sharing and relationality revealed the disproportionate impacts of the nuclear military industrial complex on Indigenous communities, creating conditions to expand allyship, enter collaboration and center possibilities for a healthy future that draw on the strengths of culture and community. Immediate outcomes include:

• Creation of a bi-monthly video call to keep the nuclear family connected. All workshop participants expressed enthusiasm to not only continue our conversations but to expand 鈥渇amily鈥� and health strategies for the future.
• New artistic collaboration between Lauren Iida and Johnny Buck interweaving nuclear impacts on Japanese, Japanese American, Yakama and Wanapum communities, initiated in the Burke Museum鈥檚 Artist Studio in May 2025 and exhibited at Seattle Center and the annual From Hope to Hiroshima ceremony at Green Lake honoring the victims of the atomic bombings of Hiroshima and Nagasaki (2025 marked the 80th anniversary).
• A poem, 鈥淟ove Letter to Our Mother Earth,鈥� by Johnny Buck selected by independent juror Sierra Nelson as winner of the Hanford Challenge 2025 Hot Poetry Contest.
• A new archival collaboration between Torin Burns, who will begin the 糖心少女MLIS program in the fall, and Lauren Contreras to identify declassified documents from the 糖心少女Radiation Ecology Laboratory in the Libraries Special Collections of interest to Yakama Nation Environmental Restoration & Waste Management; Torin will scan and upload these documents to the digital archive 鈥淎rchiving for Community Use: Digital Collections of the United States Nuclear Legacy.鈥�
• A commitment by workshop participants to show up for one another at conferences, events (such as the August 2025 From Hope to Hiroshima event), student organizations and classes and to share food and laughter as part of healing, resistance and survivance.

Individual and community-level effects from climate change driven heat and wildfire smoke co-exposures among a Washington state agricultural community

Investigators
John Flunker, Department of Environmental & Occupational Health Sciences
Coralynn Sack, Departments of Environmental & Occupational Health Sciences and Pulmonology
June Spector, Department of Environmental & Occupational Health Sciences
Pablo Palm谩ndez, Department of Environmental & Occupational Health Sciences;

Project summary
Our project seeks to examine the impact of extreme heat and wildfire smoke (WFS) co-exposures on the respiratory health of an at-risk agricultural population in Yakima County, Washington. Yakima County is the state鈥檚 top apple producing county and also supports the state鈥檚 largest population of tree fruit workers. Residents of Yakima County and many Eastern WA agricultural regions experience WFS and extreme heat co-exposure events that are increasing in frequency and duration. Tree fruit workers often must endure these exposures while engaging in demanding physical labor yet with limited access to cool clean air. Little is known about the impacts of such exposures on the respiratory health of tree fruit workers and the communities in which they reside. We hypothesize that worker respiratory health will decline following acute heat (鈮�90掳F) and/or WFS exposure events (PM2.5 鈮�100 碌g/m3) with the most pronounced reductions in respiratory health resulting from dual heat and WFS exposure events in comparison to no/low exposure conditions.

During the award period, we met our proposed goals including establishing a cohort of tree fruit workers and assessing WFS and heat exposure associated respiratory health. Specifically, we recruited 35 workers from three apple farms in Yakima County, Washington, obtaining sequential measures of respiratory health following heat and WFS exposure events from workers at their worksite. Measures of respiratory health were taken at baseline and within two days of the onset of an exposure event by a bilingual multi-disciplinary team of 糖心少女researchers. Measures included self-reported heat-related illness and respiratory symptoms, spirometry and exhaled Nitric Oxide (i.e. airway inflammation). All measures of worker lung health were obtained in person at the worksite. There were no acute exposure wildfire smoke days in August and September 2024 with relatively few acute heat exposure days. Furthermore, no dual acute heat and wildfire smoke events occurred during the study period. As such, we were only able to measure respiratory health following either singular high heat or lower intensity WFS exposure events.

We successfully retained orchard worker participants for the two-month study duration. However, one farm (approximately ten workers) was not able to participate in our final (third) set of measurements due to apple harvesting activities. Measures of health effects followed WFS exposure events with PM2.5 concentrations of approximately 60 碌g/m3 and heat exposure events with a dry air temperature of 90掳F. Results indicate that concern over WFS and heat exposure is highly prevalent among our sample of orchard workers. Most workers reported receiving WFS and heat training from their employer during the 2024 work season. Self-reported respiratory symptoms and heat related illness symptoms were common following WFS and heat exposure events. Although the majority of workers reported that employers made N95 respirators available during WFS events, workers reported infrequent usage of N95 respirators and frequent usage of facial coverings such as a bandana. Changes in pace, workload, shift duration and shift start time during WFS and heat exposure events were reported frequently. Most workers reported living in housing or apartments with access to clean and cool air. No changes in lung function were observed following WFS and heat exposure events. Overall, our results point to an outdoor worker group at risk of experiencing adverse respiratory health effects related to WFS and heat exposures. Access to and usage of available exposure reduction tools both in the workplace and at home may help to mitigate potential adverse health effects experienced by workers and members of the regional community following WFS and heat exposure events.

Sustainable metamaterials for insulation applications

Investigators
Eleftheria Roumeli, Materials Science & Engineering
Tom谩s M茅ndez Echenagucia, Architecture

Project summary
The project set out to pair biomatter-derived foam blocks with metamaterial architectures to yield low-carbon high-performance acoustic insulation. We (i) focused on understanding processing-structure-property relationships for Ulva-based foams and (ii) initiated finite-element (FEA) design of hybrid block/resonator assemblies.

Our experimental campaign began by selecting three green-seaweed feedstocks (Ulva ohnoi, U. lactuca and a wild Ulva sp.) and converting them into aqueous slurries at 5, 7.5 and 10 wt%. After ball-milling and ultrasonication, slurries were freeze-cast either by liquid-nitrogen quenching or conventional freezing. The rapid quench produced fibrillar cell walls and pore diameters roughly 6 to 20 times smaller than those formed by slow freezing whereas the slower route yielded sheet-like walls and lower bulk densities (0.002鈥�0.024 g cm-3). SEM and micro-CT imaging confirmed these morphological distinctions and enabled a porosity-modulus analysis explaining the systematic rise in compressive strength (1鈥�600 kPa) and modulus (0.03鈥�14.1 MPa) with solids content and pore refinement.

Acoustic impedance-tube measurements demonstrated that most of our Ulva foams outperformed commercial polyester panels in the 0鈥�2000 Hz band where most day-to-day noise is heard. The foam with most promising performance is 10 wt% foams of U. ohnoi and U. lactuca which achieved near-unity absorption at ~1.4 kHz. The impedance tube measurements were used to create a porous media FEA model using the Johnson-Champoux-Allard method. The resulting material model was used to create a hybrid porous and resonant acoustic absorber. The results show that the hybrid material can benefit from both acoustic absorption types showing the potential for efficient broadband sound absorption with limited use of space or emissions.

Impact and Future Directions

• Demonstrated that freeze-dried Ulva foams can meet or exceed commercial acoustic panels in the low- to mid-frequency range critical for occupant comfort.
• Generated the first quantitative LCA for algae-based insulation identifying processing energy as the primary hotspot and directing future scale-up research.
• The FEA鈥揺xperimental loop provides a transferable tool for tailoring broadband absorbers from any biomatter feedstock.

Next Steps: We are finalizing a first manuscript for a high-impact materials science journal and expect to submit it in October 2025. A second paper centered on the metamaterial architecture will follow once the initial study is under review. These publications will position us to craft a strong data-driven research proposal immediately thereafter.

Wild food plant diversity, conservation, and community knowledge in the Eastern Mediterranean

Investigators
Danya Al-Saleh, Jackson School of International Studies
Jon Bakker, Environmental and Forest Sciences
Omar Tesdell, Birzeit University

Project summary
The overarching goal of this project was to carry out ex situ conservation of at least 10 key wild and native food plant species in Palestine with the Ardeea research group (link). Wild food plants have been and remain an important source of food for peoples of the region. Despite being the center of origin of wheat, barley, lentils and other major world crops, the vast majority of staple foods and feed for livestock are imported to Palestine from abroad. Climatic shifts threaten these wild foods in Palestine and throughout the Eastern Mediterranean region. Palestine has a wealth of native food plants and wild relatives of crops and knowledge about how they are used. This research team brought together expertise in plant ecology (Dr. Bakker), feminist methodology, climate justice and gender (Dr. Al-Saleh) and the geography of native plants and agriculture in the Eastern Mediterranean (Dr. Tesdell).

This work has contributed to the documentation of wild food plant use in the West Bank. Over the course of this project, the team focused on conservation through a combination of methods including collection of seeds from numerous species, seed storage and oral history interviews with keepers of knowledge about these species. The result of this project included ex situ conservation of 15 key wild and native food plant species from 10 target populations in Palestine鈥檚 hill region in the West Bank. The Ardeea research team conducted, transcribed, translated and coded over 40 interviews with farmers largely women about these species. This project also strengthened UW鈥檚 international engagement and facilitated the interchange of ideas about the production of native plants in Palestine and the Pacific Northwest. During February 2025, Dr Omar Tesdell visited the 糖心少女for a research talk and a week-long visit to campus that engaged faculty and students with interests in food sovereignty, the ethics of data collection, Indigenous knowledge and plant ecology. Regional conflict unfortunately prevented Drs. Al-Saleh and Bakker from visiting Palestine.

DecarbCityTwin: A Platform for Equitable Decarbonization of the Built Environment

Investigators
Narjes Abbasabadi, Architecture
Christopher Meek, Architecture
Kate Simonen, Architecture
Carrie Sturts Dossick, Construction Management
Daniel Kirschen, Electrical & Computer Engineering
Mehdi Ashayeri, Southern Illinois University
Lylianna Allala, City of Seattle鈥檚 Office of Sustainability & Environment
Ani Krishnan, City of Seattle鈥檚 Office of Sustainability & Environment

Project summary
DecarbCityTwin aims to facilitate building decarbonization while addressing energy, health and equity challenges particularly in marginalized communities. By integrating advanced physics-based and data-driven modeling with AI and machine learning and leveraging sensing technology, the project supports the monitoring, modeling and simulation of 鈥渨hat-if鈥� scenarios to inform design, retrofit interventions, policy strategies and deepen community engagement.

This pilot phase achieved three major goals that form its foundation, encompassing three interconnected components. The first component focuses on air quality modeling, prediction, visualization and Virtual Reality (VR)-based immersive experiences. In this pilot project, we developed a novel AI-enhanced Land Use Regression (LUR) framework to predict fine particulate matter (PM鈧�.鈧�), a critical pollutant associated with severe health outcomes. The model was designed to capture PM鈧�.鈧� variability across Seattle WA, leveraging machine learning and various data sources including socioeconomic factors, building urban infrastructure, environmental conditions, transportation networks and low-cost sensors. By incorporating advanced machine learning techniques, the model effectively captured complex non-linear relationships in urban air quality at a high spatial resolution of 30 脳 30 meters, significantly improving the accuracy and robustness of PM鈧�.鈧� predictions. Additionally, an immersive VR model was developed to visualize dynamic pollution patterns, offering actionable insights into daily air quality fluctuations. This interactive approach enhances accessibility and engagement, enabling community members to intuitively interpret complex data and simulation results.

The second component addresses building retrofits and decarbonization strategies. Machine learning-enhanced urban building energy modeling was developed to identify optimal health-driven retrofits. This pilot study focused on the Duwamish Valley neighborhoods鈥攁reas facing significant challenges related to energy inefficiency, air pollution and health disparities. Archetypal models were developed to represent common housing typologies (e.g. single-family homes, duplexes, quadplexes and small apartments) within the pilot community. Thousands of retrofit simulations were explored to enhance energy efficiency while simultaneously improving indoor air quality and occupant health.

The third component emphasizes community engagement and education. This aspect of the project aims to increase public awareness of air pollution and energy efficiency through participatory workshops. Two major community engagement initiatives were conducted: (1) an Earth Day event at Duwamish/Concord International Elementary School involving approximately 200 participants and (2) a focus group session at the Duwamish Hub with 20 participants representing local organizations, stakeholders and households. Findings from the project were featured through an educational module and through an immersive VR-based tool designed to help residents better understand pollution dynamics. The effectiveness of the DecarbCityTwin platform was assessed through pre- and post-experience surveys which revealed gains in knowledge, behavioral motivation and user engagement. These findings underscore the platform鈥檚 potential as a transformative tool for community empowerment, illustrating how digital solutions can be leveraged to address such critical challenges.

The results of this project contribute to a growing body of literature on air pollution prediction, energy efficiency and the role of digital tools in fostering health-driven and equitable decarbonization. This pilot project focused on Seattle WA with a particular emphasis on the Duwamish Valley neighborhoods, developed in collaboration with the City of Seattle鈥檚 Office of Sustainability and Environment and the Duwamish River Community Coalition (DRCC).

Assessing the Benefits of Community Photovoltaic Power Projects in Washington

Investigators
Dargan Frierson, Atmospheric Sciences
Josh Lawler, Environmental and Forest Sciences
Alyssa Poletti, Atmospheric Sciences
Eileen V. Quigley, Clean Energy Transition Institute
Ruby Moore-Bloom, Clean Energy Transition Institute

Project summary
We collaborated with the Clean Energy Transition Institute (CETI) on a study of community solar in Washington state. Community solar is defined as mid-sized solar arrays larger than a single household but smaller than 1 megawatt capacity that are distributed and aim to provide community benefit.

Our research culminated in the publication of an ArcGIS Storymap entitled The Sun Also Rises in Washington: Exploring Community-Scale Solar Power (available at https://storymaps.arcgis.com/stories/53ce8eb2b5d948ba9642f5870e195f30), published on December 2, 2025.

Our study began with a quantification of available solar radiation in Washington during different months, taking the commonly held assumption of ever-gray skies in our state: although winter generally lacks sunlight, summers are characterized by long daylight hours and clearer skies. Thus the available solar power is significantly higher in those months.

We next studied a range of existing community solar projects in the state using data from Washington State University鈥檚 Community Solar Expansion Program. We then performed interviews with a set of stakeholders around the state to get a variety of perspectives on how they view community solar and what research questions were most useful to study from their perspective. We depicted some of the installations that we learned about in the Storymap including installations at the Vashon Island United Methodist Church which features battery storage, Merritt Manor Community Solar in Olympia which provides benefits to low-income residents and Haystack Heights in Spokane, a novel co-housing development that has shared spaces to build community among residents. We additionally highlighted the recent community solar installations on the nation of the Spokane Tribe of Indians with their Children of the Sun Solar Initiative program. We also highlighted projects in Jefferson County which recently municipalized their power authority.

Based on the interviews with the stakeholders, we proposed two different lenses of benefits of community solar. First, from a renter鈥檚 perspective, community solar can have benefits by lowering the cost of electricity which is a particularly salient problem since rates have skyrocketed in recent years. While renters cannot themselves purchase solar panels, subscription-based models can allow renters to accrue these benefits. To support this lens, we created maps that showed the fraction of renters in each census tract across the state. More than 270,000 households in Washington are energy-burdened, spending over 6% of their income on home energy bills.

The second lens is based on resilience benefits. When connected to battery storage to create a microgrid, solar power can increase the resiliency of electricity since power is generated where it is used even without active connections to the larger electricity grid. With a rapidly changing climate causing increasing flooding events, heatwaves and other disturbances, increased resiliency will only become more important. For this lens, we studied data such as outage frequency across different counties in Washington, finding that the coastal counties are particularly plagued by outages. We also studied the number of residents that are dependent on home medical devices that need electricity as a measure of the need for consistency of electricity for life.

In summary, we found community solar to be important in creating a resilient affordable electricity system for Washington residents. Our Storymap was shared widely across CETI鈥檚 network and has generated a wide range of positive responses from recipients. The work was additionally presented by Ruby Moore-Bloom at the 2025 Washington State Solar Summit in October 2025.