Current Grant Projects
Advancing Disability Measurement
National survey data are essential for informing policies and allocating resources across the United States, helping to efficiently address disparities in socioeconomic and health outcomes. However, current U.S. policy guiding disability measurement in national surveys relies exclusively on functional limitation criteria. These question sets fail to reflect the full spectrum of disability as defined by the Americans with Disabilities Act (ADA) and its Amendments Act (ADAAA), systematically undercounting disabled people—especially those with chronic, episodic, invisible, or mitigated conditions, including a growing number of older adults aging into disability.
This project will evaluate the performance of a Comprehensive Disability Status (CDS) question set that conceptualizes disability as a demographic status aligning with the ADA and ADAAA, reflecting bodily or cognitive differences with or without functional limitations. Using 50 cognitive interviews with disabled adults representing the heterogeneity of the disability experience, the researchers will examine question validity and response error of the CDS. The cognitive interviews will assess how respondents interpret each question, what bodily characteristics and activities they consider when answering, and whether the disability status categories adequately capture the full range of disability experiences.
Results from this project will provide an alternative for measuring disability in U.S. data that is more accurate and inclusive.
Principal Investigator: Scott D. Landes, Professor of Sociology
Co-Investigator: Bonnielin K. Swenor, Endowed Professor of Disability and Health Justice and Director of the Disability Health Research Center, Johns Hopkins University
Understanding Access to Home Health Care and the Role of Medicare Insurance Policy
Home health care (HHC) is the most common post-acute care setting for older adults and helps prevent future institutionalization. Yet access is declining dramatically. Between 2019 and 2023, referrals to HHC increased by 17%, but acceptances fell by nearly 30%. These access failures may stem from Medicare insurance changes, specifically the rapid shift from government-run traditional Medicare to privately-run Medicare Advantage (MA) plans, which now cover over half of Medicare beneficiaries. While MA offers extra benefits attractive to disadvantaged older adults, its cost-containment tools like prior authorization, narrow networks, and low payment rates may restrict access. MA enrollees use less HHC, receive care from lower quality agencies, and have worse outcomes, raising equity concerns about how insurance structures shape who receives care.
This project will use novel, multi-payer referral-level data from 57 HHC agencies in five states to directly measure how insurance type, payment rates, patient characteristics, and market conditions influence agency response to HHC referrals from 2023-2025. The unique dataset captures referral outcomes and rejection reasons to HHC for both traditional Medicare and Medicare Advantage enrollees, allowing for unprecedented comparisons in care access. The study will (1) compare HHC referral rejection rates and reasons between insurance types, (2) quantify payment differences, and (3) examine how multiple factors jointly affect access to HHC using multivariable regression analysis.
This research will address a critical population health gap by providing actionable evidence on how Medicare policy affects access barriers and will inform efforts to promote equity in care access for older adults.
Principal Investigator: Jun Li, Assistant Professor, Department of Public Administration and International Affairs
Co-Investigator: Rachel Werner, Professor, University of Pennsylvania
Previous Grant Projects
Promoting Mental Health Help-Seeking via Online Media: A Randomized Control Trial
Suicide ranks is a leading cause of death among adolescents and young adults in the United States. The 988 Suicide and Crisis Lifeline holds significant potential as a vital resource for individuals considering suicide.
However, awareness of the 988 service still remains low. While public awareness campaigns for 988 have been implemented by various entities, there is limited evidence on the effectiveness of these campaigns in promoting the utilization of crisis hotline services.
There is also a critical lack of understanding about which types of messages and campaigns are most effective in encouraging help-seeking behavior.
The objectives of this project is to use a randomized control design to evaluate the effectiveness of online media campaigns in promoting mental health help-seeking behavior via the 988 Suicide and Crisis Lifeline, and to identify whether messages conveying hope and recovery are more effective in encouraging help-seeking behavior compared to typical promotional messages.
PI: Michiko Ueda-Ballmer, Associate Professor of Public Administration and International Affairs
Co-PIs: Colleen Heflin, Professor of Public Administration and International Affairs; Seethalakshmi Ramanathan, Associate Professor in Psychiatry and Behavioral Sciences and Co-Director of the Upstate Suicide Prevention Center, Upstate Medical University
The Effects of Health Communication Discrimination on Healthcare Utilization Among Individuals with Traumatic Brain Injury
In the U.S., over 5.3 million people are living with traumatic brain injury (TBI). TBI can cause physical and cognitive impairments and increase risks for neurodegenerative diseases like dementia.
Individuals with TBI often face barriers to accessing healthcare, yet little is known about how health communication discrimination affects their service utilization.
This study aims to examine the relationship between health communication discrimination and healthcare utilization among individuals with TBI.
Findings will advance our understanding of healthcare access barriers faced by individuals with TBI, provide evidence for addressing health communication as one modifiable social determinant of health, and inform interventions that reduce healthcare access disparities and improve recovery outcomes for individuals with TBI.
PIs: Haowei Wang, Assistant Professor of Sociology; Yalian Pei, Assistant Professor of Communication Disorders
The Long Run Effects of Exposure to Universal Free Meals in the Early Childhood Grades
The National School Lunch Program (NSLP) is the country's second-largest food assistance program, serving free or reduced-price meals to 30 million students daily.
A growing number of schools and districts offer Universal Free Meals (UFM), which provides free meals to all students regardless of income. This project examined how exposure to UFM in kindergarten influenced attendance and weight outcomes among NYC students from grades K-3.
Results showed that children who received free meals through UFM in kindergarten had better school attendance than those who do not. In addition, there was no evidence that receipt of free meals in kindergarten affected weight outcomes.
Read more about this study in this Lerner Center research brief.
PI: Amy Schwartz
How Did COVID-19 School Closures Affect Adolescents with ADHD
COVID-19 school closures drastically affected school-aged youth and their parents, with greater challenges among youth with attention deficit/hyperactivity disorder (ADHD).
This study examined the risks, protective factors, and family processes that shaped well-being among adolescents during COVID-19-related school closures.
Findings show that adolescents with ADHD were more likely to experience negative consequences from school closures, including difficulty adjusting to online learning, reduced socialization, and increased mental distress. However, youth and families also experienced some benefits, including increased family reconnection and reduced school-related anxiety.
Read more about this study in this Lerner Center research brief.
PIs: Kevin Antshel and Andrew London
Cardiovascular Age in the Community Post-COVID-19: We are Only as Old as our Arteries
Cardiovascular disease (CVD) was a prominent risk factor for severe outcomes from coronavirus. African Americans have higher CVD risk factor burden and as such experienced higher mortality rates from coronavirus.
This study a) developed a new metric of CVD risk (related to artery age) that can be easily assessed in community-based (non-clinic) settings without need for advanced equipment or technical expertise and b) examined changes in blood pressure among U.S. adults in fall 2020 and spring 2021.
The team found that poor sleep quality and poor mental health were associated with less desirable blood pressure patterns. The results indicate a need for healthcare providers to consider sleep quality and mental health when assessing patients for cardiovascular disease.
Read more about these findings in a peer-reviewed paper and Lerner research brief stemming from these studies.
PI: Kevin Heffernan
Impact of Gardening on Refugee Mental Health, Community Building, and Economic Well-being in Central New York
Home and community gardening is emerging as a beneficial intervention for resettled refugee populations. This project used surveys and semi-structured interviews to examine whether gardening influences mental health, food security, and economic well-being among resettled refugees.
Findings showed gardeners reporting fewer symptoms of anxiety, depression, and trauma, and less food insecurity than non-gardeners, and similar indicators of economic well-being. In interviews, gardeners reported improved mental health, closer family, social relationships and connections with culture, and more access to fresh and organic food.
The multiple, simultaneous benefits of gardening provide strong support for building community-based health promotion programs to assist refugee integration, including long after arrival. The study further highlights the importance of examining the interrelated factors of mental health, food security, and economic well-being.
Read more in the peer-reviewed article stemming from this study.
PIs: Rashmi Gangamma, Laura-Anne Minkoff-Zern, and Bhavneet Walia
Nudging Physical Activity in Early Adolescents with ADHD
Attention deficit/hyperactivity disorder (ADHD) is a mental health disorder that represents a significant public health problem among adolescents.
Physical activity (PA) holds promise as a potentially effective, broadly health-promoting, and accessible intervention for adolescents with ADHD. Drawing on behavioral economics principles, this project evaluated the feasibility of using motivational interviewing and contingency management/external reinforcers as a way to increase physical activity among 11-16 year old adolescents with ADHD.
It also examined the impact of the PA intervention on ADHD symptom severity. Forty adolescents randomly assigned to three treatment groups and a control group completed the pilot study. Results are consistent with hypotheses and will be used as a preliminary study for a grant application for an expanded trial in the future.
PIs: Kevin Antshel, Andrew London, and Scott Landes
Contact
Shannon Monnat
Professor, Sociology Department
Lerner Chair in Public Health Promotion and Population Health
426 Eggers Hall
315.443.2692 | smmonnat@syr.edu