California Initiative to Advance Precision Medicine News & Announcements

Project Title: The SYSTEMAATIC Project: Systems-based, Multidisciplinary Assessment of Adversity and Toxic Stress for Individualized Care (Stanford University, Lead Principal Investigator, Dr. Tina Sindher).

1). Why are community partnerships important for health research?

Community partnerships are the key component to health research and vital to success in addressing toxic stress. Including both traditional and non-traditional stakeholders enhances the opportunity to reach diverse sectors. However, while conducting health research, we must build authentic relationships with our stakeholders, acknowledging cultural norms and diverse perspectives among diverse parties.

2). How has your background and experience with this CIAPM-funded project impacted your research and academic direction?

As the director of perinatal health, my role is to identify and address reproductive health disparities, systemic racism and factors that may contribute to maternal-infant mortality and morbidity among our black and brown families. The CIAPM project will further explain the correlation between adverse childhood experiences and health outcomes.

For most of my career, I have advocated on a systems-level for maternal health care reform; noting that our physical and perinatal mental health disparities are linked to toxic stress. We know that social determinates of health are drivers that perpetuate toxic stress and we have now linked toxic stress to chronic medical conditions. With this framework in mind, the CIAPM research project might be able to shed light on maternal mortality, pre-term birth, as well as infant loss among our black and brown perinatal women. I foresee this research project contributing to the body of knowledge in my academic field associated with birth equity.

3). What impacts have you seen from this CIAPM-funded project addressing the health impacts of Adverse Childhood Experiences (ACEs) and advancing health equity?

Our Fresno County stakeholders are excited to participate in this CIAPM project. They have undergone training which outlined the significance of addressing toxic stress. Now, our stakeholders are eager to progress in this work by formulating strategies that result in better health outcomes for our Fresno County residents. The CIAPM project has re-energized our community stakeholders to continue in developing policies that advance health equity.

Project Title: Scalable Measurement and Clinical Deployment of Mitochondrial Biomarkers of Toxic Stress (Children’s Hospital Los Angeles, Lead Investigator: Dr. Pat Levitt)

1. Why are community partnerships in health and behavioral research important, and how did you and Fiesta Educativa get involved in this research?

As the director of Fiesta Educativa, I initially got introduced to academics in the Southern California region who had personal experiences with disabled family members and were involved with our program. Through this connection, I was invited to a three-day conference by the National Institutes of Health (NIH) emphasizing the importance of non-profit involvement in biomedical research.

Upon return to California, I brought some of the ideas and lessons learned to our board of directors at Fiesta, institutionalizing the framework for our program to get involved in academic research via frequent training sessions and changing our bylaws to allow for university collaborations. This started a collection of many more frequent academic collaborations, and we were honestly one of the first non-profits to be involved in that space in Southern California.

Several academics emphasized the importance of non-profits like ours in being trusted community messengers, and even established trainings with the parents and families to collect buy in from the Fiesta community.

2. What lessons have you learned during your career to maintain long-lasting community-academic partnerships to advance health research and equity?

As the non-profit go-between of families with disabled children and researchers, one of the most important lessons I learned to maintaining those partnerships was to learn from the parents themselves about behavioral methods and research techniques that worked for their children, what works with different cultures, and those subtle differences. Much of this is not something you can learn in formal training.

This kept our program pragmatic and grounded with realistic goals parents could expect when participating in a research program. Additionally, the dedication and time to teach families across various cultures about the purpose of research in plain language was crucial to maintaining relationships, further validating information and techniques they may have already been familiar with.

Over time, many families became more confident interacting with researchers, and university partners in our area began to streamline and institutionalize partnerships with community-based organizations (CBOs) like ours. These partnerships further diversified participant pools in pioneering areas of research, including our program being one of the early partners for increasing participation of Latinos in autism research.

3. How did you and Fiesta Educativa get involved in the Children’s Hospital of Los Angeles Adverse Childhood Experiences (ACEs) project?

I was initially introduced to Dr. Pat Levitt with a project he was attempting to expand to Mexican communities via collaboration with the Mexican consulate. His initial research involved Chinese families and behavioral research, and he sought to expand this research to other communities.

One of the families at Fiesta was initially involved, before my contact information was shared and our relationship was established via collaboration on a research grant. We have worked for 15+ years with him now, demonstrating a framework for how to work with diverse communities, often represented by foreign entities and consulates that require out-of-the-box thinking for research enrollment.

Our partnership also demonstrated that parents and families can participate in community friendly ‘citizen science’ without needing to be highly educated, and learn advocacy skills, otherwise not learned in their home countries, along the way. These processes are time consuming, but they make the research goals more realistic and imbue trust in the community for further research.

On May 1st, Director of the Precision Medicine program Dr. Julianne McCall was invited as the only state-level government representative to participate in the 2024 White House Summit on STEMM Equity and Excellence: Propelling Progress and Prosperity by 2050 in Washington, DC.

There, more than 200 leaders across the STEMM sector launched the first-of-its-kind initiative coordinating cross sector actions for greater equity in both the research workforce and outcomes.

As a result of this gathering, both federal and non-federal partners developed a strategic action plan to drive progress in accountability, education, strategic communications, and diversity in the STEMM sector.

On April 5th, by invitation of San Diego State University Vice Chancellor for Research Dr. Hala Mandanat, Director of the Precision Medicine program Dr. Julianne McCall attended a gathering of the Minority-Serving Institutes Summit on Health Care Equity and Access in San Diego, CA.

At this summit, Director McCall met with the Advanced Research Projects Agency for Health (APRA-H) Director Dr. Wegrezyn and U.S. Health & Human Services Secretary Xavier Becerra, and many others, engaging leaders from across the state to contribute to ARPA-H's next priorities and foster cross-sector collaborations.

As part of a larger campaign through the State of California, Secretary Becerra further promoted a major government initiative to spur medical innovation, with a focus on equitable care for Latinos and other underserved communities.

Project Title: Using Precision Medicine to Tackle Impacts of Adverse & Unpredictable Experiences on Children’s Neurodevelopment

1. Why are community partnerships important for health research?

The population of health researchers in our country is not representative of our population as a whole in terms of demographic characteristics and life experiences that influence health. Community partnerships can enhance the representation of systematically excluded and marginalized communities in health research, which in turn has the potential to foster more innovative, ethical, and culturally responsive research. Community input can help to ensure alignment of research and community priorities, increasing the likelihood that research findings will be beneficial to community health. Community input early in the research process also often significantly bolsters recruitment and retention efforts, contributing to the overall success of research projects. Perhaps most importantly, transparent, respectful, and equitable community partnerships are critical for building trust that has been damaged by the historical exclusion of community members from decisions about health research design, implementation, and dissemination. Rebuilding this trust is paramount, particularly for addressing persistent health disparities that have seen limited improvement or have, in some cases, worsened over time. Honoring the expertise and insights of those who have lived experience of the health conditions or risk factors under study, along with those actively working to address these issues outside of research, is an important avenue for making meaningful progress in health research. I am so grateful for the community partners on our CIAPM research project, who have provided transformative input that has deepened our understanding and perspective of the work we are doing. We have refined study protocols, chosen alternative measures, better contextualized preliminary findings, and adjusted research questions based on community partner guidance. Community members have also shared with us the personal value they find in participating and partnering in our research, citing the potential to create positive changes for future generations. This underscores the potential reciprocal nature of community partnerships, where benefits extend beyond researchers to create (hopefully) a rewarding experience for community members.

2. How has your background and experience with this CIAPM-funded project impacted your future academic and/or career plans?

I began working on this project as a postdoctoral fellow. This experience enhanced my research skills, deepened my understanding of Adverse Childhood Experiences (ACEs), and solidified my interest in pursuing an academic career. Then, approximately one year ago, I started an assistant professor position. I am deeply appreciative for the chance to continue community-engaged research on ACEs and health equity, and to be able to involve students in this meaningful work. I am also grateful to have had the opportunity to collaborate with and learn from an outstanding, multidisciplinary group of colleagues as part of this CIAPM-funded project. Our collaborations have now expanded beyond just this project to several other community-engaged, health equity-focused research projects.

3. What impacts have you seen from this CIAPM-funded project addressing the health impacts of ACEs and advancing health equity?

As we know, ACEs have a tremendous detrimental impact on health and development, and because they are disproportionately distributed among racially and ethnically minoritized populations and low-income populations, they also contribute to persisting health inequities. Therefore, I see our CIAPM-funded project, and all of the CIAPM-funded projects, as having an immense opportunity to advance health equity. I have already seen our work begin to address the health impacts of ACEs through our community-engaged work. In collaboration with the University of California Irvine’s Institute for Clinical and Translational Science, we have conducted a series of Community Engagement Studios, which provided a platform for gathering project-specific insights from relevant community stakeholders during the early stages of our project. We have also established a Community Advisory Board (CAB) of community leaders, advocates, parents, field experts, nonprofit representatives, clinicians, and medical students. The feedback and insights gleaned from our CAB and community engagement studios have played a pivotal role in enhancing the responsiveness of our research to community needs and priorities. Another exciting aspect of our project involves the incorporation of a 5-item questionnaire assessing a novel dimension of ACEs – early life unpredictability in social, emotional, and physical environments. This questionnaire is administered during well-child visits for tens of thousands of Orange County youth, along with the PEARLS. With this data, we will be examining associations between unpredictability, standard ACEs, and child mental and physical health outcomes, with one important goal being to identify crucial focal points for improving health equity.

Project Title: Reducing Cancer Disparities Through Innovative Community-Academic Partnerships

1. Why are community partnerships important for health research?

Community partners can provide community expertise, both from historical and personal context, and insight into local needs, resources, and overall culture. Implementing a team-based approach can maximize the expansion and utilization of resources available through different programs in the community. It helps foster trust by using local experts and respected community members, making it more sustainable.

2. How has your background and experience with this CIAPM-funded project impacted your future academic and/or career plans?

This CIAPM-funded project, better known as the ALCANCE project, has allowed me to better understand there is more to address than just a patient’s symptoms when they walk into a healthcare facility. Even though this is something I was aware of since a young age when I translated at my parents’ medical appointments, now we are able to provide evidence-based results on the impact a bilingual patient navigator has on a patient’s well being. Whether it is connecting patients to community resources, providing health education on precision medicine and their condition, discussing Goals of Care and Advanced Care Planning, or just being a point of contact for any questions or concerns that might arise. Providing this extra layer of support to address health disparities and create more health equity results in more efficient treatment and recovery. Exposure to community-based participatory research provided me with opportunities to not only serve patients, but also to contribute to translational science, patient advocacy and case management. Skills I plan to implement and build on one day as a doctor.

3. What impacts have you seen from this CIAPM-funded project addressing cancer health disparities and advancing health equity?

Patients who I have worked with tell me they feel less stressed and more engaged and in control of their care, having a better understanding of their cancer diagnosis and treatment regimen. Patients also felt more comfortable expressing concerns to their providers, and as a result, their symptoms were better managed. Thanks to this project’s positive impact on the patient population, and support for the role among providers and staff, the role of the CHW has been fully integrated into the clinic’s standard of care and is now offered to every patient who needs it.

We are excited to announce that researchers Blanca Meléndrez and Amina Sheik Mohamed of the UCSD Center for Community Health, who are supported through the California Initiative to Advance Precision Medicine (CIAPM) for work addressing Adverse Childhood Experiences (ACEs), received the 2024 James Irvine Foundation Leadership Award!

On February 12th, CIAPM staff attended Blanca and Amina’s recognition on the Senate floor in Sacramento. Please help us in celebrating this recognition of our two esteemed research colleagues!

Photos by Blanca Meléndrez and Chase Daley

On November 16 in San Diego at Biocom’s largest annual gathering, Biocom California recognized Director Dr. Julianne McCall as the organization’s 2023 Government Official of the Year. In his remarks at the event, Biocom California Chair Tim Scott stated, “This special award is rarely given, bestowed only when we identify a deserving public servant who has demonstrated an appreciation, understanding, and strong support for the life science industry... Because of her exemplary work, California is better connected within and beyond state borders to leverage the nation’s diverse community of R&D innovators.” Biocom California represents over 1,700 life sciences institutes and companies in the state, notably the largest life science cluster in the world.

1. How does your project address the health impacts of ACEs and advance equity in California?

As we know, adverse early-life experiences (ACEs) have a profound cumulative impact on lifespan trajectories of mental and physical health. Notably, the burden of ACEs is not equally distributed, with a heightened risk of exposure among individuals in low socioeconomic (SES) and ethnic/racial minority communities in California as well as the rest of the world. ACEs predict health problems at the population level but not at the level of the individual child. We have no tool to know if a child will or will not be impacted by ACEs. In addition, the known types or dimensions of ACEs do not fully explain the variance in outcomes, leading us to wonder if we are missing important dimensions of ACEs.

Our project now addresses both questions. First, after engagement of parents, physician and community advocates, we are looking for predictive markers for vulnerability to adverse ACEs outcomes in a group of 150 infants. We obtain samples of saliva at ~one month and one year of age have found that changes in DNA methylation of an individual child over the first year of life might inform us about their health outcomes. Second, we are adding a 5-item questionnaire about a novel dimension of ACEs to assess its importance in predicting outcomes. Recently, we developed a novel conceptualization of an additional ACE characterized by unpredictable sensory signals from the parents /caregivers and the environment. The importance of unpredictability of sensory inputs was initially supported by preclinical work demonstrating that fragmented and unpredictable maternal signals directly and causally influence the maturation of brain systems governing emotional and cognitive function. Inspired by these discoveries and complementary theoretical models in infants, we have now established that unpredictable environmental signals contribute significantly to adverse neurodevelopmental outcomes and compromised mental health in several human cohorts, even after accounting for the predictive capacity of established ACEs. These findings have independently been replicated by others in outside the U.S. In our current project we are using real-world validation to ask if unpredictability is an important ACE. We anticipate more than 50,00 kids will complete the questionnaire and enable us to analyze their health outcomes, via anonymous medical records. All this takes place here, within diverse populations of Southern California, in real time.

2. Why have you dedicated your work to this field?

I spent part of my childhood in Ethiopia and saw poverty around me, but relatively little mental and cognitive health issues, in a society that was stable and embraced predictable routines for kids. I then encountered a similar level of socioeconomic status in inner city Los Angeles, but it was associated with a remarkable level of mental health problems in children. I could not reconcile the existing notions of ACEs to what I saw. I knew we were missing something and set out to model resource scarcity in preclinical models and uncover the actual signals that poverty may emit to the developing brain. This is how we discovered that low resources in preclinical models changed the patterns and predictability of maternal caring behaviors.

3. What is special about being a CIAPM PI?

Two aspects. First, I am incredibly motivated to try to improve the health of kids in my own state of California and make a change here. The second exciting aspect is the opportunity to interact with other, similarly motivated CIAPM teams.

On September 22, the California Initiative to Advance Precision Medicine (CIAPM) team released a Request for Proposals (RFP) on precision medicine approaches for the prevention, diagnosis, and treatment of depression.

This funding opportunity aims to drive innovation by applying a precision medicine approach to improve outcomes for patients with or at-risk for depression, particularly as a path to reduce health inequities. The CIAPM team will award up to $9 million total across three to five independent research teams ($1.8 to $3 million per team) over a three-year project term. To ensure the RFP is responsive to community needs, CIAPM hosted a Request for Information and held listening sessions throughout California.

California-based research teams must be co-led by at least one non-profit academic research institution and at least one non-profit community-based organization, patient advocacy group, community clinic, or public or tribal entity that provides support to people with or at risk for depression. By the full proposal stage, projects must also include at least one private sector collaborator that contributes in-kind, financial, or other resources to the project. The private sector collaborator should not be a PI and CIAPM funds will not be allocated to private sector collaborators.

Letters of Intent (LOI) are required, nonbinding, and not scored during the selection process, but must be received by the noted deadline. CIAPM encourages applicants to begin drafting the concept proposals as soon as possible and not necessarily wait until submitting the LOI.

View deadlines and more information on the RFP

1. How does your project address the health impacts of ACEs and advance equity in California?

The HEALthy4You study addresses the impact of ACEs on Latino youth experiencing obesity. We do this by addressing the issue from multiple angles. Adverse Childhood Experiences (ACEs) do not happen in a vacuum. Therefore, we are exploring unique ways to unpack and address the underlying issues that cause both obesity and high ACEs scores. Some participants will receive only the Healthy Together curriculum, a health and nutrition curriculum from our partner Family Health Center’s clinic, while others might receive support for mental health and case management through a Promotora or community health worker. Additionally, we’re studying the surrounding environmental factors that might impact individual ACEs scores and obesity rates by looking at the “exposome,” which refers to environmental factors that may affect health. We study a participant’s “exposome” through a platform called Streetwyze – Participants use Streetwyze to “check in” to areas around their community and report out what they like, what needs work and what they don’t like about their communities. We believe that our approach advances healthy equity in California by addressing ACEs and obesity from a holistic perspective.

2. Why have you dedicated your work to this field?

Blanca Melendrez, MA: As an immigrant, I have witnessed firsthand the challenges and inequities that can be prevalent in healthcare systems, along with the profound impacts of social determinants of health (SDOH) on access to and utilization of health services in underserved communities. My steadfast commitment to the field of community-engaged public health has always been deeply rooted in this personal background and my lived experiences, igniting a passion within me to drive change, address health disparities, and advocate for health equity within communities of color. For the past 20 years, I have been privileged to hold a leadership role within a university-based Center that enables me to make these passions my work, driving community-based public health initiatives aimed at improving health outcomes and equity for immigrant, refugee, and other underserved populations. Employing a combination of community partnerships, innovative public health practice, research, and education, my work strives to foster health justice in communities that have historically faced disparities in healthcare access and outcomes, for example through initiatives such as the HEALthy4You research study. Moving forward, I am committed to continuing to build on my over two decades of experience and deep understanding of the intersection of health disparities and SDOH with ongoing dedication to improving the lives of communities of color and relentless advocating for health justice.

Dr. Kyung Rhee: As a pediatrician and behavioral researcher, I am always struck by the effects of adverse childhood experiences and adverse SDoH on a child's trajectory. If you put the same child in a different environment, they may be able to thrive and attain better health, academic, and socio-emotional outcomes. But it has been challenging to truly understand or identify what a child needs to obtain these outcomes, and how these mix of "ingredients" or factors may differ for each children. So it has been important to me to find ways to modify this effect and help emphasize the strengths each family brings to the table and the positive experiences in a child's life that will promote better growth and development. This project helps us to identify what these positive factors are and how they interact or potentially counteract the adverse experiences that a person may experience. This is what Pediatricians and child researchers strive to do.

Dr. Eric Hekler: As a public health professor who is trained as a psychologist and dedicated to advancing population health, I am biased towards looking toward what are the “upstream” challenges and “root cause” issues that propagate health disparities, including adverse childhood events. I am dedicated to this work because of what I see are the biggest predictors of health, particularly a person’s zip code. This signals to me that, to achieve precision health, we need approaches that match to the core driving determinants that propagate health disparities. I’m dedicated to finding ways to provide the type of precision support needed to counteract health disparities, with a particular focus on matching support to the underlying social determinants of health factors that are the largest predictors and thus likely drivers of health disparities.

3. What stands out about your experience as a CIAPM-funded PI?

Blanca Melendrez, MA: In my experience, the preeminent aspect of being a CIAPM-funded Co-PI has been the ability to bring together researchers, community partners, and residents as part of a co-design process to develop impactful community interventions that address health needs. This community-based, partnership-focused approach fostered by CIAPM:

• Acknowledges that community members have insights and answers to their unique problems and thus enables community to inform the development of precision medicine interventions.
• Empowers community leaders as co-principal investigators (CO-PIs) which is instrumental in building trust and generating solutions rooted in community perspective.
• Builds on established community partnerships and trust developed through the San Diego County Childhood Obesity Initiative (COI) collective impact coalition from which the HEALthy4You study originated, combining precision-medicine research with a collective impact approach to build a community-developed research model that collects and distributes data that is both meaningful and impactful to the community.

This type of true community-informed work supported through CIAPM has the potential to lead to sustainable translation of impactful interventions back to impacted communities and in turn transform health outcomes for families who could benefit most from this work.

Dr. Gary Firestein: Serving as lead PI with my co-PIs has been an amazing learning experience and journey. My previous experience was primarily focused on more traditional research methods, and I was exposed to alternative approaches to collaboration, community engagement, and scientific approaches. Our stakeholders, including our community partners, were able to work together, compromise, collaborate, and find solutions that would allow us to develop new ways to help families and children overcome adversity.

Dr. Kyung Rhee: I would say that this process of pulling in different perspectives and really trying to create something that addresses the needs of the whole group has been very interesting. While it can be challenging and takes more time than any of us expected, it is well worth the effort. This process of consensus building and creating something more comprehensive and potentially more meaningful to everyone is important and should be taken on more often.

Dr. Eric Hekler: What has stood out for me a MPI for a CIAPM Project is the ways in which CIAPM are allowing us to explore and go deep into systemic challenges that are embedded in how we’ve traditionally done research. There are hard, intractable issues we have and need to work through together in a way that honors each of our different ways of knowing and understanding, while still also driving towards a shared sense on how to study and make progress through complex issues like ACES. I’m grateful to CIAPM to give us the opportunity to take on these complexities in a thoughtful way in partnership with the communities most effected.

CIAPM hosted a virtual research symposium on September 14 as the three State-funded Cancer Disparities research teams wind down their projects, which they began in 2019. CIAPM's Drs. McCall and Reiner overviewed the cancer disparities research portfolio. Cancer Disparities Principal Investigators, Dr. Manali Patel (Stanford University), Drs. William Kim and Pablo Tamayo (University of California, San Diego), and Dr. Elad Ziv (University of California, San Francisco) gave brief presentations of their projects and project team members engaged in rich discussions of lessons learned and paths forward.

The California Initiative to Advance Precision Medicine (CIAPM) team, which is part of the Governor’s Office of Planning and Research, has released a Request for Information (RFI) on community needs for mental health, particularly the prevention, diagnosis, and treatment of depression. The CIAPM team invites the public to share their perspectives. Please submit written responses via this form by August 18 at 5:00 p.m. PDT for consideration. If you cannot access the submission form or would like to share a supplemental attachment, email your response or supplemental attachment to ciapm@opr.ca.gov with the email subject line, “CIAPM Depression RFI.”

The feedback you submit in response to the Request for Information may help the CIAPM team develop the scope of future research funding opportunities that aim to address health inequities and improve Californians’ mental health, especially by preventing depression or improving its diagnosis or treatment. CIAPM will also hold an informational webinar with a Q&A session on July 27 at 3:30p.m. PDT.

The California Initiative to Advance Precision Medicine supports collaborative research and fosters partnerships between the State, researchers, patients, communities, and industry to improve health outcomes for Californians. Precision medicine considers the whole person, such as their age, ethnicity/race, gender, geographic location, and socioeconomic status. Providing the right treatment or prevention strategy at the right time for the right patient leads to optimal health outcomes.

On June 20th, the Select Committee held an Informational Hearing on the current state and future of the biotechnology industry.

Greg Theyel, Director of the Biomedical Manufacturing Network, presented an overview of the life sciences sector in California. The network tracks individual biotech companies, including their locations, headcounts, clinical trial progress, and other relevant information. The industry is categorized into eight sectors, ranging from biotechnology to digital healthcare. Theyel discussed different geographical regions in California, known as "Microclimates of innovation," with various concentrations of biomedical companies.

Julianne McCall, Director of the CA Initiative to Advance Precision Medicine, defined precision medicine, explaining how it tailors healthcare to individual characteristics, such as genomics, environment, nutrition, and health behaviors. The initiative has received significant funding, and they focus on reducing health disparities through cross-sector partnerships and innovative research projects.

Abigail Lore, Director of Policy and Research at PhRMA, highlighted the negative consequences of the Inflation Reduction Act (IRA), a new federal policy. This law imposes price controls on medicines, potentially hindering the development of new drugs. Lore emphasized the importance of post-approval research for the development of new uses for existing medicines and the role of biosimilars/generic versions in maintaining competitive pricing.

Veronica Sandoval, Ph.D., J.D., from Genentech, shared the company's commitment to diversity, equity, and inclusion in driving scientific innovations. She outlined three core pillars of their approach: fostering belonging, advancing inclusive research and health equity for all patients, and transforming society. Sandoval also highlighted the progress made in increasing representation of underrepresented groups and supporting diversity in the industry.

Dr. Joe Alvarnas from City of Hope emphasized that cellular and gene-modified therapeutics are the future of cancer care. He highlighted the need for policy measures to ensure equitable access to these therapies for cancer patients.

The hearing provided valuable insights into the state of the biotechnology industry in California and addressed policy challenges and opportunities for future growth and innovation.

Dr. Tina Sindher serves Stanford University as Clinical Associate Professor of Medicine and Pediatrics. She earned her Doctor of Medicine degree from the State University of New York (SUNY) Downstate Medical Center in Brooklyn and completed her Pediatric residency at Albert Einstein College of Medicine, Children’s Hospital at Montefiore in Bronx, New York. In 2017, she began expanding her clinical research in food allergies at the Stanford University Sean N. Parker Center for Allergy and Asthma Research. Project: Systems-based, Multidisciplinary Assessment of Adversity and Toxic Stress for Individualized Care (The SYSTEMAATIC Project).

1. How does your project address the health impacts of ACEs and advance equity in California?

The goal of the SYSTEMAATIC project is to develop a multidisciplinary assessment strategy that can be translated to clinical practice to diagnose toxic stress, guide integrated precision medicine treatment recommendations, and ultimately assess treatment efficacy. Having a toxic stress assessment tool that provides physiologic, systems-based, individualized, and clinically-relevant information will open the door to identifying individual biological needs and targeted therapeutic interventions.

ACEs and additional stressors such as poverty, racism, and discrimination disproportionately impact marginalized communities. Recognizing the critical importance of long-standing relationships within the community in building safety and trust, and the historical lack of voice of minority and socially disadvantaged populations in shaping research and health assessments, the SYSTEMAATIC project works with community organization partners, including the Fresno Community Health Improvement Partnership, to create community advisory boards and develop focus groups to lift up community voice and address long-standing health inequities.

Overall, we hope to impact ACE-Associated Health Conditions by allowing providers to (1) assess dysregulation in neurologic, endocrine, and immune (NEI) pathways, (2) identify patients with NEI dysregulation who might otherwise be missed by current assessments, (3) develop a system for multidisciplinary, integrated care that accounts for protective factors, supportive relationships and environments, and community voice, and (4) leads to novel, multi-disciplinary, stress-physiology-based therapeutic interventions and approaches to healing.

2. Why have you dedicated your work to this field?

Tina: as a pediatric allergist and immunologist, I have routinely taken care of patients with difficult to manage allergic conditions that likely exacerbated by ACEs. The need for an alternative treatment and management strategy for those impacted by ACEs led to my collaboration with the Center for Youth Wellness and Dr. Rachel Gilgoff in the development of the National Committee on Asthma and Toxic stress (NCATs). Our work in that area highlighted the gap in our understanding of how to identify the underlying changes to a person’s neurologic, endocrine, metabolic and immune (NEI) system. A better understanding of the multisystemic changes and response to interventions will allow us to better care for our patients impacted ACES.

Rachel: My original training was as a Child Abuse Pediatrician and my role was to evaluate for physical abuse, sexual abuse, and neglect. I remember vividly talking to a mother, telling her that her infant son had multiple broken bones consistent with physical abuse, and her tearful response: “How did this happen? I swore I would be a better mother than my mother was.” Learning about the ACEs study, the neurobiological and physiologic impact of trauma and toxic stress, and the intergenerational transmission of suffering, made me realize I needed to learn more about ways in which I as a medical provider could do my part in the multidisciplinary prevention and healing of toxic stress. Since then, I switched gears, started doing clinical research and program development, completed an Integrative Medicine Fellowship to further my knowledge of therapeutic approaches to heal toxic stress. We often boil the stress response in both clinical practice and research to the Sympathetic Nervous System and Hypothalamic-Pituitary-Adrenal Axis, but there are so many other aspects to the stress response such as endorphins, endogenous cannabinoids, oxytocin, immune cytokines, and the list goes on. All of these neural pathways and chemical signals are potential areas for targeted assessments and therapeutic interventions that we have only just begun exploring and translating for clinical potential. My strong belief is that toxic stress is treatable and that we as medical clinicians have a vital and unique role in treating toxic stress biology as part of a multidisciplinary approach to healing. I am dedicated to addressing health issues resulting from child abuse and toxic stress, creating systems of care that incorporate the science of stress biology and wellness, and collaborating across sectors to develop multidisciplinary, integrative, human-centered, and holistic approaches to healing.

3. What stands out about your experience as a CIAPM-funded PI?

We have been continually impressed by the collaborative nature of CIAPM and its strong focus on community. There is an emphasis on pursuing progress in the field-not generation of data. CIAPM recognizes that with participatory research comes with additional hurdles and challenges that are not always seen in standard clinical trials. CIAPM staff foster collaboration across research teams to promote best practices and shared solutions to these common challenges. CIAPM is a trauma-informed organization that focuses on support, trust, collaboration, and empowerment to truly advance community voice and scientific rigor in precision medicine efforts across the state of California. Thank you CIAPM!

CIAPM celebrates the tenure of Co-Director Dr. Shannon Muir upon concluding her time at the helm of the first-in-the-nation state-funded precision medicine research program in April. Over the course of four years, she applied her multi-faceted expertise in cancer biology, mental health, process optimization, health policy, and research administration to uplift the program to its current state.

Dr. Muir led the establishment of and staffed the California Precision Medicine Advisory Council, engaging eleven world-class, cross-sector experts in guiding the program. Additionally, her oversight of and partnership with State-funded precision medicine cancer disparities project teams saw the development of many new research collaborations across the state and advanced the science of community engagement and cancer care, particularly focused on Latine communities. Extending beyond CIAPM, she served as a member of the Governor’s COVID-19 Testing Task Force and helped write the first-ever California Surgeon General’s Report.

Always quick to advocate for stronger support for the most vulnerable populations, Dr. Muir is known by her colleagues to center equity in her approach to making change and has inspired countless conference audiences, staff, grantees, and members of the CIAPM Network. Her passion for research and commitment to improving public health have been evident throughout her time at the program. She is a gifted leader and mentor, and we are grateful for her dedication. Dr. Muir’s legacy will continue to be felt at the program for many years to come. She has made a significant contribution to the field of precision medicine, and we are proud to have had her as a colleague. We wish her all the best as she steps into the role of Chief of Staff of the Latino Cancer Institute.

CIAPM established itself in the precision medicine landscape by funding community-centric research; with $9.25 million in new funding from the California State Legislature, we will additionally promote health equity research in yet another way. CIAPM is launching the Representative Research Collaborative, a partnership with the National Institutes of Health All of Us Research Program to increase participation of people who are underrepresented in biomedical research (UBR). Building on the California-for-All motto, all communities deserve to benefit from research.

All of Us aims to include at least one million participants who reflect the diversity and intersectionality of the US population. California is readily equipped to contribute meaningfully to this effort, bringing its rich cultural, geographic, ethnic, and racial spectra as well as world leadership in research innovation. CIAPM’s Representative Research Collaborative is the first state-driven partnership with the NIH, aiming to engage people from three California cohorts who are particularly underrepresented thus far in All of Us: Central Valley residents, Far Northern California residents, and migrant workers. The Representative Research Collaborative will also contribute to the science of increasing UBR participation in research, and recruit researchers who are themselves from underrepresented backgrounds to utilize the All of Us database.

The Representative Research Collaborative will build a cross-sector coalition of entities that are uniquely positioned to include these three California cohorts: external organizations (selected through a forthcoming competitive process) and fellow state agencies who serve these communities. The Representative Research Collaborative will form an exhaustive strategy by studying best practices and consulting experts across government, academia, and the non-profit sector. The Collaborative will be fortified by both a Steering Committee and Advisory Group, which will guide the enterprise, aid in the formation of external collaborations, and help identify prospective partners. The Steering Committee will meet monthly to facilitate the project’s progression through milestones; Advisors will provide ad hoc high-level strategy.

Members of both the Steering Committee and Advisory Group will also contribute their expertise to boost interest and participation of the three underrepresented California cohorts in the All of Us database. Participants currently contribute biological samples and data from surveys, physical measurements, electronic health records (EHRs), and wearable devices, but All of Us is expanding the types of data it collects. For example, All of Us anticipates it will soon begin analyzing health data, and future surveys may gather data regarding physical activity, diet, medications, environmental exposures, and other factors. All of Us also intends to increase data available from fitness trackers, mobile apps, and other digital health technology. All participant data is securely stored and kept confidential, and participants always have the right to revoke their commitment to participate.

In addition to the long-range population-level benefit the database provides, participants may also receive immediate benefit through genetic screening. Following recommendations from the American College of Medical Genetics and Genomics, All of Us screens for 59 genes and variants that are associated with specific cancers, heart conditions, blood disorders, and other serious health conditions. Participants whose results show they may be at risk will be offered a free clinical DNA test through the program’s genetic counseling resource.

Through March 20, CIAPM will receive nominations for both the Steering Committee and Advisory Group via the Call for Nominations: Steering Committee and Advisory Group form. Any questions may be sent to ciapm@opr.ca.gov.

1. How does your project address the health impacts of ACEs and advance equity in California?

We know that prevention and early intervention for any health risk can reduce negative outcomes and be more cost-effective and scalable than interventions undertaken well into a course of a disease, and that scalability allows preventive strategies and interventions to be more widely available. Adverse Childhood Experiences (ACEs) drastically increase risk for many chronic diseases, and have a disproportional impact on underserved, overburdened families, especially those from underrepresented communities. Our research team is focused on developing a new approach for family healthcare providers that would enable screening for the ‘red flags’ of early adversity risk by using a simple swab of an infant’s cheek to test for biomarkers of stress.

2. Why have you dedicated your work to this field?

My career as a scientist has been focused on determining why lifelong health – good or bad – is so dependent upon what happens early in child development. Why it is that some individuals who experience early adversity exhibit resilience, while others suffer? I started with basic science studies that I hoped would translate into discoveries that benefit humans. I am a neuroscientist, studying the genetic and environmental factors that wire our brain circuits. To me, the brain and its functions represent the essence of the uniqueness of being human. I have spent most of my career addressing the complexities of how cells and circuits assemble to make us social beings who experience emotions. As Chief Scientific Officer at Children’s Hospital Los Angeles, I couldn’t be more proud to work at an institution that serves as a safety net for California families, no matter their financial resources, community origin, or immigration status, and it’s heartening to see so many families feel rewarded for their participation in research studies.

3. What stands out about your experience as a CIAPM-funded PI?

CIAPM encourages innovation, collaboration, and relevant research for the public good. Most of my research funding comes from federal programs like the National Institutes of Health, which tend to avoid risk. However, CIAPM recognizes that some risk can bring major rewards, such as a new way of addressing difficult health challenges. CIAPM requires that their funded projects include collaboration across a wide variety of expertise, incorporate meaningful community engagement that embraces equity, and provide training opportunities for curious and enthusiastic students and research fellows. When asked about CIAPM, I simply say that CIAPM supports research that solves real-life medical challenges, and improves the future of California’s children and families.

1. What are the primary goals of your project, and how does the project address the health impacts of Adverse Childhood Experiences (ACEs) and advance equity in California?

ACEs can have profound effects even in early childhood, and our current efforts would benefit from translating evidence into improved screening, referral, and support for patients and their families. Our study, the CARE Study, seeks to understand the biology of toxic stress, how ACEs contribute to toxic stress, which interventions are effective in reducing the effects of ACEs in early to middle childhood, and how screening and primary care can be implemented optimally in settings where there may not be many resources available to provide patients, such as community health centers or federally qualified health centers.

2. What are the most exciting project accomplishments or developments so far?

Through this grant effort we were able to bring together an amazing transdisciplinary team that covers extensive geography from central to northern California. This funding mechanism helped bring together and accelerate our partnership with individuals doing similar research and community engagement in Santa Barbara, Oakland, and Richmond. That’s particularly noteworthy because we often consider partnerships a side project but for this kind of work, partnerships and transdisciplinary collaborations are key if we really want to accelerate the development of knowledge and the translation of that knowledge into practice. Another exciting accomplishment relates to working with our family board for the research study to better understand how to talk about ACEs with patients and their families. Understanding patients’ and families’ expectations of resources when they are being screened for ACEs has been a gap in existing implementation strategies. Also, we have been able to work with our clinics across the three sites to develop better ways of connecting families to existing resources and the community, as opposed to trying to develop new support within primary care where we know sustainability and staffing can be really difficult.

3. How do projects funded by CIAPM differ from those funded by other sponsors?

CIAPM is unique due to its focus on launching and fostering new collaborations and partnerships. I especially appreciate two aspects of CIAPM’s ACEs Program: One is that it was written into the proposal request that cross-institutional, cross-sector, and cross-community partnerships are highly valued, in addition to the irreplaceable significance of community voices as equal partners. I really thought that was unique and excited us because it felt more in line with our ideal approach and allowed us to accelerate our plan for the coming years. The second way is that this mechanism is for high-risk, high-reward research compared to other mechanisms, which provided us the critical opportunity to focus on developing and optimizing much-needed evidence-based interventions, namely, caregiver dyadic interventions, in a way that hasn’t been done before. By investing in intervention research, we will be able to contribute new and proven approaches to reducing the impacts of ACEs for all California communities, especially in low-resource areas.

On Nov. 7, UCLA hosted all seven CIAPM-funded research projects addressing Adverse Childhood Experiences (ACEs) with a precision medicine lens. The inaugural one-day event included a showcase of ongoing projects which focus on advancing the science of ACEs, developing innovative community partnership models, and building networks of researchers, community clinics, nonprofit organizations, and others. Discussions focused on data science, federated data systems, and computational tools as well as on evidence-based strategies for collecting community guidance and better engaging the public as partners in research. Opening remarks were delivered by CIAPM Advisory Council Chair and UCLA Precision Health Institute Deputy Director Dr. Lajonchere as well as UCLA ACEs Lead Principal Investigator Dr. George Slavich, who also graciously hosted the event.

Project Overview

Project CELSUS is led by Principle Investigators Pablo Tamayo, PhD and William Kim, PhD at the University of California, San Diego.

This project connects a community of researchers, clinicians, patients and community advocates, who join forces as Project CELSUS to apply precision medicine genomic profiling to find new treatments and create a more precise and rational system to match TNBC tumors and existing cancer treatments. The project draws its name from Aulus Cornelius Celsus, an early pioneer of evidenced-based medicine in the 1st century A.D.
Since launching on August 14, 2019, the Project CELSUS team has made important strides towards developing project infrastructure and bringing together stakeholders from 14 separate institutions.
The Project CELSUS team is building on its 2020 accomplishments by improving their models, refining their system for testing the effectiveness of medications, validating their results in additional models, and strengthening engagement with partnering community hospitals. The work will support the ultimate goal of optimizing treatments for Hispanic women with TNBC.

1) What are the major goals of your project, and how does the project address health impacts of cancer disparities, and advance equity in California?

We made significant progress over the past decade in the development of novel treatments and molecular cancer diagnostics to guide the choice of treatment for Breast Cancer. However, in Triple-Negative Breast Cancer (TNBC), which accounts for approximately 20% of all breast cancers and have a poor clinical outcome, the treatment options are limited because they lack specific drug targets. Because they are more prevalent among Hispanic women, this results in a major health disparity in cancer diagnosis and treatment.
A major goal of our project is to leverage the rich scientific, and clinical expertise at Moores Cancer Center (MCC), UC San Diego, and the large Hispanic population in the greater San Diego area to apply precision medicine approaches to medically underserved Hispanic TNBC patients. We have thus worked to better understand TNBC biology, towards better intervention strategies, and improved clinical management of TNBC Hispanic patients and community stakeholder engagement for optimal study implementation, interpretation, and dissemination. In the process, we were aiming to foster a strengthened relationship and dialogue between UCSD, community cancer physicians, community hospitals, patients, and stakeholders to ensure equitable participation and benefit.

2) What are the most exciting project accomplishments or developments so far?

We are excited about several accomplishments so far. First, we are completing the development of the novel Cancer States and Archetypes (CSA) analysis framework, a multi-omic methodology incorporating over 20 different algorithms as a comprehensive disease model. The CSA breast cancer disease model represents the most common oncogenic states and incorporates predictive models that defines a high-resolution functional taxonomy of breast cancer, identifies novel targets for investigation, and provides a precision medicine paradigm to inform the choice of therapeutics for individual or groups of patients.
Second, as molecular tumor data and preclinical models from Hispanic TNBCs are enormously underrepresented, we are excited that our project has facilitated the collection of a number of rare tumor specimens from Hispanic patients, some of which are being cultured in the laboratory, and some of which are being molecularly profiled. This will be of great resource for the cancer research community as we learn more about the specific biology that may underlie Hispanic breast cancer patients.
Third, the project has allowed us to learn a great deal about the biology of TNBCs. We have systematically tested more than 40 individual agents, and 35 drug combinations across 24 breast cancer cell lines resulting in more than 1000 assays in triplicates. We are hopeful that some of these results may lead to promising therapeutic strategies towards TNBCs.
This project has also allowed us as the first and only academic center in San Diego to establish remote consenting and blood/tissue acquisition with patients seen at community hospitals. This successful collaborative model between UCSD and El Center Regional Medical Center through the CIAPM project has sparked further discussions regarding future collaborations with ECRMC to expand across all other disease types. We believe that this will facilitate other investigators at MCC to engage in research through community partnership.
Finally, we have generated community report from interviewing 44 patients and other stakeholders in San Diego and Imperial Counties will be published soon in both Spanish and English to disseminate key findings and recommendations. This will provide a unique opportunity to understand, through their own words and experiences, the stories of some amazing Latina women who have survived breast cancer in hopes that these stories will help guide future research – and practice – in breast cancer care.

3) How do projects funded by CIAPM differ from those funded by other sponsors?

CIAPM project has served as a one-of-a-kind opportunity to bring together a large number of investigators, clinicians, cancer patients and survivors, and stakeholders across various disciplines, institutions and backgrounds with the common goal to recognize and to address a broad unmet problems of cancer disparities within our communities.
The CIAPM’s approach to support the projects in a problem-centric way has made possible for us to expose a number of real-life challenges that were not obvious until they are executed. While some of these involve administrative and logistical issues that can eventually be resolved, we have also come to further appreciate the enormous complexities underlying cancer as a disease and the major challenges of effectively treating them in the clinic. While realization of such complexities can be discouraging and appear to thwart immediate progress, it is through projects like those supported by CIAPM that will help revisit and re-assess many current state of the knowledge to better understand what it takes to eventually tackle this terrible disease.
We believe that the lessons and resources from these investigations, uniquely made possible through the CIAPM support, will seed many more future efforts to help bring us closer to realizing precision cancer medicine and narrowing the health disparities of underrepresented patients.

Yuki Hebner

Yuki is a PhD Candidate at UCLA in Cellular and Molecular Biology, with a focus on Gene Regulation, Epigenomics and Transcriptomics. She received a BA and MA in Molecular Biology and Biochemistry from Wesleyan University, conducting research into genetic mechanisms. In addition to her work in the lab, Yuki serves as President of the Science Policy Group at UCLA and co-founded and directs the Neuroscience Communication Seminars at the UCLA Brain Research Institute. Beyond academia, she is also engaged in scientific publishing as an Editor of Knowing Neurons, science communication as a published author of policy memos in the Journal of Science Policy & Governance, and public outreach as a volunteer with numerous community organizations. At CIAPM, she will support the Impact Assessment project, among others.

Dr. George Slavich is featured for this month’s Investigator Spotlight.

1. What are the major goals of your project, and how does the project address health impacts of Adverse Childhood Experiences (ACEs) and advance equity in California?

The overarching aim of this project is to harness the power of cutting-edge tools from psychology, immunology, multi-omics, and translational bioinformatics to identify social, molecular, and immunological processes that can be targeted to mitigate toxic stress effects and enhance personalized resilience in California.

To address our overarching aim, we are conducting a highly collaborative, multi-site demonstration project in which we are monitoring the stress levels and physiologic and biological functioning of more than 700 adults using state-of-the-art tools for life stress and Adverse Childhood Experiences (ACEs) assessment, mobile/smartwatch physiologic assessments, non-invasive blood microsampling, proteomics, metabolomics, lipidomics, immune protein assessments, electronic health record mining and analysis, and translational bioinformatics. In addition, we are developing a personalized online biopsychosocial resiliency training program, a Personal Health Dashboard, and a stress tracking website, which will display real-time estimates of stress burden at the city, state, and country level to predict stress-related health events and inform policymakers and health officials across California and the world.

Our goal with this project is to help reduce the substantial disparities in human health and those attributable to ACEs and toxic stress, which are one of the most costly, burdensome, and deadly social and medical challenges that we face today.

2. What are the most exciting project accomplishments or developments so far?

We are excited about the launch of the California Stress, Trauma, and Resilience (CAL STAR) Network. This is an amazing collaboration among scientists, academic institutions, healthcare providers, and public health advocates in California. Our main goal is to connect innovative research, public engagement, and leadership development to enhance resilience, promote community health and well-being, and prevent and mitigate toxic stress and health inequities caused by ACEs. As part of this work, we are developing a Massive Open Online Course (MOOC) on stress, health, and resilience, and we will soon be launching the CAL STAR Research Training Program, which will help trainees advance their conceptual and technical knowledge of topics related to stress, health disparities, multi-omics research, and precision medicine. Our website just went live, and we hope folks will reach out and join us in this important work.

3. How do projects funded by CIAPM differ from those funded by other sponsors?

I think the biggest difference between CIAPM projects and those funded by other sponsors is the direct focus on translating cutting-edge science into practice. By requiring each CIAPM project team to have clinical and/or community partners, CIAPM is helping ensure that the taxpayer dollars that are spent supporting cutting-edge science in California will translate into better health and wellbeing for the great people of this state. All too often, amazing projects that are funded by other sponsors yield incredible breakthroughs that are never translated into better health or health care. That's why we are so honored and proud to be supported by CIAPM. We really want our work to have an immediate and positive impact on the health and wellbeing of the people of California, and we simply cannot think of a better way to accomplish this important goal than to work with this amazing organization.

CAL STAR Network Launch

A major milestone was met by ACEs Lead PI Dr. Slavich and his team at UCLA, Los Angeles County Department of Health Services, Stanford University, and UCSF when they launched the California Stress, Trauma, & Resilience (CAL STAR) Network this summer. CAL STAR is a collaboration among scientists, academic institutions, healthcare providers, and public health officials and advocates focused on enhancing resilience, promoting community health and well-being, and preventing and mitigating toxic stress and health inequities in California related to ACEs. For more information visit https://calstarnetwork.org/.

The Governor's Office of Planning and Research is hiring for two positions! OPR is looking for a full-time Communications Specialist & Administrator and a half-time Communications & Administrative Student Intern to work with the CIAPM.

Both roles work closely with staff and external leaders from industry, academia, health care, and community-based organizations, as well as officials from the Newsom Administration.

Applications close October 2. Follow the links for more information and to apply. For any questions about the positions, contact Julianne McCall. For questions about the application process, contact Joanna Sledge.

The final state budget passed by the legislature in June and signed by the Governor includes $19.25 million to launch two new projects led by CIAPM: a $10 million depression research program and a $9.25 dollar five-year interagency project to boost representation in biomedical research. Requests for proposals will launch as early as this fall.

Dr. Manali Patel is featured for this month’s Investigator Spotlight.

1. What is the major goal of your project, and how does the project address the benefits and use of Precision Medicine in cancer research?

The major goal of our project is to reduce cancer disparities in Monterey County by focusing on the integration of precision medicine education and care delivery across the continuum of cancer. We designed a multi-level intervention that integrates community health worker-led educational approaches for precision cancer care delivery, clinician engagement, and clinic and health system process changes to ensure equitable receipt of precision cancer care. We hope to improve patients’ understanding of precision medicine and enhance evidence-based cancer care among low-income and Latinx adults.

2. What are some of the most exciting project accomplishments or developments so far?

The most exciting project accomplishments thus far have been the development, adaptation, and implementation of a novel approach to ensuring evidence-based precision cancer care delivery in our target population. With guidance from our community advisory board, we have designed, implemented, and are now testing an intervention which integrates community health workers into cancer care delivery after diagnosis, prioritizes cancer screening and genomic testing throughout the continuum of the disease. Along the way we have identified several barriers to evidence-based cancer care delivery, such as food insecurity and other complications from social determinants of health. We’re addressing these barriers by developing and testing new interventions with county partners such as the Monterey County Food Bank.

3. How do projects funded by CIAPM differ from those funded by other sponsors?

First, the premise for achieving equity was built into CIAPM’s RFP, differing from any other cancer-related precision-medicine award opportunity. This laser focus on underrepresented populations in precision medicine was unique in that it recognized that while precision cancer care improves clinical outcomes for some populations with cancer, it can also exacerbate existing disparities.

Second, CIAPM required engagement with community partners. From our prior work, we know that community engagement inevitably leads to more effective, acceptable, and sustainable approaches, and with CIAPM’s encouragement we have continued to adapt our project based on community input

Finally, the partnership with the Governor’s Office of Planning and Research provides us with a direct opportunity to inform policy and sustain change. The engagement by the CIAPM staff and the integration of our results into potential policy change is crucial given that cancer health equity is truly a policy issue. We are thankful for the award and the opportunity to make meaningful changes in the way that precision cancer care is delivered in the state.

Find us at PMWC 2022

Don’t miss the many representatives of the CIAPM network, including Advisors, researchers, community partners, and staff who will deliver talks, moderate panels, emcee sessions, and host booths throughout the three-day conference.

CIAPM will be showcased in its own session on Thursday, June 30 at 1:00pm at the Track 4 stage, featuring PIs from the Cancer Disparities and Adverse Childhood Experiences research programs: Dr. William Kim from UCSD and Dr. Michael Synder from Stanford University.

CIAPM Co-Director Dr. Julianne McCall will also moderate a stellar panel on Tuesday, June 28 at 3:45 at the Track 1 stage: “Past, Present, and Future: How will we manage the next pandemic?” The panel features California State Health Officer Dr. Tomás Aragón, CIAPM Advisor and Stanford University Chief of Pediatric Infectious Diseases Dept. Dr. Yvonne Maldonado, Former President of the Fred Hutchinson Cancer Research Center Dr. Lawrence Corey, and UCSF Dept. of Medicine Chair Dr. Robert Wachter.

Stop by our booth #A201 at the main hall entrance to meet CIAPM staff and learn more about our forthcoming RFPs on depression research and equitable participation in research.

View attendance announcement

Full conference information

CIAPM 2021 Annual Report Released

CIAPM’s 2021 Annual Report was released on May 17, 2022. The report covers the year’s major accomplishments including:

• Advances made by our cancer disparities and ACEs research teams.
• The substantial revitalization of CIAPM’s California Precision Medicine Asset Inventory.
• The activities of the Precision Medicine Advisory Council including the Data Integration and Equitable Consent Working Groups.

On May 17, CIAPM shared highlights of the report with a public briefing.

View 2021 Annual Report briefing

In this CIAPM Investigator Spotlight, we feature Dr. Ariane Marie-Mitchell, Associate Professor of Preventive Medicine and Pediatrics at Loma Linda University. Since 2021, Dr. Marie-Mitchell and her team have worked on her CIAPM-funded project, A Multi-Component Intervention to Strengthen Families and Build Youth Resilience.

What are the major goals of your project, and how does the project address health impacts of Adverse Childhood Experiences (ACEs) and advance equity in California?

The major goal of this project is to foster partnerships between pediatricians, community health workers and parenting educators to improve the delivery of vital information and resources to a diverse population of families with ACEs. All partners will be trained with an evidence-based method that strengthens families and builds youth resilience. A second major goal is to use biological, psychological, and social data from a large cohort of children to evaluate whether our intervention reduces signs of toxic stress and improves child health outcomes, health care utilization, and school performance.

Our clinic is located in San Bernardino County, a region of California that is challenged by high rates of both poverty and ACEs. Along with these risk factors are higher-than-average rates of substantiated child abuse cases, substance use deaths, and chronic diseases. We’re hoping that our intervention will be an efficient and scalable model for pediatric preventive care that improves health and psychosocial outcomes for families with ACEs, in addition to reducing disparities by socioeconomic status and race/ethnicity.

A unique feature of CIAPM funding is the opportunity to combine a community intervention with a basic science research. Other sources of funding often focus on either community programs or biological research, but rarely both.

How is the work that CIAPM funds different from the work being funded at the federal level?

A unique feature of CIAPM funding is the opportunity to combine a community intervention with a basic science research. Other sources of funding often focus on either community programs or biological research, but rarely both. Because of the unique nature of the CIAPM funds, we are creating primary care and community-level partnerships which will directly benefit the families served, and we are conducting a rigorous biological, psychological, and social evaluation. Our results will serve to guide the implementation of similar interventions in other communities, and to advance scientific understanding of the biology of adversity and resilience.

What are the most exciting project accomplishments or developments so far?

We have developed and refined a bilingual curriculum for pediatricians, community health workers, and parenting educators that translates the scientific knowledge about ACEs and resilience into useful information, skills, and resources for families. Approximately 1500 families with ACEs have been counseled by our 65 trained pediatric providers, and over 300 families have been referred to our community partners. We have also navigated some of the challenges of information sharing across different organizations and have begun building an infrastructure that will be available to partners beyond the duration of this project.

CIAPM Investigator Spotlight: Dr. Elad Ziv

In our first CIAPM Investigator Spotlight, we feature Dr. Elad Ziv, MD, Professor of Medicine and member of the Helen Diller Family Comprehensive Cancer Center and the Institute for Human Genetics at UC San Francisco. Since 2019, Dr. Ziv and his team have worked on his CIAPM-funded project, Addressing Disparities in Breast Cancer in Latinas: A Multi-Tiered Approach.

What are the major goals of your project, and how does the project address cancer health disparities in California?

This project is focused on understanding the genomic variants affecting breast cancer risk and progression among Latinas. Latina women are one of the largest demographic groups in California and breast cancer is the most common cancer in this group, like women from every population. However, we know a lot less about breast cancer in Latina women. Our project seeks to identify the inherited genetic variants that affect Latinas’ risk of developing cancer. We are also studying genetic changes in Latinas’ breast tumors, which may affect the way breast cancer progresses and could also affect treatment outcomes. Very little work of this kind has been done in this population.

The project team is also working with community-based organizations to help educate Latina women in the community about hereditary breast cancer. We encourage women to learn about their risk, to discuss the possible need for genetic testing with their doctors, and to get tested if appropriate. So the disparities we are trying to address are mostly disparities in knowledge: lack of knowledge in the medical community about how inherited genes and novel genetic changes affect breast cancer risk, progression, and treatment in Latinas, and lack of knowledge in the community about genetic risk.

Latina women are one of the largest demographic groups in California...[v]ery little work of this kind has been done in this population...CIAPM's funding is allowing us to recruit a large number of women who are not currently represented well in existing datasets.

How is the work that CIAPM funds different from the work being funded at the federal level?

First, federal granting agencies often assume that research participants have already been recruited and consented, and that samples have been collected prior to applying for funding. However, scientists have not yet recruited enough Latinas and women from other non-European ancestries to have the large sample sizes that are needed for genetic studies in specific populations. CIAPM’s funding is allowing us to recruit a large number of women who are not currently represented well in existing datasets. Second, at the federal level it is not expected, emphasized, or understood that genetic studies should involve community partners. Community partnerships and the extensive educational component of our project are part of the fabric of the study, and CIAPM’s funds are being used to build new relationships between scientists and the communities they serve.

What are the most exciting accomplishments or developments so far?

We have added over 900 samples from Latina women with breast cancer to existing datasets. This is making a big impact by improving sample size for discovery, and we are beginning to identify previously-unknow genetic variants that affect breast cancer risk in this population. We have also learned a tremendous amount by building collaborations with community organizations. CIAPM has allowed us to bring together a new group of bright, creative, and motivated scientists and leaders from organizations across California in pursuit of a common goal, which is also a noteworthy accomplishment.

Governor Newsom Proposes $19.3M for Precision Medicine

On January 10, Governor Newsom released his 2022–2023 state budget proposal, the California Blueprint. Included is a $19.3M allocation for CIAPM: $10M for research to improve prevention, diagnosis, and treatment of depression with a focus on underserved populations, and $9.3M to create a cross-sector network of state agencies, nonprofits, and universities with the goal of boosting representation in biomedical research.

This proposal sets in motion a months-long period of negotiations with the Legislature that will conclude with a budget bill passed by both the Senate and the Assembly, signed by the Governor, and enacted July 1, 2022.

Budget Goal: Addressing Depression With Precision

The current trial-and-error approach to depression treatment can be costly and dangerous, potentially subjecting patients to prolonged suffering, significant side effects, and debilitating changes to medication regimens.

"The lack of reliable biomarkers for depression and suicidality makes diagnosis and treatment metrics difficult across cultures, genders, age, and other factors. Precision medicine techniques like pharmacogenetics can increasingly offer physicians modern tools to accurately identify which patients will benefit from a given therapeutic," said Clara Lajonchere, PhD, Chair of the California Precision Medicine Advisory Council.

COVID-19 continues to devastate community-wide mental health. New research is urgently needed to increase clinical and social options to combat the current and anticipated surge in depression, especially in underserved communities.

Using the principles of precision medicine to address depression involves harnessing the power of computational analytics, next-generation genetic sequencing, and data sharing and aggregation to provide interventions that are tailored to a specific patient, instead of an "average patient."

The 2018 report Precision Medicine: An Action Plan for California identifies depression as an area in which precision medicine research can benefit patients in the short and long term.

These depression research funds would be competitively granted to research institutions that partner with community groups and/or county clinics that provide services to Californians that suffer from depression at disproportionate rates. As with previous CIAPM RFPs, research teams must be co-hosted by at least one academic research institution and one nonprofit community/patient organization.

Budget Goal: Equitable Inclusion in Biomedical Research

Diversity in all its forms is one of California's greatest assets. So too is the state's world-class biomedical research ecosystem, pushing the boundaries of science in service of health and wellbeing. Not all Californians have benefitted equally, however, from cutting-edge innovations. Disparities continue to grow for patients in rural settings, communities of color, for those with disabilities, and others. One of the many upstream explanations is the lack of representation in research. Simply put, folks who are not engaged in research studies may not be able to see themselves in the results.

The Governor's proposed budget includes $9.3M to increase representation in biomedical research so that scientific advances better reflect California's diversity. CIAPM will lead an interagency collaboration to develop best practices, create informational materials, and host events to raise awareness and strengthen participation among underrepresented communities in research studies.

"The Governor's vision of a California for All necessitates cross-sector leadership across our state's scientific landscape to pursue health equity as the primary focus. Until researchers embrace the full range of social, physiological, economic, cultural, geographic, and other determinants of health, current disparities are likely to persist. As the Governor's long-range and strategic planning office, we are excited to lead this effort to advance health and medical strategies that work for all Californians," commented Sam Assefa, MCP, Director of the Governor's Office of Planning and Research.