Project Summary Abstract
This is one of the first mixed methods studies to examine barriers to healthcare, medical comorbidities [i.e.,
cardiovascular risk factors (CRF)], and accelerated brain aging in Hispanic persons with multiple sclerosis (H-
pwMS). This CDA will provide the necessary support for Dr. Cristina Román, a trained clinical psychologist and
early career researcher, to obtain the mentorship and training needed to reach her long-term of goal of
becoming an independent clinical researcher and leading expert in social determinants of health/health
disparities, brain aging, CRFs, and mixed methods. H-pwMS have disproportionately worse outcomes than
their non-Hispanic counterparts. These disparities are likely driven by social determinants of health (SDOH),
especially those related to healthcare access, since early intervention and consistent, ongoing maintenance
are critical to MS prognosis. As a minoritized group, Hispanics encounter more barriers to accessing equitable
healthcare, not only contributing to poorer MS outcomes, but also increasing their risk for comorbid medical
conditions, like CRF. CRFs independently and disproportionately impact pwMS and Hispanic persons living in
the U.S., Accelerated brain aging is emerging as an important biomarker of disease progression in MS that is
also sensitive to CRFs. The primary aim of the proposed study is to use mixed-methods to investigate the
impact of barriers to healthcare and CRFs on MS-related outcomes, namely level of disability and accelerated
brain aging. This project aligns with NIMHD’s mission to “improve minority health and reduce health
disparities.” We will recruit eighty English and/or Spanish-speaking H-pwMS to partake in virtual or in-person
study sessions. In addition, a subset of the sample (N=40) will undergo structural brain imaging. Study aims
are as follows: (1) investigate how CRFs moderate the relationship between barriers to healthcare access and
disability; (2) correlate accelerated brain aging to barriers to healthcare, accelerated brain aging, and disability;
and (3) qualitatively examine lived experiences accessing healthcare. This work will have direct implications for
early intervention, while also filling a substantial gap in our understanding of how societal factors directly
impact brain health and health disparities in neurological disorders. To this end, the current CDA will capitalize
on the on the rich infrastructure and resources of Kessler Foundation and provide necessary training in: (1)
healthcare related social determinants of health/health disparities; (2) modeling (i.e., machine learning) of brain
aging and cardiovascular influences; (3) mixed-methods design and analysis; and (4) professional
development. Dr. Román has assembled an exemplary mentorship team of experts: John DeLuca, PhD,
Jennifer Manly, PhD, Adam Brickman, PhD, Denise Fyffe, PhD with expertise in SDOH/health disparities,
cardiovascular influences on brain aging, and mixed methods design and analysis. The training afforded by
this CDA will ensure Dr. Román makes a successful transition to independent investigator who continues to
carry NIMHD’s mission to reduce health disparities.
