Archives: 2016

It’s been 5 years since the last funding opportunity announcement (FOA) for the Research Centers in Minority Institutions (RCMI) was issued. Today I’m pleased to share news that the National Institute on Minority Health and Health Disparities (NIMHD) is releasing a new FOA that will capitalize on the program’s capacity to generate new scientific discoveries in minority health and health disparities research and to stimulate the next generation of researchers from underrepresented populations in institutions that are committed to this mission.

The RCMI will continue to serve as a flagship program aimed at the development and enhancement of institutional research infrastructure necessary to conduct world-class biomedical, behavioral, and clinical research and to produce well-trained investigators from underrepresented populations who will help enhance diversity in the biomedical research enterprise.

We have modified the RCMI program to make it even stronger in the future, with more flexibility and a three-tiered research structure opportunity for basic, clinical, and/or behavioral research. Eligible institutions must award doctoral degrees in the health professions or health-related sciences, have a historical and current commitment to serving students from underrepresented populations, and receive less than $50 million in average annual NIH funds within the 3 years prior to the time of application.

Given that the single most important predictor of choosing a scientific career is whether an individual participates in a rigorous, mentored research experience, the RCMI program now enables all levels of investigators, especially new and early career investigators, to experience rigorous, mentored research experiences focused on diseases that disproportionately affect minority and other health disparity populations. At least one research project will be included, as well as funds allocated to support pilot projects by postdoctoral fellows and assistant professors.

These program changes support NIMHD’s vision to advance the science of minority health and health disparities, and I encourage eligible institutions to apply. Click here to learn more about the new RCMI FOA.

The National Institutes of Health (NIH) Medical Research Scholars Program (MRSP) is an excellent research enrichment opportunity for promising students from diverse backgrounds to gain real-life experience in NIH laboratories and patient care areas. NIMHD is proud to participate with other NIH Institutes and Centers in the MRSP. Our goal is to introduce the MRSP to medical, dental, and veterinary students from diverse racial and ethnic backgrounds and encourage them to consider biomedical research as a career.

A medical researcher at work.

The U.S. population continues to increase in diversity, and there is an urgent need to ensure that the scientific talent which is key to our nation’s success is nurtured, recognized, and supported across all demographic groups. We need more researchers from diverse backgrounds to contribute minority perspectives and priorities to the research agenda, and advance the likelihood that underserved or health disparity populations participate in and benefit from health research.

However, minorities are seriously underrepresented in the biomedical workforce. In a recent study of U.S. citizens applying for investigator-initiated NIH research funding, African Americans were 13 percentage points less likely to receive awards, compared with Whites. African Americans/Blacks, American Indians and Alaska Natives, Hispanics/Latinos, and Native Hawaiians and other Pacific Islanders make up a disproportionately small component of the NIH Principal Investigator (PI) pool.

MRSP works to address this deficit in the research workforce by providing a comprehensive, year-long residential program designed to attract the most creative, research-oriented medical, dental, and veterinary students to the NIH intramural campus in Bethesda, Maryland. Student scholars in their second, third, or fourth year of study engage in a closely mentored basic, clinical, or translational research project that matches their research interests and career goals.

In addition to pursuing a rigorous research agenda, MRSP scholars participate in career development activities, lectures, journal club seminars, patient rounds, and clinical research coursework. They also highlight their research in formal presentations to the NIH community and at professional conferences. Each scholar is assigned an advisor who provides guidance in defining a well-articulated career development plan and selecting a dedicated NIH research mentor. Mentors are full-time NIH investigators with established and successful basic, translational, or clinical research programs.

The mentorship of students and early-career scientists is essential to professional success and the future of the biomedical research enterprise as a whole. The availability and quality of mentoring support for graduate students and newly graduated doctorates is important to increasing the proportion of underrepresented minority students who will ultimately obtain an independent position in a research university, medical school, or independent research institute, and finally, successfully compete for R01 grants.

As part of NIH’s mission to train the next generation of clinician-scientists and biomedical researchers, this program is designed for U.S. citizens and permanent residents currently enrolled in an accredited medical, dental, or veterinary program who have completed their core clinical rotations. This does not preclude students with strong research interests from applying before they complete their clinical rotations. Medical and osteopathic students may participate after completing their first year of clinical rotations (i.e., third year of medical school). Dental and veterinary students may participate in the MRSP after completing their second or fourth year of study, due to the integrated nature of the third and fourth (clinical) years.

MRSP scholars experience the full continuum of biomedical research—the bench, the bedside, between the two, and beyond. So this is a comprehensive, integrated, rich opportunity for students ready to build a solid foundation for their careers in biomedical research. I encourage students who are ready to take this competitive, yet rewarding next step to apply.

Applications for the 2017–2018 program will be accepted from October 1, 2016, through January 13, 2017. Interviews will be held in early March 2017, and selections will be announced in mid-March.

Visit the NIH MRSP website at http://cc.nih.gov/training/mrsp/index.html to learn more and submit your online application.

By Spero M. Manson, Ph.D.
Distinguished Professor of Public Health and Psychiatry
Director, Centers for American Indian and Alaska Native Health
Colorado Trust Chair in American Indian Health
Associate Dean for Research at the Colorado School of Public Health
University of Colorado Denver

Over the past 20 years, as research on alcohol, drug, and mental health disorders has advanced, scientific inquiry among American Indian and Alaska Native (AI/AN) people has shifted from a primary focus on describing the prevalence of such problems to explorations of ways to address well-documented health disparities.

One example involves detecting and managing depression and subsequent alcohol and substance abuse, risk of suicide, and, more recently, trauma among patients in large primary care settings operated by tribal health programs. In 2001, the Southcentral Foundation’s Primary Care Center in Anchorage, Alaska, initiated Screening, Brief Intervention, and Referral for Treatment (SBIRT) among Alaska Native patients age 18 and older.¹ Their efforts, which integrated masters-level behavioral health clinicians within the care teams, demonstrated that such evidence-based practices could be tailored to this population in scientifically sound and clinically meaningful ways.² Over a 5-year period beginning in 2004, 55 percent of the 8,000 patients who scored positive for alcohol use disorder agreed to follow-up treatment. Thanks to those results, the state of Alaska authorized Medicaid reimbursement for SBIRT, leading to the service becoming fully self-sustainable. This approach has been expanded to other tribal primary care settings in Alaska and in rural, reservation, and urban clinics in the lower 48 states. It now includes AI/AN youth ages 12 to 17 and covers other conditions, notably suicide risk and trauma.³

A second example arose in response to the widespread lack of access to mental healthcare in rural, isolated Native communities. In 1999, I co-developed a pilot project with funding from the Veterans Health Administration that deployed real-time, interactive videoconferencing to increase tribal veterans’ access to treatment resources.⁴ The effort proved remarkably successful and was singled out by Telehealth Magazine as one of the 10 best telemedicine programs in the United States, well before use of such technologies to address the mental health needs of disadvantaged populations became common. Research sponsored by the National Institute on Minority Health and Health Disparities documented the effort’s organization, process, clinical reliability, treatment, and cost outcomes and justified its expansion across the country.⁵ The U.S. Department of Veterans Affairs now funds 12 telepsychiatry clinics co-located in tribal veterans centers and Indian Health Service primary care clinics that serve hundreds of patients and family members.

A third example reflects increasing attention to the role of anxiety, depression, and trauma in the risk, prevention, and treatment of chronic physical health conditions such as diabetes and cardiovascular disease, which occur with alarming frequency among Native people. Supported by the National Institute of Diabetes and Digestive and Kidney Diseases, my colleagues and I examined the association of psychological distress, coping skills, family support, trauma exposure, and spirituality with initial weight and weight loss among participants in the Special Diabetes Program for Indians’ Diabetes Prevention Program, which was implemented at 36 Indian health care programs across the country.⁶ Psychological distress and negative family support were linked to greater weight at the beginning of the study, while cultural spirituality was correlated with lower weight. Furthermore, over the course of the intervention, psychological distress and negative family support predicted less weight loss, and positive family support predicted greater weight loss. These findings demonstrate the influence of psychosocial factors on weight loss in AI/AN communities and have substantial implications for incorporation of additional intervention components.

These exciting advances, all supported in part by the National Institutes of Health (NIH), illustrate how the emphasis and scope of alcohol, drug, and mental health research among Native people have evolved over the last two decades. They represent the continued marriage of good science with local benefit, consistent with the expectations of NIH and tribal communities.

References

¹Dillard DA, Muller CM, Smith JJ, Hiratsuka VY, Manson SM. The impact of patient and provider factors on depression screening of American Indian and Alaska Native people in primary care. J Prim Care Community Health. 2012; 3:120-124.

²Hiratsuka VY, Smith JJ, Norman SM, Manson SM, Dillard DA. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care. Int J Circumpolar Health. 2015; 74: 28315. doi: 10.3402/ijch.v74.28315

³Hiratsuka VY, Moore L, Dillard DA, et al. Development of a screening and brief intervention process for symptoms of psychological trauma among primary care patients of two American Indian and Alaska Native health systems. J Behav Health Serv Res. 2016 doi: 10.1007/s11414-016-9519-6.

⁴Shore JH, Brooks E, Anderson H, et al. Characteristics of telemental health service use by American Indian veterans. Psychiatr Serv. 2012; 63(2): 179-181.

⁵Shore JH, Brooks E, Savin D, Manson SM, Libby A. An economic evaluation of telehealth and in-person data collection with rural and frontier populations. Psychiatr Serv. 2007; 58(6): 830-835.

⁶Dill EJ, Manson SM, Jiang L, et al. Psychosocial predictors of weight loss among American Indian and Alaska Native participants in a diabetes prevention translational project. J Diabetes Res. 2016; 1546939. doi: 10.1155/2016/1546939.

By Linda Burhansstipanov, M.S.P.H., Dr.P.H.
Founder, Native American Cancer Research Corporation and President, Native American Cancer Initiatives, Inc., Pine, Colorado

Linda U. Krebs, RN, Ph.D., AOCN, FAAN
Associate Professor (retired), College of Nursing, University of Colorado at Denver, Anschutz Medical Campus

American Indians and Alaska Natives (AI/ANs) have long experienced lower health status than other U.S. populations do. AI/ANs born in 2011 have a lower life expectancy than all other U.S. populations (73.7 years vs. 78.1 years).[1] The poverty level among AI/ANs is nearly twice that of the overall U.S. population, and only half as many AI/ANs have health insurance

The socioeconomic conditions where people live and work have a substantial influence on health, and effects are cumulative over a lifetime.[2]^,[3] In the United States, educational attainment and income are the indicators most commonly used to measure the effect of socioeconomic status on health.³ Compared with other populations, AI/ANs are more likely to have lower socioeconomic status and to live in poverty, leading to less access to cancer prevention and screening and other healthcare services. Additionally, 20 percent of AI/ANs have not completed high school, compared with 8 percent of non-Hispanic Whites. Not completing high school has been associated with unhealthy and risk-taking behaviors.

Adult AI/ANs have behaviors and co-morbidities that increase their risk for cancer and other chronic conditions. They are more likely to be obese, use commercial tobacco, and have diabetes or high blood pressure.[4] Centers for Disease Control and Prevention (CDC) data reported that more than ¼ (29.5 percent) of AI/ANs reported having no healthcare provider, compared with 18.9 percent for whites and 24.2% of AI/ANs report having no healthcare coverage as compared with 12.5 percent for whites.[5]

Frequently, AI/ANs are also physically inactive. For example, one third of participants in the Education and Research Towards Health Study did not meet current physical activity recommendations; a high proportion were completely sedentary during leisure time.[6]

The Indian Health Service (IHS) reported that AIAN cancer screening rates were significantly lower than in the overall population, with only 59 percent receiving cervical screening, 48 percent breast screening, and 37 percent completing colorectal screening, leading to increased risk of late diagnosis and decreased survival from cancer.[7]

What does this mean for AI/ANs? These data tell us we need:

• Tobacco prevention programs and interventions, starting early with pregnant mothers as well as elementary school students
• Tobacco control and cessation programs targeting adolescents and adults
• Physical activity/exercise programs, starting with pregnant mothers
• Environmental safety programs (e.g., safe well water, pollution and contamination reduction)
• Cancer screening programs
• Cancer survivorship programs, including resources that are culturally relevant for AI/AN cancer survivorship plans
• Palliative care and end-of-life programs that are culturally and geographically relevant
• Genetic studies on molecular markers or alleles that may contribute to or interfere with cancer medicines and treatments
• Clinical trial recruitment and retention protocols that address barriers to participation (e.g., high blood pressure, cost of medications, lengthy travel to in-person clinic sessions)

Although AI/ANs continue to struggle with health inequities, they have many strengths. AI/ANs need interventions that build upon these strengths rather than repeatedly focusing on weaknesses. This community has survived hundreds of years of invasion and has the potential to continue to thrive as strong Native Peoples. Their traditions honor and respect their elders and families (despite historical trauma and community dysfunction). Their communities have strong foundations and emphasize the need to be healthy again like their ancestors by continuing to use native languages, consuming traditional foods, reserving tobacco for ceremonial uses only, and taking part in daily prayers, healing rituals (e.g., sweat lodges), and formal ceremonies (e.g., Green Corn, Stomp Dance, Sun Dance) as part of organized religions. These strengths affect AI/AN spirits, minds, emotions, bodies, and social interactions and contribute to the balance of these for health and wellness.

References

1. IHS. IHS fact sheets. Indian Health Service website. https://www.ihs.gov/newsroom/factsheets/disparities/ Published 2016.
2. Beckles GL, Truman BI, CDC. Education and income—United States, 2009 and 2011. MMWR Suppl. 2013; 62(3): 9-19.
3. CDC. CDC health disparities and inequalities report—United States, 2013. MMWR Suppl. 2013; 62(3): 1-187. http://www.cdc.gov/MMWR/pdf/other/su6203.pdf
4. Yurgalevitch SM, Kriska AM, Welty TK, Go O, Robbins DC, Howard BV. Physical activity and lipids and lipoproteins in American Indians ages 45-74. Med Sci Sports Exerc. 1998; 30(4): 543-549.
5. Cobb N, Espey D, King J. Health behaviors and risk factors among American Indians and Alaska Natives, 2000-2010 [published online April 22, 2014]. Am J Public Health. 2014; e1-e9. doi:10.2105/AJPH.2014.301879.
6. Duncan Glen E, Goldberg, Jack, Buchwald, Dedra, Wen, Yang and Henderson, Jeffrey A. Henderson. Epidemiology of Physical Activity in American Indians in the Education and Research Towards Health Cohort. American Journal Preventive Medicine, 2009. December 37(6): 488-494. Doi: 10.1016/j.amerpre.2009.07.13
7. https://www.ihs.gov/default/assets/File/GPRA/2010_12AreaReport_FINAL.pdf (cited 11/21/2016)