• Communicating the Value of Race and Ethnicity in Research

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    Earlier this year, NIMHD Director Dr. Eliseo J. Pérez-Stable wrote a post for NIH’s About Science, Health, and Public Trust blog. This website aims to share strategies and best practices to help improve public understanding of how biomedical research impacts personal health. In his post, Dr. Pérez-Stable raises awareness about the vital role that race and ethnicity play in clinical research. Read the post in its entirety below.

    Until recently, researchers assumed that what they learned about White male participants could be safely applied to anybody, regardless of gender, race, ethnicity or other variables. We now know that this isn’t true. When you’re communicating about research results, it’s vital not only to explain how a study was done, but who was being studied.

    Unfortunately, racial and ethnic minorities experience more preventable diseases and poorer health outcomes—referred to as “health disparities ”—yet they are not included in research studies as often as White people are. This is true even though researchers who get NIH funding have been required since 1993 to report race, ethnicity, and gender of participants in their biomedical research. African Americans and Latinos make up 30% of the U.S. population but account for less than 10% of participants in genetic studies.

    We know now that when it comes to medical research, there is no standard or average human. No single group can truly represent us all. In fact, many differences have already been identified.

    The FDA has approved drugs which were proven to be safe and effective for overwhelmingly White study participants. However, we found out later that these drugs do not necessarily work the same for minority populations. For example, clopidogrel, an anti-platelet drug, is no better than a placebo for 75% of Pacific Islanders who take it. The most common asthma-controlling medications were approved by the FDA based on how they performed in studies that included mostly White people. But later studies showed that they often don’t work as well for Puerto Ricans and African Americans, who have the highest rate and greatest severity of asthma. Carbamazepine, a drug used to treat seizures and nerve pain, is more likely to cause Stevens-Johnson syndrome in Asians than in other racial groups.

    Despite the growing evidence that race and ethnicity play an important role in the risks for many diseases and responses to environmental exposures, my fellow researchers and I still devote much of our time to explaining why scientists should include more racial and ethnic minorities in their studies. Clinical research has the potential to help advance health for everyone. But for that to work, it must include people from all groups.

    Clinical trials of diabetes medication should include Mexican Americans and Puerto Ricans—populations with high rates of diabetes. Prostate cancer trials would be remiss if they fail to enroll African American men, who are twice as likely as White men to be affected by and die from the disease.

    Many studies do show differences in health outcomes between racial and ethnic groups. When we interpret these studies, we should also consider the underlying factors causing those discrepancies. At NIH’s National Institute on Minority Health and Health Disparities (NIMHD), we sponsor many researchers who study the various factors that influence health.

    The easiest reaction to a study finding a health difference between, say, African Americans and White Americans might be to think the difference is due to something biological related to race. Sometimes there is a genetic element; for example, people of African descent are more likely to have high blood pressure and lung cancer. But we know that the health disparities experienced by minority populations can have many other causes. People of different races and ethnicities often grow up in different cultural environments, with diverse diets and health practices. Economic opportunity is not evenly distributed among all races, and different populations have unique histories that can contribute to health differences today. We can’t work to reduce these disparities if we don’t understand the mechanisms underlying them. To do that, our scientific research must include those groups that have historically been excluded or underrepresented.

    The inclusion of minorities affects more than minority health and health disparities. It is also a question of social justice—and of good science. To be truly thorough and meaningful, our clinical studies must include diverse populations.

    When you write about a study, consider who is included. Did ethnic and racial minorities participate in the study? If not, why not? If the study population is overwhelmingly White, you should be skeptical. If the researchers found differences between people of different populations, did they consider all the reasons why such differences can occur, or just jump to a conclusion that it must be because the races are biologically different? By asking these questions, we can help improve clinical research and ultimately help end health disparities.

  • Celebrating Native American Heritage Month!

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    By Dorothy Castille, Ph.D.
    Scientific Program Officer, Community Health and Population Sciences Division
    National Institute on Minority Health and Health Disparities


    Image Caption

    The National Institute on Minority Health and Health Disparities (NIMHD) celebrates Native American Heritage Month in November and recently published two articles featuring NIMHD-supported research on American Indian health disparities. Both featured studies were led by recipients of NIMHD’s Loan Repayment Program.

    The first article of the month highlights the Food Resource Equity and Sustainability for Health (FRESH) study by Valerie Jernigan, Ph.D., a researcher at the University of Oklahoma and a member of the Choctaw Nation of Oklahoma. In this study, also recently featured in Nature, Dr. Jernigan discusses her work with the Osage Tribe in improving the food resources and health of tribal families through a community gardening program. Read the full story.

    NIMHD’s second featured story this month introduces a Native American researcher of the Lumbee Nation at University of North Carolina-Chapel Hill School of Nursing, Jada Brooks, Ph.D., M.S.P.H., RN. Dr. Brooks has focused her studies on understanding why Lumbee women have the highest death rate related to heart disease in Robeson County, North Carolina, and determining if a positive perspective could help counteract the environmental exposures that increase their risk of heart disease. Read the full story.


  • Guest Blog Post: Reducing Health Disparities and Enhancing Diversity in Aging Research

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    This is part of a series of guest NIMHD Insights blog posts where NIH Institute and Center Directors highlight initiatives, resources and funding opportunities relevant to minority health and health disparities research, and training at their Institutes. The goal of this guest blog series is to link NIMHD stakeholders to minority health and health disparities-related information and opportunities across NIH.

    This post is from the director of the National Institute on Aging (NIA). NIA leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. NIA is the primary federal agency supporting and conducting Alzheimer’s disease research.

    By Richard J. Hodes, M.D.
    Director, National Institute on Aging

    Reducing health disparities and increasing diversity in the research workforce are key priorities for the National Institute on Aging (NIA). As Director of the Institute for the past 25 years, I have seen enormous growth in NIA’s health disparities and diversity programs. We’re working to address the complex scientific questions of health disparities in aging-related diseases and conditions on a variety of fronts, including funding research into health disparities and aging and training a new, diverse generation of aging researchers.

    Funding Health Disparities Research Related to Aging
    In 2015, NIA staff and others, including Dr. Eliseo J. Pérez-Stable, director of NIMHD and former National Advisory Council on Aging member, collaborated to develop and adopt the “NIA Health Disparities Research Framework” aiming to stimulate the study of environmental, sociocultural, behavioral, and biological factors that influence health disparities related to aging. Since then, our Office of Special Populations has developed a web portal and video to support researchers’ use of the Framework. Using it as a guide, since 2015, NIA has awarded over $100 million in research awards to explore health disparities related to aging. To learn more about NIA funding opportunities in health disparities research related to aging, visit the Framework or check out the opportunities below:

    The NIA Resource Centers for Minority Aging Research (RCMARs), seek to decrease health disparities by supporting and mentoring researchers in minority aging, improving minority recruitment in research studies, creating culturally sensitive health measures, and increasing the effectiveness of interventions for special populations.

    Training a Diverse Pool of Aging Researchers

    Input from individuals from diverse backgrounds, ethnicities, and perspectives is fundamental to producing good science. At NIA’s Intramural Research Program in Baltimore, we have developed the Diversity in Aging Research Pipeline Program (DARPP) to expose underrepresented and socioeconomically disadvantaged students to aging research and enhance their scientific skills.

    Additionally, NIA’s Summer Internship Program gives high school, college, graduate, and medical students opportunities to develop skills in scientific research and hands-on experience working in aging research. In 2017, over 60% of the NIA summer interns were women, and over 70% belong to racial and ethnic minorities.

    For junior faculty and researchers who are new to aging research, each summer NIA also hosts the Butler-Williams Scholars Program, which offers participants unique opportunities to learn more about the field. Researchers with an interest in health disparities research related to aging are encouraged to apply. The application period for next year’s program will open in late fall 2018.

    Through these and other efforts, NIA is seeking to improve research in aging, Alzheimer’s disease, and related dementias by diversifying research studies and our scientific workforce. If you have any questions, please be in touch with us!

  • Health Literacy: Why It Matters for Minority Health and Health Disparities

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    By Sherine El-Toukhy, Ph.D., M.A.
    Earl Stadtman Tenure-Track Investigator & NIH Distinguished Scholar
    Division of Intramural Research, National Institute on Minority Health and Health Disparities

    A basic principle of effective communication is to know the audience.1 This principle is especially important for patient-provider interactions that involve risk and diagnostic information, preventive measures, and instructions on medication regimens. But a message said is not necessarily a message understood. A patient’s understanding requires an ability to deal with written and spoken word and a grasp of basic math skills and concepts.2 It requires a health literate patient.

    As a researcher in the Division of Intramural Research at the National Institute on Minority Health and Health Disparities (NIMHD), I have been intrigued by how people of all races and ethnicities consume and understand health information and how this affects their health decision making and behaviors. Recently, I published a review of factors that affect the quality of patient-provider interactions among underserved populations.3 My co-author and I found that health literacy was prominent among other patient and clinician related factors.

    Indeed, the link between health literacy and health outcomes is indisputable. 4 From self-reported health and health knowledge, to preventive behaviors, chronic disease management, and hospitalization, individuals with limited health literacy fare worse than health literate ones.4 Even more unsettling is that minority racial/ethnic groups, individuals who are socioeconomically disadvantaged, the elderly, and immigrants are disproportionally limited in their health literacy.4 Low health literacy exacerbates poor health outcomes associated with other factors such as limited English proficiency that burden these populations to begin with.5

    Until recently, patients’ health literacy was simply presumed and sometimes overestimated.6 However, results of the National Adult Literacy Survey in the early 1990s revealed that almost 90 million Americans scored below the minimum threshold of basic skills deemed necessary to survive in an industrialized society. These basic skills include the ability to use written words and numbers in daily activities and problem solving.7 Three decades later, the numbers remain unchanged.8 These results were eye-opening because of their implications for healthcare.9

    Although the thought of a patient mistaking a “stepping stool” for a laboratory “bowel stool” sample seems improbable, there is evidence to the contrary. Researchers have documented how limited health literacy patients misunderstand doctors’ instructions and drug labels.10, 11 As one patient put it, “Sometimes [doctors] come out with big words and I don’t know what to make of it … they don’t say stomach or belly, they say something else, abdominal … I don’t understand that.”12

    Beyond patient-provider interactions, possessing the skills to seek and process medical and health information, communicate needs, and weigh available choices are prerequisites to quality patient-clinician communication, patient engagement in health decision making, medical adherence, and ultimately positive health outcomes.

    Addressing low health literacy thus is a necessity.13 The question is how? Initially, low health literacy was characterized as a patient attribute. This risked the belief that, first, limited health literacy is not malleable, and second, if it were, this responsibility rested outside the healthcare system. Alternatively, a comprehensive approach to address limited health literacy encompasses, besides the patient, the clinician, the message, the channel, and the context. Example approaches include training medical students on health literacy; tailoring easy-to-understand, culturally and linguistically appropriate messages with creative content such as risk assessment charts, cartoons, and narratives; and using different user-centric channels, such as interactive digital platforms. Within a healthcare organization, identifying limited health literacy individuals in electronic health records and building feedback systems allows for appropriate allocation of resources based on patient outcomes and reduction of health disparities as performance metrics.1, 13

    As the Institute tasked with improving minority health and reducing health disparities, NIMHD is committed to improving communications with diverse populations.3 An example of such efforts is the Language Access Portal that provides health information in seven languages in nine areas with significant disparities such as cancer and cardiovascular disease. The portal is a collaborative effort among the centers and institutes at the National Institutes of Health and other federal agencies to improve access of individuals with limited health literacy and English proficiency to health information.

    With the emphasis on patient-centeredness, a health literate public, healthcare and public health organizations are ever so important.

    References

    1. S. Department of Health and Human Services, National Institutes of Health, & National Cancer Institute. (2008). Making health communication programs work: a planner’s guide, pink book. Bethesda, MD: U.S Department of Health and Human Services.
    2. Ratzan, S. C., Parker, R. M. (2000). Introduction. In K. Patrias (Ed.), National Library of Medicine current bibligoraphies in medicine: health literacy (pp. v–vii). Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
    3. Pérez-Stable E.J., El-Toukhy S. Communicating with diverse patients: How patient and clinician factors affect disparities. Patient Education and Counseling, 2018
    4. Kindig D.A., Panzer A.M., Nielsen-Bohlman L. Health literacy: a prescription to end confusion: National Academies Press 2004.
    5. Sentell Sentell, T., & Braun, K. L. (2012). Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of Health Communication, 17(Suppl. 3), 82– doi:10.1080/10810730.2012.712621
    6. Kelly P.A., Haidet P. Physician overestimation of patient literacy: a potential source of health care disparities. Patient Education and Counseling, 2007; 66(1): 119-22.
    7. Kirsch, I. S., Jungeblut, A., Jenkins, L., & Kolstad, A. (1993). Adult literacy in America: A first look at the results of the National Adult Literacy Survey. Washington, D.C.: National Center for Education Statistics, Office of Educational Research and Improvement.
    8. The Organisation for Economic Cooperation and Development (OECD). United States – Country Note – Survey of Adult Skills – First Results 2013. Accessed September 24, 2018.
    9. Rudd, R. E., Moeykens, B. A., & Colton, T. C. (1999). Health and literacy: a review of medical and public health literature. In C. Smith (Ed.), Annual review of adult learning and literacy, Vol. 1 (pp. 158–199); Jessup, MD: Jossey-Bass, Inc., & Office of Educational Research and Improvement.
    10. Davis, T. C., Wolf, M. S., Bass, P. F., et al. (2006). Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine, 145(12), 88– doi:10.7326/0003-4819-145-12-200612190-00144
    11. Wolf, M. S., Davis, T. C., Shrank, W., Rapp, D. N., Bass, P. F., Connor, U. M., Clayman, M., & Parker, R. M. (2007). To err is human: patient misinterpretations of prescription drug label instructions. Patient Education and Counseling, 67(3), 293– doi: 10.1016/j.pec.2007.03.024
    12. Jordan, J. E., Buchbinder, R., & Osborne, R. H. (2010). Conceptualising health literacy from the patient perspective. Patient education and counseling, 79(1), 36– doi:10.1016/j.pec.2009.10.001
    13. S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, D.C.: Author.

  • Tackling Health Disparities Among Latinos in the United States

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    By Mariana Sanchez, Ph.D.
    Assistant Professor, Robert Stempel College of Public Health & Social Work,
    Florida International University
    Research Associate, Center for Research on U.S. Latino HIV/AIDS and Drug Abuse

    Mario De La Rosa, Ph.D.
    Professor, Robert Stempel College of Public Health & Social Work,
    Florida International University
    Director, Center for Research on U.S. Latino HIV/AIDS and Drug Abuse


    National Hispanic Heritage Month (September 15–October 15) provides an opportunity to reflect on how the histories, cultures, and contributions of Latino Americans have enriched our nation and society. As the largest ethnic minority group in the United States, numbering nearly 58 million, Latinos are the principal driver of demographic growth, accounting for half of the national population growth since 2000.1 The U.S. Latino population continues to not only grow but diversify. While Mexicans remain the largest U.S. Latino immigrant group, shifts in immigration patterns over the past decade indicate steep increases in Latino immigrants of Caribbean and Central and South American origin arriving in the U.S.1

    Health disparities (e.g., alcohol liver disease, HIV/AIDS, obesity, and mental health) impact Latinos in the U.S. These disparities are influenced by sociodemographic, behavioral, social, and societal factors including language and cultural barriers, lack of access to health care, and structural discrimination.2,3 To tackle these issues, researchers must first identify the mechanisms influencing health disparities and explore multilevel interventions to address them. There also remains a salient need to increase the number of Latinos and other ethnic/racial minority investigators pursuing careers in biomedical and behavioral research.

    The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA) at Florida International University (FIU) is at the forefront of these efforts with an overarching goal to prevent and eliminate health disparities affecting Latino communities in Miami-Dade County, Florida. This work centers around conducting community-based research and establishing community engagement strategies and partnerships to build a long-term, sustainable presence in vulnerable and marginalized Latino communities, including immigrants and farmworkers. CRUSADA has also funded and trained nearly 60 health disparity professionals at the faculty, postdoctoral, and predoctoral levels. Most recently, CRUSADA is home to FIU’s Health Disparities Initiative, funded through an endowment by NIMHD.

    We are currently conducting innovative research to better understand how pre-immigration experiences influence health trajectories among Latino immigrants. While Latinos face a host of previously mentioned health disparities, there is a perplexing phenomenon known as the Hispanic/Latino Paradox. The paradox explains that even with social and structural barriers, Latinos in the U.S. tend to be in better health and live longer than non-Latino Whites. Furthermore, Latino immigrants are healthier than their U.S.-born counterpart­­­­ – experiencing health declines as their time in the U.S. increases. Diminishing health among U.S. Latino immigrants has frequently been attributed to the acculturation process. Among these, is the well-documented escalation of alcohol use and misuse.5 Yet, previous studies have focused primarily on the drinking patterns of Latinos living in the U.S. for extended periods of time. Little is known about how shifts in alcohol use behaviors occur from the pre- to post-immigration context among Latino immigrants.

    Among our ongoing research initiatives is CRUSADA’s Recent Latino Immigrant Study (RLIS). Originally funded through an NIMHD P20 Center of Excellence, the RLIS was the first community-based cohort study to examine the pre to post-immigration alcohol use trajectories of young adult, recent Latino immigrants, as well as the underlying social determinants contributing to these trajectories. Subsequently funded by the National Institute on Alcohol Abuse and Alcoholism this ongoing study has successfully followed a cohort of more than 500 immigrants representing 17 Latin American countries across a 10-year span. The study’s remarkable 97% retention rate over the past decade speaks to our culturally relevant and effective recruitment and retention strategies in the Miami-Dade County Latino community).6

    Findings from the RLIS challenge our current understanding of alcohol use trajectories among U.S. Latino immigrants and have identified various sociocultural determinants as potential mechanisms of alcohol use in this population.7 Rather than indicating typical patterns of increased alcohol use among women (and little change in men) over time, our findings revealed decreases in alcohol use in men, with no significant change in women.8 Results showed associations between various social determinants (i.e., social support, neighborhoods, religious coping, social capital, and family cohesion) as potential mechanisms of acculturative stress and alcohol use.9,10, 11, 12 Collectively, these outcomes suggest that, for at least some subsets of Latino immigrants, the well-known escalation of alcohol use as their time in the U.S. increases may not hold.

    This ongoing study continues to identify how risk and protective social determinants interact with the acculturation process to influence distinct pre- to post-immigration alcohol use patterns among distinct Latino immigrant subgroups as their time in the U.S. increases. Findings from the RLIS have laid the groundwork for the development of alcohol misuse prevention interventions targeting Latino immigrants early in the immigration process.

    References:

    1. Flores, A. (2017). How the U.S. Hispanic population is changing. Washington, DC: Pew Research Center.
    2. S. Department of Health and Human Services Office of Minority Health (2018). Profile: Hispanic/Latino Americans.
    3. Alarcón, R. D., Parekh, A., Wainberg, M. L., Duarte, C. S., Araya, R., & Oquendo, M. A. (2016). Hispanic immigrants in the U.S.A.: social and mental health perspectives. The Lancet Psychiatry, 3(9), 860–870. doi: 10.1016/S2215-0366(16)30101-8
    4. Lacayo, J. (2016). NIH endowment makes FIU regional hub for the study of HIV/AIDS, substance abuse, obesity, and diabetes. FIU News.
    5. Li, P. P., & Zamboanga, B. L. (2018). A critical review and meta-analysis of the associations between acculturation and alcohol use outcomes among Hispanic Americans.Alcoholism: Clinical and Experimental Research, 42(10), 1841– doi:10.1111/acer.13845
    6. De La Rosa, M., Babino, R., Rosario, A., Martinez, N. V., & Aijaz, L. (2012). Challenges and strategies in recruiting, interviewing, and retaining recent Latino immigrants in substance abuse and HIV epidemiologic studies. The American Journal on Addictions, 21(1), 11– doi: 10.1111/j.1521-0391.2011.00193.x
    7. De La Rosa, M., Dillon, F. R., Sastre, F., Sanchez, M., & Babino, R. (2013). Alcohol use among Latinos: a comparison of pre-immigration, post-immigration, and U.S.-born Latinos. American Journal on Addictions, 22(2), 162– doi:10.1111/j.1521-0391.2013.00310.x
    8. Sanchez, M., Rosa, M. D. L., Blackson, T. C., Sastre, F., Rojas, P., Li, T., & Dillon, F. (2014). Pre-to post-immigration alcohol use trajectories among recent Latino immigrants. Psychology of addictive behaviors, 28(4), 990. doi:10.1037/a0037807
    9. Sanchez, M., Dillon, F. R., Concha, M., & De La Rosa, M. (2015). Impact of religious coping on the alcohol use and acculturative stress of recent Latino immigrants. Journal of Religion and Health, 54(6), 1986–2004. doi:10.1007/s10943-014-9883-6
    10. Cano, M. Á., Sánchez, M., Rojas, P., Ramírez-Ortiz, D., Polo, K. L., Romano, E., & De La Rosa, M. (2018). Alcohol use severity among adult Hispanic immigrants: examining the roles of family cohesion, social support, and gender. Substance use & misuse, 53(4), 668– doi:10.1080/10826084.2017.1356333
    11. Rojas, P., Dillon, F. R., Cyrus, E., Ravelo, G. J., Malow, R. M., & De La Rosa, M. (2014). Alcohol use as a determinant of HIV risk behaviors among recent latino immigrants in South Florida. Journal of the Association of Nurses in AIDS Care, 25(2), 135-144. doi: 10.1016/j.jana.2013.02.003
    12. Sanchez, M., Romano, E., Dawson, C., Huang, H., Sneij, A., Cyrus, E., … & De La Rosa, M. (2016). Drinking and driving among recent Latino immigrants: The impact of neighborhoods and social support. International journal of environmental research and public health, 13(11), 1055. doi:10.3390/ijerph13111055

  • Three New Research Areas Added to NIMHD’s Language Access Portal

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    By Kelli Carrington, M.A.
    Director, Office of Communications and Public Liaison
    National Institute on Minority Health and Health Disparities

    Are you looking for health information in languages other than English for your local community or patient population? As the communications director for NIMHD, I’m excited to share the latest health topic release on our Language Access Portal (LAP).

    Our expanded content includes dementia, with specific resources from the National Institute on Aging, mental health, with resources from the National Institute on Mental Health, and substance abuse, with information from the National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism. Resources from the National Library of Medicine are provided as well.

    Research has shown that language can be one of the most significant obstacles to health literacy and making informed decisions about one’s health, so we’re working to share resources that may help improve access to reliable health information.

    The LAP provides a single-entry point for health resources from across the National Institutes of Health (NIH) and other federal agencies in non-English languages spoken by populations experiencing significant health disparities. The pages provide cross-cultural and linguistically appropriate health information in Spanish, Hindi, Bengali, Tagalog, Korean, Chinese, Japanese, and Vietnamese. At the time of the LAP’s launch in spring 2017, the portal included six research areas: Cancer, Cardiovascular Disease (CVD), Diabetes, HIV/AIDS, Immunizations, and Infant Mortality.

    The LAP is a powerful tool for sharing health information with people who have limited English proficiency and who may not be able to access such resources otherwise. This new expansion of the portal is part of NIMHD’s commitment to breaking down communication barriers as we focus on improving the health of all health disparity populations. We hope you’ll find this resource useful and share with your communities.

  • Guest Blog Post: Interdisciplinary Association for Population Health Science

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    By Christine Bachrach, Ph.D.
    IAPHS Executive Director and Research Professor in the Department of Sociology and the Maryland Population Research Center at the University of Maryland, College Park

    Recently, the Interdisciplinary Association for Population Health Science (IAPHS) published a blog post summarizing the NIMHD inaugural Director’s Seminar Series presentation by Ana Diez Roux, M.D., Ph.D., Dean and Distinguished University Professor of Epidemiology in the Dornsife School of Public Health at Drexel University. The lecture was held on December 7, 2017 and the IAPHS post provides another chance to learn from this very informative talk about “Challenges and Opportunities in Health Disparities Research.”

    The blog post summary was written by Christine Bachrach, Ph.D., the IAPHS executive director and a research professor in the Department of Sociology and the Maryland Population Research Center at the University of Maryland, College Park.

    View the IAPHS post, Making Methods Work for and Inform Each Other, at https://iaphs.org/making-methods-work-inform-ana-diez-roux-health-disparities-research.


  • Congratulations to the 2018 Health Disparities Research Institute Scholars

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    By Richard Palmer, Dr.P.H., J.D.
    Former NIMHD Health Scientist Administrator

    The National Institute on Minority Health and Health Disparities (NIMHD) held its annual Health Disparities Research Institute (HDRI) from July 23–27, 2018 in Bethesda, Maryland. As with previous years, the selection process was very competitive with nearly 300 applications received from early stage investigators. Fifty scholars from 24 U.S. states, the District of Columbia, and one U.S. territory were accepted to the Institute. Selected scholars shared one common attribute—a strong commitment and desire to build a research career focused on minority health and health disparities research.

    During the weeklong Institute, leading scientists in minority health and health disparities research held interactive sessions that highlighted the current state of research. Lectures and lively scientific discussions focused on how to advance the field. Scholars were exposed to a wide array of research topics that spanned from how health disparities occur to how they can be effectively eliminated. Topics covered included the embodiment of social factors, big data, systems science, and the use of artificial intelligence, as well as promising and innovative intervention approaches to reduce health disparities. One theme clearly resonated with HDRI scholars—health disparities research is becoming inherently more transdisciplinary and requires a team science approach that harnesses the expertise of scientists from different fields.

    HDRI scholars also gained considerable knowledge about NIH, grant writing, and peer review during the Institute. Scholars attended a workshop that taught effective grant writing strategies, witnessed a mock review of grant applications and discussed common shortcomings of applications, and attended meetings with program officials from NIMHD and 14 additional NIH Institutes, who gave advice on preparing and submitting applications.

    2018 HDRI Group Photo

    Positioning early stage investigators so that they can submit research applications to NIH and other funding institutions is essential for ensuring that minority health and health disparities research continues to make advances. New ideas, insights, and approaches are needed to address the scientific gaps in our understanding of how health disparities occur, as well as fostering innovative solutions that will achieve reductions in health disparities. This year’s HDRI scholars are surely up for the challenge. Given the level of engagement exhibited by this year’s scholars, there is little doubt that many will build successful careers in minority health and health disparities research.

    At NIMHD, we are committed to training and fostering the development of the next generation of minority health and health disparities research scientists. Program activities, such as the HDRI, are key in this endeavor. Ensuring that early stage investigators are well versed in the field of health disparities science and capable of competing for extramural funding to support a program of research is central to our mission. We look forward to welcoming the next cohort of scholars in 2019.

    To be notified when the 2019 application cycle opens and other NIMHD announcements, please sign up here.




  • Healthy Mind Initiative Addresses Mental Health of Asian American and Pacific Islander Youth

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    By Victoria Chau, Ph.D., M.P.H.
    Substance Abuse and Mental Health Services Administration

    By Lieutenant Commander Kelly Leong
    United States Public Health Service

    By David J. Robles, B.A.
    Graduate Intern, Substance Abuse and Mental Health Services Administration


    From left to right: Dr. Victoria Chau, SAMHSA, LCDR Kelly Leong , United States Public Health Service and Mr. David J. Robles, SAMHSA

    July is National Minority Mental Health Awareness (NMMHA) Month—a practical time to highlight the importance of mental health for everyone. In a recent NIMHD Insights blog post, Dr. Xinzhi Zhang raised serious concerns about mental health awareness among Asian American and Pacific Islander (AAPI) youth and families. Suicide deaths have catapulted to the top as the leading cause of death for AAPI adolescents 12-19 years old in 2016.1 AAPI youth are the only racial/ethnic group for whom suicide is the leading cause of death, yet this is rarely discussed. The challenge of raising mental health awareness among AAPI communities is multifaceted but includes two key barriers: language issues and lack of culturally sensitive educators.

    In response to this urgent challenge, the Healthy Mind Initiative (HMI) was established to create a collaboration across the federal, county, and community sectors with two intents. The first aim is to improve mental health literacy in AAPI communities. The second aim is to address the mental health stigma and cultural barriers to seeking mental health treatment faced by AAPI youth and communities. The HMI is led by the Asian Pacific American Officers Committee (APAOC) of the U.S Public Health Service Commissioned Corps (USPHS), in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), the Montgomery County Health and Human Service’s Asian American Health Initiative (AAHI), the National Institute on Minority Health and Health Disparities (NIMHD), and AAPI community organizations.

    Unique to the HMI is its focus on leveraging APAOC as primarily non-mental health professionals to deliver key mental health messages to AAPI communities with the support of SAMHSA and AAHI. The mission of the USPHS is to protect, promote, and advance the health and safety of our nation. As America’s uniformed service of public health professionals, the Commissioned Corps achieves its mission through rapid and effective response to public health needs; leadership and excellence in public health practices; and advancement of public health science. The APAOC is uniquely positioned to deliver critical, culturally specific information to AAPI communities, as it consists of multilingual “trusted messengers” in their ethnic communities. These messengers also serve as advisors to the U.S. Office of the Surgeon General on AAPI issues. Each partner agency serves a specific role. SAMHSA provides the mental health expertise by developing the educational materials with input from its federal partners and the community organization leaders. These materials serve as a guide for APAOC officers to deliver mental health training modules. AAHI assists as the community outreach expert, trains the APAOC on “Mental Health First Aid” to equip members with the skills to conduct outreach activities, and provides community resources. NIMHD promotes the initiative and is a bridge to the health disparities federal and research community interested in multi-level collaboration.

    This model highlights the potentially broad reach to diverse AAPI communities through the trusted APAOC and its partners. From this initiative, four key components to successful collaboration have emerged and include:

    1. Identifying a specific critical issue with partners who share a common vision
      A common purpose among partner agencies and community organizations is most essential to any collaboration and acts as the glue.
    2. Establishing specific roles for each partner
      Defining specific roles for each partner agency/organization from the start allows all partners to understand their role and how each complements one another, and prevents duplicating work.
    3. Securing leadership buy-in of each partner
      Having supportive leadership at each partner agency/organization help moves the project forward with greater ease and reach.
    4. Leveraging the existing resources from partners
      Each partner agency/organization has their own strength and network of resources; leveraging existing expertise and resources reduces time and cost.

    The HMI seeks to reach a population that often views mental health negatively or not at all due to stigma, lack of awareness and education, and differences in cultural conceptualization of mental health. Currently being piloted in Montgomery County, Maryland, the HMI model is an example of collaboration working to reach health equity and may be expanded to other areas as needed. As we reflect during this NMMHA Month, it is important to remember that mental health is essential to overall well-being and health. To improve the trajectories of our youth, including minority youth such as AAPI youth, it is crucial for us to increase our understanding of mental health. To learn more about mental health and the HMI partners please visit:

    Mental Health Resources

    AAPI Mental Health Resources

    HMI and Partner Websites


    References

    1Centers for Disease Control and Prevention (2018). WISQARS Leading Causes of Death Reports, 1981-2016. Retrieved from https://webappa.cdc.gov/sasweb/ncipc/leadcause.html


  • Asthma, A Common But Controllable Illness

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    By Roselyn Hicks, M.D.
    Visiting Scholar, Division of Scientific Programs National Institute on Minority Health and Health Disparities


    Everything is abloom—spring has finally arrived. Pollen is everywhere, and for many of us, so is allergen-induced asthma.

    Asthma, one of the most common childhood illnesses and a leading cause of work and school absences, continues to cause symptoms for nearly 25 million Americans. As a board-certified allergist and immunologist, my most frequent patients were individuals with this adult and pediatric inflammatory, chronic lung disease of the airways. This inflammation causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. The prevalence of asthma, with marked disparities between various populations, continues to increase within the United States. The greatest rising trend is in adult women, non-Hispanic Black children, and those individuals living in poverty—especially boys.2,5 Medical management has improved in recent years, but asthma is still related to more than 3,000 deaths per year.2 What can we learn from the extensive information available about asthma?

    The National Institute on Minority Health and Health Disparities (NIMHD) supports targeted, ongoing research, such as University of California at San Francisco’s “Genes, Air Pollution, and Asthma Severity in Minority Children” and Nova Southeastern University’s “Health Literacy Assessment and Intervention to Reduce Disparities.” These studies are intensely focused on bringing forth up-to-date information to address asthma care, particularly in reducing the disparities that exist among specific patient populations. Currently, however, as there is no cure for asthma; control is the key.

    Asthma Prevention

    Identifying one’s triggers is the first aspect of gaining control and management of asthma. The most common triggers are indoor and outdoor allergens, e.g., animal dander, dust mite, mold and pollen; air irritants, e.g., tobacco smoke and perfumes; as well as weather conditions, respiratory illness, stress, and exercise. Individuals with asthma may employ several initial steps for decreasing indoor allergens. The most beneficial options have been encasing of mattresses, pillows, and box springs in allergen-impermeable covers and choosing smooth surface flooring, either vinyl or hardwood. Regular steam cleaning and frequent vacuuming are recommended for carpeted areas, if they must remain. To minimize dust mite exposures, washing sheets and blankets in hot water every week is necessary. Cockroach and mice extermination are also essential for indoor allergen reduction, especially in schools.6 Additionally, individuals with asthma should be aware of weather fronts, poor air quality days, and infectious seasons, which are known non-allergic triggers. Once avoidance measures are instituted, modify risk factors, such as obesity and smoking; then develop an Asthma Action Plan. The Action Plan, central to patient education, is one of the key components of effective asthma management supported by the National Institutes of Health (NIH) Guidelines developed by the National Asthma Education Prevention Program (NAEPP).1 This plan will guide patients in self-management of acute and chronic symptoms, i.e., when to add quick-relief medications, call their physician, or go to the emergency department.

    Asthma Management

    A second aspect of asthma management, which is of great significance, is using asthma medications in a preventative manner. Reviewing and understanding one’s management plan with a health care provider and even enlisting the expertise of an allergist is ideal in controlling asthma. It is well-known that individuals with asthma can lead normal and healthy lives, even as Olympic athletes.

    Medical management includes quick-relief as well as long-term controller (oral, inhaled and injectable) medications—and often patient-specific management by an allergist or pulmonologist. All these actions are important, given that approximately 50 percent of individuals with asthma in the U.S. report having an “asthma flare” in the preceding 12 months. As allergic and non-allergic asthma sufferers, we must continue to ask questions in our management of asthma as we work to avoid emergency department visits/hospitalizations, work/school absences, and missed opportunities for early intervention or prevention of asthma flares.

    Lastly, as we continue to learn from ongoing asthma research at NIH, we will improve overall outcomes and reduce and ultimately eliminate health disparities. Recently, NIMHD funded Seattle Children’s Hospital “TEXT2BREATHE” and Emory University’s “Effect of School-Based Health Centers on Reducing,” which are investigating ways to decrease the persisting divide of asthma care in minority populations. For now, as we work for better asthma control through research, medical management, self-education, and awareness, the following resources for asthma information may be helpful:

    Visiting Scholar: Roselyn Hicks, M.D.

    Play your role in healthy breathing environments, and empower all to enjoy spring and every season with well-controlled asthma.

    References:

    1. American Academy of Allergy, Asthma and Immunology School Based Asthma Management Program. (SAMPRO)
    2. Centers for Disease Control and Prevention. (2011, May 6). Vital Signs: Asthma Prevalence, Disease Characteristics and Self-Management Education–United States, 2001-2009. MMWR. Morbidity and Mortality Weekly Report, 60(17), 547-552. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htm
    3. Ginde, A. A., Espinola, J. A., Camargo, & C. A. (2008). Improved overall trends but persistent racial disparities in emergency department visits for acute asthma, 1993-2005. Journal of Allergy and Clinical Immunology, 122(2), 313-318.
    4. Greenblatt, R., Mansour, O., Zhao, E., Ross, M., & Himes, B. E. (2017). Gender-specific determinants of asthma among U.S. adults. Asthma Research and Practice, 3, 2-11.
    5. McHugh, M. K., Symanski, E., Pompeii, L. A., & Delclos, G. L. (2009). Prevalence of asthma among adult females and males in the U.S.: results from the National Health and Nutrition Examination Survey (NHANES), 2001-2004. Journal of Asthma, 46(8), 759-766.
    6. Sheehan, W. J., Permaul, P., Petty, C. R., Coull, B. A., Baxi, S. N., Gaffin, J. M…Phipatanakul, W. (2017). Association between allergen exposure in inner city schools and asthma morbidity among students. JAMA Pediatrics, 171(1), 31-38.
    7. Solé, D., Dirceu, Aranda, C. S., & Wandalsen, G. F. (2017). Asthma: epidemiology of disease control in Latin America—short review. Asthma Research and Practice, 3, 4-6.