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• Tackling Health Disparities Among Latinos in the United States

  

  Posted on October 11, 2018
  
  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

• Congratulations to the 2018 Health Disparities Research Institute Scholars

  

  Posted on August 8, 2018
  
  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.

  
  

  
  

  
  

• Guest Blog Post: Improving Diversity in Basic Biomedical Research

  

  Posted on April 2, 2018
  
  This is the first in a series of guest NIMHD Insights blog posts where NIH Institute and Center (IC) 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.

  The inaugural post is from the National Institute of General Medical Sciences (NIGMS). With a $2.6 billion budget, NIGMS supports basic research that increases understanding of biological processes and lays the foundation for advances in disease diagnosis, treatment and prevention.

  By Jon R. Lorsch, Ph.D.
  Director, National Institute of General Medical Sciences

  

  Fostering a diverse and inclusive future workforce has long been a key priority for NIGMS. The Institute strongly believes that incorporating a full range of perspectives, skills, and experiences will benefit the biomedical research enterprise—and our society as a whole. This standpoint is one of the factors that attracted me to the NIGMS Director’s position.

  During my tenure at the Johns Hopkins School of Medicine, one of my proudest achievements was launching a summer research program for Baltimore-area high school students. Many of the students came from groups underrepresented in the biomedical sciences. Most had never been exposed to a career in science.

  At NIGMS, I help impact the careers of students and researchers nationwide. Two of the Institute’s five divisions are dedicated to developing a robust, highly skilled, geographically widespread, and inclusive biomedical research workforce.

  The Division of Training, Workforce Development, and Diversity offers a suite of programs to science students and scientists already in the workforce. These include:

  • Maximizing Access to Research Careers Undergraduate Student Training in Academic Research (MARC U-STAR) awards, which provide support for undergraduate students from underrepresented backgrounds to gain skills and prepare for high-caliber, doctoral-level training. The program supports the final 2 years of undergraduate training for honors students majoring in biomedical sciences with an interest in pursuing a postgraduate degree.
  • The Research Initiative for Scientific Enhancement (RISE) program, which aims to help reduce the existing gap between underrepresented and well-represented students in completing doctoral degrees. The program provides grants to institutions with a commitment and history of developing students from underrepresented populations so they can strengthen academic preparation, research training, and professional skills development.
  • Building Infrastructure Leading to Diversity (BUILD) grant awards, which help undergraduate institutions engage and retain biomedical research students from diverse backgrounds. (NIGMS manages this NIH Common Fund program.)

  The Division for Research Capacity Building focuses on states that historically haven’t received significant levels of NIH research funding. Its programs include:

  • Institutional Development Award (IDeA), which supports faculty development and research infrastructure enhancement.
  • Native American Research Centers for Health (NARCH) program, which supports partnerships between American Indian/Alaska Native organizations and biomedical research-intensive institutions.
  • Science Education Partnership Awards (SEPA), which use innovative education programs to engage students in pre-kindergarten through 12th grade.
  • Support of Competitive Research (SCORE) awards, which increase the competitiveness of faculty at institutions with a mission to serve underrepresented students.

  NIGMS also participates in NIH-wide programs to enhance the diversity of the NIH-Funded Workforce and to provide research supplements to promote diversity in health-related research.

  Through the efforts listed above, NIGMS aims to train and retain an inclusive and diverse workforce. This will in turn maximize opportunities to advance biomedical science, improve our nation’s health, and maintain its global competitiveness.

  If you have questions or comments, feel free to reach out to me or the NIGMS staff listed as contacts for our various programs.