NIMHD Insights Blog Posts: 2023
A blog featuring research, resources and people who are diligently working to improve minority health and eliminate health disparities.
A blog featuring research, resources and people who are diligently working to improve minority health and eliminate health disparities.
Posted December 8, 2023
By Aditi Mallick, M.D.
Acting Director, Centers for Medicare & Medicaid Services, Office of Minority Health
Earlier this year, state Medicaid and the Children’s Health Insurance Program (CHIP) began the process of conducting renewals for health care coverage, following the end of the COVID-19 public health emergency. While many individuals and families who are no longer eligible for Medicaid or CHIP have or will transition to other forms of coverage during this process, many people are at risk of becoming uninsured and having a harder time accessing critical health services.
The Centers for Medicare & Medicaid Services (CMS) is committed to connecting with underserved communities that are medically underserved so that they have the resources needed to determine if they or a family member will still qualify for Medicaid and CHIP, or an alternate form of coverage, such as through HealthCare.gov.
What Happens During Medicaid Renewals
Medicaid and CHIP renewals are a multi-step process, and states must begin the process by attempting to complete renewal of coverage based on information available to them without contacting the individual. If that is not possible, agencies must send renewal notices and requests for information to enrollees.
Many individuals enrolled in Medicaid may have moved during the pandemic and may not receive renewal notices at their new addresses. Others may receive notices but may not know that Medicaid renewals have restarted, or they may face barriers as they take steps to complete renewals. These challenges may lead individuals to be disenrolled from Medicaid or CHIP, even if they are still eligible, leading them to lose access to necessary health care services and medications, or their health care coverage may be interrupted or discontinued.
While each state is approaching Medicaid and CHIP renewals differently, racial and ethnic minority communities that are underserved are likely to be disproportionately impacted. Medicaid and CHIP disproportionately provide coverage to individuals and families from racial and ethnic minority communities and people living in rural areas. Higher rates of homelessness or language barriers may further impede the ability of these communities to receive or understand renewal notices crucial to ensuring continuity of coverage.
Medicaid Renewals 101
In March 2020, as part of COVID-19 relief, Congress authorized additional Medicaid funding for states on the condition that they satisfied a “continuous enrollment” condition, which generally prohibited states from terminating most Medicaid enrollees’ enrollment until the end of the COVID-19 public health emergency. This helped to ensure millions of people could remain enrolled in Medicaid coverage without interruption during the pandemic. The continuous enrollment condition ended on March 31, 2023, allowing states to begin to return to normal operations around eligibility and enrollment, including conducting Medicaid renewals, beginning on April 1, 2023.
States have independent obligations under federal civil rights laws to ensure that individuals and families continue to have access to Medicaid and CHIP, as states conduct renewals. For example, states are required to take reasonable steps to provide meaningful language access for individuals with limited English proficiency and ensure effective communication with individuals with disabilities. Ensuring access to information is vital and required.
Know Who is Affected
Millions of people could be disenrolled from Medicaid and CHIP during this renewals process, with people from racial and ethnic minority communities at higher risk. Children and young adults, as well as Latino and Black individuals, are predicted to be disproportionately impacted. Seamless transitions to other forms of coverage, such as through HealthCare.gov, will play an important role for many in maintaining coverage for those who are no longer eligible for Medicaid and CHIP coverage.
Nearly one-third of those predicted to be disenrolled from Medicaid are Latino individuals (4.6 million) and 15% (2.2 million) are Black individuals. As the single largest payer for mental health services in the United States, Medicaid is critical in the treatment and success of those with mental illness. With health care coverage, mental health patients have access to ongoing treatment, medicines, and care that help keep them out of hospitals, emergency rooms, and the cycle of chronic homelessness. Furthermore, individuals with serious mental illness often have co-morbid physical health conditions and substance use disorders, making continuous health care coverage even more critical.
Know How to Help
Without health coverage, people from racial and ethnic minority communities and other populations that are underserved could see a lapse in the progress they were able to make during the pandemic when Medicaid enrollment was continuous. Information on the Renew Your Medicaid or CHIP Coverage webpage is a great starting point for helping people better navigate Medicaid and CHIP renewals. The webpage outlines how to get ready for the renewal process, what to do if you no longer qualify for Medicaid or CHIP, and where to go for more help, including how to contact each state’s Medicaid office. Find toolkits, drop-ins, creative assets, and translations on the Medicaid and CHIP Renewals Outreach and Educational Resources webpage and be sure to download the All Hands-on-Deck Toolkit to get started in your community. Keep the conversation going throughout Open Enrollment! Find your state here to learn more.
By sharing these resources and information with your networks and communities, you can help continue to improve mental and behavioral health in all communities.
Let’s be intentional about helping to educate all racial and ethnic minority communities and others who are underserved on ways to better understand the Medicaid unwinding process, their health coverage and how to access care and services. Join CMS and share Medicaid and CHIP renewal information and resources to help more people keep their coverage.
Posted November 1, 2023
By Deborah Guadalupe Duran, Ph.D.
Senior Advisory- Data Science, Analytics and Systems, National Institute on Minority Health and Health Disparities
Luca Calzoni, M.D., MS, Ph.D. Cand.
Physician and Data Scientist, National Institute on Minority Health and Health Disparities
Since February 17, 2023, thousands of researchers, educators, students, and community members have gathered at ScHARe Think-a-Thons to join a paradigm shift in health disparities and health outcomes research.
These Think-a-Thons are part of the Science Collaborative for Health disparities and Artificial intelligence bias Reduction (ScHARe)—a new NIH resource designed to expand access to large health disparities and health outcomes datasets and the data science skills required to analyze them. ScHARe Think-a-Thons offer free training that enables participants to link cloud-based datasets, access federated data, begin learning the Python programming language, and more.
And we’re just getting started. As we prepare for exciting new phases in the Think-a-Thon series, we want to highlight what participants have gained so far and preview the many opportunities ahead.
Training Think-a-Thons: Successfully Upskilling to Advance Careers
People without access to data science tools have gained access for the first time through ScHARe’s Training Think-a-Thons. More than two-thirds of participants report having little to no prior experience in cloud computing or programming languages, and many belong to populations that are historically underrepresented in these fields. In participant polls, nearly all respondents agree that our Training Think-a-Thons have taught them how to access and work with the large datasets hosted on ScHARe and on Terra, the web platform where ScHARe is housed. With these new skills and membership in the ScHARe learning community, participants are poised to make significant novel contributions to health disparities and health outcomes research.
(Anyone can benefit from Training Think-a-Thons: recordings are posted online two weeks after sessions conclude.)
Training Think-a-Thons: Asking New Questions to Get Better Answers
Think-a-Thon participants are enthusiastic about a paradigm shift in health disparities and health outcomes research. More than 90 percent report that they want to learn to use AI tools and cloud computing to conduct new Big Data-driven research in these areas. As one Think-a-Thon participant noted, researchers can use ScHARe’s advanced computing tools and large datasets to figure out “the basis of disparities”—what mechanisms really drive them—and thus yield powerful new approaches to persistent public health challenges.
Research Collaboration Think-a-Thons: People from Many Disciplines and Career Levels Are Joining to Advance Health Disparities & Health Outcomes Research
The ScHARe community includes people from many backgrounds and career levels—Python programmers, social scientists, community health workers, and more. Two-thirds have expressed interest in forming cross-disciplinary, multi-level collaborations to generate publishable research using cloud computing and AI tools. Starting in 2024, ScHARe Think-a-Thons will begin directly supporting these research collaborations, with dedicated space for participants to form new research teams or to introduce their existing research teams to ScHARe.
The first research collaboration Think-a-Thons will focus on Individual Social Determinants of Health (SDOH), structural SDOH, and health outcomes. Think-a-Thon participants have a wide range of research interests—the intersection of the gastrointestinal microbiome, culture, and cognition; demographic impacts on gene expression; improving LGBTQ research through linked datasets; using informatics to improve community-based care; and more. All projects are welcome!
Coming in 2024: AI Bias Mitigation
Many Think-a-Thon participants want to tackle an important challenge: bias mitigation and ethical Artificial Intelligence strategies. Several ScHARe Think-a-Thons will focus on this goal.
AI is a key tool for analyzing large datasets and building new health-related systems, such as algorithms that assess patient risk and guide care. However, its use can also reproduce and amplify existing biases in data. For example, several populations are underrepresented in biomedical and demographic datasets, and when these datasets are biased, AI can also reflect these biases, ultimately leading to incomplete research, missed or delayed diagnoses, and worse health outcomes.
In 2024, we’ll launch Think-a-Thons to address this challenge. By tapping the diverse expertise of members of the growing ScHARe community, we’ll be able not only to share best practice tools and workflows, but also develop innovative solutions.
Opportunities for Tailored Think-a-Thons
We’ve heard participants ask how to use ScHARe in unique settings, such as college-level research methods courses. In May 2023, we responded by launching special tailored Think-a-Thons.
At our first tailored Think-a-Thon, with more than 60 educators, we outlined how ScHARe’s free tools could help low-resourced colleges and community colleges teach data science and connect their students to this important field. This August, we offered a second tailored Think-a-Thon highlighting how ScHARe can be useful to Tribal Colleges and Universities and Native American-serving institutions. All Think-a-Thons are free and open to the public.
We welcome suggestions—let us know if there’s a tailored Think-a-Thon you would like to see.
In just their first few months, ScHARe Think-a-Thons have become a space for a diverse community of individuals interested in health disparities, health outcomes, and AI bias research. Regardless of your knowledge of data science or cloud computing, you can join Think-a-Thons to build new skills and meet new collaborators. Women and members of groups traditionally underrepresented in data science and health research are especially encouraged to participate. Join us in making data science work for everyone!
Posted October 18, 2023
Rebecca Delafield, Ph.D., M.P.H.
University of Hawai`i
John A. Burns School of Medicine
Department of Native Hawaiian Health
Conversations with Community
Conversations with Community
“Please share your name, the name of your island home, and the ancestors that you bring with you to our gathering today.”
This is the protocol that one of my Pacific Islander community partners uses to open gatherings. The last time we gathered, I introduced myself like this, “My name is Rebecca Delafield. I live here on ‘Oahu. I am Chamorro and was born in Saipan, and my father is from the island of Tinian. The ancestor I bring with me tonight is my paternal grandmother.” The women assembled are young and old. They speak Pohnpeian, Chuukese, Palauan, and Kosraean, and interpreting responsibilities are shared among several bi- and multilingual members of the group that speak English. They are from many different island homes, but all of them live in Honolulu, and many live in the public housing complex where we are gathered.
This night, the members, all women and all from the Western Pacific region referred to as Micronesia, were asked to share something about motherhood in their introduction. The things they mentioned—the role of mothers in their community, the importance of childbearing in their respective cultures, the sacrifices of being a mother, and struggles with health care systems—are familiar to me. Their comments echo findings from studies I have conducted into Native Hawaiian and Pacific Islander (NHPI) maternity care experiences in Hawai‘i. I was invited to the gathering to begin a dialog on addressing needs related to pregnancy and childbirth in the community and to share findings from my latest research project, which was funded through an NIMHD Diversity Supplement.
Maternal Health Data & Research
National increases in maternal mortality have prompted calls to action by numerous public health agencies and medical associations. NHPIs are profoundly underrepresented in maternal health research, despite increasing evidence of poor maternal health outcomes and inequities among this population. A recent report from the Centers for Disease Control and Prevention found that the pregnancy-related mortality ratio for Native Hawaiian and Pacific Islanders, Non-Hispanic in the United States was more than 4.5 times higher than Asians, Non-Hispanic and 5 times higher than Latinos—the racial and ethnic group with the lowest ratio. Yet, the causes of racial disparities in maternal health outcomes in the United States are not well understood. There is also little research into the specific experiences of NHPIs in the context of pregnancy and childbirth. One consistent finding from pregnancy surveillance data and research studies is that NHPIs, compared to other racial and ethnic groups, are much more likely to receive late or no prenatal care. This suggests that, among NHPIs, the challenges go beyond medical and behavioral risk. Therefore, to advance equity in health outcomes among this population, researchers must consider a broader set of factors, including access and engagement with health care systems and sociocultural factors.
My Research Path and NIMHD Diversity Supplement
Shortly after being hired as an assistant professor with the Department of Native Hawaiian Health at the University of Hawai‘i John A. Burns School of Medicine (JABSOM) in 2020, I was awarded an NIMHD Diversity Supplement through JABSOM’s Ola HAWAII Center. The funding allowed me to investigate the maternity care experiences of NHPI women and to culturally adapt a tool for NHPIs to assess quality of maternity care, with a particular emphasis on patient-provider relationships and communication. Additionally, the funding supported my participation in training programs, including the NIMHD Health Disparities Research Institute. These opportunities, along with support from the Center for Pacific Innovations, Knowledge and Opportunities, helped me design, develop, and submit a proposal for an NIH Mentored Research Scientist Career Development Award (K-01). My application was successful, and I was awarded funding from NIMHD in July of this year (2023).
The NIMHD Diversity Supplement was critical in advancing me to this stage in my career and research. The award sustained my research and opened doors to the mentoring and training I needed to draft a strong K-01 proposal. Importantly, it also bolstered my professional networks and helped me nurture my community partnerships.
Ultimately, I aspire to develop an independent research program that will develop and test a multi-level intervention to improve maternal health and health care for NHPI women and families. My motivations for doing this work are reflected in the conversation I had with the group of community members and leaders the other night. Their words expressed their deep value and commitment to the health and welfare of mothers and families. Equally, they expressed a collective concern about the problems they witness as leaders, language interpreters, and mothers in the health care institutions that are intended to promote and preserve their health. These community members, along with other NHPI groups I have had the privilege of working with, have put out a call for action on maternal health. As a scientist, a mother, and a child of the Pacific, I am obligated and honored to respond with an effort and rigor equal to the value that they have placed on me.
Note on language usage: My language choices for this blog post reflect the gender identity of the people I spoke with and the attachment of mother/maternal in this specific context of pregnancy and childbearing. I recognize that there are pregnant and birthing people, including Pacific Islanders, that may not identify as women and that the reference to “motherhood” and “maternal” health outcomes can make people feel excluded. My intent here is not to exclude, but to utilize the terms that most closely reflect the language of the people I reference and the findings from my research study.
Posted October 5, 2023
By Carolina Solis Sanabria, M.D., M.P.H., FACS
Physician (Research), Program Official
Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities
Returning to the Washington D.C. area to do health disparities work at the National Institute on Minority Health and Health Disparities (NIMHD) and practice as a general surgeon at Holy Cross Hospital has been an opportunity to return to my community and my roots. I get an amazing opportunity to tackle health problems at the systemic/public health level as a program official at NIMHD. I also have the immense privilege of making an impact on individuals as a community general surgeon serving patients who are underserved. The combination of surgery and health disparities research reflects my personal experiences and passions.
As a 4-year-old girl, my family and I crossed the Rio Grande from Juarez, Mexico to El Paso, Texas. We quickly learned the challenges that came with being undocumented in the United States. Growing up, my family had limited access to health care—rarely seeing a doctor unless it was an emergency. Given these challenges, my family was quick to instill in me the value of getting an education.
It did not take much convincing on my family’s part for me to engage in academic pursuits. Early on, I developed a love for the medical sciences and in particular surgery given my love for human anatomy. I was always very curious about learning about how things work, and I got my first exposure to research in high school after winning a summer internship at the National Cancer Institute. In college, at Yale University, I studied Hookworm disease, a disease that is prevalent in low- and middle-income countries and contracted by walking barefoot on contaminated soil. After graduating from Yale, I was accepted into Harvard Medical School. I continued my interest in research and spent a summer in San Juan del Sur, Nicaragua, doing a prevalence study on intestinal parasites. These experiences led to my interest in health disparities research.
Photo of Dr. Carolina Solis Sanabria at the Cerro Negro Volcano in Leon, Nicaragua where she did a prevalence study on intestinal parasites.
Even though I had a strong interest in parasitology, I ultimately reverted to my original passion for surgery. One of my mentors was a surgeon who was doing global health work. It was exposure to this surgeon that showed me that I could merge my interests in surgery and health disparities research. As a result, in the middle of my residency at Duke University, I returned to Harvard University to pursue a master’s in public health and specializing in global health. I later won a Fulbright scholarship and traveled to Nicaragua to study access to surgical care.
After completing my training in surgery at Inova Fairfax Hospital in Virginia, I practiced as a traveling surgeon, working with the Indian Health Services in rural communities in Oklahoma, Montana, and Appalachia. As a traveling surgeon, I witnessed some of the challenges associated with practicing medicine in rural settings. This, and other experiences, help to inform the work I do daily at NIMHD. For example, my previous global health experiences helped to inform my participation in the Latin America: Synergizing Health Research Across the Hemisphere workshop, which focused on discussing research opportunities to reduce health and health care disparities related to non-communicable diseases. It also helped with my role as a project scientist in the Data Science Center for the Study of Surgery, Injury, and Equity (D-SINE) Africa. Additionally, my experiences in rural settings have helped to inform my work with the NIMHD Rural Health concept.
I worked full time as a general surgeon at Holy Cross Hospital from 2018–2020. A large segment of the populations I worked with was Hispanic/Latino and many were uninsured. I witnessed the differences in access between those who had insurance and those who did not. Those without insurance came primarily to the emergency department and had complicated cases. I was truly grateful to be able to serve my community during this time.
When I was offered the role of a program official at NIMHD, I felt it would be an opportunity to help my community on a more significant level. It would provide an opportunity to contribute to policy and research on health issues related to my community, while I can still positively affect people’s lives as a physician and surgeon.
My clinical practice drives my public health work and vice versa. I currently work at the Holy Cross Health Center and the patients appreciate having a Hispanic physician who speaks their language. My experiences working with populations who are medically underserved fuels the passion for my health disparities work at NIMHD.
My work with populations experiencing health disparities has been influential in helping to develop various initiatives at NIH. For example, the Health care Worker Well-Being initiative was inspired by my work as a traveling surgeon in rural communities and seeing how nursing shortages affected patient care in these settings. I presented a concept on spirituality and religiosity that was, in part, fueled by identifying a health gap — which is that patients need to receive whole person health care for holistic well-being. Oftentimes, patients coming to me have complex psychosocial factors impacting their physical health and it is important to take these into consideration when providing care to them.
Although it has been a long journey since first crossing the Rio Grande to arrive in the United States, my experiences have brought me back full circle to pursue my passions while serving my community and the nation.
Posted August 30, 2023
By Paul Cotton, Ph.D., RDN
Director, Office of Extramural Research Activities
National Institute on Minority Health and Health Disparities
Today, we have an exciting development to discuss—the adoption of a federal standard acronym, "NOFO," by the National Institute on Minority Health and Health Disparities (NIMHD) and the National Institutes of Health (NIH) to replace the familiar "FOA" (Funding Opportunity Announcement). In this article, we will delve into the reasons behind this change, the benefits it brings, and what it means for researchers and grant applicants.
The Need for Clarity and Consistency:
In the realm of grant funding, clarity and consistency are paramount. Over time, the use of different acronyms, such as "FOA," "RFA," and "PA," has led to confusion and hindered effective communication across federal agencies. Recognizing the importance of a unified approach, NIMHD and NIH have taken the initiative to adopt the federal standard acronym "NOFO" for their funding announcements. This change aims to streamline the process, enhance transparency, and eliminate ambiguity.
Introducing NOFO: Notice of Funding Opportunity:
The transition from FOA to NOFO represents a shift towards a more standardized and intuitive terminology. The acronym "NOFO," or Notice of Funding Opportunity, provides a clear and concise description of the purpose and nature of the funding announcement. It offers a straightforward way for researchers, institutions, and organizations to identify and engage with relevant funding opportunities, regardless of the federal agency involved.
Improved Understanding and Accessibility:
By adopting the NOFO acronym, NIMHD and NIH seek to improve understanding and accessibility for grant applicants. The consistent use of the term across federal agencies will reduce confusion and allow researchers to more easily identify funding opportunities aligned with their research interests and objectives. This change aligns with broader efforts to enhance transparency and promote equitable access to funding opportunities for the scientific community.
Navigating the Transition:
While the adoption of NOFO brings positive changes, it is essential for researchers and grant applicants to familiarize themselves with the new terminology. Understanding the nuances and implications of NOFOs will allow applicants to navigate the funding landscape more effectively and align their proposals with the specific objectives outlined in each opportunity. Staying updated with the latest guidance and resources provided by NIMHD, NIH, and other federal agencies will ensure a smooth transition and maximize the chances of success.
The adoption of the federal standard acronym "NOFO" by NIMHD and NIH marks a significant step towards clarity, consistency, and improved accessibility in grant funding. By embracing this change, researchers and grant applicants can expect a more streamlined, transparent, and user-friendly experience when exploring funding opportunities. As we move forward, let us embrace the NOFO era, leveraging its benefits to advance research, address health disparities, and drive innovation for the betterment of society.
Posted July 17, 2023
Eliseo J. Pérez-Stable, M.D., Director, National Institute on Minority Health and Health Disparities
Shannon N. Zenk, Ph.D., M.P.H., RN, FAAN; Director, National Institute of Nursing Research
Why does the statement “Your ZIP code is more important to your health than your genetic code” surprise people but resonate with many population scientists?
In the United States, 21 percent of the population lives in concentrated poverty areas, limiting access to health-promoting resources and services. Research shows people living in concentrated poverty areas have poorer health outcomes across a wide range of diseases and conditions and are also more likely to die than those living in other areas.
Recognition that concentrated poverty along with other social and economic factors have profound and prolonged impacts on health has recentered attention on identifying evidence-based solutions to address them.
Social determinants of health (SDOH) have emerged as an increasingly high-priority research area for the National Institutes of Health (NIH), other Federal agencies, and organizations across a variety of sectors and NIH is at the forefront of building this evidence base to improve health and advance health equity.
The NIH-wide Social Determinants of Health Research Coordinating Committee (SDOH RCC), established in 2022, was created out of an urgent need to develop a coordinated strategy to propel discoveries to improve individual and population health, reduce health disparities, and advance health equity. Growing out of a grassroots effort by staff across NIH, the SDOH RCC’s overarching goal is to accelerate NIH-wide SDOH research across diseases and conditions, populations, stages of the life course, and SDOH domains. It also focuses on effectively leveraging SDOH investments and innovations across NIH Institutes, Centers, and Offices (ICOs) to advance discoveries in this dynamic multi-disciplinary scientific field, ranging from foundational research to intervention research to implementation science. Importantly, it is a cross-cutting effort with 20 ICOs participating in the leadership committee and even more represented in the larger SDOH RCC.
As a leader in research discovery and funding, a unified conceptualization of SDOH is essential for NIH-wide coordination and strategic growth of the evidence base for SDOH impacts on health and mechanisms, advancement of methods, and intervention development and testing. The conceptualization that the SDOH RCC developed builds on existing conceptualizations but is refined to help the NIH effectively communicate with the scientific community and, over time, continue to strengthen and expand a framework for SDOH research. The NIH conceptualization underscores that SDOH are the conditions in which people are born, grow, learn, work, play, live, and age and the broader set of structural factors shaping the conditions of daily life. These structural factors include social, economic, and legal forces, systems, and policies that determine opportunities and access to high-quality jobs, education, housing, transportation, information and communication infrastructure, food and health care; the social environment; and other conditions of daily life. Our conceptualization recognizes that SDOH can improve, maintain, or hinder health through multiple direct, indirect, and interacting mechanistic pathways. And SDOH may have different health consequences within and across populations due to differences in exposure or susceptibility to health-promoting or health-compromising conditions of daily life. The unequal allocation and distribution of power and resources based on race, ethnicity, sex, gender identity, sexual orientation, socioeconomic position, geography, and their intersections manifest in inequitable conditions of daily life, contributing to the large and persistent health disparities we see in this country.
In fiscal year 2022, NIH invested about $4.1 billion, funding more than 8,300 SDOH research and training programs. In addition, not only does NIH’s 2021-2025 strategic plan call for research on SDOH, but most NIH ICOs explicitly mention SDOH in their strategic plans. Further, several NIH-wide research initiatives were established to specifically focus on advancing SDOH research. Here are a few examples of NIH-wide SDOH research initiatives and their aims:
- The Community Partnerships to Advance Science for Society (ComPASS) Program seeks to 1) develop, share, and evaluate community-led health equity structural interventions that leverage partnerships across multiple sectors to reduce health disparities and 2) develop a new health equity research model for community-led, multisectoral structural intervention research.
- Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities is a cross-collaborative initiative, encompassing 14 ICOs that is supporting 38 applications with more than $125 million committed over 5 years for 1) observational research to understand the role of structural racism and discrimination (SRD) in causing and sustaining health disparities, and 2) intervention research that addresses SRD in order to improve minority health or reduce health disparities. This funding opportunity has been reissued by NIMHD, NINR, and other ICOs.
- Firearm Injury and Mortality Prevention Research complements existing ICO initiatives focused on many types of violence like child maltreatment, intimate partner violence, or elder abuse. Since fiscal year 2020, Congress has appropriated $12.5 million a year to NIH for firearm injury and mortality prevention. Initiatives using the appropriated funds have focused on a wide range of populations and settings, capacity building, and research on implementing and testing innovative community-level interventions that address SDOH in various ways.
There are many more Notices of Funding Opportunities (NOFOs) focused on SDOH in addition to parent NOFOs that provide opportunities for scientists to propose new SDOH research.
NIH seeks research that yields rigorous and actionable evidence, including a focus on:
- Upstream structural factors to address the fundamental causes of poor health and health disparities and involves meaningful partnerships with communities; local, state, and federal agencies; and multiple sectors.
- Viewing and approaching SDOH research through a lens of intersectionality.
- Linkable high-quality data and measures of SDOH at multiple levels to comprehensively understand independent and combined contributions and to identify intervention targets and policy levers.
As we continue to expand and innovate in accelerating SDOH research, we invite you to visit the respective ICO websites and reach out to program officers that align with your research to understand SDOH priorities and to view current and upcoming SDOH NOFOs.
SDOH research is essential to fulfilling NIH’s mission of enhancing health for all people. The progress in recent years has increased the depth and breadth of the NIH SDOH research portfolio, but there is more to be done. The SDOH RCC is committed to integrating and accelerating SDOH research across NIH. The ultimate goal of this coordinated effort is to increase the impact of the research so that the findings support individuals, communities, and populations in a manner that improves health, reduces health disparities, and advances health equity.
So, the answer is yes. Your residential zip code may be more important to your health than your genetic code. Like gene therapy, “zip code therapy” will entail new scientific challenges. The prospect of discovering structural interventions that will eliminate disparities and achieve equity makes it a frontier well worth our collective commitment.
Posted July 10, 2023
By Joshua A. Gordon, M.D., Ph.D.
Director, National Institute of Mental Health
At the National Institute of Mental Health (NIMH), we have made it a priority to advance science focused on decreasing youth mental health disparities by 2031. In this message, I’d like to focus specifically on one group: Hispanic and Latino youth. When it comes to mental health research, Hispanic and Latino youth have been woefully understudied, but the research we do have suggests a real cause for concern. Evidence indicates that Hispanic and Latino youth have pressing mental health needs and are not receiving adequate mental health care. The dramatic, and dramatically unequal, effects of the COVID-19 pandemic have further disproportionately affected youth from minority communities and exacerbated these disparities.
It’s important to understand the specific factors Hispanic and Latino youth may experience—including discrimination, exposure to traumatic events, and migration experiences—that are contributing to these mental health concerns. It’s also important to understand the barriers—including stigma, racism, and lack of cultural understanding, as well as cost and insurance coverage—that may make it difficult for Hispanic and Latino youth to access mental health care.
NIMH is committed to advancing research that seeks to understand the varied experiences of Hispanic and Latino youth and identify the most effective ways to meet their mental health needs.
What Is NIMH Doing?
To ensure that research will have direct, real-world relevance, NIMH is supporting research that engages Hispanic and Latino youth and families in community-based settings.
For example, in one NIMH-supported project out of the University of California, San Francisco, researchers are taking a participatory approach to involve youth, caregivers, health care providers, and community members in the design and implementation of a digital mental health tool called 4Youth. The researchers plan to test the digital intervention at school-based wellness centers and primary care practices that primarily serve Latino, Black, and Asian youth and young adults. The hope is that 4Youth will offer a scalable, culturally responsive digital tool that can help connect youth in these communities with mental health care when they need it.
In another NIMH-funded project, researchers at the University of Miami Coral Gables are adapting an existing, evidence-based parenting intervention so that it can be delivered to Hispanic youth in primary care settings. The researchers will test whether the enhanced intervention—called eHealth Familias Unidas—is effective in preventing or reducing symptoms of depression and anxiety and suicide-related behavior among youth receiving care at one of 18 primary care clinics.
In addition, NIMH supports research aimed at addressing mental health disparities by improving the quality of mental health care received by Hispanic, Latino, and other racial and ethnic minority youth. For example, researchers at the University of Washington are rolling out a training program for school mental health clinicians that aims to support equitable and sustainable implementation of measurement-based care. The researchers will examine whether this approach effectively improves clinicians’ practices and, if so, whether those improvements lead to better mental health outcomes among Latino and Black youth.
Barriers to access, including a lack of culturally informed approaches to care delivery, contribute to lower engagement in care by Hispanic and Latino youth, who are less likely to continue treatment for serious mental illness. To help engage youth in the treatment process, NIMH is funding a study to adapt and test an intervention focused on increasing the engagement of racial and ethnic minority young adults in treatment as a way of decreasing mental health disparities.
NIMH is also focused on efforts to improve research practices so that interventions reflect and respond to the needs of Hispanic and Latino communities. For example, the NIMH Office for Disparities and Workforce Diversity is hosting a webinar during National Hispanic Heritage Month this September titled, “Engaging Community Stakeholders to Reduce Mental Health Inequities in the Hispanic Community.” The webinar will explore the impact and significance of engaging community stakeholders in developing culturally responsive interventions and the need for implementation science to improve mental health care uptake in the Hispanic community. The webinar will also explore ways to bridge the gap between implementation science and health disparities research to address health inequities experienced by racial and ethnic communities that have been historically marginalized in health care.
Envisioning the Future
These projects reflect a small sample of NIMH activities focused on Hispanic and Latino youth. We know that Hispanic and Latino communities are diverse, with unique cultural identities and sources of resilience. Identifying effective evidence-based interventions requires a community-focused approach—what works for people in one neighborhood or city won’t necessarily work elsewhere. By supporting culturally responsive research that engages families and communities, we hope to push the field forward to address the pressing mental health needs of Hispanic and Latino youth.
Posted June 22, 2023
By Leonardo Mariño-Ramírez, Ph.D.
Earl Stadtman Investigator
Epidemiology and Genetics Branch
Division of Intramural Research
I was born and raised in Bogotá, a city of seven million people situated on the altiplano (high planes) of the Andes mountain range in the South American country of Colombia. I studied microbiology as an undergraduate at the University of Los Andes and came to the United States on a Fulbright Scholarship to pursue a Ph.D. in biochemistry at Texas A&M University. Later, I started as a postdoc at the NIH’s National Center for Biotechnology Information (NCBI), where I cultivated my passion for bioinformatics and computational genomics. After years of working at NCBI, my work on human genomics eventually took me back to Colombia, an unexpected development that forever changed the trajectory of my career and ultimately brought me to NIMHD.
Colombia is well known among scientists as a global hotspot for biodiversity, think of this as biological diversity, hosting close to 10 percent of the earth’s biodiversity despite making up one percent of its landmass. What is far less well known, but no less important in my estimation, is the fact that Colombia is also a hotspot of human genetic diversity. Colombia is a remarkably diverse and multiethnic society made up of descendants of the original Indigenous inhabitants of the region, Spanish colonizers, and enslaved Africans brought by force to the New World. These three main groups of people have mixed continuously over the centuries, via the process known as mestizaje, to produce a modern, cosmopolitan population that is characterized by high levels of interbreeding. The clear racial boundaries so easily recognized in the U.S. are thoroughly blurred in Colombia. In Colombia, we are all Mestizos, bound up by a common culture, set of values, and a shared sense of destiny.
My own research on Colombian genomes shows that mestizaje is also written in our DNA. Virtually all Colombians have substantial amounts of African, European, and Indigenous genetic ancestry. It was this profound genetic diversity that could be found in the Colombian population, which finally led me to work on health disparities.
Over the last decade, it has become increasingly apparent that genomics research is failing on diversity. The so-called “genomics research gap” refers to the fact that the vast majority of human genetics research cohorts are made of participants with European ancestry. This lack of diversity threatens to exacerbate existing health disparities, since results of studies on European ancestry cohorts may not transfer to other ancestry groups, particularly individuals of African descent who already bear a disproportionate burden of morbidity and mortality in the U.S.
Although, I did not set out to work on health disparities, it became apparent to me that our work on genetically diverse Colombian genomes was exactly the kind of research that was needed to ensure that the benefits of the precision medicine revolution can be shared more broadly – among all people, everywhere. I have since become convinced that genomic diversity is a powerful tool that can and must be leveraged in support of health equity. This is the central theme of my research group – to use genetic diversity in support of epidemiological studies of health disparities in complex, common diseases.
Our focus is not limited to genetics, however. We are relentlessly focused on understanding on how genetics, the environment, and interactions between these two classes of exposures, contribute to disparate health outcomes. In particular, we are using genetic ancestry inference as a means to disentangle genetic, social, and environmental risk factors of health disparities. This approach relies on the fact that genetic ancestry is a characteristic of the genome, which can thus be defined independently of the social dimensions of race and ethnicity, thereby allowing us to partition the genetic and environmental variance components of human health within and between population groups. Publications in [PubMed].
* Mestizaje: A Spanish phrase that refers to racial mixing.
Get to Know Dr. Leonardo Mariño-Ramírez
Your title at NIMHD is …
- Stadtman Investigator in the Division of Intramural Research. I am also a 2020 NIH Distinguished Scholar.
Your major responsibilities are …
- My work focuses on genetic ancestry and environmental factors in large biobank cohorts and how their interactions affect health outcomes on diverse populations. I also serve as the Acting Head of the Genomic and Epidemiology Sciences Research Program at the Division of Intramural Research. I enjoy teaching and mentoring. I also participate in the Genomics and Health Disparities Interest Group, the DCEG Cancer Health Disparities Working Group and ad-hoc committees as needed.
- BSc, Microbiology - Universidad de Los Andes (Colombia)
- PhD, Biochemistry – Texas A&M University (College Station, TX)
The best thing about your work …
- Every day is different. I believe that scientists like artists have a constant need for inspiration that keep creative work flowing. I enjoy challenges, learning and discovering new things in hope to make meaningful contributions to society.
Your favorite quote is …
- “There is no substitute for hard work,” by Thomas Alva Edison
Posted May 31, 2023
Rachel Zajdel, Ph.D., M.A., M.S., Postdoctoral Fellow
Sana Rahman, B.A., Special Volunteer
Chelsea Truong, B.S. Postbaccalaureate Fellow
Erik Rodriquez, Ph.D., M.P.H., Staff Scientist
Division of Intramural Research
National Heart, Lung, and Blood Institute
Since the 1964 Smoking and Health Report of the Advisory Committee to the Surgeon General, public discussion in the U.S. surrounding the use of tobacco has emphasized its detrimental health effects. Through public health efforts, cigarette smoking rates have decreased among adults and youth since that time. However, as the prevalence of cigarette smoking has dropped, these successful efforts have led to a diminished sense of urgency among the public, with people questioning whether tobacco use remains a prominent public health issue. The World Health Organization’s “World No Tobacco Day,” occurring each year on May 31, aims to refocus attention to the dangers of smoking and their relevance today.
Tobacco continues to kill more than 8 million people worldwide and is the leading preventable cause of death in the U.S. Additionally, while the increased risk of lung and throat cancer among smokers is widely known, smoking is also the second leading cause of cardiovascular disease (CVD), with one in every four deaths from CVD caused by smoking. Considering that CVD is the leading cause of death in the U.S., continued advocacy through events such as “World No Tobacco Day” can help improve U.S. health outcomes.
While 7 million worldwide deaths due to tobacco are a result of direct tobacco usage, 1.2 million people each year die because of secondhand exposure to smoking. Research has shown that there is no safe level of secondhand smoke exposure, with even short term exposure heightening the risk of heart attacks. Secondhand smoke has also been identified as a cause of stroke. Increasing awareness about the risks of secondhand smoke exposure remains a key focus in anti-tobacco public health efforts.
The harmful effects of tobacco use are not evenly distributed across the population. In the U.S., commercial tobacco product use is higher among members of groups that have been marginalized, including American Indian or Alaska Native (AI/AN) individuals; lesbian, gay, or bisexual persons; and those with lower levels of education and income. Individuals with multiple social identities that have been marginalized may be particularly affected by tobacco use. Inequitable exposure to tobacco industry marketing and access to cessation therapies contribute to these disparities in tobacco use by race and ethnicity, sexual orientation and gender identity, and socioeconomic status.
Not only have tobacco companies targeted specific populations within the U.S., but they have also turned their attention to international targets as the tobacco market in the U.S. has shrunk. Tobacco use remains high in low- and middle-income countries (LMICs), where 80% of the world’s tobacco users live. Tobacco companies have leveraged their economic influence to prevent implementation of tobacco control policies, sponsor tobacco-farming communities, and target children and women in LMICs. As a result, compared to high-income countries (HICs), a lower proportion of LMICs have implemented tobacco control measures including anti-tobacco campaigns, tobacco taxes, age requirements, graphic packaging, flavor bans, or comprehensive cessation services.
“World No Tobacco Day” reminds us that these glaring national and international inequalities in tobacco use persist, and in some cases are even widening. Researchers at the National Institutes of Health have heeded this call to action by illuminating disparities in tobacco use by social characteristics and demonstrating the significant harms to population health wrought by the tobacco industry. Research in the lab of Dr. Eliseo J. Pérez-Stable in the National Heart, Lung, and Blood Institute has shown that smoking susceptibility and exposure to tobacco marketing are predictive of cigarette smoking even after accounting for the use of electronic nicotine delivery systems. In addition, Dr. Kelvin Choi’s lab in the National Institute on Minority Health and Health Disparities has established that concern about COVID-19 discrimination, an experience disproportionately borne by Asian and Asian American individuals, is associated with increased cigarette consumption. This research can be used to inform policies and interventions addressing the mechanisms underlying tobacco use and the many health disparities they generate.
Various interventions, such as raising the price of tobacco products, passing smoke-free policies in public places, and increasing equitable cessation access, can help further reduce tobacco exposure and its associated health consequences. Specific tactics to ban the sale of flavored tobacco products, restrict price promotions, and implement culturally-informed anti-smoking campaigns can begin to address the disparities caused by the tobacco industry’s legacy of targeting AI/AN, Black, Latino, sexual and gender minority, and low income communities.
Nevertheless, we must also turn our collective attention to think beyond tobacco control and reach for a tobacco endgame, with an emphasis on the upstream causes of tobacco use. With respect to an endgame strategy, policies could be implemented to regulate the content of nicotine in tobacco products, which could reduce it to a non-addictive level, as well tobacco industry marketing at the point of sale, including characteristics of tobacco package labeling and warnings. Among the upstream causes, dismantling the drivers of structural racism could also advance progress towards tobacco health equity. In summary, systematic social changes will be needed before we truly see a “World No Tobacco Day.”
Posted March 24, 2023
By Triesta Fowler, M.D.
Scientific Diversity Officer, National Institute on Minority Health and Health Disparities
Monica Webb Hooper, Ph.D.
Deputy Director, National Institute on Minority Health and Health Disparities
March is women’s history month, and we thank and celebrate women across the U.S. and globally for their many essential contributions to science and medicine. Entering and succeeding in a field of study and/or professional practice, especially as a member of an underrepresented group is no small feat. Getting there often means beating the odds and rising above continual challenges. Women’s history includes many exemplars of such formidable efforts, people who are deserving of celebrations this, and every, month.
In this blog, we commemorate the work and legacies of pioneering women whose historic accomplishments made critical strides toward improving minority health, reducing disparities, and advancing health equity, from the late 1800s to today.
Trailblazing Women in Science
In 1864, Dr. Rebecca Lee Crumpler (1831-1895) became the first African American woman to obtain an M.D. degree at the New England Female Medical College in Boston, Massachusetts. Dr. Crumpler provided medical care to formerly enslaved people at the Freedmen’s Bureau in Richmond, Virginia, and later took care of patients in her home in Boston regardless of their ability to pay. She also published the first medical text by an African American author in 1883 entitled A Book of Medical Discourses, which focused on women and children’s health and was based on journal notes she kept while in practice.
In 1933, Dr. Inez Beverly Prosser (unknown birth year – 1934) became the first African American woman to earn a Ph.D. in psychology from the University of Cincinnati in Ohio. With a passion for education, she taught at Historically Black Colleges and Universities (HBCUs) and was interested in personality, self-esteem, and adjustment among children. Her research focused on the impact of racism on the education and educational experiences of African American children and was cited in the debates leading to the landmark 1954 civil rights case, Brown v. Board of Education of Topeka, Kansas.
Drs. Crumpler and Prosser were remarkable women who blazed the trails so that we could follow in their footsteps. They overcame racial discrimination, biases, segregation, and societal and cultural norms that prevented women from working outside of the home, and barred Black women from educational opportunities. They helped launch the cross-cutting fields of minority health and health disparities research. And while there has been some progress, there remains much more work to be done. About 37.1% of total active physicians are women (American Medical Association 2021), but only 2.8% are Black women. About 69% of psychologists are women, but just 5% are Black (women and men combined).
NIMHD’s Very Own Trailblazer
We also acknowledge and celebrate a modern-day pioneer in the field, Dr. Anna María Nápoles, Scientific Director of the Division of Intramural Research at NIMHD, who retired from federal service on February 28, 2023. Dr. Nápoles is a behavioral epidemiologist and the first Latina named to the position of Scientific Director at an NIH Institute. She worked tirelessly to grow the Division and maintained a steadfast commitment to mentorship and sponsorship. We benefitted tremendously from her expertise and outstanding leadership.
We honor the legacies of these amazing individuals with a daily commitment to mentor and sponsor the next generation of scientists as they maximize their potential. We encourage others to learn about the many historic women in science and medicine, and to emulate their persistence and determination for improving the health of populations with health disparities.
NIMHD is committed to supporting the careers of all women, and a culture that supports recruitment and retention. In science and medicine, we know that this must include opportunities for mentorship, professional network development, and research funding, which are associated with increased productivity, career satisfaction, and achievement of professional goals and skills.
NIMHD Supports Women
We strongly encourage investigators supported by eligible grants to identify and support scientists through our funding mechanisms.
Our flagship program, the annual Health Disparities Research Institute, is a big draw for early career investigators and an opportunity to foster peer relationships and expand professional networks. The idea of a shared vulnerability and the ability to connect is key to building knowledge and skills and promoting wellness.
In short, NIMHD has resources in place to support women’s professional trajectories and success. And we are proud that over half of principal investigators supported by grants awarded by NIMHD identify as women.
Dr. Triesta Fowler leads NIMHD diversity, equity, inclusion, and accessibility efforts in collaboration with NIMHD leadership and staff. She was previously a medical officer and Director of Communications and Outreach within the Division of Intramural Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), leading key diversity activities. She began her work in diversity outreach and engagement at NICHD in 2007 as the director and creator of The National Child and Maternal Health Education Program.
Dr. Monica Webb Hooper is an internationally recognized translational behavioral scientist and licensed clinical health psychologist. She has dedicated her career to science that benefits and serves communities with a focus on chronic illness prevention and health behavior change. Her overarching goal is to do the work necessary to produce meaningful, positive change and assure health equity. Before joining NIMHD, Dr. Webb Hooper was a tenured Professor of Oncology, Family Medicine & Community Health, and Psychological Sciences at Case Western Reserve University and Associate Director for Cancer Disparities Research at Case Comprehensive Cancer Center.