Category Scientific Research   Show all

• Voices from the Pacific: Advancing Maternal Health Equity Together

  

  Posted October 18, 2023

  Rebecca Delafield, Ph.D., M.P.H.
  Assistant Professor
  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.

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  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.

• Supporting the Mental Health Needs of Hispanic and Latino Youth

  

  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.

  
  

  Additional Resources

  • NIMH webinar: Engaging Community Stakeholders to Reduce Mental Health Inequities in the Hispanic Community
  • Behavioral Health Equity: Hispanic and Latino Americans
  • Mental Health Resources for Latinx/Hispanic Community
  • Publicaciones acerca trastornos de la salud mental y temas relacionados

• Genomic Diversity for Health Equity: My Journey from Colombia to NIMHD

  

  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.

  Photo Caption: Dr. Leonardo Mariño (4th from left) in December 2022 with scientific colleagues in the Colombian Andes Mountains. From L to R: Andrés Moreno Estrada, Angélica Borbón, Karla Sandoval, Leonardo Mariño, King Jordan, Alejandro Matamoros, Juan Esteban Gallo, Augusto Valderrama.

  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.

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  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. Your education 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

• Tobacco Endgame: Improving Outcomes for People from Marginalized Communities

  

  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.”

  
  

• Advancing the Health and Wellbeing of Black and Latino Sexual Minority Men

  

  Posted March 8, 2023

  By Jordan J. White, DrPH, MSW
  Assistant Professor
  Bachelors of Social Work Department
  School of Social Work
  Morgan State University

  
  

  

  In the 1990s, I witnessed several community members and relatives pass away from HIV/AIDS. These experiences piqued my interest in the role of social networks, assets, and resources in health promotion in minority communities. Family members (grandparents, parents, uncles, aunts, siblings) , many of whom attended Historically Black Colleges and Universities (HBCUs), supported my interests.

  I am a tenure-track Assistant Professor of Social Work at Morgan State University in Baltimore, Maryland. I am also an NIMHD Diversity Supplement awardee. I have worked in HIV prevention and community health across government, academic, corporate and community-based settings for the past decade. My Diversity Supplement has allowed me to better understand gaps in HIV care as well as strategies to address COVID-19 and Mpox (formerly known as monkeypox) vaccine hesitancy among sexual minority men.

  In 2019, I was honored to become the first graduate of the Lesbian, Gay, Bisexual, Transgender and Queer Public Health Certificate Program from the Johns Hopkins Bloomberg School of Public Health, due to my longstanding interest in sexual minority health.

  My main research interests focus on advancing the health and wellbeing of populations experiencing disadvantage, particularly Black and Latino sexual minority men, in the United States. While there are many inequities and health disparities that urgently need to be addressed among these populations, HIV continues to be one of the most complex. The research for my supplement was primarily conducted during the COVID-19 pandemic and Mpox outbreaks of 2022 and 2023. Black and Latino sexual minority men were two of the most affected demographic groups. A key lesson or theme from this ongoing work is the need to encourage communication between providers and patients to promote healthy sexual practices within shifting health, clinical, and sociocultural contexts.

  

  
  

  My research has primarily focused on HIV prevention, treatment and care among these populations. I have used qualitative and quantitative methodologies to explore factors that promote health and resilience among these populations. I have engaged hundreds of Black and Latino sexual minority men in qualitative and survey research over the past decade. Anecdotally, my research during the COVID-19 pandemic and Mpox outbreak period (2020-2023) documented some of the most intersectional, challenging, and dire outcomes that I have ever encountered. One example is how Black and Latino sexual minority men are less likely to be virally suppressed than White sexual minority men, thus leading to worse Mpox outcomes.

  My hope is that some of these findings and counter-narratives may help to address gaps in our knowledge of resilience and its multi-level determinants among Black and Latino sexual minority men. Future resilience-based public health interventions, policies and practices for these populations are critical to increasing health equity.

  HIV continues to have a devastating impact on Black and Latino sexual minority male populations throughout the United States. The persistently high community viral load and gaps in retention in care are increasingly recognized as contributing factors to these HIV-related racial disparities. Viral suppression rates are high among Black and Latino sexual minority men who are engaged in care. Many Black and Latino sexual minority men are living with stress and stress-related comorbidities that exacerbate HIV-related racial disparities. Psychosocial approaches emphasize that subjective experiences can produce acute and chronic stress which affect physical and mental health outcomes. For some sexual minority populations, the house and ballroom community are considered sources of resilience and social support that protect members from various stressors. Understanding how a disproportionately affected subpopulation of Black and Latino sexual minority men adjust or readjust to stressors can inform future behavioral resilience interventions and may help reduce HIV-related racial disparities.

  Receiving the NIMHD Diversity Supplement funding was invaluable to my research. It has allowed me to conduct primary data collection, analysis, build my research program, and provided pilot data that I hope will inform future NIH grant applications. It also has fostered collaboration between Morgan State University and the Johns Hopkins Bloomberg School of Public Health.

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  Dr. Jordan White is an Assistant Professor of Social Work at Morgan State University in Baltimore, MD. He is trained as a public health and social work scientist. Dr. White’s research and practice are centered on understanding and addressing health disparities and inequities among minority populations particularly sexual minority men in the United States.