National Hispanic Science Network on Drug Abuse: Improving Health of Hispanics

1. NIDA Council Meeting Bethesda, Maryland February 12, 2004 Funded by NIDA Contract N01DA-1-1200

2. Mission Statement The National Hispanic Science Network on Drug Abuse is dedicated to improving the health of Hispanics by: • Increasing the amount and quality of interdisciplinary translational research on Hispanic drug abuse; and • Fostering the development of Hispanic scientists in drug abuse

3. Major Activities • National Network of Hispanic scientists, students & NIH federal advisors • National scientific conference • Summer Research Training Institute for graduate students & post-doctoral fellows • On-line Measures Archive • Website (www.HispanicScience.org)

4. A National Strategic Plan for Hispanic Drug Abuse Research Funded by Robert Wood Johnson Foundation

5. Cultural Social Psychological Biological

6. Goal • To identify gaps in research and scientific opportunities – that can quicken the rate of discovery with regard to Hispanic drug abuse

7. Why? • To improve the health of Hispanics • To capitalize on ethnic variability to enhance our scientific understanding of universal principles

8. National Strategic PlanHortensia Amaro, Ph.D. Chair • Epidemiology • Human Genome & Neurobiology • Prevention • Treatment • Health Services • Blending Research to Practice • HIV/AIDS • Training & Mentoring

9. Development Process • More than 60 researchers participated in the formulation of the Strategic Plan • Each chapter was externally reviewed by a minimum of 2 outside experts in the field of drug abuse research • NHSN Steering Committee provided a second level of review

10. Common Themes • No or low samples of Hispanics in most drug abuse research studies • Few studies provide analyses of data by race/ethnicity including Hispanics • NIH Guidelines for inclusion of racial/ethnic minorities and valid analyses

11. Common Themes • Few studies of prevention and treatment interventions with Hispanics • Few validated instruments in Spanish • Need for a better understanding of the role of culture, cultural adaptation and acculturation in drug use/abuse

12. Common Themes • Few Hispanic researchers across all areas, but particularly severe in behavioral prevention and treatment intervention research

13. Hispanics are 13% of the US populations • 4 genetic studies • 4 adolescent behavioral treatment trials from one lab • 3 pharmacotherapy trials • No behavioral treatment trials of Latinas

14. EPIDEMIOLOGY

15. The Latino population is growing at a rate of 4.7%, as compared to 0.3% for whites and 1.5% for African Americans • Rates for illicit drug abuse and dependence are highest for Hispanics (7.8%), followed by Whites (7.5%) and Blacks (6.2%) (SAMHSA, 2002).”

16. “Hispanic adolescents are more likely to abuse drugs, especially crack cocaine, heroin, and ‘ice,’ than are adolescents from other ethnic groups (Johnston, O’Malley & Bachman, 2003). • Inhalants- epidemic • Latino youth are more likely to report having been approached by someone selling drugs

17. Latinos experience more serious consequences of drug use (e.g., school drop out, prison, HIV) • Such consequences may be a function of lower access to drug abuse treatment services. • Hispanics report as much need for services as Whites, but are more likely to report not receiving services and to be less satisfied with the services they receive.

18. EpidemiologyNativity • US born Latinos in all sub-groups report higher rates of use, abuse and dependence than immigrants • Many studies show that higher acculturation leads to more drug use, but this does explain drug use for all Latino groups

19. Risk and Protective Factors for Drug UseSocial Context Effects • Familism (family as referent, value family) is uniquely important in the Latino culture and is seen as protective against drug use; and should be studied as a protective factor • Factors that diminish the positive influence of the family should be investigated.

20. Future Research • Empirically validated measures for acculturation (cultural change) need further evaluation. • What are the mechanisms by which acculturation influence drug use?

21. In First Generation Hispanic immigrant families, YOUTHS ACCULTURATION INTER-GENERATIONAL/ ACCULTURATIONAL DIFFERENCES PARENTS TIME (Szapocznik, Scopetta, Aranalde & Kurtines, 1978)

22. In second generation adolescents, Mother’s Familism Values .13 .15 Mother’s Behavioral Hispanicism Adolescent Deviancy .48** .23** -.68** Parenting ** = p<.01 (Santisteban, et al., 2000)

23. Human Genome and Neurobiology

24. Global Recommendation: Hispanic Populations • Hispanics are biologically heterogeneous • Human studies on candidate genes as well as on neurobiology should consider biologically homogeneous subpopulations of Hispanics

25. Biological Differences Related to Health • Hispanic subpopulations show biological differences in comparison with other populations • genes, proteins and risk for disease

26. Recommendations: Genes • Target Hispanic populations for research on candidate genes related to addiction • Genetic vulnerability-environment interactions, for example, may account for the very high rates of drug use among Puerto Ricans

27. PREVENTION

28. Hybrid Interventions • Developing “Hybrid Prevention Interventions,” that build-in cultural adaptation as a formal design feature of the prevention program

29. TREATMENT

30. Adolescents: What we know • Group therapy has iatrogenic effects on delinquent and drug abusing adolescents – also true for Hispanics • One family therapy treatment has been found to be efficacious with Hispanic drug using adolescents

31. Treatment Research with Hispanic Women: • There are no published randomized clinical trials of a behavioral treatment with Hispanic women.

32. Hispanic Women: Recommendations • Test Motivation Enhancement Therapy, Contingency Management and Engagement Moms interventions - to improve engagement, retention and treatment outcomes. • Test trauma treatments because exposure to trauma is high among drug using Hispanic women

33. PHARMACOTHERAPY RESEARCH • Differences in response to pharmacotherapy for depression and schizophrenia in Hispanic populations vs. others • Only three published studies have explored pharmacotherapy for drug abuse in Hispanic populations • Methadone treatment for heroin addicts • Nicotine patch for smokers • Naltrexone for alcoholism

34. Recommendations: Pharmacotherapy • Test the hypothesis that Naltrexone may be more acceptable to Hispanics when family involvement is a component of treatment

36. Training Establish a National Training Center on Interdisciplinary, Translational Hispanic Drug Abuse Research

37. www.HispanicScience.org

38. www.HispanicScience.org

39. BLENDING RESEARCH AND PRACTICE

40. The workgroup selected a strategic research focus on: . • Issues impacting the training of Hispanic services providers in innovative treatments • The characteristics of organizations/providers that facilitate or hinder adoption of innovative treatments for Hispanics (e.g., Hispanic agencies are more likely to be small, and small agencies are less likely to innovate). •  The nature of multilevel dissemination in the Hispanic community

41. Recommendations for Training Research: • Research can be most productive by focusing on: 1) The impact of different types of training on competence and adherence for Hispanics serving counselors. 2) The impact on adoption of a Hispanic-serving provider’s philosophy of change and problem conceptualization; and 3) Perceptions regarding the usefulness and limitations of manualized treatment. The impact on adoption of having Latinos counselors and manual developers collaborate on adaptations.

42. Organizationalbarriers/facilitators to adoption of innovative interventions • Organizational variables including size of organization, functional differentiation, number of years of operation, and level of training of the administrator appear to be positively related to adoption. • Also appearing in some literature: having patients covered by HMOs, PPOs, or other managed care arrangements, client clinical characteristics, and having higher percentage of relapsers treated by the center. • Hodge, Cardenas, & Montoya (2001) – Staff reported that financial problems did not allow for rewarding of innovation. Financial weaknesses did not allow agency to invest in a promising ATOD pilot programs.

43. Implications for Hispanic/Latino Serving Organizations • The potential impact on adoption rate of agency size and level of training and education of administrators may be particularly important given that many Hispanic serving agencies may be smaller size. • The finding that individuals enrolled in HMOs and managed care programs were more likely to receive innovations, is also problematic given that Latinos/ Hispanics are over-represented among the uninsured and thus, may be less likely to receive innovative treatment intervention.

44. Recommendations for Research on Organizational factors • Research specifically focused on: • 1) The makeup and characteristics of Hispanic- serving agencies and key organizational characteristics related to adoption. 2) Testing the generalizability of previous findings with Hispanic serving agencies. • 3) How the unique clinical characteristics of Hispanics impact variables related to adoption, such as clinical characteristics of caseload and high relapse rates.

45. The Nature of Multilevel Dissemination in the Hispanic Community Social marketing - a consumer-oriented approach to dissemination – would help bridge the gap. Aguilar-Gaxiola et al. (2002), working with Mexican Americans in California, report on evidence-based processes to educate the community, mobilize action, translate research for multiple stakeholders, and to effect regional policy changes that directly impact services.

46. Recommendations for Research on Multi-level Dissemination. Research must be conducted on the unique needs of Hispanic-serving substance abuse prevention and treatment providers, and study the effectiveness of matching innovations to those needs. Research on marketing strategies that reach multiple stakeholders (e.g., community agencies, state and county-level funders) relevant to Hispanics. Research must also focus on effective strategies for mobilizing public and political pressures to facilitate the adoption of innovation in the Hispanic community.

47. HIV/AIDS

48. Sexual Risk within the Context of Drug Abuse • Hispanics have more negative attitudes towards safe sex practices and a corresponding tendency towards risky sexual behaviors such as not using condoms. • “with those less acculturated reporting the most negative attitudes” towards safe sex practices.

49. Initiation of Injection Risk in Latino Youth & Young Adults. • Pedagogy of technical skills necessary to prepare and inject illicit drugs. • Prospective studies of Latino IDUs • Evolution of social, behavioral, & environmental processes. • Situate within context of key life-course changes.

50. Sexual Risk within the Context of Drug Abuse • Latinosacross all sexual orientations report more negative attitudes toward safer sex practice.Correlates with level of acculturation. • High-risk heterosexual activities are the main predictor for HIV seroconversion among Latinas. • Latinas have low overall sexual assertiveness. • Significant proportion believe they never have the right to make decisions about condom use.