Minority Health Disparities at NIDA

1. Minority Health Disparities at NIDA Lula Beatty, Ph.D. Special Populations Office/Office of the Director National Advisory Council on Drug Abuse September 21, 2005

2. SPO Staff • Ana Anders • Pamela Goodlow • Flair Lindsey • LeKhessa Doctor

3. Objectives • To describe the need for minority and health disparity programs in drug abuse research • To discuss NIDA’s approach to addressing racial/ethnic minority and health disparities needs in drug abuse research • To present NIDA’s major minority and health disparity programs and activities • To identify challenges in developing and implementing minority health disparity programs

4. Need • Public Health/Science Need • Science Workforce Need • Adherence/Cooperation with Policy Need

5. Public Health/Science Need • Limited information on drug abuse in racial/ethnic minority populations • Severe, long-term consequences of drug abuse and addiction experienced by racial/ethnic minority populations • Not enough specific knowledge to inform prevention and treatment

6. Science Workforce • Not enough racial/ethnic minority researchers in drug abuse/addiction research • Not enough racial/ethnic minority researchers conducting drug abuse/addiction research in racial/ethnic minority populations • Not enough drug abuse/addiction researchers conducting research on drug abuse research in racial/ethnic minority populations

7. Adherence with Goals and Policies • Congressional Directives/Interest • White House/Departmental Initiatives • E.g., Tribal Colleges and Universities Hispanic Plan of Excellence • NIDA Initiatives • E.g., African American Initiative • HBCU

8. NIDA’s Responsibility • NIDA is chief architect and supporter of the U.S. and world’s research on the health aspects of drug abuse and addiction • About ¾ of HIV/AIDS behavioral research is federally funded – NIDA, NIMH, CDC (Semaan et al., 2002) • Must stimulate and increase the scientific knowledge base on drug abuse and addiction needed for all population groups

9. Special Populations Office Created in 1993 To: • Encourage and enable minority scientists participation in drug abuse research • Encourage increased research on drug abuse in minority populations in NIDA divisions

10. Through • Stimulating and encouraging, e.g., • Presentations • Publications • Providing research experiences and preparation for research careers, e.g., • Diversity supplements • Providing research opportunities and support, e.g., • MIDARP • HBCU Recruited Scientist

11. SPO’s Major Programs/Initiatives • Diversity (Minority) Supplement Program • Summer Research with NIDA • HBCU Initiative • Research Development Seminar Series • Minority Institutions’ Drug Abuse Research Program

12. SPO’s Major Programs/Initiatives • Health Disparities Strategic Plan • African American Initiative • Expert Racial/Ethnic Minority Work Groups • National Hispanic Science Network • Southern Africa Initiative

13. Other Programs/Efforts • Minority Training and Recruitment Program (IRP) • Co-sponsored Programs

14. Diversity (Minority) Supplements • Research Supplements to Promote Diversity in Health-Related Research http://grants2.nih.gov/grants/guide/pa-files/PA-05-015.html • Diversity PA includes A. individuals from underrepresented racial and ethnic groups; B. individuals with disabilities; and C. individuals from socially, culturally, economically, or educationally disadvantaged backgrounds that have inhibited their ability to pursue a career in health-related research.

15. Consortium on Minority Concerns Jean Lud Cadet, M.D., IRP Dorynne Czechowicz, M.D., DCNDBT Lynda Erinoff, AIDS Dionne Jones, Ph.D., DESPR Catherine Mills, GMB Amrat Patel, Ph.D., DPMCDA Pushpa Thadani, Ph.D., DBNBR Don Vereen, M.D., OD Lula Beatty, SPO Ana Anders, SPO Pamela Goodlow, SPO

16. Minority Supplement Awards New & Continuing FY 1994 – FY 2005

17. New Minority Supplement Awards FY 1994 – FY 2004 Gender, Level of Support & Ethnicity

18. Minority Supplement Recipients Applying to NIH: 1995 and 2000 • 72 recipients • No. and percent who submitted applications to NIH: 27, 37.5% • No. and percent of applicants awarded NIH grants: 12, 44.4% • No. and percent of grantees published (PubMed): 8, 66.7% of those with grants

19. Summer Research with NIDA • Created in 1997 to provide research experiences for high school and undergraduate students requiring more support from PIs • Provides additional mentoring and logistics assistance • Initially supported as pilot project by Office of Research on Minority Health (NCMHD) • NIDA supported as part of Diversity (Minority) Supplement Program funds

20. Summer Research with NIDA Program FY 1997 – FY 2005

21. Number of Summer Sites by Year

22. MIDARP • Capacity development program, provides • Institutional resources and support • Faculty development • Student development • Research support • New MIDARP announcement in 2005: http://grants2.nih.gov/grants/guide/pa-files/PAR-05-069.htmle-released

23. MIDARP • Improved MIDARP reviews • NIDA reviewed • Stable group of reviewers • Clear SRA instructions • All applications reviewed (no unscored)

24. Current MIDARP Programs • Current programs in DBNBR and DESPR • Florida International • U. Central de Caribe • Hunter College • SUNY, Old Westbury • Morgan State • Hampton U. • Charles Drew

25. MIDARP Research Examples • Inter-generational transmission of drug use between Cuban mothers and daughters (FIU) • Effects of drug use on the immunology system and patterns of health care among HIV seronegative and seropositive drug abusers (U. Central de Caribe) • Neurobiology of drug addiction and impulsive behavior (Hunter) • Investigation of the opioid-immune-stress relationship (SUNY, Old Westbury) • Elucidate the underlying biochemical mechanisms associated with the neurotoxicity of methamphetamine (Hampton)

26. Seminar Series • Technical assistance program established in 1980s for underrepresented scientists who are ready to apply for independent awards • Must have written concept • Provides science and proposal development lectures, small group discussion, and one-on-one mentoring in two-session seminars (about 6 months apart)

27. Seminar Series • Mentoring provided by staff and extramural scientists • Second session centers on mock review led by NIDA SRA • Expectation is that application will be submitted within 6 – 12 months after last session

28. Seminar Series Outcomes • In early years, success rate reported at over 80% • A number of participants have become NIDA and other NIH grantees

29. HBCU Initiative:Selected Activities and Programs • HBCU Supplements • Support annual Lonnie E. Mitchell HBCU conference on substance abuse (CSAT is lead) • HBCU Technical Assistance Program • Center on Drug Abuse Research Program (Howard University) • HBCU Recruited Scientist Award

30. Historically Black Colleges and Universities Recruited Scientist • Capacity development effort at HBCU: Recruit an experienced researcher to develop research program • Three programs: • Allyn Howlett, NC Central • Dorothy Browne, Morgan State • Kathy Sanders Phillips, Howard • Faculty and student development, e.g., • NC Central established training links with Wake Forest • Morgan established links with Hopkins

31. Historically Black Colleges and Universities Recruited Scientist • Each has secured other NIH research support, e.g., • National Health Disparities Center awards from NCMHD • NIDA’s Health Disparities grant and supplement • MIDARP • Staff/Postdoc have secured NIH awards • Have secured other sponsored support • Publications

32. Leading causes of death and actual causes of death in the United States, 2000

33. 10 Leading Causes for Blacks, 2001 Black White AI A/PI Diseases of heart 1 1 1 2 Malignant neoplasms 2 2 2 1 Cerebrovascular disease 3 3 5 3 Accidents 4 5 3 4 Diabetes mellitus 5 6 4 5 Assault 6 19 11 10 (Homicide) HIV disease 7 22 16 24 Chronic lower 8 4 7 6 Respiratory diseases Nephritis, nephrotic 9 9 10 9 Syndrome and nephrosis Septicemia 10 11 12 11

35. Reported AIDS Cases and Rates Among Female Adults and Adolescents, by Race/Ethnicity, 2002, US Rate (per 100,000 population) % Number Race/Ethnicity 2.2 1,928 18 White, not Hispanic Black, not Hispanic 7,326 67 49.1 Hispanic 1,556 14 11.2 68 <1 1.3 Asian/Pacific Islander American Indian/ <1 Alaska Native 4.4 42 Total* 10,930 Note. Excludes persons from US dependencies, possessions and associated nations. * Total includes 10 persons of unknown race.

36. Some Criminal Justice Facts(from Blankenship et al., 2005) • In 2003 Blacks were 5 times more likely than whites to be in jail; true for males and females • In 2003 39% of jail inmates were Black • In 2003, 12.8% of all Black males aged 25-29 were in prison or jail (compared to 1.6% of white males • In 1999, 40% of all juveniles in facilities were Black; 52% were there for drug offenses

37. Some Criminal Justice Facts(from Blankenship et al., 2005) • Between 1980 and 1995, drug offenders in state prisons increased 1000%, 1 out of 4 • Drug offenders account for more than 80% of the total growth in the federal inmate population • 42% of federal inmates in for drugs are Black • 30% of U.S. persons on probation are Black (drug offenses account for ¼ of probation offenses) • 41% of persons on parole are Black

39. From Iguchi, Rand, 2005. Number of reported admissions to prison for a drug offense, by race

40. Iguchi, Rand, 2005. Rate of yearly prison admissions for a drug offense per 100,000 adults, by race

41. Why Is Criminalization A Public Health Research Issue • Prisons and jails are major providers of drug treatment, notably Cook and Los Angeles Counties • Correctional facilities provide other health assessments and care, e.g., HIV • Correctional facilities are high risk settings for promoting/encouraging risky behaviors • Highest behavioral risk takers may be are under supervision • Drug courts, growing alternative to incarceration, is treatment option that needs to be further explored esp. for Blacks

42. African American Initiative • Out of great concern about the disproportionate consequences of drug abuse on the African American population especially in the rates of HIV/AIDS and criminal justice involvement, • Director initiated activity to identify ways in which NIDA can become more strategic and supportive of efforts to ameliorate HIV/AIDS and criminal justice consequences of drug abuse in the African American population.

43. African American Initiative • NIDA-wide committee established • Committee charged to present Director with a set of recommendations addressing research needs and priorities, research training, collaborations, and outreach and dissemination activities. • Portfolio analysis done • Expert meeting held in October 2004 to assess status of the field

44. Steve Belenko Faye Belgrave Kim Blankenship Ronald Braithwaite Lawrence S. Brown Victoria Cargill Karen Freeman-Wilson Robert Fullilove James Griffin Martin Iguchi Kevin Knight Vickie Mays George W. Roberts Pamela Rodriguez Claire E. Sterk Carolyn A. Stroman Faye Taxman David Vlahov Wendee Wechsberg Gail Wyatt Reducing HIV/AIDS and Criminal Justice Involvement in African Americans as a Consequence of Drug AbuseOctober 12-13, 2005

45. African American Initiative • $500,000 supplement program established; 44 applications received; six awards made • Two Program Announcements are in process for FY 06: Criminal Justice and HIV/AIDS with Office on AIDS • Special Issue of Journal of Health Care for the Poor and Underserved to be published in November, 2005

46. Membership: African American Initiative Committee Jean Lud Cadet, M.D., IRP Gayathri Dowling, Ph.D., OSPC Dionne Jones, Ph.D., DESPR Steven Oversby, Ph.D., DPMCDA Carmen Rosa, M.S., CTN Paul Schnur, Ph.D., DBNBR Donald Vereen, M.D., OD  Lula Beatty, Chair

47. Racial/Ethnic Minority Work Groups • Groups of primarily researchers and others in drug abuse programs representing the four major racial/ethnic minority populations • Purpose is to provide advice and/or support to NIDA’s efforts at increasing racial/ethnic participation in research and improving research on racial/ethnic minority issues, specifically to address • Researcher development needs and obstacles • Research needs within the population • Barriers to research • Research dissemination

48. Racial/Ethnic Minority Work Work Group Models • Advisory/Constituency Group • African American Researchers and Scholars • Native American/Alaska Natives • Asian Americans/Pacific Islanders • Contracted Services • National Hispanic Science Network

49. Selected Accomplishments: Advisory/Constituent Groups • Increased member involvement in NIDA and other drug abuse research • Mentoring, and identifying persons for NIDA programs/activities • Networking among/across groups • Presentations and Publications

50. Jean Oyemade Bailey, Ph.D. Professor and Director Howard University Faye Belgrave, Ph.D. Professor, Psychology Virginia Commonwealth University Ronald L. Braithwaite, Ph.D. Professor,Morehouse School of Medicine Lawrence Brown, M.D., M.P.H. Senior Vice President, Addiction Research and Treatment Corporation Julius Debro, Ph.D. Professor (Retired) University of Washington Roy Griffin Coordinator, Health Services Fort Worth Independent School District Franklin Hamilton, Ph.D. Professor, Environmental Sciences Florida A & M Carl Hart, Ph.D. Assistant Professor and Research Scientist Columbia University and New York State Ernest Quimby, Ph.D. Associate Professor, Sociology and Anthropology, Howard University Daniel Sarpong, Ph.D. Director and Senior Biostatistician Jackson State University Tony Strickland, Ph.D. Behavioral Neuroscience Research Center Charles R. Drew University Janet Mitchell, M.D. Addiction Research and Treatment Corp. Kathy Sanders-Phillips, Ph.D. Professor, Howard University Flavia Walton, Ph.D. Director, COSMOS Corporation Murelle Harrison, Ph.D. Professor/Chair, Dept. of Psychology Southern University African American Researchers and Scholars