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 � 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.

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

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

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 � 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. Reducing HIV/AIDS and Criminal Justice Involvement in African Americans as a Consequence of Drug AbuseOctober 12-13, 2005 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

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�

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. African American Researchers and Scholars 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

51. Native American/Alaska Native Work Group Thomas Ball, Ph.D. Oregon Social Learning Center LaDonna Blueeye U. of OK David Burgess, Ph.D. Boston College Raymond Daw Na�nizhoozhi Center Phillip Fisher, Ph.D. Oregon Social Learning Center Candace Fleming, Ph.D. U. of CO Health Sciences Center Pamela Jumper Thurman, Ph.D. CO State University� Clyde McCoy, Ph.D. U. of Miami Leo Nolan, M.Ed. Indian Health Service Bernard Segal, Ph.D. U. of Alaska, Anchorage Sally J. Stevens, Ph.D. U. of Arizona Jerry Stubben, Ph.D. Iowa State U. Roger Dale Walker Oregon Health & Science U. Karina L. Walter, Ph.D. U. of Washington

52. Asian American/Pacific IslanderResearchers and Scholars WorkgroupMember List Linda Chang, M.D. Professor, U. of Hawaii Denise Hien, Ph.D. Research Scholar Columbia University Yih-Ing Hser, Ph.D. Adjunct Professor UCLA Martin Iguchi, Ph.D. UCLA School of Public Health Professor RAND Bosseba Kong, MSW Mental Health Clinician Stanilaus County Behavioral and Recovery Services Ford Kuramoto, DSW National Director National Asian Pacific American Families Against Substance Abuse Grace E. Macalino, Ph.D. Tufts New England Medical Center (NEMC) Tooru Nemoto, Ph.D. Associate Professor University of California, San Francisco Keum Pang, Ph.D. Professor, Howard University Rumi Price, Ph.D. Research Associate Professor Washington University Frank Wong, Ph.D. Associate Professor Georgetown University Elmer Yu, M.D. Clinical Director of General Research University of Pennsylvania/Philadelphia VAMC

53. Selected Accomplishments: National Hispanic Science Network Annual conference on drug abuse in the Hispanic population Website providing information on Hispanic drug abuse research and researchers Summer research training workshop Publication: National Strategic Plan on Hispanic Drug Abuse Research

54. NHSN 2004 Steering Committee Jose Szapocznik, Ph.D., Chair, U. of Miami Hortensia Amaro, Ph.D. Northeastern University Ana Mari Cauce, Ph.D. U. of Washington Alexander Kopelowicz, M.D. UCLA Joe Martinez, Ph.D. U. of Texas, San Antonio Patricia Molina, M.D., Ph.D. Louisiana State U. J. Bryan Page, Ph.D. U. of Miami Rafaela Robles, Ed.D Universidad Central el Caribe, Bayamon

55. Health Disparities Strategic Plan NIH requirement NIH plan includes each IC plan NCMHD is coordinator; Determines Structure/format of plan Time for plan submission, review and revision Submits for public response

56. NIDA�s Strategic Plan Developed by NIDA-wide Committee, chaired/staffed by SPO Committee retained to set priorities, monitor and implement plan

57. NIDA�s Health Disparities Plan Outline Research: 1: Epidemiology, Health Consequences, & Infectious Diseases 2: Prevention of Drug Abuse and Addiction 3: Treatment and Health Services 4: Basic and Clinical Neurosciences Infrastructure Public Information and Outreach

58. NIDA�s Strategic Plan Developed Health Disparities Supplement Program, 29 awards made (4 supported by NCMHD) Committee encouraged/endorsed RFA released by DESPR/CAMCODA (resulted in 8 awards) Committee explored issues: Definition of health disparities Coding/Reporting issues

59. Health Disparities Committee Ann Anderson, Ph.D., DPMCDAJean Lud Cadet, M.D., IRPDorynne Czechowicz, M.D., DCNDBTLynda Erinoff, AIDS Office Joseph Frascella, Ph.D., DCNDBT Steve Gust, Ph.D. International Office Dionne Jones, Ph.D., DESPRGloria Lester, OPRM Catherine Mills, GMB Cindy Miner, Ph.D., OSPCCarmen Rosa, M.S., CTNPaul Schnur, Ph.D., DBNBRDavid Shurtleff, Ph.D., DBNBRDonald Vereen, Ph.D., OD Lula Beatty, SPO, Chair Ana Anders, M.S.W., SPO Flair Lindsey, SPO

60. Health Disparities Conference, October 24-26, 2005 Plenary sessions on genetics, HIV/AIDS, criminal justice, structural factors Workshop sessions Poster sessions by new investigators and service providers Travel awards

61. Health Disparities Planning Committee NIDA Staff Lula Beatty LeKhessa Doctor Pamela Goodlow Ana Anders Joni Rutter Pushpa Thadani Dionne J. Jones Aria Davis Crump Joseph Frascella Gloria Lester Carmen Rosa Monica Jones Mark Swieter Suman Rao King African American Work Group Daniel Sarpong Julius Debro Janet L. Mitchell Lawrence Brown Asian American/Pacific Islander Work Group Rumi Kato Price Frank Wong Hispanic American Work Group Avelardo Valdez Ana Mari Cauce Native American/Alaska Native Work Group Pamela Jumper Thurman Raymond Daw Bernard Segal

62. Minority Recruitment and Training Program (IRP) Summer program for persons in high school through college; some faculty support About 25 students participate each summer Partnered with an IRP scientist

63. National Center on Minority Health and Health Disparities SPO is liaison to NCMHD Reporting requirements Cofunding

64. National Center on Minority Health and Health Disparities Support FY # of Projects $ Amount 94 5 $ 235,544 95 7 485,000 96 3 152,000 97 5 575,000 98 8 712,000 99 5 1,853,357 00 4 327,400 01 8 1,473,000 02 0 0 03 2 1,230,061 04 1 900,000 05 1 900,000 Total $8,843,362

65. Selected NIDA Meetings Differential Drug Use, HIV/AIDS, and Related Health Outcomes among Racial and Ethnic Populations: A Knowledge Assessment Workshop, 2002 (DESPR, support from NCMHD and ORWH) Methodological issues in health disparities, 2002 (DESPR) July 2005 meeting with health disparities supplement and RFA grantees (DESPR and SPO)

66. Support/Participate in Other Meetings: Examples American Psychological Association National Hispanic Science Network conference and training institute National Asian Pacific American Families Against Substance Abuse CPDD Association of Black Psychologists Latino Behavioral Health conference HBCU Substance Abuse conference American Society of Criminology

67. Selected Recent Publications Array of material developed/supported by OSPC, e.g., NA/AI and AAPI calendars, information in Spanish NHSN�s Hispanic Strategic Plan, available in journal Drug Use among Racial/Ethnic Minorities, revised in 2003 (DESPR was lead) Methodological Challenges in Conducting Health Disparities Research, Journal of Urban Health, 2005, Dionne Jones and Aria Crump (Eds.) Drug Use, HIV/AIDS, and Health Public Health Reports, Outcomes among Racial and Ethnic Populations, 2002, Dionne Jones, Arnold Mills, and Henry Francis (Eds.)

68. Selected Recent Publications Articles by Beatty, Wheeler and Gaither (HIV Prevention Research), and Jones (HIV Risk Reduction Strategies) in Enhancing Research and Clinical Responses to HIV/AIDS in African Americans: Social, Psychological, and Contextual Issues, Journal of Black Psychology, 2004 Book chapter by Beatty (Changing their Minds: Drug Abuse and Addiction in Black Women) in In and Out of Our Right Minds, The Mental Health of African American Women, Brown and Keith (Eds.), 2003. Weiss, S.R., Kung, H.C. & Pearson, J.L. (2003). Emerging issues in gender and ethnic differences in substance abuse and treatment. Current Women�s Health Reports, 3(3), 245-253.

69. Selected Recent Publications Journal of Health Care for the Poor and Underserved, Beatty, Jones & Doctor (Eds.), 2005, in press. Beatty, L.A., Wetherington, C.L, Jones, D.J., & Roman, A.B. (2005). Substance use and abuse in girls and women. In J. Worrell and C. D. Goodheart, Handbook of girls� and women�s psychological health. Oxford University Press.

70. Southern Africa Initiative Responsive to Department�s interest and call for assistance in South Africa (Binational Commission) Established in 2000 (stimulated by HBCU activity) Capetown meeting in Summer, 2000, attended by NIDA Director and staff and South Africa�s Deputy President and Cabinet Ministers

71. Southern Africa Initiative Major focus on capacity development and HIV/AIDS Mutual research interests and possible generalizability particularly to African Americans and prison populations Research Supplement Program 11 grants supported (2001 and 2002) across divisions Research addressed includes: HIV/AIDS and health in prisons, HIV prevention with women, adolescent substance use in rural areas

72. Southern Africa Initiative Capetown meeting in Summer, 2003 to facilitate collaborative ties between sponsors and among researchers; expand network (sponsors/participants included Ministers, Medical Research Council, HHS representative, World Health Organization, U.S. Department of State) Meeting of PIs is being planned by SPO and International Office to determine next steps

73. Selected Current Co-sponsored Programs Physician Scientist Program (NCMHD) Longitudinal research development program for racial/ethnic minority students (starting at 7th grade) High school students placed in NIDA IRP during summer Clinical Research Education and Career Development in Minority Institutions (NCRR) Specialized Neuroscience Research Program (NINDS) Minority Fellowship Programs (to professional associations) Native American Research Centers of Health (Indian Health Service) Summer Program at Harvard for Native American students (with NIMH and others) Summer internships, e.g., HACU, NAFEO, WIN

74. Assessment of NIH Minority Research and Training Programs National Academy of Sciences study to Assess how well these NIH minority research training programs work Identify characteristics of successful programs, trainees and institutions Recommend strategies to render future assessments feasible Provide recommendations for a coordinated trainee tracking information system

75. Difficulties Experienced Inadequate trainee tracking data Available data are not readily accessible Prohibition against accessing or viewing individual trainee race and gender data Lack of coordination among NIH minority research training IC representatives

76. Conclusions Underrepresented minorities are entering the biomedical workforce as a direct result of the NIH minority research training programs Best feature is the research experience itself Financial support was another best feature, though needs to be increased Other positive features were opportunities to network and collaborate, prepare grant proposal

77. Conclusions Mentoring needs to be improved (e.g., mundane administrative tasks) Half of T32 minority postdocs reported having no mentor Drop off of females at postdoc/junior faculty level Look beyond training the individual fellow to effect long-term change

78. Recommendations By the end of 2005, the NIH director should articulate a set of clear and measurable training goals and objectives specific to minority training NIH should commit to the continued funding of minority-targeted research training programs The director of each IC should designate a single individual as minority research training programs coordinator for that IC by the third quarter of FY 2005

79. Recommendations The NIH training director should convene a meeting of all minority training coordinators on at least a quarterly basis, beginning with the third quarter of 2005 The committee of minority training program coordinators should establish appropriate guidelines and measures for evaluating NIH minority research training programs

80. Recommendations Further study of the relative effectiveness of minority-targeted vs. nontargeted programs should be carried out by NIH ICs under coordination from the Office of the Director The director of NIH training should administer the funds for evaluation, data collection, and marketing by FY 2006

81. Recommendations The general issues reviewed in this report should be revisited periodically at the NIH level with the next report submitted by 2009. The OD should take the lead. NIH should develop a relational database that collects a minimum data set for all persons who received funding as trainees, fellows, research assistants, or postdoctorates, including those programs targeted to underrepresented minorities

82. Lessons Learned at NIDA Supportive leadership Supportive colleagues Greatest barrier may be mistrust of us and the process Willingness to listen and ability to participate in difficult conversations (racism, oppression, review, criticism of NIDA, NIH and self)

83. Lessons Learned at NIDA  Takes long-term commitment Requires active outreach Tolerance for missteps along the way Minority involvement leads to minority focused research Welcoming opportunities (e.g., for people and issues)