Caribbean Exploratory Research Center Phase II: Building On Our Progress

1. Caribbean Exploratory Research Center Phase II: Building On Our Progress NEXT STEPS Grant Support: National Institute on Minority Health and Health Disparities , NIH (# P20MD002286).

2. MAJOR STUDIES Abuse Status and Health consequences for African American and Afro-Caribbean Women. This (RO1) is the major study funded with the establishment of the Center. The study is focused on examining the health effects of intimate partner violence (IPV). It is a case-control comparison study with sites in Baltimore and the Virgin Islands. • Our Haiti project titled : Protecting Haitian Women and Children Survivors of the 2010 Haiti Earthquake from Violence and Abuse involves collaboration with experts in gender based violence including intimate partner violence (IPV) and sexual assault, and working with groups to assess and meet the needs of internally displaced persons following disasters. • This research is funded as a supplement to CERC’s P20 funding as an Exploratory Research Center of Excellence.

3. NEXT STEPS The goals of the Caribbean Exploratory Research Center Phase II are to 1) document health disparities in the USVI 2) describe determinants of health disparities in the USVI and 3) ultimately reduce health disparities in the USVI.

4. NEXT STEPS • Critical : • develop academic and community collaborations • expand the infrastructure to support research projects aimed at understanding and eventually eliminating disparities in health status in the Territory of the USVI.

5. NEXT STEPS • Phase II of the CERC • Continue to build important academic and community collaborations established over the past five years, • Continued development of a beginning core of researchers in the USVI with increasing skills in conducting research on health disparities in the USVI • Conduct research designed to detect, understand and ultimately reduce health disparities in the Territory.

6. Phase II Specific Aims Continued integrated functioning of our four Cores: 1) Administrative, 2) Research, 3) Research Training/Education, and 4) Community Engagement and Outreach providing • A centralized administrative structure, coordination and resources to facilitate cohesive function of the Center of Excellence for the conduct of research, training and education on health inequities and disparities. • Continue original, innovative, and translational research based on a three stage research framework of detecting, understanding and reducing health disparities that leads to improving minority health and reducing, and ultimately eliminating, health inequities and disparities in the USVI and other Caribbean Islands. • Strengthen the research skills and expertise of members of the UVI faculty, students and community partners through research training activities in minority health disparities and health disparities research, and • Enhance the capacity of academic, institutional, and community partners to participate in the development, use, and evaluation of culturally relevant interventions designed to improve minority health and health of health disparity populations in the USVI.

7. Administrative Core Action Plan Facilitate and support the functioning of the Cores in efforts to: 1.Increase the capacity of University faculty, students and community partners to participate in and conduct research 2. Support research that provides data on which to build an understanding of factors contributing to health disparities in the Virgin Islands and to develop interventions to address these disparities. 3. Provide community education and outreach to improve individual access to health information and the ability to assume responsibility for one’s health. 4. Provide the leadership for regional and national institutes that focus on health issues that are relevant to the VI and Caribbean region that will facilitate joint efforts to address health disparity problems common to the region.

8. RESEARCH CORE ACTION PLAN • Objectives: • Further build the research infrastructure to support the research projects of CERC II and future independently funded projects to reduce health disparities • 1) Support the conduct of two substantive research studies • 2) Train junior researchers and project staff in data management, research coordination, geo-mapping, data analysis, publication and research translation skills. • Deepen expertise to better understand and develop and/or tailor existing interventions to reduce major selected Health Disparities affecting Virgin Island residents, especially diabetes and violence (other and self inflicted) and trauma and associated physical and mental health outcomes (e.g. HIV/AIDS)

9. RESEARCH CORE NEXT STEPS • Detectionhealth disparities specific to the USVI with some activities moving into Understanding. • Understanding :combining qualitative and quantitative data as well as knowledge from our other cores to understand the Reducing health inequities in the US Virgin Islands • Complex intersection of community attitudes, resources and agencies & best strategies to tailor interventions to USVI culture to make reductions in health disparities.  

10. RESEARCH FRAMEWORK • The health disparities research agenda progresses in three sequential phases of research. • Phase 1 (detecting disparities) informs • Phase II studies (understanding disparities), which in turn informs • Phase III research (interventions to reduce or eliminate disparities).

11. Understanding the Transition to Insulin Resistance in the VI. • In the U.S. Virgin Islands (USVI) as on the  US mainland, the prevalence of diabetes mellitus has reached epidemic levels in children. • In the USA the higher prevalence of Type 2 diabetes in African American children is linked to their greater tendency to insulin resistance which cannot be accounted for by conventional risk factors. • The proposed study will examine the relationship of a mother’s coping style to dysregulation of the hormone cortisol, low birth weight, weight gain from birth and insulin resistance in USVI children. • The study also will assess whether relationships between gender, low birth weight, catch-up weight gain, family history of diabetes and insulin resistance that were observed in African-Caribbean adolescents extend to children ages 2 to 4.

12. An Integrated Risk Reduction Intervention for African Caribbean Women Experiencing Intimate Partner Violence (IPV). • A randomized clinical trial (RCT) will test an intervention designed to reduce the risk of intimate partner violence and associated risks of sexually transmitted infections (STIs) including HIV infection in African Caribbean women in the US Virgin Islands. • The expected outcomes are reduced levels of IPV, STI’s, improved physical and mental health .The specific aims are to 1) combine and adapt an Intimate Partner Violence Empowerment Intervention with the “Sister to Sister” HIV prevention intervention 2) establish treatment fidelity procedures and 3) conduct a test of the combined intervention with abused women in the US Virgin Islands. • The proposed intervention study builds on the ongoing study of intimate partner violence (IPV) being conducted as a collaborative project by investigators at the Caribbean Exploratory NCMHD Research Center, University of the Virgin Islands with researchers at several major mainland universities described above.

13. RESEARCH CORE Join other Caribbean nations for synergy in efforts • Encourage, support and facilitate proposals for funding contributing to the CERC mission of understanding and reducing health disparities by other external sources (e.g. CDC, other NIH institutes, foundations) from other faculty at UVI. • Identify and join data collection initiatives to use for ongoing surveillance of the health of USVI citizens and in depth analysis for understanding health disparities and how they can be reduced • Use results of analysis of surveillance data bases and other research activities to influence health policy in the USVI toward taking action to reduce health inequities. • Identify and deepen understanding of the complex intersection of community attitudes, resources and agencies and best strategies to tailor interventions to USVI culture to make reductions in health disparities

14. Research Education/Training Core • Goal • To promote UVI faculty and student, and VI health care professional and community partner participation in health disparities research through implementation of a program that incorporates training, mentoring, and enrichment.

15. NEXT STEPS • CERC through the Research Education and Training Core will continue • Research Training/Education projects supporting the development of UVI faculty, students and community participants in research projects designed to address specific health disparities in the USVI. • Solidify the presence of competent researchers in the Territory who understand the nature of the population and can initiate, adapt, or translate research and education activities to be congruent with the needs, culture and diversity of the population.

16. RESEARCH EDUCATION AND TRAINING CORE Specific Objectives 1. Enhance knowledge of minority health and health disparities among UVI faculty, VI health care professionals, and VI community partners 2. Increase opportunities for education/training in minority health and health disparities research for UVI faculty, VI health care professionals, and VI community partners 3. Facilitate UVI student participation in minority health and health disparities research and dissemination projects

17. RESEARCH EDUCATION AND TRAINING CORE • Strategies • Enhancement of knowledge of minority health disparities will be promulgated for UVI faculty, VI healthcare professionals and VI community partners through the design and implementation of a program of quarterly forums on subjects related to minority health and health disparities. • Increased capacity of Virgin Islands health care professionals and community partners to conduct research on minority health or health disparities through the design and implementation of a program of quarterly short courses on research design and implementation and the responsible conduct of research. These modules will be presented through a variety of distance teaching-learning modalities which proved to be successful in increasing capacity among UVI faculty during Phase I of the CERC.

18. NEXT STEPS COMMUNITY ENGAGEMENT AND OUTREACH CORE • Specific Aim 1: Establish innovative partnerships for promoting health and reducing health disparities throughout the U.S. Virgin Islands by: • 1a. Training Community HealthWorkers (CHW) to enhance the health promotion and disease prevention activities of the CEOC; and, • 1b. Engaging owners of barbershops, beauty and nail salons to host health promotion and disease prevention activities in these trusted environments.

19. COMMUNITY ENGAGEMENT AND OUTREACH CORE Specific Aim 2: Disseminate health promotion information to increase knowledge of health disparities and ways to identify, prevent, reduce or eliminatethem by: 2a. Further disseminating the health education toolkit developed by the Community Core; 2b. Developing additional health education toolkits targeting specific consumer groups (i.e., men, women, children, older adults).

20. COMMUNITY ENGAGEMENT AND OUTREACH CORE Specific Aim 3: Use a community based strategy (Concept Mapping) to identify and prioritize the relationships of social and environmental factors to men’s health, in order to inform activities related to Specific Aims 1 and 2; and to: • 3a. Implement a model for developing community-based and culturally sensitive educational approaches to increase understanding and awareness of men’s health in the U.S. Virgin Islands. • 3b. Inform the development of this model by identifying best practice and evidence-based interventions that can be replicated or modified for men in the U.S. Virgin Islands. • 3c. Train U.S. Virgin Islanders (i.e., health and human service providers, community stakeholders, researchers) to use this mixed method approach to inform healthcare, and health promotion/disease prevention activities.

21. Thank you