>> GOOD MORNING, EVERYONE.
I'M NORA VOLKOW, DIRECTOR OF
NATIONAL INSTITUTE ON DRUG
ABUSE.
IT'S A PLEASURE TO BE BY THE
SIDE OF MY COLLEAGUE AND FRIEND
DR. GEORGE KOOB WHO OF COURSE
NEEDS NO INTRODUCTION BUT HE'S
THE DIRECTOR OF THE NATIONAL
INSTITUTE OF ALCOHOL ABUSE AND
ALCOHOLISM.
SO FIRST OF ALL I WANT TO THANK
EVERYONE BOTH FROM THE COUNCIL
OF THE NATIONAL IN NATIONAL
INSTITUTE OF ALCOHOLISM AND DRUG
ABUSE FOR BEING HERE.
THIS IS AN OPPORTUNITY FOR
PEOPLE ON TWO COUNCILS TO GET
TOGETHER, IT'S AN EVENT THAT
ONLY HAPPENS ONE YEAR.
I LOOK FORWARD TO IT AND I'M
INTERESTED ON SEEING HOW COUNCIL
MEMBERS FROM THE NIAAA REACT TO
OUR SIDE AND THE OTHER WAY
AROUND, ADDICTION SAN ADDICTION.
BEFORE WE START I THINK IT IS
IMPORTANT FOR ALL OF US AS WE
DON'T NECESSARILY KNOW EACH
OTHER, TO INTRODUCE ONESELF.
>> GEORGE KOOB, DIRECTOR OF NIAA
>> TRISH, DEPUTY DIRECTOR AT
NIAA.
>> PHILIPPE MARMILLOT.
>> RHONDA JONES-WEBB, UNIVERSITY
OF MINNESOTA SCHOOL OF PUBLIC
HEALTH.
>> REGINA LABELLE, GEORGETOWN
UNIVERSITY, ADVISORY BOARD FOR
NIDA.
>> MICHAEL LEWIS, CITY
UNIVERSITY OF NEW YORK AND
HUNTER COLLEGE, NIAA COUNCIL.
>> UNIVERSITY SCHOOL OF
MEDICINE, NIDA COUNCIL.
>> HAIDEN HUSKAMP, DEPARTMENT OF
HEALTH CARE POLICY HARVARD
MEDICAL SCHOOL, NIAA COUNCIL.
>> SHELLY GREENFIELD, NIDA
COUNCIL.
>> GOOD MORNING, KATIE
WITKIEWITZ NIAA COUNCIL.
>> DANE MAYFIELD, UNIVERSITY OF
TEXAS AUSTIN.
>> ANNA ROSE CHILDRESS, NIDA
COUNCIL.
>> TINA CHAMBERS, UNIVERSITY OF
CALIFORNIA SAN DIEGO, NIAA
COUNCIL.
>> GOOD MORNING, KATE DEBURNY,
CONSULTANT, NIDA COUNCIL.
>> DAVID KAREKEN, INDIANA
UNIVERSITY SCHOOL OF MEDICINE.
>> COLUMBIA UNIVERSITY, NIDA
COUNCIL.
>> GOOD MORNING, BILL CLINE,
ASSOCIATE DIRECTOR OF BEHAVIORAL
RESEARCH NATIONAL CANCER
INSTITUTE.
>> SUSAN WEISS, NATIONAL
INSTITUTE ON DRUG ABUSE,
DIRECTOR OF EXTRAMURAL RESEARCH.
>> WILSON COMPTON, NATIONAL
INSTITUTE ON DRUG ABUSE.
>> GOOD MORNING, I'M GOING TO GO
INTO THE SCREENS IN THE CLOUD.
SO I'M GOING GIVE YOUR NAME AND
IF YOU CAN JUST SHOW AND SAY
HELLO SO WE CAN ALL RECOGNIZE
EACH OTHER.
DR. ASSAD MILLHOFFER.
I DON'T SEE -- I'M GOING TO THE
NEXT PERSON.
DR. NANCY BARNETT.
>> BROWN UNIVERSITY, NIAA
COUNCIL.
>> DR. RICHARD BOXER.
>> GOOD MORNING, UCLA MEDICAL
CENTER, NATIONAL CANCER ADVISORY
BOARD.
>> DR. ANDREW CAMERON.
>> HI, ANDREW CAMERON,
TRANSPLANT SURGEON JOHNS HOPKINS
ON THE COUNCIL.
>> DR. JOHN COMPTON.
>> JOHN COMPTON, CANCER CENTER,
CURRENT CHAIR FOR (INAUDIBLE)
REPORT.
>> DR. DEBRA CHASLER.
>> GOOD MORNING, BOSTON
UNIVERSITY, ON THE NIDA COUNCIL.
>> DR. CHARLES CHATKIN.
>> UNIVERSITY OF WASHINGTON,
NIDA COUNCIL.
>> DENNIS DEER.
HE'S NOT UP THERE.
HE'S NIDA COUNCIL.
DR. LUIS DIAZ?
>> YEAH, MEMORIAL
SLOAN-KETTERING, NCAB.
>> ISABELLE DURON.
I DON'T THINK SHE'S THERE.
ANIT NET KIN, NOT THERE.
HOWARD FINGERT.
>> HELLO, HOWARD FINGERT,
HEMATOLOGIST ONCOLOGIST, ONO
PHARMACEUTICALS, ON THE NCAB.
>> JULIE GRANT.
>> HELLO, NICE TO MEET YOU,
GENERAL PARTNER AT VENTURE FUND,
CANAAN, A SMALL START-UP BIOTECH
ONCOLOGY COMPANY, NCAB.
>> DR. HAIMY HAMBURGER.
>> NORTHWESTERN UNIVERSITY,
NATIONAL CANCER BOARD.
>> DR. KA TIBI.
I DON'T THINK SHE'S THERE.
DR. ANGELA LAIRD.
>> FLORIDA INTERNATIONAL
UNIVERSITY, NIDA COUNCIL.
>> DR. FRANCES LEVIN.
>> SHE'S NOT, THERE NIDA
COUNCIL.
DR. ANNA NAVAS-ACIEN.
>> GOOD MORNING, COLUMBIA
UNIVERSITY, HEALTH SCIENCES,
MEMBER OF THE NATIONAL CANCER
ADVISORY BOARD.
>> DR. ANDREW OSTROWSKI.
I DON'T THINK HE'S THERE.
HE'S NIDA COUNCIL.
DR. MELANIE OTT.
SHE'S NOT THERE.
DR. TRAVIS RYDER.
HE'S NIDA COUNCIL, HE'S NOT
THERE.
DR. FRED TABUNG.
>> HI, OHIO STATE UNIVERSITY,
COLLEGE OF MEDICINE AND
COMPREHENSIVE CANCER CENTER,
WITH THE NATIONAL CANCER
ADVISORY BOARD.
>> DR. VON ZASTROW.
>> UNIVERSITY OF CALIFORNIA, SAN
FRANCISCO.
>> NIDA COUNCIL.
>> I'M TERRITORIAL, I'M SORRY.
DR. MELISSA WELLS.
SHE'S NOT THERE.
SHE'S NIDA.
AND THEN WE HAVE DR. KAREN WINK
FIELD.
>> KAREN WINK FIELD, RADIATION
ONCOLOGIST VANDERBILT, NATIONAL
CANCER BOARD.
>> THANKS VERY MUCH.
ANYONE ELSE THAT WE MISSED?
IF NOT I THANK VERY MUCH FOR
YOUR WILLINGNESS TO BE PART OF
OUR COUNCILS AND BEING HERE
TODAY.
I'M GOING TO GIVE THE NIDA
DIRECTOR'S REPORT FOR CRAN FROM
OVER THERE IF THAT'S OKAY.
I GAVE A REPORT YESTERDAY AND
SAID IT'S A GREAT TIME TO
PREPARE BECAUSE IT FORCES ME TO
LOOK AT WHAT WE'VE DONE EVERY
FOUR MONTHS FOR COUNCIL, FOR
CRAN TO TRY TO IDENTIFY TOPICS
PARTICULARLY SALIENT NIDA AND
NIAAA, NOT WANTING TO DISCUSS
THINGS DISCUSSED YESTERDAY IN
NIDA COUNCIL.
NOT ALWAYS SUCCESSFUL BUT TRY TO
DO MY BEST.
WHAT I LIKE TO DO AT CRAN FIRST
OF ALL GET PERSPECTIVE OF
ANYTHING IN THE FIELD AND WE
HAVE BEEN WITHOUT A DIRECTOR OF
THE DIVISION OF THERAPEUTICS AND
MEDICAL CONSEQUENCES, THE MAIN
DIVISION AT NIDA, THAT HELPS
ACCELERATE DEVELOPMENT OF
THERAPEUTICS.
AND AFTER DR. RASMUSSEN LEFT,
AFTER A LENGTHY SEARCH, THE
DECISION BASICALLY BECAME CLEAR
THAT DR. MONTOYA WAS THE BEST
PERSON TO LEAD THAT EFFORT.
SO NOW HE HAS BEEN OFFICIALLY
APPOINTED, I THINK I HAVEN'T
SEEN HIM THIS MORNING BUT IF
HE'S NOT THERE WE LOOK FOR HIS
LEADERSHIP, WHICH HE HAS BEEN
CARRYING IT ALL ALONG, I WELCOME
AGAIN.
I ALWAYS SAY IT IS AN INCREDIBLE
OPPORTUNITY WE HAVE ABSOLUTELY
FOR PARTNERSHIP BETWEEN BOTH OF
OUR INSTITUTES, BECAUSE
MEDICATIONS AS WE MOVE AND MOVE
WE'RE MOVING TOWARDS MEDICATIONS
THAT ARE NOT SPECIFIC FOR ONE
DRUG BUT MEDICATIONS THAT TARGET
ADDICTION.
IT DOES NOT MAKE SENSE TO BECOME
REDUNDANT SO OPPORTUNITIES TO
MAXIMIZE INFRASTRUCTURE FOR BOTH
OF OUR INSTITUTES AND VICE
VERSA, THIS DIALOGUE IS CRUCIAL.
I WANT TO GIVE AN UPDATE OF
WHERE WE ARE IN TERMS OF THE
CONSUMPTION OF SUBSTANCES AMONG
TEENAGERS, HIGH SCHOOL STUDENTS,
AND THE REASON WHY I DO THINK
IT'S IMPORTANT IS WHILE ACTUALLY
THIS IS THE STAGE IN LIFE WHERE
TEENAGERS START TO EXPERIMENT
WITH DRUGS AND WHERE CAN YOU
START TO SEE INITIATION OF
CAREERS THAT CAN THEN LEAD TO
ESCALATION OF DRUG USE,
ADDICTION, OR IN SOME INSTANCES,
VERY SEVERE OUTCOMES FROM CON
CONSUMPTION OF THOSE DRUGS.
I'M NOT GOING INTO GREAT DETAIL
BECAUSE THE STORY CAN BE SAID IN
THIS VERY NICE SLIDE THAT SHOWS
ACTUALLY NOT THAT IT'S A NICE
SLIDE BUT THE RESULTS ARE
BEAUTIFUL.
EVERYTHING IS GREEN, THAT MEANS
GOING IN A GOOD DIRECTION.
SIGNIFICANT REDUCTION IN THE
CONSUMPTION OF SUBSTANCES FROM
THE YEAR PRIOR.
AND YOU CAN SEE IT FOR 8th,
10th, 12 GRADERS, IN
PARTICULAR CHANGES IN 12th
GRADERS ARE RELEVANT BECAUSE
THEY HAVE THE HIGHEST RATES OF
DRUG CONSUMPTION.
8th GRADERS CONSUMPTION IS
VERY LOW.
IT'S STRIKING THAT YOU SEE THE
REDUCTIONS IN DRUG USE ACROSS
ALL CATEGORIES OF DRUGS IN
12th GRADERS WHETHER IT IS
LEGAL OR ILLEGAL.
I HAVE PRESENTED THAT LAST YEAR
THAT ALSO WE HAVE SEEN FOR THE
PAST I WOULD SAY THREE OR FIVE
YEARS SIGNIFICANT REDUCTIONS IN
ALCOHOL CONSUMPTION AMONG
TEENAGERS THAT YOU CAN SEE IT
NOT JUST IN TERMS OF INITIATION
OF ALCOHOL DRINKING BUT
IMPORTANTLY IN THE PATTERNS OF
HARMFUL ALCOHOL CONSUMPTION.
ALSO NOTABLE IS WE'RE NOT SEEING
THE RISE IN CONSUMPTION OF
CANNABIS THAT WE SEE IN ADULTS
ACROSS ALL OF THE UNITED STATES.
FOR WHATEVER REASON, TEENAGERS
APPEAR TO BE PROTECTED.
NOW, WHY IS IT THAT I AM
HIGHLIGHTING THIS AS A VERY
IMPORTANT NEWS?
IT IS IMPORTANT BECAUSE WHEN THE
COVID PANDEMIC CAME AROUND WE
SAW DRAMATIC REDUCTION IN DRUG
CONSUMPTION AMONG TEENAGERS.
FOR MANY OF THE DRUGS THAT WERE
THE HIGHEST REDUCTIONS WE'VE
SEEN IN PATTERNS.
NATURAL EXPLANATION, LIKELY
CORRECT BECAUSE DRUG USE IN
TEENAGERS IS VERY MUCH SENSITIVE
TO PEER PRESSURE.
THE FACT THAT TEENAGERS WERE NOT
HAD THE OPPORTUNITIES OF
INTERACTING WITH ONE ANOTHER AS
SCHOOL GOES DOWN AND ACTIVITIES
WHERE THEY USED TO GATHER WERE
NO LONGER PRESENT, WHERE THEY
WERE STUDYING AT HOME, WHERE THE
PARENTS WERE OBSERVING THEIR
BEHAVIORS, WOULD MAKE IT MUCH
HARDER TO INITIATE AND TAKE
DRUGS.
INDEED THAT'S LIKELY TO HAVE
BEEN DRIVEN VERY IMPORTANT
FACTOR DRIVING THE VERY
SIGNIFICANT REDUCTION THAT WE'RE
OBSERVING DURING THE COVID
PANDEMIC.
OUR FEAR WAS THAT WHEN THE
SCHOOLS WILL OPEN UP, THEN THE
RELATIVE PREVALENCE AMONG
TEENAGERS WOULD GO TO PRE-COVID
LEVELS.
WE'VE BEEN MONITORING LAST YEAR
AND THIS YEAR TO SEE THAT
HAPPENS, IT HAS NOT HAPPENED,
WHICH AGAIN IS WHY I THINK IT IS
VERY GOOD NEWS.
AND YOU CAN SEE TO THE RIGHT
THAT INDEED I DO NOT KNOW IF YOU
CAN SEE MY POINTER, YOU CANNOT
SEE MY POINTER BUT MAYBE THIS
THING WORKS.
ANYWAY, SORRY, SORRY, YOU CAN
SEE TWO SLIDES HERE, BASICALLY
YOU CAN SEE HOW IT HAS STAYED
DOWN, HAS NOT GONE UP.
IN THE TOP PANEL IS PERCENT OF
STUDENTS REPORTING ILLICIT DRUG
USE IN THE PAST YEAR BY GREAT.
LOWER ONE IS DAILY USE OF
MARIJUANA BY GRADE.
MARIJUANA CARRIES THE WEIGHT IN
INDICATOR MEASURE OF ANY ILLICIT
SUBSTANCE, MOST REFLECTS
MARIJUANA, YOU CAN SEE
REDUCTION, STATE STABLE DESPITE
LEGALIZATION AND PROLIFERATION.
THAT IS NOTABLE.
WHAT ARE THE ISSUES THAT I DO
THINK IT'S IMPORTANT WE LOOK
INTO THE DATA, AS IT JUMPS AT MY
BRAIN, IN THE TABLE TO YOUR
LEFT.
ALCOHOL CONTINUES TO BE THE
NUMBER ONE DRUG USED BY
TEENAGERS.
AND THIS IS PREVALENCE PAST YEAR
IN THE 12th GRADERS, IN THE
PAST YEAR HAVE YOU USED ALCOHOL.
YOU CAN SEE EVEN THOUGH IT HAS
GONE DOWN THERE'S STILL A
SIGNIFICANT NUMBER OF TEENAGERS
THAT ARE CONSUMING ALCOHOL.
BUT THEN THE OTHER POINT THAT I
WANT TO MAKE YOU AWARE OF IS
CONSISTENTLY WHEN THIS TABLE IS
PRESENTED, IT'S ALCOHOL FOLLOWED
BY MARIJUANA.
NOW MARIJUANA HAS A COMPETITOR,
VAPING, ANY.
SECOND USE AFTER ALCOHOL AMONG
12th GRADERS IS MARIJUANA AND
ANY TYPE OF VAPING.
AND THIS IS SOMETHING THAT WE
HAVE SEEN EMERGE VERY, VERY
RAPIDLY IN FROM 2017 ONWARD,
TAKING EXTREMELY HIGH LEVELS
FORTUNATELY HAVE GONE DOWN,
STILL LEADING TO BEING THE
SECOND, ALONG WITH MARIJUANA,
MOST FREQUENTLY USED DRUG.
FOR VAPING NICOTINE, IT'S THE
MAIN ONE, THERE'S ALSO VAPING
FOR MARIJUANA, A WAY AT
DELIVERING NICOTINE AT HIGH
CONTENT FAST.
REPORTS SHOW VAPING NICOTINE
LEADS RAPIDLY TO ESCALATION INTO
NICOTINE DEPENDENCE AND THEN
INCREASING RISK FOR COMBUSTIBLE
TOBACCO WITH ALL OF ITS NEGATIVE
CONSEQUENCES.
WHAT ELSE JUMPS INTO MY BRAIN IS
WHERE I HAVE THE LITTLE STAR,
HALLUCINOGENS, BECAUSE I HAVE
BEEN IN NIDA SINCE 2003 AND HAVE
NEVER SEEN HALLUCINOGENS MAKE IT
TO THE TABLE AT THE TOP DRUGS
TEENAGERS PICK UP AND THAT HAS
CHANGED.
IT'S AMONG THE TEN TOP DRUGS
THAT TEENAGERS ARE USING, 12TH
GRADER, SOMETHING WE NEED TO
KEEP OUR EYE ON AND CERTAINLY
ONE OF THE FACTORS IS
HALLUCINOGENS HAVE BEEN IN THE
MEDIA IN THE INTEREST AND
BASICALLY THAT GENERATES
CURIOSITY.
TO THE RIGHT OF THAT TABLE YOU
SEE IN RED ALL OF THE
PSYCHOTHERAPEUTIC DRUGS, NOT
THAT THEY PER SE ARE AT HIGH
LEVELS, THEY ARE MUCH LOWER THAN
WHERE THEY ARE, FOR EXAMPLE
AMPHETAMINES 2.1%, NARCOTICS
OTHER THAN HEROIN ARE VERY LOW
REFLECTING OPIATE ANALGESICS.
AT ONE POINT VICODIN WAS 9%, AT
ONE POINT OXYCONTIN WAS 4.5
DOWN, DOWN DRAMATICALLY.
AMPHETAMINES AND TRANQUILIZER,
ADDERALL, OPIATE ANALGESICS, ONE
WAY FENTANYL IS GETTING INTO THE
UNITED STATES IS DISGUISED AS
ILLICITLY MANUFACTURED
PRESCRIPTION PILLS,
AMPHETAMINES, TRANQUILIZERS,
OPIOID ANALGESICS.
TO THE EXTENT THAT TEENAGERS GET
THEIR HANDS ON THOSE PILLS THAT
CAN LEAD WITH NO EXAGGERATION
ONE SINGLE PILL CAN LEAD TO A
STATE OF OVERDOSE, UNFORTUNATELY
WE'VE SEEN THOSE GOING UP.
HALLUCINOGENS, WHY IS IT THAT IT
IS SORT OF ACTUALLY IN
TEENAGERS, WHAT DOES IT TELL US
IN ADULTS?
IN GENERAL IT'S NOT LIKE THERE'S
A PARALLEL WHAT HAPPENS IN
ADOLESCENTS HAPPENS, MARIJUANA
IS GOING UP IN ADULTS, NOT
ADOLESCENTS.
IN TERMS OF THE LANDSCAPE OF TWO
PRODUCTS, NICOTINE VAPING AND
HALLUCINOGENS, VAPING HIGHER
AMONG TEENAGERS THAN ADULT
POPULATION BUT WE'RE SEEING
NICOTINE VAPING ACTUALLY ALSO
RISING.
NICOTINE VAPING AGAIN HAS THE
SAME PROBLEMS THAT WAS REPORTING
FOR ADOLESCENTS.
I HAVE TWO FIGURES THAT ARE
TAKEN FROM THE SAMHSA SURVEY.
I'M POINTING YOU DIRECTING YOUR
EYES TOWARDS WHAT CAUGHT MY
ATTENTION.
ALCOHOL NUMBER ONE AMONG ADULTS
IN SUBSTANCES.
THEN NUMBER TWO IN ADULTS
TOBACCO PROVIDES.
WE SEE MARIJUANA IS THIRD DRUG
AMONG ADULTS.
SO, HOW DOES IT -- THAT'S WHERE
WE ARE RIGHT NOW, AND
HALLUCINOGENS, 2.3 MILLION
PEOPLE THAT SAID THEY HAVE USED
HALLUCINOGENS IN THE PAST MONTH.
TO THE RIGHT ARE THE NEW
INITIATES EVERY YEAR, SOMETHING
THAT NIDA REPORTS ALSO.
WHAT CAUGHT MY EYE IS RELATIVE
RATIO BETWEEN NEW INITIATES AND
PREVALENCE IN THE PAST MONTH.
AND IN PARTICULAR, HALLUCINOGENS
CURRENTLY IN THE PAST MONTH
2.3 MILLION AMERICANS TAKING
HALLUCINOGENS, AND WE HAVE IN
THE PAST YEAR 1.4 MILLION
AMERICANS INITIATING
HALLUCINOGENS.
SO YOU SEE WHY THIS CAUGHT MY
ATTENTION.
THE NUMBER OF NEW INITIATES IS
ALMOST EQUATING TO PATH MONTH OF
USE WHICH BASICALLY IN MY BRAIN
AT LEAST IS AN INDICATOR OF THE
RATE OF RISE THAT WE'RE TO BE
EXPECTING.
SIMILARLY, THE OTHER ONE THAT
ATTRACT MY ATTENTION NOT AS
DRAMATICALLY BECAUSE HERE IT'S
MORE THAN 50% NEW INITIATES OF
THE TOTAL, AND THEN FOR VAPING
APPROXIMATELY 25% OF NEW
INITIATES FOR THE TOTAL.
SO WE'RE GETTING -- IF YOU SEE
RATIO VERSUS 23.5 YOU CAN SEE
ALSO WHY IN MY BRAIN THIS
INDICATES THAT THERE MAY BE
POTENTIALLY AN INDICATION OF A
RISE ON NICOTINE VAPING.
NOW, SO THIS IS WHERE WE ARE
WITH THE PANORAMA.
IN TERMS OF RESEARCH PROGRAMS
THAT ACTUALLY OBVIOUSLY ARE
EQUIVALENT VALUE FOR BOTH OF OUR
INSTITUTES AND FOR WHICH WE
BASICALLY BOTH INSTITUTES HAVE
BEEN WORKING SIDE BY SIDE
CLOSELY AT ALL LEVELS, OF COURSE
THE ABCD, WHICH HAS NOT BEEN
POSSIBLE WITHOUT SUPPORT FROM
THE NATIONAL INSTITUTE OF
ALCOHOL ABUSE AND ALCOHOLISM,
AND SORT OF CERTAINLY THE
LEADSHIP OF DR. GEORGE KOOB,
EIGHT YEARS AGO, THESE CHILDREN
9 TO 10 ARE NOW GETTING AT
ADOLESCENTS, AGE OF RISK FOR
INITIATION.
AND THAT DATA IS BECOMING
AVAILABLE.
I'M NOT GOING TO GO INTO IT
BECAUSE YOU'LL HEAR FROM DR.
GAYA DOWLING IN THE UPDATE FOR
THIS EXTREMELY SUCCESSFUL STUDY
AND FASCINATING STUDY.
IT WAS SO SUCCESSFUL IT INSPIRED
US TO SAY, WELL, WE MISSED
INFANCY AND CHILDHOOD, SO
INSPIRED BY ABC D WE STARTED THE
HBCD, DISCUSSING IT FOUR YEARS
AGO, AND WE STARTED SOME PILOTS
2 1/2 YEARS AGO, OFFICIAL
DELIVERRIVE GRANTS LAST YEAR,
2023.
AND THIS IS THE NETWORK.
JUST CONCEIVED IN A SIMILAR WAY
TO ABCD, INSTEAD OF RECRUITING 9
TO 10 YEAR OLDS IT WILL RETHE
VIEW INFANTS, THE OTHER ASPECT
THAT MADE THIS MORE CHALLENGING
WAS THE AIM TO RECRUIT 15% OF
WOMEN EXPOSED TO OPIOIDS THAT
NATURALLY ARE GOING TO ALSO VERY
LIKELY AS WE WILL SEE JUST BY
THE NATURE OF THE PREVALENCES BE
EXPOSED TO A WIDE VARIETY OF
OTHER SUBSTANCES INCLUDING
ALCOHOL AND MARIJUANA.
YOU ARE ALSO GOING TO BE HEARING
AN UPDATE FROM DR. KATHLEEN
COLE.
LET ME JUMP TO THE REPORT OF
OVERDOSE CRISIS.
YESTERDAY I WAS SO HAPPY,
DELIGHTED, LOOK, GUYS, IT'S THE
FIRST TIME I PRESENT THIS TABLE
WE SEE A REDUCTION.
COLUMN TO THE LEFT, ALL DRUGS,
IT'S IN GREEN, .49%, NOT A MAJOR
NUMBER BUT IT'S NOT INCREASE,
INCREASE, EVERY SINGLE MONTH
THERE'S INCREASE, I WAS EXCITED.
SOMEONE AT COUNCIL POINTED OUT
THERE ARE MANY CHALLENGES BUT AT
THE SAME TIME I TO NOT NEGATE
THE PLEASURE OF SEEING A GREEN
NUMBER.
IT'S DRIVEN REDUCTION, WE
CONTINUE TO SEE DRAMATIC
REDUCTION IN DEATHS FROM HEROIN,
SIGNIFICANT FROM OPIOID
ANALGESICS, NO DEATHS REALLY
THAT HAVE INCREASED FOR
METHADONE.
WE STILL SEE SIGNIFICANT
INCREASES IN MORTALITY FROM
FENTANYL, FROM COCAINE,
METHAMPHETAMINE.
COCAINE AND METHAMPHETAMINE
MOSTLY ARE ASSOCIATED WITH
COMBINATIONS OF THESE DRUGS,
STIMULANTS, WITH FENTANYL.
SO FENTANYL IS DRIVING REALLY
MANY, MANY OF THE CHALLENGES
THAT WE HAVE.
SO, BECAUSE OF THIS, BECAUSE
RECOGNITION ALSO THAT EVEN
THOUGH IT STARTED WITH PAIN
OPIOID OVERDOSE CRISIS AT THE
BEGINNING, IT'S NOW FAR FROM
THAT.
AND, YES, THE MAIN CULPRIT IS
FENTANYL.
THERE'S NO TWO WAYS AROUND IT.
BUT REALITY BEING SINCE THE
MAJORITY OF THE CASES OF
OVERDOSES CONTAIN MULTIPLE
DRUGS, AND BASICALLY EXACERBATES
DIFFICULTIES THAT CLINICIANS ARE
HAVING, FIRST RESPONDERS IN
REVERSING OVERDOSES ON ONE HAND
BUT ALSO MAKING INCREASINGLY
MORE COMPLEX TREATMENT OF PEOPLE
THAT HAVE AN OPIOID USE
DISORDER, BUT ALSO MAKING IT
MORE URGENT TO PROVIDE FOR
TREATMENT OF PEOPLE WITH
STIMULANT USE DISORDER BECAUSE
THE DRUGS THAT THEY BUY MAY BE
CONTAMINATED WITH FENTANYL.
WE MOVE REALLY TO TRY TO PUSH
THE FIELD TO FOCUS ON
INTERVENTIONS THAT WOULD BE
BENEFICIAL ACROSS A WIDE VARIETY
OF DRUGS.
AND, AGAIN, THE FENCE OF
ADDICTION WE KNOW AND SORT OF
WHETHER IT IS FROM GENETICS THAT
THE MOST SIGNIFICANT EXPLANATION
OF GENES FOR THE VARIANTS IF YOU
PUT ADDICTIONS OF ALL KIND IS
FOR A GENERAL ADDICTION.
IT DOESN'T MATTER THAT IT'S
ALCOHOL.
DOESN'T MATTER THAT IT'S
CANNABIS OR OPIOIDS.
IT'S A GENERAL ADDICTION FACTOR
THAT ACCOUNTS FOR MOST OF THE
VARIATION IN THAT POLYGENIC RISK
SCORE.
WHAT IT'S TELLING US WHAT DRUGS
YOU MAY END UP TAKING VERY MUCH
ARE LIKELY TO HAVE A BIG
INFLUENCE WHAT YOU CAN
ENCOUNTER.
YES, THERE ARE SPECIFIC GENES
THAT CAN DRIVE SPECIFIC
CANNABIS, SPECIFIC ALCOHOL,
SPECIFIC OPIOIDS, BUT THE
RELATIVE WEIGHT OF THOSE GENES
IS GENERAL ONE, MUCH MORE
RESTRICTED.
SIMILARLY WITH NEURAL IMAGING,
ACTUALLY WE HAVE MANY OTHERS
INCLUDING OUR LAB HAVE BEEN
SHOWING THAT CONSISTENTLY REALLY
THERE ARE ABSOLUTELY COMMON
SEQUENCES DISRUPTED IN A SIMILAR
WAY BETWEEN VARIOUS ADDICTIONS.
WE, WE KNOW FROM BIOLOGY IT DOES
MAKE SENSE TO TARGET COMMON
INTERVENTIONS FOR VARIOUS
SUBSTANCES.
WHAT ARE THE SORT OF THINGS THAT
HAVE ME VERY EXCITED BECAUSE OF
NOVELTY, BECAUSE OF THE
OPPORTUNITY THAT THEY CAN
TRANSFORM TREATMENT IS OF COURSE
NEUROMODULATION.
YOU PROBABLY HAVE HEARD ABOUT IT
A LOT, I'M NOT GOING INTO IT,
JUST TO SAY THAT IT'S NOT JUST
THAT WE'RE UNDERSTANDING ABOUT
HOW AREAS OF THE BRAIN CONNECT
WITH ONE ANOTHER AND HOW THEY
ARE IMPLICATED IN DIFFERENT
FUNCTIONAL PROCESSES, BUT THEN
ALLOW US TO TAKE A TAILORED
INTERVENTION TO THOSE, TO
ADDRESS THE BEHAVIORAL
DYSFUNCTIONS, BUT IT'S THE
OPPORTUNITY TO ALSO ADVANCE
TECHNOLOGY THAT CAN ALLOW US TO
NEUROMODULATE THE BRAIN IN WAYS
THAT ARE MUCH MORE PRECISE.
AND THAT'S I THINK -- SO WE HAVE
AT THE SAME TIME WE'RE GATHERING
THE DATA IN LARGE DATABASES THAT
CAN HELP US UNDERSTAND ALSO
TRAJECTORY, SO THAT'S A
FASCINATING AREA OF RESEARCH
WHERE I THINK IT'S GOING TO BE
REVOLUTIONIZING A LOT OF THE
PSYCHIATRIC DISEASES, AND MAY IN
FACT IN ONE DAY AND I THINK
THAT'S WHY WE HAVE TO -- I THINK
WE HAVE TO DARE TO IMAGINE, ONE
SOMEDAY -- DAY WE IMAGINE USING
IT FOR PREVENTION, CERTAIN
CHARACTERISTICS THAT MADE YOU
VULNERABLE TO IMPULSIVE ACTION
COULD HELP MODULATE SO YOU DON'T
ENCOUNTER RISK AND YOU MAXIMIZE
POTENTIAL BENEFITS.
ON THE MEDICATION, I MEAN,
CERTAINLY PSYCHEDELICS GENERATED
A LOT OF INTEREST.
IN MY BRAIN I LOVE THEM BECAUSE
IT OPENS UP THE WORLD OF THE
OPPORTUNITY OF WORKING WITH
NEUROPLASTICITY, ACCELERATING
NEUROPLASTICITY AND LINKING IT
WITH WHAT YOU WANT TO ACCELERATE
SO IT'S SORT OF CHANGING THE WAY
WE LOOK AT DRUGS.
I'M FASCINATED LIKE MANY OTHERS
BY GLP-1 RECEPTOR AGONIST,
REPORTS IN ANECDOTAL REPORTS,
STARTING TO CASE REPORTS IN
LITERATURE SAYING PEOPLE THAT
ARE ON OZEMPIC OR WAGOVY
BASICALLY DON'T HAVE THE NEED TO
ACTUALLY TAKE THESE DRUGS
ANYMORE, AND THE DATA COMING OUT
FROM ELECTRONIC RECORDS SHOWING
PEOPLE THAT ARE GIVEN THESE
MEDICATIONS FOR OBESITY OR
DIABETES ARE IMPROVING ON
SUBSTANCE USE DISORDER OUTCOMES.
THERE ARE CLINICAL TRIALS BOTH
IN THE ALCOHOL INSURE INSTITUTE
AND OURS TO DO RANDOMIZED
SELECTION TO DETERMINE ARE THERE
EFFECTIVE OR NOT, WHAT
CONDITIONS AND HOW TO USE THEM.
BUT IT IS VERY EXCITING TO SEE
THESE BECAUSE IF THEY DO WORK,
IF THEY ARE RANDOMIZED CLINICAL
TRIALS, DO WORK, THEN THIS CAN
BE BROUGHT INTO THE CLINIC
RELATIVELY FAST.
BECAUSE IT'S A NEW INDICATION AS
OPPOSED TO HAVING TO GO FROM
BEGINNING.
THE FINAL POINT I WANT TO MAKE,
I WANTED TO ACTUALLY HIGHLIGHT
IT BECAUSE I DO KNOW THAT
NATIONAL INSTITUTE OF ALCOHOL
ABUSE AND ALCOHOLISM HAS BEEN
VERY MUCH INVOLVED IN SOME OF
THE CHALLENGES THAT NATIVE
AMERICANS HAVE IN TERMS OF
ALCOHOLISM AND NEGATIVE
CONSEQUENCES, TO THEM AND THEIR
CHILDREN.
AND THIS IS A SPACE THAT OVERALL
AT THE NIH WE'VE NOT BEEN ABLE
TO PENETRATE.
IT'S A SPACE THAT IS VERY
UNFORTUNATE BECAUSE IT IS
HURTING THIS COMMUNITY.
SO ALL OF THE ADVANCES THAT WE
HAVE SCIENCE DON'T NECESSARILY
RESULT IN BENEFITS FOR
COMMUNITIES THAT ARE VERY, VERY
AFFLICTED BY ACTUALLY TREMENDOUS
HEALTH DISPARITIES.
SO FOR THE OVERDOSE CRISIS LOOK
AT THESE NUMBERS.
THAT'S WHY I SORT OF SAID IN MY
VIEW WHEN YOU HAVE NUMBERS LIKE
THIS YOU CANNOT NOT DO SOMETHING
THAT IS REALLY DIFFERENT FROM
WHAT WE'VE BEEN DOING BEFORE.
THE MORTALITY FROM OVERDOSES IS
DOUBLE IN NATIVE AMERICANS TO
THAT OF GENERAL POPULATION IN
THE UNITED STATES.
BLACK AMERICANS IT'S 50% HIGHER.
SO, ONE OF OUR PRIORITIES THAT
WE'RE LAUNCHING THIS YEAR IS
BASICALLY THE NATIVE COLLECTIVE
RESEARCH EFFORT TO ENHANCE
WELLNESS, LED BY DR. KATHY EPPS
IN PARTNERSHIP WITH ALL OF THE
INSTITUTES THAT HAVE BEEN
INVOLVED AS PART OF "HEAL" AND
THE IDEA IS VERY BOLD APPROACH
TO DO AN INVESTMENT ON TRIBES
AND NATIVE AMERICANS SERVING
ORGANIZATIONS TO ALLOW THEM TO
BE ABLE TO DO RESEARCH, TO
SELECT THE QUESTIONS THAT ARE
RELEVANT TO THEM, TO ACTUALLY
DEVELOP MODELS OF CARE THAT ARE
AKIN TO THEIR CULTURE.
THIS PROGRAM IS DIVIDED INTO
PHASES, FIRST TWO YEARS
APPROXIMATELY A TOTAL OF $25
MILLION, AND THEN THE LAST PHASE
2, IT WILL BE TO GIVE THE
OPPORTUNITY TO -- FOR THE
COMMUNITIES TO ORGANIZE
THEMSELVES INTO A RESEARCH
GROUPS GROUP DEPARTMENT, PARTNER
BETWEEN THEM, OR WITH
ORGANIZATIONS THAT CAN HELP
PROVIDE THEM WITH SUPPORT IN
ORDER TO BE ABLE TO BE PHASE 2 A
$240 MILLION INVESTMENT TO
EMPOWER NATIVE AMERICAN
COMMUNITIES TO DO RESEARCH.
AND THIS IS SORT OF SOMETHING
THAT I COULD NOT NOT SHOW YOU,
OH MY GOD, WHAT AM I SAYING?
THIS IS OVERDOSE MORTALITY BY
AGE.
AND IT TELLS YOU THAT PEOPLE
THAT ARE 35-44 YEARS OF AGE HAVE
THE HIGHEST MORTALITY.
SECOND HIGHEST MORTALITY 45-54,
STARTS TO BECOME REALLY
INTERESTING BECAUSE 45-54 IS NOT
A DEMOGRAPHIC WITH HIGH LEVELS
OF DRUG USE, 25-23, YES, BUT
LOOK AT 55 TO 64, VERY HIGH
LEVELS, HIGH LEVELS OF OVERDOSE
MORTALITY.
THEN COME DOWN, 65- 74 NOT AN
AGE PEOPLE ARE NECESSARILY
TAKING DRUGS THAT ARE GOING TO
KILL THEM, ILLICIT SUBSTANCES.
IN RED CIRCLES MORTALITY
INCREASING FROM THE YEAR BEFORE.
SO WE'RE SEEING, YES INCREASING
MORTALITY BETWEEN 45-54, 55-64,
65-74, AMONG THE OLDER
POPULATION.
AND EVEN THOUGH WE'RE STARTING
TO SEE IN THE 15-24 IT'S COMING
DOWN, 15-19 GOING UP.
WE'RE SEEING OUR OVERDOSE
MORTALITY IN GROUPS THAT DON'T
SEEK HEROIN AND FENTANYL, ISSUE
OF PSYCHOTHERAPEUTICS COMES TO
PLAY HIGHLIGHTING IMPORTANCE
WHAT IT IS OBVIOUS TO ALL OF US
BUT NOT NECESSARILY ENDORSING TO
THE NEXT LEVEL, IF WE TACKLE
OVERDOSE CRISIS WE CANNOT JUST
DEAL WITH TREATMENT FOR PEOPLE
WITH OPIOID USE DISORDER OR
OTHER SUBSTANCE USE DISORDER AND
HELP THEM RECOVER, WE HAVE TO DO
THAT BUT DEAL WITH PREVENTION,
CASCADES TO ADDRESS THE CRISIS
FROM PREVENTION, FROM PROVIDING
HARM REDUCTION PRACTICES FOR
THOSE ARE NOT READY FOR
TREATMENT TO PROVIDE FOR
TREATMENT, TO ACHIEVING
RECOVERY, AND THAT WHOLE CASCADE
IS AN AREA WE NEED TO INVEST
FURTHER RESEARCH BECAUSE WE HAVE
LIMITED RESEARCH ON HARM
REDUCTION PRACTICES, LIMITED
RESEARCH ALSO IN RECOVERY.
AND WITH THAT I WANT TO
ADVERTISE THAT NIDA IS TURNING
50 THIS TUESDAY, AND ALL OUR
WELCOME TO A CELEBRATION AT
THE -- THAT WILL HAPPEN FROM
FOUR TO SIX P.M. IN THE KENNEDY
CAUCUS ROOM IN RUSSELL SENATE
OFFICE BUILDING.
THANK YOU FOR YOUR ATTENTION.
>> SO, NORA, I THINK WE HAVE
TIME FOR QUESTIONS.
WE HAVE AT LEAST SIX MINUTES IF
WE WANT TO STAY ON SCHEDULE.
QUESTIONS FROM ANYONE?
I ALWAYS HAVE QUESTIONS.
WHAT ABOUT VAPING OF MARIJUANA,
IS THAT ALSO INCREASING?
I HEAR ANECDOTAL STORIES FROM
PEOPLE BUT IS THERE ANY METRIC
ON THAT WITH MONITORING?
>> WE ALSO HAVE THE METRIC IN
TEENAGERS, AND IT HAS GONE UP.
WHAT HAD HAPPENED WAS VAPING
OVERALL WHEN IT FIRST STARTED
WENT TO EXTREMELY HIGH LEVELS,
PREDOMINANTLY FAVORS.
WE STARTED TO SEE IT COMING DOWN
AND NICOTINE VAPING WENT UP, THC
VAPING CONTINUES TO GO UP.
STABILIZED SLOWLY.
IF YOU LOOK AT THE TABLE IT'S
AMONG THE TOP DRUGS.
SO IT IS NICOTINE VAPING, AND
THEN THE NEXT ONE WAS THC
VAPING.
SO IT IS AT HIGH LEVELS.
AMONG PEOPLE IT IS ALSO IN
ADULTS, I DON'T ACTUALLY RECALL
THE NUMBER IN TERMS OF THE
PREVALENCE RATES.
BUT IT IS SOMETHING THAT WE NEED
TO KEEP AN EYE ON BECAUSE THE
PROBLEM IS YOU'RE DELIVERING
EXTREMELY HIGH CONCENTRATIONS.
>> HOW DO YOU ACCOUNT FOR THE
LACK OF INCREASE IN CANNABIS USE
GIVEN MANY STATES HAVE LEGALIZED
RECREATIONAL USE OF CANNABIS AND
MEDICAL USE OF CANNABIS ALSO
AVAILABLE IN MANY STATES.
>> YEAH, NO, CERTAINLY WE HAVE
PREDICTED LEGALIZATION WOULD BE
ASSOCIATED WITH HIGHER RISK OF
CONSUMPTION.
BUT WE HAVEN'T SEEN IT.
I THINK THAT THE WAY THAT I
EXPLAIN IT IS IN THE CONTEXT OF
THE WHOLE LANDSCAPE OF DRUG USE
PATTERNS AMONG TEENAGERS.
ALL OF THEM HAVE BEEN GOING
DOWN.
NOT MARIJUANA USE WHICH IS
STABLE.
THERE'S SOMETHING THAT HAS
CHANGED IN THE PATTERN OF HOW
TEENAGERS ARE GETTING
REINFORCERS THAT HAS LED THEM TO
RELY LESS ON DRUGS THAT THEY DID
IN THE PAST.
CERTAINLY AT LEAST ON HIGH
SCHOOL STUDENTS.
AND THIS IS ALSO SURPRISING
BECAUSE WHAT WE DO KNOW IS
LEVELS OF ANXIETY, DEPRESSION
INCREASED AMONG TEENAGERS AND
SUICIDE.
SO IT'S NOTABLE DESPITE THAT THE
PATTERNS OF DRUG USE IN
TEENAGERS APPEARS TO GO DOWN.
SO IT IS ONE CAN SPECULATE AND
FROM THE BEGINNING WHEN WE
STARTED TO SEE, WAS JUST
THINKING ABOUT IT IN TERMS OF
OVERALL WHAT IS DRIVING
REDUCTION IN DRUG USE AMONG
TEENAGERS.
ONE OF THE THINGS IN MY BRAIN AT
THAT TIME WE'RE HAVING ALL OF
THESE CELL PHONE-BASED
TECHNOLOGIES THAT ALLOW
TEENAGERS TO INTERACT WITH ONE
ANOTHER, SOCIAL MEDIA.
WITHOUT NECESSARILY HAVING TO BE
WITH THE OTHER TEENAGERS.
AND STILL HAVE SOCIAL NEEDS MET.
BECAUSE OF THE PEER PRESSURE AND
LIKELIHOOD OF PEOPLE BEING
TOGETHER WHEN THEY START TO
INITIATE DRUG USE, THAT MAY
REDUCE IT.
INTERESTINGLY, THAT LESS OF AN
OPPORTUNITY FOR INTERACTION HAS
BEEN ALSO SPECULATED TO ACCOUNT
FOR SOME OF THE REASONS WHY YOU
SEE AN INCREASE IN THE
INTERNALIZING DISORDERS AMONG
TEENAGERS, THEY DON'T HAVE THE
OPPORTUNITY TO HAVE THE SOCIAL
SUPPORTS THAT ARE NECESSARY FOR
THEIR WELL-BEING.
IT'S SPECULATIVE BUT THIS COULD
BE ONE OF THE FACTOR.
INCREASINGLY OBVIOUSLY VIDEO
GAMING HAS BECOME A MAJOR
REINFORCER FOR TEENAGERS,
PARTICULARLY BOYS.
IF YOU HAVE THESE ALTERNATIVE
REINFORCERS AND YOU SEE
TEENAGERS LIKE THIS, THAT GIVES
YOU ENOUGH.
SO ABCD, THE HBCD, POISED TO BE
ABLE TO HELP US UNDERSTAND SOME
OF THOSE DYNAMICS, BECAUSE AT
THIS POINT IT'S JUST
SPECULATIVE.
ANA.
>> THANK YOU FOR THE INTERESTING
INFORMATION.
I WANTED TO ASK, YOU MENTIONED
ABOUT THE DEPRESSION THAT IS
GOING ON IN ADOLESCENTS.
I WAS WOUND -- WONDERING IF
HAVE YOU DATA CONNECTING VAPING
AND NICOTINE IN PARTICULAR WITH
DEPRESSION, IF IT'S USED AS A
WAY OF AUTOMEDICATION, TO HANDLE
DEPRESSION, IS THERE ANY
INFORMATION ON THAT CONNECTION?
>> YOU'RE ASKING ME -- IN MY
BRAIN I DON'T HAVE SOMETHING
CLEAR-CUT THAT I'VE SEEN OR PAID
ATTENTION TO.
BUT ONE CAN PREDICT IT'S THE
CASE BECAUSE THAT IS ACTUALLY
CERTAINLY MULTIPLE STUDIES SHOW
FOR SMOKING CIGARETTES,
NICOTINE, OR MARIJUANA OR OTHER
DRUGS, ONE OF THE FACTORS THAT
MAKES TEENAGERS AT RISK FOR
USING SUBSTANCES IS WHAT YOU
SAY, AUTOMEDICATION.
I WOULD BE SURPRISED THAT THIS
WOULD NOT BE THE CASE FOR
NICOTINE VAPING SINCE THIS IS
ACTUALLY A STABLE ROUTE OF
ADMINISTRATION OF NICOTINE.
IF YOU LOOK AT THE PREVALENCE
FOR TOBACCO SMOKING AMONG
TEENAGERS IT'S EXTREMELY,
EXTREMELY LOW.
NOW NICOTINE VAPING IS TAKING
OVER.
AS YOU KNOW OBVIOUSLY NICOTINE
HAS ANTI-DEPRESSANT EFFECT AND
CAN MAKE YOU FEEL BETTER.
I SUSPECT THAT'S THE CASE.
ON THE TOP OF MY BRAIN I DON'T
HAVE IT.
AND NOW IT'S A PLEASURE TO
INTRODUCE DR. GEORGE KOOB, WHO
DOES NOT NEED AN INTRODUCTION
BUT I STILL WANT TO INTRODUCE
YOU.
>> IT'S A PLEASURE TO BE HERE.
THANK YOU, NORA.
I WAS REFLECTING ON THE FACT
THIS IS MY 11th CRAN MEETING.
AND I THINK YOU ALL KNOW THAT
NORA AND I HAVE COLLABORATED
TOGETHER FOR YEARS BUT I LOOKED
IT UP TODAY, WE'VE ACTUALLY
PUBLISHED SINCE OUR FIRST CRAN
MEETING 30 PAPERS TOGETHER IN
PEER-REVIEWED JOURNALS.
SO, IT'S PRETTY AMAZING HOW WELL
CRAN IS WORKING FROM A PERSONAL
VIEWPOINT.
SO YOU KNOW ME, I'M INTO THAT
KIND OF THING.
S BEEN A PLEASURE WORKING WITH
NORA PARTICULARLY AT THE LAB
LEVEL, HERS IN NIAAA AND MINE AT
NIGHT -- NIDA, AND WITH
LORENZO, WE WORK TOGETHER.
WE ALSO IN A SENSE THE VOLKOV
LAB IS PART OF THE METAVERSE,
THOUGHT YOU SHOULD KNOW THAT
PROBABLY ONE OF THE MOST
PLEASURABLE THINGS I DO AT NIH
IS WORKING WITH YOUNG PEOPLE,
AND I THINK THE SAME GOES FOR
NORA.
THE OTHER THING I WANTED TO
MENTION WE'VE HAD A VERY GOOD
RELATIONSHIP WITH NCI OVER THE
YEARS AND I'LL SHOW A PIECE OF
DATA ABOUT THAT IN A LITTLE BIT.
BUT OUR DIVISION OF EPIDEMIOLOGY
AND PREVENTION RESEARCH HAS BEEN
WORKING WITH DAVID BARRAGEN,
BILL WILL TELL YOU ABOUT SOME OF
THIS, BUT IT REALLY HAS BEEN A
PLEASURE WORKING WITH NCI AND
SOME OF THE DATA THAT ARE COMING
OUT ARE A LITTLE BIT STUNNING.
SO THIS THING ALWAYS DECIDES NOT
TO MOVE FOR THE FIRST SLIDE.
HOW DO I GET IT TO MOVE?
ANYBODY GOT AN IDEA?
IT HAS A MIND OF ITS OWN.
I HAD THIS HAPPEN YESTERDAY.
SORRY, IT ALWAYS STICKS ON THE
FIRST ONE.
THANKS.
NORA TALKED ABOUT STATISTICS.
I WANT TO REMIND YOU DURING THE
LAST 20 YEARS, IT'S REALLY BEEN
A DRAMATIC INCREASE IN ANNUAL
DEATHS FROM EXCESSIVE ALCOHOL.
DURING THE PANDEMIC WE SAW 25%
INCREASE IN ALCOHOL ACTUALLY
MENTIONED ON DEATH CERTIFICATES
IN THE FIRST YEAR OF THE
PANDEMIC AND IT WENT UP ANOTHER
10% IN THE SECOND YEAR OF THE
PANDEMIC.
AND DIDN'T COME DOWN IN THE
THIRD YEAR OF THE PANDEMIC.
AND THERE'S A TALE TO THESE KIND
OF THINGS IS MY POINT.
AND THE CDC NOW ESTIMATES THAT
IF YOU CONSIDER EVERYTHING FROM
FALLING OFF LADDERS AND RUNNING
YOUR MOTORCYCLE INTO A WALL WHEN
INTOXICATED WE LOSE 180,000 PER
YEAR DUE TO ALCOHOL.
RALPH KINGS STONN REMIND ME
ALCOHOL RELATED FATALITIES
INCREASED IN 2021.
WE HAD A NICE DISCUSSION AT OUR
COUNCIL MEETING YESTERDAY FOR
NIAAA, I WANT TO TALK ABOUT
WOMEN'S HEALTH, OLDER ADULTS,
AND WHOLE PERSON HEALTH.
ALL THIS DOVETAILS EXACTLY WHERE
THE THEMES NORA WAS TALKING
ABOUT.
LET'S COVER WOMEN'S HEALTH
QUICKLY.
THERE'S A NUMBER OF TRENDS GOING
ON THAT I WANT TO EMPHASIZE.
FOR ALL AGE GROUPS, DIFFERENCES
BETWEEN FEMALES AND MALES IN THE
PREVALENCE OF DRINKING AND BINGE
DRINKING IS NARROWING, GOING ON
FOR SOME TIME.
I THINK CAN YOU SEE THIS
ILLUSTRATED IN THE SLIDE.
THAT STAR IS NOT A STAR FOR
STATISTICALLY SIGNIFICANT.
IT'S A STAR THE MESSAGE CHANGED
IN 2020.
SO THE DATA MIGHT NOT BE EXACTLY
COMPARABLE BUT YOU CAN SEE A
STRAIGHT LINE DECREASE IN
UNDERAGE DRINKING, THIS IS GOOD
NEWS.
THERE'S A LITTLE BAD NEWS TO
THIS, YOU'LL NOTICE THERE'S BEEN
COMPLETE CROSSOVER, AND NOW
FEMALES ARE BINGE DRINKING AND
DRINKING IN GENERAL MORE THAN
MALES FOR THE FIRST TIME IN THIS
AGE GROUP.
AND IT'S BEEN GOING ON NOW FOR
THREE YEARS.
I'LL SO DATA IN A MINUTE THIS IS
NOT JUST IN THIS YOUNG AGE
GROUP.
PEOPLE UNDER 21 DRINKING LESS
BUT DECLINES ARE BIGGER FOR
MALES THAN FEMALES.
AS A RESULT, FEMALES IN THIS AGE
GROUP ARE MORE LIKELY THAN MALES
TO DRINK AND BINGE DRINK EACH
MONTH.
A SIMILAR PATTERN FOR PEOPLE
18-25, SO AGAIN CONSISTENT WITH
WHAT NORA SHOWED IN ONE OF HER
LAST SLIDES WE'RE SEEING A SHIFT
TO THE 25-35 YEAR OLD GROUP IN
PEAK ALCOHOL CONSUMPTION NOW IN
THE UNITED STATES.
IT'S NOT THE 18-25 YEAR OLD
GROUP.
IT'S 25-34 YEAR OLD GROUP.
AND THIS IS SOMETHING THAT I
THINK, YOU KNOW, PROBABLY ABCD
CAN ALSO HELP INFORM US.
AND THEN DOWN THE LINE.
AND FOR ADULTS 26 AND OLDER
ALCOHOL USE IS INCREASING FOR
WOMEN BUT NOT FOR MEN.
WHY IS THIS IMPORTANT TO NIAAA?
WELL, THERE'S WHAT WE CALL RISK
SEVERITY PARADOX FOR WOMEN.
WOMEN TEND TO EXPERIENCE A RANGE
OF ALCOHOL-RELATED HARMS AT
LOWER DOSES OF ALCOHOL OVER
SHORTER PERIODS OF TIME THAN
MEN.
STUDIESING IS WOMEN ARE MORE
LIKELY TO EXPERIENCE HANGOVERS,
BLACKOUTS, LIVER DISEASE, BRAIN
ATROPHY, COGNITIVE DEFICITS,
CARDIOMYOPATHY, CERTAIN CANCERS.
WOMEN ALSO HAVE FASTER
PROGRESSION OF ALCOHOL USE
DISORDER IN SEVERITY,
TELESCOPING EFFECT WITH ALCOHOL.
LESS LIKELY THAN MEN TO RECEIVE
TREATMENT FOR ALCOHOL USE
DISORDER.
LESS LIKELY IN SCREENING AND
REFERRAL, LESS LIKELY TO GET A
BRIEF INTERVENTION, DECREASES IN
HOSPITAL VISITS AND DEATHSING
FOR WOMEN COMPARING TO MEN,
ALCOHOL USE IN PREGNANCY STILL
PREVALENT, IN THE "HEAL" STUDY
AND HBCD STUDY, YOU KNOW, WE'RE
UNDOUBTEDLY GOING TO BE PICKING
UP ALCOHOL IN THAT CONTEXT.
SO 11% OF PEOPLE REPORT PAST
MONTH DRINKING, PREGNANT PEOPLE,
REPORT PAST MONTH DRINKING AND
5% REPORT BINGE DRINKING.
UNFORTUNATELY, THIS IS ON US,
BECAUSE WE REALLY NEED TO GET
THE WORD OUT, WE DISCUSSED THIS
A LOT AT COUNCIL YESTERDAY, MUCH
OF THE INITIAL DRINKING IS
BECAUSE PEOPLE DON'T KNOW THEY
ARE PREGNANT.
AND SO, YOU KNOW, OUR ADVICE
THESE DAYS IS DON'T DRINK WHEN
YOU'RE PREGNANT, DON'T DRINK
WHEN YOU'RE THINKING ABOUT
GETTING PREGNANT.
AND WOMEN ARE TWICE AS LIKELY TO
DEVELOP ANXIETY DISORDERS, PTSD,
AND DEPRESSION WHICH CAN
MOTIVATE DRINKING TO COPE.
ON THAT LINE I WOULD LIKE TO
OFFER A SECOND POSSIBILITY,
NORA, THAT'S GOING TO HAPPEN.
AND CONTRIBUTE TO THIS SHIFT TO
OLDER AGE GROUPS, AND THAT IS
THAT SOME OF THESE, YOU KNOW,
ANXIETY AND MENTAL ILLNESS ON
THE PTSD AND DEPRESSION MAY TEND
LATER, WE MAY SEE NEGATIVE
REINFORCEMENT PIECE KICK IN AS
PEOPLE AGE.
AND KIND OF REVERSE BENEFITS WE
SEE.
I AGREE WITH NORA, THERE'S BEEN
A MOVEMENT IN ALCOHOL FIELD AND
WE CALL IT SOBER CURIOUS, AND
THEN THE CHALLENGE ONES, WHICH
ARE DRY JANUARY, DRY OCTOBER,
THESE ARE VERY POPULAR WITH
YOUNG PEOPLE.
IT'S ALL FOCUSED AROUND A
HEALTHIER LIFESTYLE.
I REALLY LIKE ONE OF THE
STATEMENTS IN THE SLIDE
YESTERDAY ABOUT THAT WE'RE
DESTIGMATIZING, YOU KNOW, THE
HARMS OF ALCOHOL MISUSE BUT ALSO
DESTIGMATIZING THE ABILITY OF
PEOPLE TO OPT OUT AND NOT DRINK
AT ALL, SOMETHING I WANT TO
SENSITIZE YOU ALL TO.
MY COUNCIL IS ALREADY
SENSITIZED.
THERE SHOULD NEVER BE RECEPTION
AT A MEDICAL MEETING OR ANY
PARTY WHERE NON-ALCOHOL
CONTAINING BEVERAGES ARE NOT
PROVIDED.
MY KOOB DOUBLE NEGATIVE, MY
MOTHER'S NOT HAPPY WITH THAT.
ALL RIGHT.
SHE WAS AN ENGLISH PROFESSOR.
ALL RIGHT.
SO WHAT ARE SOME THINGS WE'RE
DOING ABOUT RESEARCH ON WOMEN'S
HEALTH LIKE OTHER NIH, ALL OTHER
NIH INSTITUTES AT THIS POINT, SO
WE'RE SUPPORTING STUDIES OF SEX
DIFFERENCES IN NEUROBIOLOGICAL
MECHANISMS, UNDERLYING ALCOHOL
MISUSE INCLUDING IMPACT OF
TRAUMA, LOOKING AT UNDERSTANDING
NEUROBIOLOGY OF NEGATIVE
REINFORCEMENT DRINKING AS I JUST
TALKED ABOUT, DRINKING TO COPE,
MORE COMMON IN WOMEN WITH
ALCOHOL IN PARTICULAR.
WE'RE TRACKING GENDER
DIFFERENCES AND NORMS ACROSS THE
LIFESPAN, DEVELOPING
INTERVENTIONS FOR PREGNANT AND
POSTPARTUM WOMEN.
SOME OF OUR NEW ACTIVITIES
INCLUDE RELEASING MODELS OF
CONTINUUMS OF CARE INITIATIVE,
EMPHASIZING AREAS OF RESEARCH
FOR THE WHITE HOUSE INITIATIVE
ON WOMEN'S HEALTH RESEARCH.
WE JUST -- THIS JUST CAME OUT,
AN RFA ON THE MODEL CONTINUUMS
OF CARE INITIATIVE, GOAL OF THE
MCCI TO REDUCE PREVALENCE AND
IMPACT OF MULTI-MORBIDITY AMONG
RACIAL/ETHNIC MINORITY WOMEN AND
GIRLS OF REPRODUCTIVE AGE AT
RISK OF LIVING WITH MENTAL
HEALTH DISORDERS, SUBSTANCE USE
DISORDERS, COMMON CO-OCCURRING
PHYSICAL CONDITIONS.
AND THIS DOVETAILS INTO
SOMETHING I'LL TALK ABOUT TOWARD
THE END ABOUT A WHOLE BODY
APPROACH TO PREVENTION AND
TREATMENT.
AND SO USING IMPLEMENTATION
DISSEMINATION SCIENCE THE
INITIATIVE PROPOSES CONTINUUM OF
CARE APPROACH THAT INTEGRATES
PREVENTIVE HEALTH SERVICES,
PRIMARY CARE, BEHAVIORAL HEALTH,
INTEGRATIVE CARE, AND
CARDIOPULMONARY AND ENDOCRINE
SPECIAL SIS TO FULLY ADDRESS
HEALTH CARE NEEDS IN THIS
VULNERABLE GROUP.
AND THEN IN COORDINATION WITH
WHITE HOUSE INITIATIVE ON
WOMEN'S HEALTH RESEARCH, NIH
ISSUED A NOSI TO HIGHLIGHT OUR
INTEREST IN APPLICATIONS FOCUSED
ON DISEASES AND HELD CONDITIONS
THAT AFFECT WOMEN PREDOMINANTLY,
THAT PRESENT AND PROGRESS
DIFFERENTLY IN WOMEN, OR THAT
ARE FEMALE SPECIFIC AND SOME OF
OUR SPECIFIC RESEARCH INTERESTS
THAT WE IDENTIFIED ARE RESEARCH
FOCUSED ON MENTAL HEALTH OF
WOMEN INCLUDING ALCOHOL AND
OTHER SUBSTANCE USE DISORDERS,
RESEARCH ON HEALTH ISSUES THAT
AFFECT YOUNG WOMEN INCLUDING
ETIOLOGY PREVENTION AND
TREATMENT OF ALCOHOL USE MISUSE,
RESEARCH TO UNDERSTAND
MECHANISMS THROUGH WHICH COMMON
ENVIRONMENTAL FACTORS INFLUENCE
RESILIENCE IN DISEASE AMONG
WOMEN ACROSS THE LIFESPAN.
WHAT ABOUT OLDER HEALTH?
NORA TOUCHED ON THIS AS WELL.
WELL, THE SIZE OF THE POPULATION
AGE 65 IS GROWING RAPIDLY.
IN BOTH PERCENT AND NUMBER OF
OLDER DRINKERS INCREASING.
AND YOU CAN SEE TWO PANELS HERE.
ON THE LEFT-HAND SIDE PERCENTAGE
OF PEOPLE 65 WHO DRANK ALCOHOL
IN THE PAST MONTH INCREASED 15%
OVERALL FROM 2002 TO 2022,
THAT'S 20 YEARS.
INCREASE IN WOMEN THAT'S
DRAMATIC BUT NOT FOR MEN,
CONVERGENCE AND ALMOST PARITY OF
WOMEN DRINKING WITH MEN.
I'VE ALREADY GIVEN YOU ALL THE
BACKGROUND TO THAT.
IF YOU LOOK AT THE PERCENT
INCREASE IN NUMBER OF DRINKERS,
THE SAME PATTERN EVOLVES, NOT
QUITE AS DRAMATIC BUT YOU SEE
DUE TO RAPID INCREASE IN SIZE OF
THE POPULATION 65+ THE NUMBER OF
PEOPLE TWO DRINK ALCOHOL
INCREASED 91% IN THE LAST 20
YEARS.
SO, YOU KNOW, THIS POPULATION IS
ONLY GOING TO GET LARGER AND
LARGER.
AND, YOU KNOW, WHY ARE WE
CONCERNED IN WELL, SAME ISSUES.
BUT MORE DRAMATIC AND DIFFERENT.
HEALTH CONSEQUENCES OF ALCOHOL
TEND TO SHIFT FROM ACUTE CAUSES,
INJURIES, TO CHRONIC CAUSES.
CANCER, HEART DISEASE, WITH AGE.
OLDER ADULTS ARE MORE SENSITIVE
TO THE SEDATIVE EFFECTS OF
ALCOHOL.
THIS IS A BIG ONE, THAT SOUNDS
TRIVIAL BUT VERY IMPORTANT, TAKE
MORE MEDICATIONS THAT MAY
INTERACT WITH ALCOHOL, MORE
LIKELY TO HAVE PROBLEMS WITH
SLEEP, WHICH IS WORSENED BY
ALCOHOL.
TWO PLUS TWO EQUALS FIVE WHEN IT
COMES TO RESPIRATORY DEPRESSION
AND ALCOHOL AND THOSE DRUG
CLASSES.
MOST SLEEP MEDICATIONS ARE SAID
SEDATIVE HYPNOTICS, ALCOHOL
MISUSE ASSOCIATED WITH FASTER
COGNITIVE DECLINE AND MAY WORSEN
ALZHEIMER'S DISEASE AND OTHER
FORMS OF DEMENTIA.
SO, WE'VE BEEN ALSO WORKING WITH
THE NATIONAL INSTITUTE ON AGING.
THANKS TO THEIR GENEROUS
SUPPLEMENT PROGRAM THAT WE'VE
NOW BEEN PART OF FOR QUITE A FEW
YEARS.
AND WE'RE WORKING ON LOOKING AT
ALCOHOL EFFECTS ON THE BRAIN
AGING PROCESSES AND HOW ALCOHOL
INFLUENCES DEMENTIAS AND
ALZHEIMER'S DISEASE.
IT'S STILL AN OPEN QUESTION
WHETHER ALCOHOL PROMOTES THE
DEVELOPMENT OF ALZHEIMER'S
DISEASE, EXACERBATES ALZHEIMER'S
DISEASE, PROBABLY, BUT WE STILL
REALLY NEED A LOT MORE WORK IN
THIS DOMAIN.
SO, WE'RE WORKING ON COGNITIVE
DECLINE, BEHAVIORAL
CONSEQUENCES, FUNCTIONAL
IMPAIRMENT INCLUDING HIV ANOTHER
ALLOSTATIC LOAD ON THE SYSTEM,
ALCOHOL CONTRIBUTES TO
INFLAMMATION AND ASSOCIATED
HARMS IN OLDER ADULTS.
ADDITIONAL PRIORITIES INCLUES
BASIC TRANSLATIONAND AND
CLINICAL RESEARCH ON THE EFFECT
ON THE HEALTH SPAN OF OLDER
ADULTS.
AGE-RELATED DISEASES, IMPROVING
ALCOHOL SCREENING, PREVENTION,
AND TREATMENT FOR OLDER ADULTS.
I WANT TO MENTION THAT MY
DEPUTY, TRISH POWELL, IS ALWAYS
REMINDING ME THAT ALL THESE
ADVERTISEMENTS ABOUT JOIN, YOU
KNOW, THIS RETIREMENT COMMUNITY,
WE HAVE HAPPY HOUR EVERY NIGHT.
IT'S ALL YOU CAN DRINK.
WALL -- ALL YOU WANT TO DRINK.
IT'S A CULTURE WE HAVE TO
COUNTER IN THIS DOMAIN AS WELL,
NOT JUST PHYSIOLOGICAL PARTS.
SO, WHOLE PERSON HEALTH, YOU
PROBABLY HAVE SEEN THIS SLIDE
BEFORE FROM US BUT ALCOHOL
MISUSE IS ASSOCIATED WITH MORE
THAN 200 DISEASES AND
INJURY-RELATED CONDITIONS.
DRINKING ALCOHOL ACTUALLY
INCREASES CANCER RISK, AND THERE
ARE VERY -- VERY FEW AMERICANS
ARE AWARE OF THIS LINK.
AND EVEN A LITTLE ALCOHOL CAN
HARM YOUR HEALTH.
WHEN I SHOW THIS SLIDE IN PUBLIC
LECTURES, THIS IS THE ONE THAT
GETS THE MOST ATTENTION.
ALCOHOL IS ACTUALLY A
CARCINOGEN.
IN THE U.S. 5.6% OF CANCER CASES
AND .4% OF DEATHS FROM CANCER
CAN BE ATTRIBUTED TO ALCOHOL --
4% OF DEATHS FROM CANCER,
ALCOHOL IS THE THIRD LARGEST
CONTRIBUTOR TO ALL CANCER CASES
FOR WOMEN, FOURTH LARGEST FOR
MEN.
THE NUMBERS ARE IN THAT BULLET.
FOR WOMEN THE RISK OF BREAST
CANCER INCREASES 5 TO 15% WITH
EVEN A SINGLE STANDARD U.S.
SERVING OF ALCOHOL PER DAY.
THESE ARE EPIDEMIOLOGICAL
STUDIES, NOT CAUSAL, DIRECT
CAUSAL EVIDENCE, BUT IT'S
SOMETHING THAT PEOPLE SHOULD
KNOW ABOUT.
AND BREAST CANCER IS THE SECOND
LEADING CAUSE OF CANCER DEATH IN
WOMEN, ONLY LUNG CANCER KILLS
MORE WOMEN EACH YEAR.
AND UNFORTUNATELY AWARENESS OF
THE LINK BETWEEN ALCOHOL AND
CANCER IS LOW, SURVEY BY NCI
FOUND 70% OF PEOPLE ARE UNAWARE
ALCOHOL CAN CAUSE CANCER AND 10%
BELIEVE WINE REDUCES RISK OF
CANCER, A LOT OF PEOPLE THINK
WINE DOES EVERYTHING YOU WANT
FOR YOURSELF.
MOST OF THE DATA THAT WE'VE
ANALYZED, AARON WHITE HAS BEEN
DOING THIS FOR A NUMBER OF
YEARS, IT'S NOT THE WINE, IT'S
THE MEDITERRANEAN DIET.
IT'S NOT THE DRINK; IT'S THE
DRINKER.
ADDRESSING ALCOHOL IN THE
CONTEXT OF THE WHOLE PERSON
APPROACH, THAT LOOKS ACROSS
DIFFERENT DOMAINS OF HEALTH AND
INTEGRATES CARE OF
ALCOHOL-RELATED PROBLEMS CAN
IMPROVE PREVENTION DIAGNOSIS,
TREATMENT AND RECOVERY STRATEGY.
A COUPLE EXAMPLES.
INTEGRATING TREATMENT FOR
ALCOHOL USE DISORDER AND
ASSOCIATED DELIVER DISEASE HAS
POTENTIAL TO PROMOTE RECOVERY
FROM BOTH CONDITIONS AND ENHANCE
LONG-TERM SURVIVAL OF PATIENTS,
WE HAD A MEETING IN THIS ROOM A
COUPLE WEEKS AGO WITH THE LIVER
COMMUNITY AND IT WAS REALLY,
REALLY EYE OPENING AND
INFORMATIVE, AND THERE'S A GOOD
BIT OF INTEGRATION GOING ON NOW.
AND AT A MINIMUM YOU CAN THINK
OF LIVER DISEASE AS A VERY
POWERFUL BIOMARKER FOR A MAJOR
ALCOHOL PROBLEM.
ALCOHOL SCREENING, BRIEF
INTERVENTION, REFERRAL TO
TREATMENT IN PRIMARY CARE CAN
HELP IDENTIFY OTHER PHYSICAL AND
MENTAL HEALTH-RELATED ISSUES
AFFECTED BY ALCOHOL MISUSE
INCLUDING CO-USE OF OTHER DRUGS
OF ADDICTION.
I MIGHT POINT OUT THAT WE GET A
LOT OF SCREENING, 70% IN SOME
STUDIES, BUT BRIEF INTERVENTION
AND REVEAL TO TREATMENT IS
ABYSMAL.
I KNOW IT'S SIMILAR FOR OTHER
DRUGS OF ADDICTION.
AND OUR COLLABORATIVE RESEARCH
ACROSS WITH NIDA AND NCI AND
OTHERS HOLDS PROMISE FOR
UNDERSTANDING WHOLE BODY HEALTH,
WHOLE PERSON HEALTH, IMPROVING
SUBSTANCE MISUSE HEALTH-RELATED
CONSEQUENCES AND OUTCOMES.
I'M PROUD TO ANNOUNCE THAT WE
HAVE LAUNCHED OUR NEW STRATEGIC
PLAN AS OF THIS WEEK.
ADVANCING ALCOHOL RESEARCH TO
PROMOTE WHOLE PERSON HEALTH AND
WELL-BEING.
IT'S NOW LIVE ON OUR WEBSITE.
BY THE WAY, THERE'S A LOT OF
GREAT INFORMATION ON OUR
WEBSITE.
PLAN CHARTS A COURSE OVER THE
NEXT FIVE YEARS WHILE MAIN TAKES
FLEXIBILITY TO ADDRESS RESEARCH
OPPORTUNITIES AND URGENT PUBLIC
HEALTH NEEDS, THE PLAN IS A
LIVING DOCUMENT AND WE WELCOME
YOUR FEEDBACK.
THANK YOU TO ALL OF NIAAA STAFF
WHO CONTRIBUTED TO THE STRATEGIC
PLAN CONTENT INCLUDING COUNCIL
MEMBERS.
SPECIAL THANKS TO THE NIAAA
STRATEGIC PLAN TEAM, CARY,
LAURA, LAURA, BRIDGIT, AND
RACHEL.
BRIDGIT GAINED TEN YEARS TO HER
LIFE AFTER THIS WAS LAUNCHED,
YOU KNOW HOW CHALLENGING IT IS
TO PULL TOGETHER A STRATEGIC
PLAN.
SO THE TITLE IS THE FUTURE IS
NOW.
WHAT ARE WE FOCUSING ON?
THESE ARE COME OF THEM.
DIVERSITY, EQUITY, INCLUSION,
AND ACCESSIBILITY IN THE ALCOHOL
RESEARCH ENTERPRISE, WOMEN'S
HEALTH RESEARCH, AS I
ILLUSTRATED, WHOLE PERSON HEALTH
AND INTEGRATED HEALTH APPROACHES
AS I TALKED ABOUT, DATA SCIENCE,
ARTIFICIAL INTELLIGENCE, AND
DATA MANAGEMENT, TRANSLATION AND
BACK-TRANSLATION OF RESEARCH
FINDINGS, AND I EMPHASIZE BACK
TRANSLATION PART, HAPPY TO
DISCUSS THAT IF YOU'RE
INTERESTED.
SOCIAL DETERMINANTS OF HEALTH IN
THE CONTEXT OF RISK AND
RESILIENCE.
AND SOCIAL MEDIA IMPACT, NORA
WAS TALKING ABOUT THAT AND
SOCIAL MEDIA AS A TOOL FOR
INNOVATING INTERVENTIONS.
I'M GOING TO PREACH FOR ONE
MINUTE OR TWO BUT WE HAVE A LOT
OF RESOURCES OUT THERE THAT CAN
BE USED.
I'D LIKE ALL OF YOU, NOT JUST
THE NIAAA COUNCIL MEMBERS BUT I
WOULD APPRECIATE IT EVEN IF THE
NIDA COUNCIL MEMBERS WOULD ACT
AS AMBASSADORS TO LET PEOPLE
KNOW THAT THESE EXIST.
RETHINKING DRINKING, A POPULAR
WEBSITE FOR THE PUBLIC.
AND IT JUST BASICALLY HELPS YOU
EVALUATE YOUR RELATIONSHIP WITH
ALCOHOL.
COLLEGE AIM IS INFORMATION ON
PREVENTION APPROACHES, EFFECTIVE
IN COLLEGE ENVIRONMENTS.
IF YOU'RE SENDING A CHILD TO
COLLEGE, LOOK AT IT YOURSELF,
NOT JUST WAIT FOR THE UNIVERSITY
ADMINISTRATORS TO LOOK AT IT.
THE ALCOHOL TREATMENT NAVIGATOR
IS A RESOURCE THAT HELPS
INDIVIDUALS UNDERSTAND AND
SEARCH FOR TREATMENT OPTIONS
INCLUDING TELEHEALTH SERVICES,
ALSO INCLUDES PORTAL TO ASSIST
HEALTHCARE PROVIDERS IN MAKING
REFERRALS FOR THEIR PATIENTS.
MANY OF YOU KNOW YOU CAN FIND
OUT WHAT IS A SPECTRUM USE
DISORDER, YOU CAN FIND ABOUT
SPECTRUM OF TREATMENT AND TYPE
YOUR ZIP CODE IN THE LOCATOR AND
FIND A TREATMENT FACILITY.
AND LATEST ONE IS HEALTHCARE
PROFESSIONAL CORE RESOURCE, I
TOLD YOU ABOUT THIS BEFORE BUT
I'LL KEEP TELLING PEOPLE ABOUT
IT.
IT'S AN ONLINE EDUCATIONAL
RESOURCE THAT COVERS BASICS OF
WHAT EVERY HEALTH CARE
PROFESSIONAL SHOULD KNOW ABOUT
ALCOHOL, OR NEEDS TO KNOW ABOUT
ALCOHOL.
AND INCLUDING MANY WAYS THAT
ALCOHOL CAN IMPACT A PATIENT'S
HEALTH AND PROVIDE STRATEGIES
FOR ALCOHOL SCREENING AND
INTERVENTIONS.
AND IT SHOULD BE GOOD FOR
ANYBODY, FOR THAT MATTER.
IT WAS AIMED AT PRIMARY CARE
DOCS BUT ANY INDIVIDUAL WANTS TO
KNOW ANYTHING ABOUT ALCOHOL,
IT'S IN THERE.
IT'S DOCUMENTED.
AND REFERENCED.
WE HAVE A NEW WEBSITE, WEB
RESOURCES FOR YOUTH PREVENTION,
WE HAVE NIAAA FOR MIDDLE SCHOOL,
CONTAINS INTERACTIVE ACTIVITIES
TO HELP PARENTS, CAREGIVERS AND
TEACHERS INTRODUCE AND REINFORCE
KEY MESSAGES ABOUT PEER
PRESSURE, RESISTANCE, HOW
ALCOHOL AFFECTS YOUR HELP,
WARNING SIGNS AND SYMPTOMS,
WHERE TO GET HELP.
YOU CAN VISIT OUR WEBSITE, IT'S
SIMPLE.
NORA AND I WERE TALKING HOW GOOD
GOOGLE IS.
IF YOU TYPE NIAAA IN, YOU COME
TO OUR WEBSITE SO PLEASE USE IT.
THANK YOU VERY MUCH.
>> BESIDES THE MEDITERRANEAN
DIET IS THERE ANY OBJECTIVE
INFORMATION FROM OTHER REGIONS
WHERE LIFESPAN IS PROLONGED BLUE
ZONE SUCH AS OKINAWA FOR EXAMPLE
THAT PERHAPS PROVIDE BASIS FOR
FURTHER ACTIONABLE RESEARCH AND
INTERVENTION?
>> MOST OF THE DATA WE KNOW, THE
J-SHAPED CURVE DISAPPEARS WHEN
YOU ACCOUNT FOR OTHER VARIABLES
SUCH AS THE SICK ABSTINENT
INDIVIDUALS, NEVER ACCOUNTED
FOR.
IF YOU DO COMPARISON BETWEEN
MODERATE DRINKERS DEFINED BY
DIETARY GUIDELINES AND
INDIVIDUALS WHO WERE DRINKING
WINE, AND THOSE THAT ARE NOT, IN
THE MODERATE DRINKING CATEGORY,
THE J-SHAPED CURVE OR BENEFITS
OF ALCOHOL FALL, FALL OFF.
I HATE TO BREAK THE NEWS TO
EVERYBODY BUT THAT'S THE WAY IT
IS.
YOU KNOW, WHEN I GO OUT TO
DINNER WITH MY FELLOW I.C.
DIRECTORS THEY WAIT FOR ME TO
ORDER A GLASS OF WINE BECAUSE
THEY ARE TERRIFIED I'M GOING TO
SAY SOMETHING.
BUT I DO ORDER A GLASS OF WINE
OCCASIONALLY, ALL RIGHT?
SO I THINK, YOU KNOW, I'M SURE
THERE ARE HEALTH UN-BENEFITS TO
EATING FRITO CORN CHIPS BUT WHEN
SOMEBODY SERVES THEM AT A PARTY
WHAT AM I GOING TO DO, WHAT ARE
YOU GOING TO DO?
THERE'S REALLY NO HEALTH
BENEFITS TO ALCOHOL.
HONESTLY A REPORTING ASKED ME
RECENTLY, I DON'T SEE ANY WAY TO
STUDY THAT THAT'S REALLY WORTH
THE RESOURCES WHEN WE HAVE SO
MANY OTHER THINGS TO PAY
ATTENTION TO.
>> THANK YOU SO MUCH FOR THAT
PRESENTATION.
AND I JUST WANT TO THANK YOU FOR
THE COMPREHENSIVE PRESENTATION
ABOUT WOMEN'S HEALTH, WHICH IS,
YOU KNOW, I'M REALLY HAPPY TO
SEE.
IT'S VERY LONG OVERDUE.
AND I'M VERY HAPPY WITH THE
LEADERSHIP AT NIAAA TO LEAD THAT
FORWARD.
I-- THE ENORMITY OF THE PROBLEM
IS IT'S STUNNING, ACTUALLY.
AND I THINK THAT I WAS TRYING TO
THINK ABOUT, YOU KNOW, HOW WE
WIND OUR WAY OUT OF THIS, GIVEN
WHERE WE'VE GOTTEN TO AT THIS
POINT.
AND JUST A COUPLE THINGS.
YOU KNOW, WE TALK ABOUT THE
SOCIAL DETERMINANTS OF HEALTH, I
THINK W.H.O. TALKS ABOUT THE
COMMERCIAL DETERMINANTS OF
HEALTH AS WELL, AND I THINK THAT
MAKES IT VERY DIFFICULT FOR THE
SCIENTIFIC COMMUNITY, THE PUBLIC
HEALTH COMMUNITY, AND MEDICAL
COMMUNITY TO INTERVENE IN THE
WAYS WE WISH TO.
SO, I WAS THINKING ABOUT LIKE
WITH REGARD TO NIAAA AND
RESEARCH, AND I KNOW YOU'VE
TALKED ABOUT IMPLEMENTATION
RESEARCH, IMPLEMENTATION
SCIENCE.
I THINK SO MANY OF THESE FACTS
ARE SO NOT PART OF THE MEDICAL
COMMUNITY'S AWARENESS AND I
THINK IF THERE'S GOING TO BE ANY
CHANGE IT MEANS THAT EVERY
SINGLE TOUCH POINT IN THE
MEMORIAL COMMUNITY WITH EVERY
SINGLE WOMAN ACTUALLY NEEDS TO
INCLUDE THIS CONVERSATION.
BUT HOW DO YOU GET FROM HERE TO
THERE?
I WOULD SAY, YOU KNOW, SINCE
WE'RE TALKING ABOUT RESEARCH,
ANY TYPE OF RESEARCH NOW ABOUT
IMPLEMENTATION AS TO WHAT WOULD
BE SUCCESSFUL IN ASSISTING
MEDICAL PROFESSIONALS TO BE ABLE
TO HAVE THESE CONVERSATIONS EVEN
IF THEY ARE LITERALLY 60
SECONDS, 60-SECOND CONVERSATION
WITH A HANDOUT, NONE OF THAT
TAKES PLACE IN MOST MEDICAL
SETTINGS.
BUT, YOU KNOW, WOMEN AND GIRLS,
PEDIATRICIANS, OBSTETRICIANS,
PRIMARY CARE, MENTAL HEALTH
CLINICIANS, THESE CONVERSATIONS
DO NOT HAPPEN.
THE MEDICAL COMMUNITY IS NOT
AWARE OF THESE FACTS.
I WOULD JUST SAY THAT WE HAVE A
LOT TO DO.
IT'S ONLY WORSENED DURING THE
PANDEMIC AND POST-PANDEMIC.
THERE WAS TREMENDOUS AMOUNTS OF
DIRECT ADVERTISING TO PEOPLE,
YOU KNOW, AROUND THE STRESS OF
THE PANDEMIC.
WE'RE IN THE PLACE WE ARE, I CAN
ONLY SEE ONE STRATEGY IS THAT
THE MEDICAL COMMUNITY BE MUCH
MORE AWARE AND ABLE TO HAVE
THAT.
REGARDING RESEARCH I THINK, YOU
KNOW, IMPLEMENTATION SCIENCE
WHERE WE EXPERIMENT WITH HOW CAN
WE BEST -- WHAT ARE THE BEST
APPROACHES TO HAVING THIS HAPPEN
MIGHT BE ONE APPROACH, AMONG
OTHERS, I'M SURE.
SO I JUST AGAIN WANT TO THANK
YOU FOR THE WHOLE PERSON CONCEPT
AND FOR WOMEN'S HEALTH AND FOR
JUST LEADING THIS EFFORT WHICH
IS INCREDIBLY IMPORTANT FOR THE
HEALTH OF THE ENTIRE COMMUNITY.
>> THANKS.
YEAH, WE'RE WORKING ON IT.
WE DID DISCUSS THIS IN DETAIL
YESTERDAY, AND I DON'T WANT TO
TAKE UP THE TIME NOW, BUT OUR
COUNCIL IS WHERE YOU ARE.
DAVE?
REAL QUICK BECAUSE WE HAVE TO
MOVE ON.
>> I WAS STARING AT THE SLIDE,
WHERE WOMEN START TO SURPASS
MEN.
I WONDER IF THERE MIGHT BE
ANOTHER INTERPRETATION, IT
SEEMED MEN WERE DECLINING
FASTER, WOMEN WERE DECLINING
SLOWER RATHER THAN OUTRIGHT
INCREASE IN WOMEN, WONDER IF
THERE MIGHT BE SOCIOLOGIC BASIS
BEHIND THAT FOR FUTURE RESEARCH
REGARDING GENDER ROLES IN
SOCIETY OR SOMETHING.
>> YEAH, NO, I THINK IT'S A
VALID POINT.
BUT THE FACT OF THE MATTER IS
BECAUSE WOMEN HAVE MORE
PATHOLOGY ASSOCIATED WITH
ALCOHOL AND IF THEY ARE DRINKING
THE SAME AMOUNT AS MEN THEY CAN
GET HIGHER BLOOD ALCOHOL LEVELS,
IT REALLY IS A TOUCH POINT THAT
WE'RE STILL GOING TO HAVE TO
STRUGGLE WITH.
I'M GOING TO STOP.
>> I'LL JUST MAKE A POINT.
WE'VE BEEN FOCUSED ON THE SOCIAL
DETERMINANTS OF HEALTH, AS WE
SHOULD, BUT LISTENING TO YOUR
PRESENTATION, ALSO RELEVANT FOR
OTHERS, ANOTHER COMPONENT WE
SHOULD BE USING MORE IN
NARRATIVE AND TO A CERTAIN
EXTENT HOW DO WE DEAL WITH THE
ECONOMIC INTERESTS BEHIND THE
ALCOHOL INDUSTRY, COMMERCIAL
DETERMINANTS OF HEALTH.
I THINK THAT'S JUST AS WE SPEAK
OF SOCIAL DETERMINANTS OF HEALTH
WE NEED TO ACTUALLY START TO
DESCRIBE THESE MORE EXPLICITLY
BECAUSE THE HEALTH OF
INDIVIDUALS IS ACTUALLY BEING
DISRUPTED BY COMMERCIAL
INTERESTS.
SO YOU HAVE ABSOLUTELY OBESITY,
ALCOHOL, AND DRUGS.
AND SORT OF THIS GIGANTIC
INTEREST, AND TACKLES TO THE
CONCEPT OF HOW -- WHAT POLICIES
CAN BE CONSTRUCTIVE, SO THE
POINT THAT I THINK THAT SPEAKING
ABOUT COMMERCIAL DETERMINANTS OF
HEALTH CAN MAKE POLICY MOVE
TOWARDS BETTER REGULATION OF
PRODUCTS.
>> GIVEN MY INTERACTIONS WITH
THE BEVERAGE INDUSTRY I THINK
NORA, THIS IS A REALLY GOOD
IDEA.
BUT I'M GOING TO BE RIGHT BEHIND
YOU.
IT'S A JOKE BUT SERIOUSLY YOU
KNOW EXACTLY WHAT I'M TALKING
ABOUT.
>> YEAH.
>> WHEN WE INTERACT WITH THESE
ENTITIES, THERE'S ALWAYS, YOU
KNOW, A NUANCED WAY WE CAN DO IT
WITHOUT GETTING IN TROUBLE.
SO THAT'S WHAT I'M TRYING TO
THINK, HOW DO WE -- WE'RE WELL
AWARE, THE RESEARCH HAS BEEN
DONE, IF YOU INCREASE
ADVERTISING TOWARD YOUNG PEOPLE
THEY DRINK MORE.
WE KNOW IF YOU INCREASE
AVAILABILITY OF OUTLETS FOR
ALCOHOL, THEY DRINK MORE, IN
THAT PART OF THE TOWN.
I REMEMBER A GENTLEMAN TELLING
ME AFTER THE RIOTS IN LOS
ANGELES, 20 YEARS AGO, THAT THE
FIRST THING THAT CAME BACK
WASN'T THE SUPERMARKETS OR SMALL
STORES, CONVENIENCE STORES FOR
DELIVERING FOOD.
IT WAS THE LIQUOR STORES, OKAY?
YOU'RE ABSOLUTELY RIGHT IS WHAT
I'M SAYING BUT HOW DO WE ADDRESS
THIS IN A CURRENT POLITICAL
ATMOSPHERE AND POLARIZATIONS,
ALL THIS STUFF, IS GOING TO BE
TRICKY.
>> I AGREE.
IT'S NOT BLACK AND WHITE.
ONE WAY IT COULD BE HELPFUL IS
GET JUST LIKE YOU WERE SHOWING
AN ESTIMATE OF CANCERS BY
ALCOHOL, CANCERS FROM ALCOHOL,
WE HAVE CANCERS FROM SMOKING, WE
HAVE THE CANCERS FROM OBESITY.
THAT BECOMES A VERY NOTABLE
NUMBER, AND PEOPLE DON'T, AS YOU
SAY, DON'T KNOW.
I THINK THIS IS A WAY, WE DON'T
SAY ANYTHING, WE JUST LET IT BE
THERE AND BECOME VERY, VERY
EVIDENT BUT --
>> MAYBE BILL CAN HELP US.
>> YES, BILL, PLEASE.
I APOLOGIZE FOR ASKING THAT
QUESTION.
>> NO, IT'S AN IMPORTANT ONE AND
ONE WE SPEND A LOT OF TIME
THINKING ABOUT.
GOOD MORNING, EVERYBODY.
I'M BILL KLEIN, ASSOCIATE
DIRECTOR OF BEHAVIORAL RESEARCH
AT NCI, 30 TO 50% OF CANCERS ARE
ATTRIBUTABLE TO BEHAVIOR, MOST
STAFF ARE BEHAVIORAL SCIENTISTS,
SPEND TIME THINKING ABOUT HEALTH
BEHAVIOR AND CHANGE AND ETIOLOGY
OF BEHAVIOR.
SO, I ALSO WANT TO SAY TO GEORGE
THAT I'VE BEEN IN THE SAME BOAT
AT DINNER PARTIES.
EVERYONE LOOKING AT ME AND MY
COLLEAGUE DAVID BARRIGAN AS
WELL, OFTEN PEOPLE ARE LOOKING
TO US FIRST, IS IT OKAY TO GET A
GLASS OF WINE?
WE TALK ABOUT THE FACT ALL
THINGS ARE FINE IN MODERATION,
FRITO'S TOO, BUT WE SHOULDN'T GO
INTO IT THINKING ALCOHOL IS
HEALTHY AND SOMEHOW IS HELPING
US.
I'M AMAZED IT'S BEEN 11 YEARS
FOR CRAN, NCI HAS BEEN A WILLING
PARTICIPANT.
IT WAS AT FIRST BECAUSE WE DO
TOBACCO, WE HAVE THE LEADING
TOBACCO GROUP, TOBACCO RESEARCH
BRANCH, BUT IT'S NOT JUST ABOUT
TOBACCO.
WE'VE BEEN DOING WORK IN THE
ALCOHOL SPACE AND NOW ALSO
CANNABIS AS WELL.
SO WE'RE GETTING CLOSER TO
GETTING INVOLVED IN THE KINDS OF
DISCUSSIONS THAT NORA AND GEORGE
AND COLLEAGUES HAVE BEEN
INVOLVED IN OVER THE LAST MANY
YEARS.
I WANT TO DO WHAT NORA DID.
OH, I'M STUCK HERE NOW TOO.
OKAY, GOT IT.
I'LL START BY TALKING ABOUT
LEADERSHIP.
IT STARTS AT THE TOP.
YOU NEED TO HAVE LEADERS
SUPPORTIVE OF THE PRIORITIES,
AND THE MISSION.
AND WE'VE HAD THAT AT NCI OVER
THE LAST COUPLE YEARS.
FIRST WITH MONICA BERTAGNOLLI,
WHO IS NOW THE DIRECTOR OF NIH,
SHE WAS OUR DIRECTOR FOR LESS
THAN A YEAR BUT WAS SO TALENTED
SHE GOT SNATCHED UP, NOW HEADING
UP NIH.
AND FORTUNATELY SHE'S BEEN
REPLACED BY ANOTHER TALENTED
PERSON, KIM RATHMELL, WHO JOINED
AT THE END OF 2023, AN
ONCOLOGIST FROM VANDERBILT,
SHE'S SPENDING TIME GOING AROUND
DOING LISTENING TOURS, GETTING
SENSE OF WHAT THE INSTITUTE IS
UP TO AND WHAT ISSUES ARE.
AND I CAN EL YOU SHE'S A QUICK
STUDY, I'VE TALKED TO HER,
OTHERS HAVE AS WELL, ABOUT
IMPORTANCE OF BEHAVIORAL
SCIENCE, TOBACCO USE OF COURSE,
WHICH IS A MAJOR ISSUE FOR US AT
NCI.
SHE'S LISTENING AND SHE'S
SUPPORTIVE OF THE WORK WE'RE
DOING.
WE THINK THAT'S IMPORTANT.
I DO WANT TO NOTE THAT MONICA
WAS THE FIRST WOMAN NCI
DIRECTOR.
AFTER ALL THESE YEARS IT'S HARD
TO BELIEVE IT TOOK THAT LONG.
WE NOW HAVE KIM AS WELL, WHO IS
THE SECOND.
HOPEFULLY THERE WILL BE MANY
MORE.
OKAY.
ALSO I WANT TO MENTION A BIT
ABOUT LEADERSHIP OF OUR DIVISION
OF CANCER CONTROL AND POPULATION
SCIENCES NOW LED BY AS YOU CAN
SEE ON THE LEFT KATRINA GODDARD.
WE HAVE FOUR PROGRAMS IN OUR
DIVISION, ONE IS THE BEHAVIORAL
RESEARCH PROGRAM THAT I LEAD, WE
ALSO HAVE THREE OTHERS AND ALL
THREE OF MY PEER ASSOCIATE
DIRECTORS HAVE OR ARE ABOUT TO
RETIRE.
I HOPE IF YOU HAVE COLLEAGUES OR
YOU MIGHT BE INTERESTED IN A
MAJOR LEADERSHIP POSITION WITH
US, CAN YOU SEE THE HEALTHCARE
DELIVERY RESEARCH PROGRAM,
SURVEILLANCE RESEARCH PROGRAM,
AND EPIDEMIOLOGY AND GENOMICS,
ALL ARE ABOUT TO OPEN.
WHEN DR. GODDARD JOINED US ABOUT
2 1/2 YEARS AGO, WE STARTED A
STRATEGIC PLANNING PROCESS
WITHIN THE DIVISION AND FOCUSED
ON THESE CROSS-CUTTING AREAS OF
FOCUS.
I WANTED TO PUT THIS UP THERE,
IT'S IMPORTANT TO KNOW WHAT
WE'RE WORKING ON AND THINKING
ABOUT BUT ALSO BECAUSE ALL OF
THESE ARE RELEVANT TO THE KINDS
OF ISSUES WE'RE CONCERNED WITH
IN CRAN, ALSO THE ABCD STUDY.
RIGHT ACROSS THE BOARD.
EVEN CLIMATE CHANGE.
CLIMB CHANGES IS AFFECTING
GROWTH OF TOBACCO, RIGHT?
THAT'S JUST ONE OF MANY POSSIBLE
EXAMPLES.
THESE ARE SOME TOPICS THAT ARE
REALLY OCCUPYING OUR ATTENTION
OVER THE LAST COUPLE YEARS.
I WANT TO TELL YOU ABOUT WHAT
WE'VE BEEN DOING, OVER THE LAST
COUPLE OF YEARS, ALSO TELL YOU
ABOUT SOME OF OUR PRIORITIES.
FIRST OF ALL, SOME THINGS WE'VE
BEEN DOING INTERNALLY, THESE ARE
THINGS WE SPEND TIME TALKING
ABOUT IN HALLWAYS, BECAUSE WE'RE
NOW BACK IN THE OFFICE AGAIN.
IMAGINE.
AND REALLY ARE DRIVING MANY OF
THE TOPICS THAT LEAD TO FUNDING
INITIATIVES AND OTHER PROJECTS
THAT WE PRIORITIZE.
SO, FIRST OF ALL, YOU MIGHT KNOW
THAT THE DEPARTMENT OF HEALTH
AND HUMAN SERVICES HAS JUST COME
OUT WITH A FRA IMWORK TO SUPPORT
AND ACCELERATE SMOKING
CESSATION, NOT MANY
ADMINISTRATIONS ARE FOCUSED ON
TOBACCO.
JOE BIDEN HAS THE CANCER
MOONSHOT BACK WHEN HE WAS VICE
PRESIDENT, THAT HAS CONTINUE TO
BE A PRIORITY.
AND OUTGROWTH IS FOCUS ON
SMOKING CESSATION, SOMETHING
THAT'S A TRANSAGENCY
CROSS-AGENCY INITIATIVE TO
ADDRESS TOBACCO CESSATION, USING
ALL THE TOOLS WE HAVE AT OUR
DISPOSAL.
TWO PROGRAM DIRECTORS HAD
DETAILS, ONE OF OUR GOVERNMENT
TERMS TO ACKNOWLEDGE WHEN
SOMEONE SPENDS TIME AT ANOTHER
INSTITUTE OR ANOTHER AGENCY, SO
WE'VE HAD TWO PROGRAM DIRECTORS
SPEND A FAIR AMOUNT OF TIME OVER
THE LAST YEAR WITH THE OFFICE OF
ASSISTANT SECRETARY OF HEALTH
WORKING ON THIS IMPORTANT
INITIATIVE.
GEORGE MADE THE POINT THAT YOU
SHOULD BE USING OUR TOOLS, AS
WELL AS LOOKING FOR GRANT
FUNDING, I THINK THAT'S VERY
IMPORTANT TO ACKNOWLEDGE AND TO
EMPHASIZE.
AT NCI WE HAVE A LOT OF TOOLS,
ONE IS TOBACCO USE SUPPLEMENT
SURVEY, LINK TO U.S. CENSUS
WHICH PUTS OUT CURRENT
POPULATION SURVEY, NOT SAMPLES
OF A THOUSAND OR TWO THOUSAND,
WE'RE TALKING TENS OF THOUSANDS
AND MORE.
SO THAT'S AN IMPORTANT DATASET
WE MAKE PUBLICLY AVAILABLE.
WE'RE CONTINUING AS GEORGE
ALLUDED TO, TO GO OUT THERE AND
TALK ABOUT THIS LINK BETWEEN
ALCOHOL AND CANCER, AND MANY
CONTEXTS.
TWO PRESENTATIONS ARE COMING UP
AT ALCOHOL POLICY CONFERENCE
NEXT WEEK IN ARLINGTON, I'VE
BEEN TO THIS MEETING TWO OR
THREE TIMES AND THE FIRST TIME I
WENT CANCER WAS NOWHERE IN THE
PROGRAM.
NOW IT'S ALL OVER THE PROGRAM.
SO IT'S CLEAR THAT IT'S REALLY
HAVING AN IMPACT IN THE POLICY
SPACE.
AND THEN WCC, WORLD CANCER
CONGRESS, AND I WANT TO MENTION
AS LONG AS THAT'S UP THERE THE
LAST TIME I WENT TO THE WORLD
CANCER CONGRESS AT THEIR
COCKTAIL RECEPTION THEY HAD
MOCKTAILS, RATHER THAN
COCKTAILS.
SO CLEARLY THIS UNDERSTANDING OF
ALCOHOL AND CANCER IS PERVADING
PROFESSIONAL CONFERENCES AS
WELT.
HEALTH INFORMATION NATIONAL
TREND SURVEY, PUBLICLY AVAILABLE
DATASET TO OUR EXTRAMURAL
COMMUNITY, AND WE ADD NEW ITEMS
TO IT ALL THE TIME THAT
ACKNOWLEDGE NEW AREAS, NEW
PRIORITIES, AND ONE OF THEM IS
CANNABIS WHICH I'LL TALK ABOUT
IN A BIT.
YOU CAN SEE SOME ITEMS, TOPICS
IN THE MOST RECENT
ADMINISTRATION.
CURRENT SURVEY IN THE FIELD,
MORE INFORMATION ABOUT ATTITUDES
AND ORIENTATION TOWARDS
CANNABIS.
WE'VE BEEN WORKING WITH THE
FRENCH NATIONAL CANCER
INSTITUTE, INTERESTED IN SOME
SAME ISSUES WE ARE, TOBACCO,
ALCOHOL, CANNABIS, AND WE'RE
FINDING THAT SOME OF THEIR
APPROACHES ARE USEFUL WHEN WE
THINK ABOUT WHAT WE SHOULD BE
DOING IN THE U.S.
AND VICE VERSA.
THEY ARE VERY INTERESTED IN
CO-MORBIDITIES SUCH AS MENTAL
HEALTH CONDITIONS, SUBSTANCE USE
DISORDERS.
AND THE PROFILE LOOKS DIFFERENT
IN FRANCE THAN HERE WHICH MEANS
WE CAN LEARN FROM EACH OTHER.
YOU MIGHT BE FAMILIAR CAN THE
SMOKEFREE SITE, WE'VE HAD A
COUPLE SMALL PROJECTS TO FOCUS
ON SPECIFIC POPULATIONS, ONE OF
WHICH JUST CAME OUT LAST YEAR,
SMOKEFREENATIVE FOCUSING ON
AMERICAN INDIAN AND ALASKA
NATIVE.
AND FINALLY WE HAVE A RECENT
PROGRAM ANNOUNCEMENT TO THINK
ABOUT HOW TOBACCO POLICIES HAVE
DIFFERENTIAL IMPACT ON
DIFFERENTIAL POPULATIONS THAT
LED TO A NUMBER OF EXCITING
PROJECTS, WE BROUGHT P.I.s
TOGETHER, AND WE GOT THEM TO
TALK ABOUT THEIR PROJECTS IN A
RECENT MEETING, THAT'S STARTING
TO MAKE US THINK ABOUT HOW WE
SHOULD BE DOING THIS WORK NOT
JUST IN TOBACCO SPACE BUT IN
ALCOHOL AND CANNABIS AS WELL.
YOU CAN IMAGINE THAT MANY OF THE
NEW POLICIES REGARDING CANNABIS
MIGHT AFFECT TOBACCO USE AND
VICE VERSA, YOU CAN THROW
ALCOHOL IN THE MIX AS WELL,
REALLY CAPTURING OUR ATTENTION.
HERE ARE FUNDING OPPORTUNITIES
THAT WE PUT OUT RECENTLY, AND
THIS IS NOT NECESSARILY TO SAY,
HEY, APPLY, ALTHOUGH I HOPE YOU
DO AND YOUR COLLEAGUES DO BUT TO
IDENTIFY SOME OF OUR PRIORITIES.
SECOND ON THE LIST POPULATION
APPROACHES TO REDUCING
ALCOHOL-RELATED CANCER RISK,
THIS IS A WONDERFUL
COLLABORATION WITH NIAAA AND THE
IDEA IS TO BE ABLE TO PULL IN
APPLICATIONS THAT REALLY ADDRESS
THE PROBLEM GEORGE ALLUDED TO
WHICH IS THAT THE POPULATION IS
JUST NOT AWARE OF THIS LINK
BETWEEN ALCOHOL AND CANCER.
OBVIOUSLY POLICY APPROACHES
WOULD BE ONE APPROACH, BUT WE
ALSO NEED COMMUNICATION
APPROACHES, AND SO WE'RE HOPING
WE GET SOME APPLICATIONS THAT
ADDRESS THAT ISSUE.
FURTHER DOWN ON THE SLIDE YOU'LL
SEE RECENTLY EXPIRED FUNDING
OPPORTUNITIES.
FIRST ON TOP ADVANCING
ADOLESCENT TOBACCO CESSATION
INTERVENTION RESEARCH, IS REALLY
KEY.
I THINK YOU'LL PROBABLY GLEAN
THIS FROM ALL OF THE WORK THAT
NORA HAS DONE AND OTHERS AT
NIDA, ADOLESCENTS ARE JUST NOT
THE SAME AS ADULTS.
THEY ARE ALIENS, RIGHT?
THEIR BRAINS ARE IN A DIFFERENT
STATE, BRAINS STILL DEVELOPING.
WE KNOW RESEARCH BEHIND THAT.
BUT OF COURSE THE IMPLICATION
THEY ARE NOT GOING TO BE
RESPONSIVE TO THE SAME
APPROACHES WITH ADULTS TO STOP
USING TOBACCO.
AND THEY ARE NOT SMOKING
CIGARETTES MUCH ANYMORE EITHER,
AS NORA ALLUDED TO.
MOST OF THE DATA POINT TOWARDS
VAPING AND OTHER PRODUCTS.
WE HAVE A VERY SMALL LITERATURE
THAT ADDRESSES CESSATION IN THIS
POPULATION WHEN IT COMES TO
VAPING, SO WE PUT OUT AN RFA IN
THIS AREA, GOT LOTS OF GREAT
APPLICATIONS, WE'RE WORKING
THROUGH THEM RIGHT NOW TO DECIDE
WHAT TO FUND.
I THINK THAT'S GOING TO ADVANCE
THIS AREA IN WAYS THAT ARE VERY
IMPORTANT.
SECOND ONE DOWN ON THE RECENTLY
EXPIRED LIST, PUBLIC HEALTH
COMMUNICATION MESSAGING ABOUT
THE CONTINUUM OF RISK FOR
TOBACCO PRODUCTS, A LIGHTNING
BOLT ISSUE.
THIS IS REALLY GALVANIZING THE
PUBLIC HEALTH COMMUNITY, THE
QUESTION OF CONTINUUM OF RISK,
IS ALL TOBACCO BAD, ALL NICOTINE
BAD OR SHOULD WE THINK OF
CONTINUUM OF RISK WHERE
COMBUSTIBLE CIGARETTES ARE BAD
AND OTHER PRODUCTS ARE ALSO BAD
BUT LESS BAD.
THE PUBLIC HEALTH COMMUNITY HAS
BEEN ENGAGED IN WAYS THAT CAUSED
FIST FIGHTS AT CONFERENCES, THIS
IS REALLY A HOT ISSUE.
AND SO FOOD AND DRUG
ADMINISTRATION, CENTER FOR
TOBACCO PRODUCTS, IS NOW ENGAGED
IN TRYING TO UNDERSTAND HOW WE
SHOULD COMMUNICATE ABOUT THE
CONTINUUM OF RISK TO THE
AMERICAN POPULATION, IN WAYS
THAT DON'T GET ADOLESCENTS TO
START USING THESE PRODUCTS BUT
POTENTIALLY POSITION THE
PRODUCTS AS CESSATION METHOD FOR
ADULTS, A TRICKY NEED TOLL --
NEEDLE TO THREAD.
FDA PROVIDES FUNDING BUT WE DO
THE PEER REVIEW AND MANAGEMENT
OF GRANTS THROUGH OFFICE OF
DISEASE PREVENTION AND MANY
OTHER INSTITUTES AROUND NIH.
SO, HERE I WANT TO TELL YOU
ABOUT OUR HALLWAY CONVERSATIONS,
THINGS THAT ENGAGE US ON A DAILY
BASIS AND THINK ABOUT WHAT'S
COMING NEXT.
I'LL START WITH TOBACCO.
YOU ARE FAMILIAR WITH THE FACT
THAT FDA PUT FORWARD A PRODUCT
STANDARD FOR MENTHOL ESSENTIALLY
BANNING MENTHOL, A MAJOR GAME
CHANGER WITH REGARD TO TOBACCO
USE BECAUSE MENTHOL HAS BEEN
SHOWN TO IMPEDE ABILITY TO STOP
SMOKING.
IT SOFTENS THE REACTION TO
TOBACCO.
AND AS A RESULT OF THAT, IT
MAKES IT MORE DIFFICULT TO QUIT
AND MENTHOLATED CIGARETTES TEND
TO BE USED BY SOME POPULATIONS
MORE THAN OTHERS, PARTICULARLY
AFRICAN AMERICAN POPULATIONS,
THAT'S WHY THIS ISSUE IS VERY
IMPORTANT AND VERY HIGHLY
CONTESTED ISSUE.
AND YOU CAN TELL FROM HEADLINES
HERE IT'S BEEN AN ISSUE THAT HAS
BEEN FRAUGHT.
FDA PUSHED THIS FORWARD TO OMB
AND THE WHITE HOUSE, THERE'S
BEEN A DELAY IN TRYING TO
INSTITUTE IT BECAUSE OF MANY
SOCIAL AND CULTURAL ISSUES THAT
GO ALONG WITH THIS.
I EXPECT AT SOME POINT IT WILL
HAPPEN.
IT'S JUST INDISPUTABLE THAT IF
WE BAN MENTHOL, TOBACCO USE WILL
GO DOWN PARTICULARLY COMBUSTIBLE
CIGARETTES, AND SO WHETHER IT
HAPPENS, WHEN IT HAPPENS, I'M
PUTTING THAT OFF FOR NOW BUT I
THINK THE EVIDENCE IS CLEAR.
WE'RE NOT FOCUSING ON TRYING TO
COLLECT MORE EVIDENCE FOR THAT.
NOW WHERE THE FOCUS IS, GETTING
EVIDENCE FOR KINDS OF PROGRAMS
TO HELP PEOPLE WHO USE
MENTHOLATED CIGARETTES TO QUIT.
ALSO WANT TO MENTION SOMETHING
WE'VE BEEN INVOLVED IN OVER THE
YEARS, WHICH PROBABLY YOU'VE
SEEN IF YOU'VE WALKED INTO CVS
OR WALGREEN'S AND OTHER PLACES
THAT SELL TOBACCO.
THIS GOES BACK 20 YEARS,
DEPARTMENT OF JUSTICE AND
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, THEY ANNOUNCED A COURT
OUT THAT RESOLVED -- WELL, THIS
IS 2022, THIS RESOLUTION OF
CIVIL RECOLLECT TEARING LAWSUIT
FIRST BROUGHT AGAINST THE
TOBACCO COMPANIES.
AND WHAT THAT HAS LED TO,
THERE'S A LOT THAT HAPPENED IN
BETWEEN, THE SIGNS NOW AT POINT
OF SALE ABOUT IMPACT OF TOBACCO.
OUR STAFF HELPED DEVELOP THESE
MESSAGES AND COLLECT SOME DATA
SUPPORTING THEIR EFFICACY.
TURNING NOW TO CANNABIS, SO
WE'RE PLAYING IN THE CANNABIS
SPACE IN TWO WAYS.
OBVIOUSLY WE'RE INTERESTED IN
UPTAKE OF CANNABIS AND USE OF
CANNABIS AT THE POPULATION LEVEL
AND WE'RE CONCERNED ABOUT THE
EFFECTS OF CANNABIS SMOKE IN THE
SAME WAY WE'RE CONCERNED ABOUT
TOBACCO SMOKE AND EFFECTS ON
LUNG DISEASE, POTENTIALLY
CANCER.
THAT'S ONE PIECE.
THEN WE ALSO ARE FOCUSED ON
CANNABIS IN TERMS OF PAIN
MANAGEMENT, FOR CANCER PATIENTS,
CANCER SURVIVORS.
AND SO WE'VE GOT A TRANSNCI
CANNABIS AND CANCER RESEARCH
INTEREST GROUP FOCUSING ON ON
BOTH PIECES AND EVERYTHING IN
BETWEEN, SO MUCH TO DO HERE, SO
MANY QUESTIONS THAT NEED TO BE
ASKED, SO MANY ISSUES THAT NEED
TO BE ADDRESSED.
AND WE HAVE A BIT OF PLAYBOOK
WITH REGARD TO TOBACCO BUT THAT
PLAYBOOK DOESN'T SEEM TO WORK
QUITE AS WELL FOR CANNABIS.
THAT'S TRUE FOR ALCOHOL AS WELL.
WE NEED TO DEVELOP A NEW PLAY
BOOKER THAT LEVER AGES LESSONED
LEARNED BUT DOESN'T THINK
EVERYTHING IS GOING TO
TRANSLATE.
A NATIONAL ACADEMIES RECORD IN
2018, NOW A NEW ONE IN 2024, AN
UPDATE, AND WE'VE CONTRIBUTED,
FOCUSED ON LANDSCAPE VIEW OF
EFFECTS OF CANNABIS AND WHAT
SOME POLICY IMPLICATIONS MIGHT
LOOK LIKE, SOMETHING TO LOOK OUT
FOR.
MOVING TO ALCOHOL AND CANCER
YOU'VE HEARD ME TALK AT THIS
MEETING AND GEORGE AS WELL TALK
ABOUT THIS LINK, WORKSHOPS AND
SURVEYS, PUBLISHED THOSE DATA,
THANK YOU, GEORGE, FOR CITING
SOME DATA IN A SLIDE.
I WANT TO POINT OUT NEW THINGS
THAT WE'RE FOCUSING ON.
FIRST OF ALL WE HAVE THIS NEW
PROJECT CALLED OPTICS, PROMOTING
HEALTHY LIFESTYLES TO OPTIMIZE
CANCER SURVIVORSHIP.
I'M NOT THE ACRONYM PERSON IN MY
PROGRAM, I'M SURROUNDED BY
COLLEAGUES MORE CREATIVE THAT
CAME UP WITH THIS ONE.
WE'RE LOOKING AT CANCER CENTERS
TO SEE HOW CANCER CENTERS ARE
ADDRESSING BEHAVIORAL RISK
FACTORS FOR CANCER.
YOU WOULD IMAGINE, FOR EXAMPLE,
THAT CANCER CENTERS WOULD HAVE
WELL-DEVELOPED TOBACCO CESSATION
PROGRAMS AS PART OF THEIR
CLINICAL PRACTICE.
TURNS OUT UP UNTIL RECENTLY THAT
WAS NOT TRUE.
WE HAVE NOW FUNDED 52 CANCER
CENTERS TO BUILD UP TOBACCO
CESSATION PROGRAMS WITHIN THEIR
CANCER CENTERS.
THAT WAS A TERMINAL GRANT SO
WE'RE HOPING THERE'S SOME
SUSTAINABILITY THERE BUT THINK
IT'S IMPORTANT TO MAKE THOSE
INVESTMENTS.
NOW WE'RE WORKING WITH A
COLLEAGUE AT MEMORIAL
SLOAN-KETTERING, JENNIFER HAY,
TO UNDERSTAND HOW ALCOHOL IS
BEING ADDRESSED IN CANCER
SETTINGS.
WE WERE JOKING BEFORE THE
MEETING THIS MORNING THAT
ALCOHOL IS OFTEN RECOMMENDED TO
CANCER SURVIVORS, CANCER
PATIENTS, AS A WAY TO RELAX, A
WAY TO GET AWAY THE DIAGNOSIS
AND DIFFICULTY OF MAKING HARD
DECISIONS, WE SEE PINK WASHING
HAPPENING NOW, WHERE THE
BEVERAGE INDUSTRY WILL TAKE
BEVERAGES AND MAKE THEM PINK
LIKE MIKE'S HARD PINK LEMONADE,
RIGHT?
AND PUT THE PINK RIBBON ON THEIR
PRODUCT AND SAY THEY ARE GOING
TO DONATE MONEY TO BREAST CANCER
RESEARCH.
THAT SOUNDS GREAT.
PROBLEM, YOU KNOW, THAT
PARTICULAR PRODUCT INCREASES
RISK OF BREAST CANCER, THERE'S
AN ISSUE THERE.
AND SO WE'RE INTERESTED IN
UNDERSTANDING HOW CANCER
SURVIVORS, CANCER PATIENTS, ARE
BEING INFORMED ABOUT THIS LINK
BETWEEN ALCOHOL AND CANCER.
I'LL ALSO MENTION THAT THERE ARE
TWO REPORTS THAT ARE BEING
DEVELOPED NOW ON THE EFFECTS OF
ALCOHOL AND NOT JUST ALCOHOL AND
CANCER BUT OTHER HEALTH ISSUES
AS WELL.
THERE'S NOW A CONGRESSIONALLY
MANDATED NATIONAL ACADEMIES
REVIEW OF EVIDENCE ON ALCOHOL
AND HEALTH WHICH WILL INFORM THE
NEXT SET OF DIETARY GUIDELINES
IN THE U.S.
BOY, THIS IS GOING TO BE AN
INTERESTING ONE BECAUSE ALCOHOL
IS OFTEN PUSHED A BIT TO THE
SIDE WITH THE U.S. DIETARY
GUIDELINES, MORE OF A FOCUS ON
THE PLATE THAN MAKING SURE
APPORTIONMENT OF FRUITS AND
MEATS AND VEGETABLES IS JUST
RIGHT.
ALCOHOL WILL BIG A BIG ROLE IN
THE NEXT GUIDELINES.
LOOK NORTH TO CANADA WHO CHANGED
TO SAY THERE'S NO AMOUNT OF
ALCOHOL THAT'S SAFE AND THAT
MODERATE CONSUMPTION IS NOW ONE
OR TWO DRINKS A WEEK AS OPPOSED
TO A DAY WHAT THEY HAVE BEEN
HERE IN THIS COUNTRY.
SORRY, YOU KNOW, BAD NEWS, AS
GEORGE SAID, NOT SOMETHING WE
WANT TO HEAR BUT IMPORTANT TO
FOLLOW THE SCIENCE.
FINALLY I'LL SAY WE'VE BEEN
INVOLVED IN SOME EFFORTS TO
ADDRESS ALCOHOL LABELING.
SO YOU MAY OR MAY NOT BE AWARE
THAT SEVERAL PROFESSIONAL
ASSOCIATIONS, MAYBE SOME YOU'RE
PART OF, INCLUDING AMERICAN
PUBLIC HEALTH ASSOCIATION,
PETITIONED DEPARTMENT OF
TREASURY TO CHANGE LABELS YOU
SEE ON ALCOHOLIC BEVERAGES THAT
INDICATE WHAT THE HEALTH
PROBLEMS ARE WITH ALCOHOL USE.
YOU KNOW, IF YOU TAKE A LOOK,
PROBABLY HAVEN'T LOOKED LATELY,
THEY ARE PRETTY VAGUE.
THEY DO MAKE SOME MENTION OF
PREGNANCY AND DWI AND OTHER
HEALTH EFFECTS, WHATEVER THAT
MEANS, RIGHT?
AND SO THAT PETITION WAS
SPECIFICALLY TARGETED TOWARDS
PUTTING SOMETHING ABOUT CANCER
ON THE LABELS BUT WHAT'S THE
EVIDENCE FOR DOING THAT, RIGHT?
SO, THE DEPARTMENT OF THE
TREASURY HAS THE ALCOHOL AND
TOBACCO TAX AND TRADE BUREAU
UNDER ITS AUSPICES, AND THAT'S
THE GROUP THAT ACTUALLY OVERSEES
THOSE LABELS WHICH IS A
DIFFERENT STORY THAN FDA
OVERSEEING LABELING ON TOBACCO,
COMPLETELY DIFFERENT SETUP.
AND THE TREASURELY DEPARTMENT,
THEY DON'T HAVE BEHAVIORAL
SCIENCE EXPERTS NECESSARILY WHO
CAN ADDRESS THIS QUESTION SO
THEY WENT TO THE SURGEON
GENERAL'S OFFICE WHO CAME TO US
AND TO OTHER INSTITUTES AND SAID
WHAT DO WE DO HERE?
AND SO WE'VE BEEN TALKING ABOUT
TRYING TO HELP THEM WITH THAT.
I'M NOT SURE WHAT THE OUTCOME
WILL BE BUT JUST KNOW THAT KIND
OF WORK IS HAPPENING.
SO, THESE DATA WON'T BE ANY
SURPRISE, DATA ON THE RIGHT ARE
CONSISTENT WITH WHAT YOU HEARD
IN THE PAST, ALCOHOL IS RELATED
TO MANY DIFFERENT CANCER TYPES,
BUT I DO WANT TO HIGHLIGHT
WHAT'S ON THE LEFT OF THE SLIDE,
NOW WE'RE STARTING TO ASK
ANOTHER QUESTION, AND IT'S A
DIFFERENT QUESTION, WHICH IS
WHAT HAPPENS WHEN YOU STOP
DRINKING ALCOHOL OR REDUCE
ALCOHOL, IN TERMS OF CANCER
RISK.
OFTEN YOU GET ON THESE RISK
CALCULATORS ONLINE, YOU CAN PLUG
IN RISK FACTORS AND IT TELLS
WHAT YOUR RISK IS OF A VARIETY
OF DISEASES.
SOME OF THOSE RISK CALCULATORS,
IF YOU CLICK ON A PARTICULAR
BEHAVIOR, IT WILL SHOW YOU HOW
YOUR RISK CAN GO DOWN IF YOU
CHANGE THAT BEHAVIOR.
AND SOMETIMES THE EVIDENCE FOR
THAT IS NOT NECESSARILY CLEAR.
THERE'S A LOT OF EPIDEMIOLOGIC
EVIDENCE THAT LINKS A PARTICULAR
BEHAVIOR TO THE DEVELOPMENT OF
HEALTH PROBLEM BUT THAT'S NOT
THE SAME EVIDENCE YOU NEWED TO
SHOW REDUCING USE OF THAT
PRODUCT OR CHANGING THAT
BEHAVIOR MAKES YOUR RISK GO
DOWN.
AND SO THIS WORKING GROUP IARC
CONCLUDES REDUCTION OR
CESSATIONS REDUCES RISK OF ORAL
AND ESOPHAGEAL BUT WE NEED MORE
DATA, BREAST AN COLORECTAL ARE
TOP OF THE LIST OF CANCER SITES
SO IF IT TURNS OUT REDUCING
ALCOHOL CONSUMPTION IN YOUR
40s, 50s, WHATEVER, REDUCES
YOUR BREAST CANCER RISK, THAT
WOULD BE KIND OF AN IMPORTANT
MESSAGE FOR THE U.S. PUBLIC,
RIGHT?
SO WE NEED MORE OF THOSE KINDS
OF DATA.
I'LL WRAP UP BY SAYING THAT WE
HAVE ALL THESE RESOURCES WHERE
ONE OF MY COLLEAGUES LIKES TO
SAY WE'RE NOT JUST AN ATM WITH
GRANT MONEY.
WE HAVE LOTS OF RESOURCES.
WE LIKE TO HELP OUR EXTRAMURAL
COMMUNITY GET WHERE THEY ARE
GOING AND HERE ARE SOME
EXAMPLES.
I'VE ALREADY MENTIONED MOST.
FOURTH ONE DOWN CLASSIFICATION
OF LAWS ASSOCIATED WITH SCHOOL
STUDENTS, CLASS, AGAIN A GREAT
ACRONYM THAT I DID NOT COME UP
WITH, AND WHAT THAT DOES IS
LOOKS AT POLICIES RELATED TO
OBESOGENIC OUTCOMES, SO VENDING
MACHINE USE IN SCHOOLS, PHYSICAL
ACTIVITY GUIDELINES, AND SO ON.
HOW ARE THOSE AFFECTED TO
DEVELOPMENT OF OBESITY?
GIVEN OBESITY IS CLIMBING REALLY
QUITE DRAMATICALLY, POTENTIALLY
COULD BE THE CALLS OF INCREASING
RATES OF COLORECTAL CANCER IN
YOUNG POPULATIONS, THIS IS
OBVIOUSLY A VERY IMPORTANT
QUESTION TO BE ADDRESSING.
WE HAVE A COUPLE OTHER TOOLS
THAT GET AT DIETARY ASSESSMENT,
AS YOU CAN SEE HERE, AND WE HAVE
A LIBRARY OF WEBINARS IN ALCOHOL
AND TOBACCO AND FUNDING
OPPORTUNITIES, I WOULD ENCOURAGE
YOU TO TAKE A LOOK AT THAT.
THE LAST THING AT NCI WE CARE
ABOUT OUR JUNIOR SCHOLARS AND WE
DO A LOT OF TRAINING.
OBVIOUSLY WE PROVIDE K AWARDS
AND F AWARDS, T AWARDS, TO
ACADEMIC MEDICAL CENTERS,
UNIVERSITIES AROUND THE COUNTRY.
WE ALSO DO A LOT OF OUR OWN
TRAINING INTERNALLY AND WITHIN
OUR OWN DIVISION WE'VE HAD
APPROXIMATELY 50 FELLOWS A YEAR
WORKING WITH US IN VARIOUS
MECHANISMS, AND YOU CAN SEE THEM
LISTED HERE.
I JUST WANT TO HIGHLIGHT ONE,
CANCER PREVENTION FELLOWSHIP
PROGRAM.
THIS IS REALLY A TREMENDOUS
OPPORTUNITY, FRANKLY IF I KNEW
ABOUT THIS WHEN A GRADUATE
STUDENT I MIGHT HAVE PURSUED
THIS, AFTER GETTING YOUR
Ph.D. YOU CAN GET YOUR
MASTER'S IN PUBLIC HEALTH PAID
FOR, ANYWHERE YOU GET IN, WORK
AT US FOR THREE OUR FOUR YEARS
DOING RESEARCH POSITIONING YOU
FOR WHATEVER YOUR NEXT POSITION
IS GOING TO BE, NEXT JOB.
MANY OF OUR FOLKS, MANY FELLOWS,
MOVE ON TO GOVERNMENT JOBS,
ACADEMIC JOBS, JOBS IN INDUSTRY,
REALLY HIGH LEVEL JOBS, AND
THEIR TRAINING IS STELLAR
BECAUSE THEY NOT ONLY HAVE THEIR
DOCTORAL DEGREES BUT MASTER'S IN
PUBLIC HEALTH AND RESEARCH AT
NCI.
THE DEADLINE TO APPLY FOR THIS
PROGRAM IS COMING UP ON AUGUST
1, SO I ENCOURAGE YOU TO TALK TO
YOUR TALENTED GRADUATE STUDENTS
FINISHING SOON ABOUT APPLYING.
SO PLEASE STAY IN TOUCH WITH US.
YOU CAN SEE VARIOUS WAYS TO BE
IN TOUCH WITH US ABOUT OUR
PRIORITIES, WHAT WE'RE UP TO.
WE'VE GOT A WEBSITE.
YOU CAN PLUG IN NCI BRP AND GET
TO THIS JUST AS NIAAA.
WE HAVE A TWITTER FEED ABOUT TO
DISAPPEAR BECAUSE WE'RE
CONTRACTING OUR TWITTER ACCOUNTS
AT NIH, BUT IT'S STILL ACTIVE
NOW.
WE HAVE A NEWSLETTER WHICH HAS A
LOT OF INFORMATION I JUST TALKED
ABOUT.
AND I'LL END THERE AND THAT'S MY
TITLE, I SHOULD HAVE PUT MY
E-MAIL ON THERE.
YOU CAN GET TO THAT ONLINE.
HAPPY TO TAKE ANY QUESTIONS YOU
HAVE OVER E-MAIL AND CERTAINLY
ANY QUESTIONS HAVE YOU RIGHT
NOW.
THANK YOU.
NORA?
>> ONE QUESTION, THOSE NUMBERS,
I ACTUALLY HEARD GEORGE PRESENT
TABLES IN TERMS OF INCREASING
RISK FOR CANCER, EVEN THOUGH WE
DON'T COMPLETELY UNDERSTAND THE
MECHANISMS, THEY ARE SO QUITE
HIGH, ESOPHAGEAL CANCER
SOMETHING LIKE 37%, HUGE.
THEN SPEAKING OF THEM AS AN
ISOLATED ENTITY, DO WE KNOW HOW
THE INTERACTION WITH SMOKING
ACTUALLY IS IT SYNERGISTIC,
ADDITIVE?
AND WHAT IS OUR UNDERSTANDING OF
THE MECHANISM, INFLAMMATORY
PROCESS?
>> BEFORE I ANSWER I WANT TO GO
BACK TO THE POINT YOU MADE ABOUT
GLP AGONIST, SOMETHING WE'RE
THINKING ABOUT TOO NOW BECAUSE
GLP CAN CONNECT THOSE BEHAVIORS
TOGETHER IN INTERESTING WAYS.
WE NEED MORE DATA ON THAT
QUESTION.
WE KNOW ABOUT SOME MECHANISMS
THAT LINK ALCOHOL CANCER,
CAUSING DNA DAMAGE WHICH CAN
CAUSE CANCER.
BREAST CANCER STORY IS ABOUT
ESTROGEN, ALCOHOL INCREASES
ESTROGEN DEVELOPMENT WHICH IN
TURN CAN LEAD TO BREAST CANCER
AND OTHER CANCERS THAT ARE VERY
HIGH ON THE LIST FOR WOMEN.
WE HAVE SOME SENSE OF MECHANISMS
BUT STILL NEED MORE AND NEED
MORE ON MECHANISMS THAT EXPLAIN
WHY REDUCTION IN ALCOHOL USE
MIGHT REDUCE CANCER RISK LIKE
THE IARC REPORT.
THERE'S NOT ENOUGH OF THAT.
WITH REGARD TO SYNERGISTIC
EFFECTS OF SUBSTANCES THAT'S A
NEW AREA AS WELL.
WE HAVE A SENSE THAT THERE IS A
CORRELATION BETWEEN USING
TOBACCO AND USING ALCOHOL, BUT
IT'S MODEST.
AND THE INTERESTING THING IS IF
YOU LOOK AT THE PROFILE, THE
POPULATION PROFILE, OF TOBACCO
USE AND ALCOHOL USE, IT'S NOT
THE SAME.
SO, TOBACCO USERS PARTICULARLY
COMBUSTIBLE CIGARETTES TEND TO
BE CONCENTRATED IN LOWER SES,
PEOPLE WITH MENTAL HEALTH
CONDITIONS, PEOPLE IN THE
MILITARY, LGBTQ POPULATIONS HAVE
BEEN SHOWN TO BE HIGHER IN USE
OF COMBUSTIBLE TOBACCO.
THOSE ARE NOT NECESSARILY THE
SAME POPULATIONS USING ALCOHOL.
THE SINGLE BIGGEST USER IN THE
POPULATION OF ALCOHOL ARE US,
PEOPLE LIKE US PEOPLE HIGHER
SES, HIGHER EDUCATION AND
INCOME, CONSUMING ALCOHOL NOT
BINGE DRINKING BUT COCKTAIL
PARTIES AND SO FORTH.
TRYING TO UNDERSTAND SYNERGISTIC
EFFECTS IS COMPLICATED BECAUSE
OF OVERLAP IN USE OF SUBSTANCES
IS CERTAINLY THERE, NOT AS MUCH
AS YOU WOULD EXPECT.
THEN YOU THROW CANNABIS ON TOP
OF THAT, THE OVERLAP, THE VENN
DIAGRAM, THE CIRCLE GETS
SMALLER.
WHAT POLICY IMPLICATIONS MIGHT
LOOK LIKE FOR ANY OF THE THREE
ON THE USE OF THE OTHER THREE.
>> I REALIZE IT'S NOT EXACTLY
THE SAME DEMOGRAPHIC BUT IF
THERE IS A SYNERGISTIC EFFECT,
SOMEONE SMOKING, EVEN IF THEY
DON'T DRINK REGULARLY, DOES THAT
REALLY INCREASE THE TOXICITY OF
ALCOHOL?
THAT'S WHERE.
SO ONE OF THE THINGS I WOULD
LOVE TO SEE PRESENTED OR
ANALYZED IS WHAT IS THE
CONTRIBUTION OF ALCOHOL BY
ITSELF OR WITH TOBACCO AS A
FUNCTION OF DEMOGRAPHIC, SO IF
YOU COME FROM LOW INCOME AND
DEPRIVED ENVIRONMENT WHAT EXTENT
ACCOUNTS FOR CONTRIBUTION IN
EMERGENCE OF CANCERS, ARE THERE
STATISTICS ON IT?
IN TERMS OF INCOME AND SOCIAL
AND ECONOMICAL FACTORS?
>> YES, THERE ARE SOME DATA LIKE
THAT.
WE DO KNOW THAT DIFFERENT TYPES
OF ALCOHOL PRODUCTS ARE USED
DIFFERENTIALLY IN DIFFERENT
POPULATIONS.
FOR EXAMPLE, BEER TENDS TO BE
USED AT LOWER SOCIOECONOMIC
STRATA, WINE AT HIGHER,
IRRELEVANT, IT'S THE ETHYL
ALCOHOL IN THE WINE AND BEER
THAT HAS EFFECT, NOTHING ABOUT
THE ALCOHOL PRODUCT IN
PARTICULAR.
AND IN FACT GEORGE MENTIONED
SOME DATA SHOWING THAT PEOPLE
THINK THAT WINE REDUCES CANCER
BY 10%.
THEY DIDN'T THINK THAT ABOUT
SPIRITS.
SO, PEOPLE HAVE INTERESTING
VIEWS ABOUT HOW DIFFERENT KINDS
OF ALCOHOL CAN AFFECT CANCER
WHEN IN FACT IT REALLY IS
IRRELEVANT.
AND THERE ARE CERTAINLY
POTENTIALLY HEALTH BENEFITS OF
RED WINE BECAUSE OF RESVERATROL
BUT THE THING ABOUT RESVERATROL
YOU HAVE TO DRINK GALLONS TO GET
THE HEALTH BENEFIT, YOU COULD
JUST DRINK GRAPE JUICE INSTEAD,
MAYBE WITHOUT THE SUGAR.
IT'S VERY COMPLICATED.
TO YOUR POINT WE NEED MORE DATA
UNDERSTANDING WHAT THE
MECHANISMS ARE THAT ARE
CONNECTING THOSE TOGETHER AND
WHETHER THERE ARE SYNERGISTIC
EFFECTS.
WE DON'T HAVE ENOUGH OF THAT
YET.
>> THEN YOU CAN SORT OF CONTROL
VERY MUCH THE DOSE EFFECT,
CHRONICITY, THE PERIOD AT WHICH
YOU GET EXPOSED IN YOUR
LIFETIME.
THE FACTORS THAT WOULD HELP US
UNDERSTAND IT BETTER.
>> YES, EXACTLY.
>> QUITE IMPORTANT.
>> YEAH, NIAAA OF COURSE HAS
DONE TERRIFIC WORK UNDERSTANDING
LIFESPAN IMPACT ON ALCOHOL
CONSUMPTION.
SPENT LITTLE TIME TALKING ABOUT
KIDS OTHER THAN PEDIATRIC CANCER
SURVIVORS BUT WE NEED TO BECAUSE
EXPOSURE TO ALCOHOL MEANS
SOMETHING AT 13 WHEN YOU'RE
DEVELOPING, WE'VE DEVELOPED SOME
OF THAT KIND OF WORK BUT MORE
NEEDS TO BE DONE.
>> CAN YOU SAY MORE ABOUT
INTEREST AT NCI, LOOKING AT
DIFFERENTIAL EFFECTS OF POLICIES
ON SUBSTANCE USE?
>> YEAH, SO --
>> HEALTH OUTCOMES.
>> WE'VE BEEN VERY ENGAGED IN
THAT.
THE WORD "POLICY" CAN BE FRAUGHT
BECAUSE WE DON'T DO POLICY AT
NIH BUT WE DO WORK THAT INFORMS
RESEARCH AND WE HAVE TO BE
CAREFUL TALKING ABOUT FUNDING
INITIATIVES TO MAKE IT CLEAR
THAT'S WHAT IT'S ABOUT,
INFORMING POLICY.
BEST EXAMPLE OF THAT IS
COLLABORATION WITH FDA THAT I
MENTIONED.
SO FDA HAS CENTER FOR TOBACCO
PRODUCTS, THEIR JOB IS TO
REGULATE TOBACCO, AS OF 2009.
IT'S A NEW THING.
AND WE COLLABORATE WITH THEM
QUITE A BIT.
NOW, THEY WANT TO KNOW WHAT
KINDS OF WARNING LABELS SHOULD
WE PUT ON CIGARETTE PACKS?
OTHER COUNTRIES HAVE GRAPHIC
WARNING LABELS ON CIGARETTE
PACKS, RIGHT?
WE DON'T HAVE THAT.
WE'VE BEEN TRYING.
IT'S TAKEN A LONG TIME, A LOT OF
LITIGATION AND THE INDUSTRY
INVOLVED DOESN'T WANT THOSE
LABELS ON THOSE PACKS, RIGHT?
AND SO ONE OF THE THINGS THEY
WOULD LIKE TO KNOW FROM US IS
WHAT ARE THE LABELS THAT ARE
GOING TO BE MOST IMPACTFUL?
SO WE HAVE FUNDED RESEARCHERS TO
BE ABLE TO TEST DIFFERENT KINDS
OF LABELS, DIFFERENT MESSAGES TO
SEE WHAT'S MOST IMPACTFUL.
ONE OF THE ISSUES THAT CAME UP
IN LITIGATION WHICH I FOUND
INTERESTING IS THAT THE COURTS
CONSIDERED GRAPHIC WARNING
LABELS TO BE TOO EMOTIONAL,
FOCUSING ON SCARE TACTICS AS
OPPOSED TO BEING INFORMATIONAL.
I'M A SOCIAL PSYCHOLOGIST,
BEHAVIORAL SCIENTISTS KNOW
AFFECT IS NOT SEPARABLE FROM
COGNITION.
IT'S ALL TIED UP, RIGHT?
THOUGH
YEAH, SO EMOTION AND COGNITION
ARE WOVEN TOGETHER AND SO OUR
RESEARCHERS HAVE BEEN DOING RETO
HELP UNDERSTAND WHAT ARE THE
AFFECTIVE AND COGNITIVE EFFECTS
OF SEEING THESE LABELS AND
IMPACT ON DEVELOPING POLICY
ABOUT DEVELOPMENT OF THOSE
LABELS, TRUE FOR WARNING LABELS,
CORRECTIVE STATEMENTS I
MENTIONED BEFORE.
SMOKE-FREE POLICIES AND OTHER
KINDS OF POLICIES.
THAT'S THE PLACE WE'VE DONE THE
MOST.
AND WE WOULD LOVE TO DO MORE
WITH REGARD TO CANNABIS POLICY,
ALCOHOL POLICY, WE DO A LOT WITH
HEALTH CARE POLICY AS WELL IN
OUR SISTER HEALTH CARE DELIVERY
RESEARCH PROGRAM.
>> IT'S A PLEASURE TO PRESENT
DR. KATHY COLE, DR. CHLOE JORDAN
AND JANANI PRABHAKAR FOR AN
UPDATE ON THE ABCD STUDY.
DR. COLE IS THE PROGRAM MANAGER,
DR. JORDAN IS SCIENTIFIC PROGRAM
MANAGER, AND DR. PRABHAKAR IS
PROGRAM OFFICIAL FOR HBCD STUDY.
TODAY THEY WILL BE PROVIDING
UPDATES ON THE STUDY OVER THE
PAST YEAR.
>> THANK YOU FOR THE KIND
INTRODUCTION.
I'LL MAKE SURE THE SLIDES CAN
CLICK BEFORE I GET STARTED.
I THINK THE POINTER CAN WORK.
THANK YOU.
IT'S MY PLEASURE TO BE HERE TO
PRESENT TO THE COUNCIL, UPDATES
AND PROGRESS OF THE HBCD STUDY
WITH MY COLLEAGUES, DR. JORDAN
WILL JOIN US VIRTUALLY,
HOPEFULLY YOU'LL SEE HER ON THE
SCREEN AND DR. PRABHAKAR, THE
SCIENTIFIC PROGRAM OFFICER.
SO WHAT IS THE HBCD STUDY?
IT IS A TEN-YEAR LONGITUDINAL
STUDY LOOKING AT EARLY BRAIN AND
CHILD DEVELOPMENT.
IT'S GOING TO INVOLVE THE
COLLABORATIVE WORK OF 27
RESEARCH SITES ACROSS THE U.S.
THIS WILL BE RECRUITING
PARTICIPANTS STARTING IN THEIR
SECOND TRIMESTER OF PREGNANCY,
AND FOLLOWING THEM AND CHILDREN
THROUGH FIRST DECADE OF LIFE.
IT'S AMBITIOUS PROTOCOL WITH
ASSESSMENT OF BRAIN, COGNITIVE,
ENOTIONAL DEVELOPMENT STARTING
FROM BIRTH.
THE GOAL TO RECRUITED 7,000
PARTICIPANTS, TO BE ABLE TO
CHARACTERIZE NEURODEVELOPMENTAL
TRAJECTORIES, AS WELL AS
DETERMINE HOW SUBSTANCE EXPOSURE
AND EXPOSURE TO OTHER SOCIAL AND
ENVIRONMENTAL DETERMINANTS OF
HEALTH MAY IMPACT THESE
TRAJECTORIES.
DATA COLLECTED FROM THIS STUDY
WILL BE WIDELY SHARED WITH
SCIENTIFIC COMMUNITY, ANNUAL
DATA RELEASES.
WITH OUR FIRST RELEASE PLANNED
FOR THE END OF THIS YEAR,
STARTING EARLY NEXT YEAR.
THE HBCD STUDY IS FUNDED IN PART
BY THE HEAL INITIATIVE, AS WELL
AS SUPPORT OF 12 INSTITUTES AND
CENTERS, ALL LISTED.
I GUESS YOU CAN SEE IT, 12
INSTITUTES LISTED THERE.
SO THE HBCD CONSORTIUM IS 27
RECRUITMENT SITES ACROSS 24 U01
AWARDS, 20 STATES.
YOU CAN SEE THEM ALL WITH THE
BLACK PINPOINT.
THERE'S A COORDINATING CENTER,
SO ADMINISTRATIVE CORE, THE
HCAC, YOU CAN SEE THOSE IN
ORANGE.
THAT INCLUDES UNIVERSITY OF
CALIFORNIA SAN DIEGO, AND BOSTON
CHILDREN'S HOSPITAL.
THERE'S A DATA COORDINATING
CENTER AS WELL, IT IS
HIGHLIGHTED IN BLUE PINPOINT,
ALSO BASED AT THREE INSTITUTES,
AT WASHINGTON UNIVERSITY ST.
LOUIS, UNIVERSITY OF MINNESOTA,
AND UNIVERSITY OF CALIFORNIA SAN
DIEGO.
SO THERE ARE MULTIPLE SCIENTIFIC
QUESTIONS THAT THE STUDY HOPES
TO ANSWER.
FIRST BEING AN UNDERSTANDING OF
TYPICAL NEURODEVELOPMENTAL
TRAJECTORIES.
UNDERSTANDING OF NORMAL RANGE OF
VARIABILITY IN THESE
TRAJECTORIES.
WE ALSO HOPE TO UNDERSTAND HOW
GENETIC INFLUENCES CAN INTERACT
WITH ENVIRONMENTAL FACTORS TO
HELP INFLUENCE DEVELOPMENT,
NEUROCOGNITIVE DEVELOPMENT,
EMOTIONAL AND SOCIAL
DEVELOPMENT.
FURTHERMORE WE WANT TO INSURE
HOW OPIOIDS AND SUBSTANCES
INCLUDING ADVERSE ENVIRONMENTAL
FACTORS INFLUENCE TRAJECTORIES,
WINDOWS FOR AMELIORATING
INFLUENCES CAN IMPACT THESE
TRAJECTORIES.
THERE'S A NEED AND WANT TO
UNDERSTAND HOW PARENT CARETAKER
INTERACTIONS WITH CHILDREN MAY
HELP INFORM CHILD HEALTH
OUTCOMES.
SO THIS SCHEMATIC HERE BROADLY
REPRESENTS SOME ASSESSMENT
DOMAINS OF THE STUDY.
SO PARTICIPANTS WILL COMPLETE AN
EXTENSIVE BATTERY OF TESTS,
QUESTIONNAIRES, RESEARCH
ACTIVITIES RELATED TO
DEVELOPMENTAL ORIGINS OF
DISEASE.
PRE-PREGNANCY AND PRENATAL
FACTORS WILL BE ASSESSED TO
UNDERSTAND FACTORS THAT MAY
AFFECT HEALTH, STARTING AT
ENROLLMENT.
WE'LL BE LOOKING AT ONGOING
BIOLOGICAL FACTORS, RELATED TO
BOTH CHILD AND THE ADULT
PARTICIPANT.
WE'LL LOOK AT AND TRYING TO
UNDERSTAND PARENT AND CHILD
FACTORS SUCH AS PARENT CAREGIVER
OR CHILD CAREGIVER
RELATIONSHIPS, HOME ENVIRONMENT,
AS WELL AS MENTAL HEALTH.
FINALLY IMPORTANTLY WE WANT TO
LOOK AT AND UNDERSTAND HOW
SOCIAL AND ENVIRONMENTAL
DETERMINANTS OF HEALTH SUCH AS
EARLY LIFE STRESS, EXPOSURE TO
POVERTY AND DISCRIMINATION MIGHT
AFFECT TRAJECTORIES TO
UNDERSTAND HOW FACTORS MAY SHAPE
COGNITIVE AND NEUROLOGICAL
DEVELOPMENT.
IN ORDER TO TRY TO UNDERSTAND
ALL THESE SUBJECT MATTER DOMAINS
THAT WE'RE INTERESTED IN, THE
STRUCTURE OF THE HBCD STUDY
RELIES ON WORK GROUPS AND WORK
GROUP ORGANIZATION, SO THAT'S
THIS BUSY RAINBOW SLIDE TO SHOW
BREAD BREADTH AND DEPTH OF WORK
GROUPS, MADE OF SUBJECT MATTER
EXPERTS, INCLUDING PRINCIPAL
INVESTIGATORS, CO-INVESTIGATORS,
STUDY STAFF ACROSS 27 DIFFERENT
RESEARCH SITES.
THE WORK GROUPS SPAN ALL
ASPECTS.
HIGHLIGHTED HERE ARE WORK GROUPS
ASSOCIATED CLOSELY WITH ACTUAL
PROTOCOL AND EXECUTION OF THE
PROTOCOL INCLUDING WORK GROUPS
RELATED TO DIFFERENT AND VARIOUS
ASSESSMENT DOMAINS,
NEUROIMAGING, USE OF TECHNOLOGY
WITHIN THE STUDY, AS WELL AS
GROUPS RELATED TO STUDY DESIGN
AND STUDY MONITORING IN AN
ONGOING WAY.
THERE ARE SEVERAL GROUPS
DEDICATED TO PARTICIPANT
EXPERIENCE, WHICH WITHIN THE
HBCD CONSORTIUM WE CALL HBCD
EXPERIENCE BECAUSE OUR
PARTICIPANTS AND THEM FEELING
INVOLVED AND INCLUDED IS VERY
IMPORTANT FOR US IN THE STUDY.
THIS INCLUDES GROUPS RELATED
SPECIFICALLY TO RECRUITMENT AND
RETENTION OF THIS VERY IMPORTANT
POPULATION.
WORK GROUPS RELATED TO
UNDERSTANDING NEEDS OF RURAL AND
SOVEREIGN COMMUNITIES, WORK
GROUPS RELATED TO EMPOWERING AND
HELPING INFORM OUR STUDY
NAVIGATORS WHICH ARE LOCATED
ACROSS SITES, AND THESE ARE
FOLKS THAT ARE TRYING TO GUIDE
PARTICIPANT THROUGH THE RESEARCH
PROTOCOL AND MANY OF THESE STUDY
AND A NAVIGATORS HAVE LIVED
EXPERIENCE, A GROUP FOCUSED ON
TRANSITION IN CARE IN CASE
PARTICIPANTS LOSE CUSTODY OF
CHILDREN OR CHILDREN NEED TO
ENGAGE WITH A FOSTER CARE SYSTEM
TO MAINTAIN THE FAMILIES WITHIN
THE STUDY, AS INVOLVED AS
POSSIBLE.
WORK GROUPS RELATED TO SOCIAL
AND ETHICAL OVERSIGHT INCLUDING
DIVERSITY, EQUITY, AND INCLUSION
AND FOCUSED ON BIOETHICS AS WELL
AS ETHICAL, LEGAL, POLICY ISSUES
THAT MAY COME TO PLAY WITHIN THE
HBCD STUDY.
FINALLY THERE'S A COHORT OF
COMMUNICATION GROUPS THAT FOCUS
ON COMMUNICATION BOTH WITHIN THE
STUDY AND TO EXTERNAL
STAKEHOLDERS AS WELL AS THE
GENERAL PUBLIC.
ALL THESE GROUPS COME TOGETHER
AND ARE ORGANIZED IN
COLLABORATION BETWEEN HCAC AND
HDCC TO INTEGRATE ANY ACTIVITIES
THAT REQUIRE MORE THAN ONE WORK
GROUP AND TRYING TO MAKE SURE
ALL WORK GROUPS ARE ENGAGING
TOGETHER AND INTERACTING.
IMPORTANTLY I WANT TO POINT OUT
THERE'S A WORK GROUP CO-CHAIRS
MEETING THAT HAPPENS BIWEEKLY
WHERE THE CO-CHAIRS OF EACH OF
THESE GROUPS COME TOGETHER AND
DISCUSS WHAT TOPICS THEY ARE
WORKING ON, WHAT ISSUES THEY
MIGHT BE FACING AND ARE THERE TO
PROVIDE FEEDBACK TO THE OTHER
WORKING GROUPS.
SO IT'S A VERY NICE AND
INTEGRATED STRUCTURE THAT REALLY
COMES FROM THE GROUND UP FROM
ALL THE INVESTIGATORS INVOLVED
IN THE STUDY.
YOU CAN SEE A SCHEMATIC OF THE
TIMELINE.
YOU CAN SEE IN-PERSON VISITS
PARTICIPANTS WILL BE ENGAGED IN,
STARTING PRENATAL THROUGH VISIT
6 UP TO 48 MONTHS OF LIFE.
IN ADDITION THREE REMOTE VISITS
WHERE ASSESSMENTS CAN BE DONE IN
THE HOME AND ON THE COMPUTER.
NEXT I'M GOING TO FOCUS ON THE
FIRST THREE VISITS OF THE STUDY
AS THESE HAVE BEEN FINALIZED AND
LAUNCHED.
WE'RE STILL WORKING ON
FINALIZING THE DATA COLLECTION
PROTOCOL FOR REMAINING VISITS.
SO HERE YOU CAN SEE THE
DIFFERENT ASPECTS OF THE
PRENATAL VISIT 1, INCLUDING
ASSESSMENTS OF MATERNAL OR BIRTH
PARENT HEALTH, AS WELL AS
COLLECTION OF BIOSPECIMENS AND
UNDERSTANDING OF CULTURE AND
ENVIRONMENT OF THE BIRTH PARENT.
SUBSTANCE USE IS ASSESSED
THROUGH TWO DIFFERENT
SELF-REPORT QUESTIONNAIRES
INCLUDING ASSIST AND TIMELINE
FOLLOW BACK AS WELL AS ASSAYS OF
BIOSPECIMENS, NAILS, SALIVA,
URINE.
VISIT 2 OCCURS BETWEEN 0 AND 1
MONTH OF AGE, WHAT I'M
HIGHLIGHTING HERE IN YELLOW
BOXES ARE ALL THE NEW CONSTRUCTS
AND MEASURES ADDED IN ADDITION
TO THE ONES THAT YOU'LL SEE IN
VISIT 1.
IMPORTANTLY THIS INCLUDES FIRST
MRI OF A BABY, AGAIN 0-1 MONTH,
VERY AMBITIOUS.
AND SO FAR GOING VERY NICELY.
I'LL SHOW YOU SOME INFORMATION
ABOUT THAT SOON.
AND ALSO USE OF MOBILE
TECHNOLOGY SUCH AS MOTION AND
HEART RATE SENSOR WHERE THE
CHILDREN WEAR THAT AT HOME FOR
72 HOURS SO WE CAN UNDERSTAND
SLEEP STATES AND AROUSAL.
WE'RE ALSO LOOKING AT NUTRITION
FACTORS, AND CHILD PHYSICAL
HEALTH AND GROWTH.
VISIT 3 WE'RE NOW ADDING IN THE
FIRST INFANT EEG SCAN AT 3 TO 9
MONTHS, MEASURES OF
NEUROCOGNITION, CHILD/CAREGIVER
INTERACTION, CHILD BEHAVIOR.
SO HERE'S AN UPDATE ON WHERE WE
ARE TODAY WITH THE HBCD STUDY,
WE'VE RECRUITED 1313
PARTICIPANTS, DATA FROM MAY
ENROLLMENT STARTING FROM THE
LAUNCH OF THE FIRST STUDY IN
JULY OF 2023, INCREASE THUS FAR.
THIS IS ACROSS ALL 27 SITES.
IN TERMS OF RACE AND ETHNICITY
OF THE SAMPLE, WE'RE AT
APPROXIMATELY 50% OF THE
PARTICIPANTS WHITE, 20% BLACK OR
AFRICAN AMERICAN, DIFFERENT
PORTIONS WITH ASIAN, AMERICAN
INDIAN/ALASKA NATIVE, AND TWO OR
MORE RACES.
ABOUT 18% OF OUR SAMPLE
IDENTIFIES AS HISPANIC OR
LATINO.
THIS GRAPH IS TRYING TO SHOW
WHAT THE SAMPLE LOOKS LIKE IN
TERMS OF PRENATAL SUBSTANCE USE.
THIS GRAPH IS SHOWING NOT ONLY
SUBSTANCE USE ITSELF BUT ALSO
POLY SUBSTANCE USE.
AND I'M SHOWING DATA HERE ACROSS
FOUR DIFFERENT CATEGORIES, ALL
LISTED HERE AS WELL.
SO IMPORTANTLY THESE DATA ARE
BASED ON SELF-REPORT MEASURES.
IT'S BASED ON FREQUENCY OF USE
OF EACH OF THESE FOUR
SUBSTANCES.
FIRST BEING OPIOIDS, OR
APPROXIMATELY 4% OF SAMPLE
REPORTED PRENATAL OPIOID USE.
11% REPORTED USE OF TOBACCO OR
NICOTINE.
12% REPORTED USE OF MARIJUANA OR
CANNABIS, 12% REPORTED ALCOHOL
USE.
THIS IS NOT ANY USE, THIS IS
AGAIN MEETING SPECIFIC
THRESHOLDS, SO THERE'S A LARGER
NUMBER OF FOLKS WHO HAVE
REPORTED ANY USE BUT THERE'S
REALLY FOCUS ON TRYING TO
IDENTIFY THOSE THAT MEET THESE
FREQUENCY THRESHOLDS.
I WANT TO POINT OUT HERE THAT
OUR CURRENT RATE OF SUBSTANCE
USE IN OUR POPULATION IS AT 25%.
WHICH IS RIGHT ON TARGET.
GOAL IS 25% OF THE POPULATION TO
HAVING BEEN EXPOSED TO
SUBSTANCES PRENATALLY.
I REALLY WANT TO COMMEND ALL
RESEARCH SITES TO FOCUSING ON
DIGGING INTO GETTING THESE HARD
TO REACH POPULATIONS TO ENROLL.
I WANT TO TALK ABOUT SOME OF THE
DATA THAT ARE BEING COLLECTED
BUT ONLY BRIEFLY BECAUSE WE'RE
STILL IN THE PROCESS OF GETTING
THE DATA, CLEANING DATA, BEING
ABLE TO RELEASE IT AT THE END OF
THE YEAR.
ONE OF OUR PRIMARY GOALS IS TO
UNDERSTAND TYPICAL
NEURODEVELOPMENT AND THE RANGE
OF VARIABILITY TO FOCUS ON
MULTI-MODAL ASSESSMENT.
FIRST SHOWING DIFFERENT TYPE OF
MRI SCANS WE COLLECT STARTING AT
VISIT 1, INCLUDING BRAIN
STRUCTURE, T1 AND T2, DIFFUSION
MRI QUANTITATIVE MRI.
WE HAVE TWO SCAN TYPES FOR BRAIN
FUNCTION, INCLUDING FUNCTIONAL
MRI AND MRI SPECTROSCOPY.
I'M GOING TO HIGHLIGHT QUALITY
OF THESE SCANS AND SHOWCASE
THEM.
THIS IS BRAIN IMAGE THAT IS
DERIVED DATA FROM FUNCTIONAL MRI
SCAN.
THIS IS A SAMPLE OF ONE.
A DATA FROM OUR FIRST HBCD STUDY
INFANT AT VISIT 1.
FOR THOSE FAMILIAR WITH
FUNCTIONAL BRAIN NETWORKS AND
FUNCTIONAL CONNECTIVITY, YOU CAN
SEE HERE THAT IN JUST ONE INFANT
WE WERE ABLE TO RECAPITULATE THE
DEFAULT MODE NETWORK WITH THE
SCANS THAT ARE ACQUIRED IN THE
STUDY.
WE'RE ALSO COLLECTING EEG DATA
ACROSS FOUR DOMAINS, INCLUDING
RESTING STATE, RESPONSES TO
FACES, VISUAL EVOKED POTENTIAL,
AUDITORY ODDBALL.
NEXT I WOULD LIKE TO PASS THE
MIC OVER TO CHLOE JORDAN, AGAIN
JOINING VIRTUALLY, HOPEFULLY SHE
CAN COME OFF CAMERA.
I SEE HER RIGHT HERE.
>> HI, EVERYONE.
THANK YOU, KATHY.
HOPEFULLY YOU CAN HEAR MY.
I'M SORRY I'M NOT THERE IN
PERSON.
SO AS YOU SAW EARLIER WE'RE
ASSESSING SUBSTANCE USE IN TWO
WAYS, ONE THROUGH SELF-REPORT,
THE OTHER THROUGH COLLECTION OF
BIOSPECIMENS.
IN TERMS OF SELF-REPORT, FIRST
ALCOHOL, SMOKING, SUBSTANCE
SCREENING TEST, THIS IS GIVEN
DURING VISIT 1 AS LIFETIME USE
SCREENING SECTION, PARTICIPANTS
ASKED HAVE YOU USED ANY OF THESE
INCLUDING PRESCRIPTION
MEDICATION IF THEY ENDORSE USE
YOU FOLLOW UP WITH TIMELINE TO
GET SPECIFIC SNAPSHOTS OF WHEN
THIS IS OCCURRING DURING AND
AFTER PREGNANCY.
SO ENDORSEMENT OPENS FOLLOW
BACK, ONE IS ROUTINE, SO ANY
SUBSTANCES TAKEN DAILY,
CIGARETTES, OFTEN VAPING.
THEN FOLLOW BACK PRE-LAST
MENSTRUAL PERIOD, TWO WEEKS
PRIOR TO THE LAST MENSTRUAL
PERIOD BEFORE PREGNANCY, AS WELL
AS FOUR WEEKS POST LAST
MENSTRUAL PERIOD.
AND SUBSTANCE ABUSE IN 7 DAYS
PRIOR TO VISIT 1, OCCURRING
GENERALLY DURING THE SECOND
TRIMESTER, GIVING A SNAPSHOT
DURING AND JUST BEFORE
PREGNANCY.
THE OTHER WAY WE ASSESS
SUBSTANCE EXPOSURE IS AGAIN
THROUGH COLLECTION OF
BIOSPECIMENS, NEXT SLIDE. THAT
WILL SHOW SNAPSHOT TABLE OF THE
BIOSAMPLING TIMELINE FOR EACH
VISIT.
VISIT 1 PRENATAL COLLECT NAILS,
AS WELL AS BLOOD, SEPARATED INTO
SERUM, PLASMA, WHOLE BLOOD,
URINE FROM BIRTH PARENT, AFTER
BIRTH AND VISIT 2 AGAIN DURING
THE FIRST MONTH POST-BIRTH WE
COLLECT NAILS FROM BIRTH PARENT,
URINE, STOOL, SALIVA FROM THE
CHILD.
VISIT 3 AND THEREAFTER URINE,
STOOL, SALIVA FROM THE CHILD,
NOTHING REPEATED IN THE BIRTH
PARENT UNTIL VISIT 6 WHEN SALIVA
IS COLLECTED AGAIN.
CURRENTLY NAILS FROM VISIT 2 AS
WELL AS DRY BLOODSPOT CARDS AND
URINE ARE SHIPPED TO THE
LABORATORY FOR ANALYSIS FOR
SUBSTANCE USE, AND REMAINING
ASSESSMENTS SHIPPED TO
BIOREPOSITORY FOR STORAGE AND
FUTURE USE BY OTHER
INVESTIGATORS.
SAMPLE EXTRACTING DNA, SITES
STORING WE HOPE FOR ANALYSIS IN
THE NEAR FUTURE.
NEXT SLIDE SHOWS PRELIMINARY
SNAPSHOT OF PRELIMINARY RESULTS
FROM U.S. DETAIL ANALYSES OF
SUBSTANCE EXPOSURE FOCUSING ON
URINE AND DRIED BLOODSPOT CARDS,
PRELIMINARY RESULTS AGAIN PULLED
AS OF MAY 1 SO WE'RE STILL
COLLECTING A LOT OF DATA,
SUBJECT TO CHANGE, BUT JUST TO
GIVE A SNEAK PREVIEW OF WHAT'S
GOING ON LEFT PANELS SHOWING
URINE ANALYSIS FROM VISIT 1,
RIGHT PANELS SHOWING VISIT 1
RESULTS OF ANALYSIS OF PETH.
DETECTION WINDOW IS TWO TO FOUR
WEEKS, COLLECTED AT VISIT 1,
GIVING US A LOOK BACK FROM WHEN
VISIT 1 OCCURRED, THIS CHART
SHOWS 82% ARE NEGATIVE FOR PETH,
18% POSITIVE.
THIS IS HIGHER THAN 12% IN
SELF-REPORT, BASED ON TIMELINE.
NOTING TEST DOES NOT DETECT
LIGHT OR CASUAL DRINKING, ONE
DRINK WOULD NOT NECESSARILY
RESULT IN A POSITIVE TEST BUT
THERE'S A LOT OF INDIVIDUAL
DIFFERENCES IN HOW MUCH
COLLABORATIVE IS NECESSARY, THIS
VARIES AMONG PEOPLE THAT ARE
PREGNANT AND HAVE INCREASING
BLOOD VOLUME.
URINE AGAIN IS SHOWN ON THE LEFT
PANEL, DETECTION WINDOWS ARE
SHORTER THAN PETH ANNUAL IS, 2
TO 4 DAYS, WITH THE EXCEPTION OF
CANNABINOIDS THAT CAN DETECTS
FOR AS MANY AS 30 DAYS IN PEOPLE
THAT USE FREQUENTLY.
AGAIN THIS VARIES FROM PERSON TO
PERSON, MAY BE FURTHER IMPACTED
BY PREGNANCY.
URINE SUBSTANCES COUNTED AS
POSITIVE, ON INITIAL TEST AS
WELL AS SECONDARY CONFIRMATION
TEST, TO HELP US REDUCE RISK OF
FALSE POSITIVES HAPPENING.
TOP PANEL ON THE LEFT SHOWS
PERCENTAGE OF TOTAL SPECIMENS
ANALYZED, 753 SO FAR, POSITIVE
FOR EACH SUBSTANCE.
NOT SHOWING ALL OF THE
SUBSTANCES HERE, WE ALSO TEST
FOR KETAMINE, MUSCLE RELAXANTS,
SEDATIVES, OTHERS ARE NICOTINE
AND CANNABINOIDS.
ON THE LEFT SHOWS EXACT NUMBER
OF POSITIVE URINE SPECIMENS OF
THESE, BOTH GRAPH AND TABLE ARE
GROUPS BY SUBSTANCE SO WE HAVE
ALCOHOL, BENZOS, BARBITURATES,
NICOTINE, COULD BE USED FOR
MEDICATION, GROUPS ARE STILL
WORKING ON MATCHING DATA TO THE
SELF-REPORT DATA ON THE TIMELINE
CALLBACK, SEEING OVERLAP BETWEEN
THE TWO.
BUT OVERALL OPIOID POSITIVE
SPECIMENS ADD UP TO 4.8% AND
THAT CLOSELY APPROXIMATES 4%
POSITIVE MEETING TIMELINE FOLLOW
BACK SHOWN EARLIER.
NICOTINE ALSO CLOSE, 11.4%
ASSESSMENT SO FAR POSITIVE FOR
NICOTINE, AND ABOUT 11% OF
PEOPLE IN SELF-REPORTED USE
CRITERIA.
CANNABIS IS LOWER, 9% SO FAR
POSITIVE, 12% OF PARTICIPANTS
MET SELF-REPORT CRITERIA.
AS YOU CAN SEE ALCOHOL
PROTECTION IN URINE HAS BEEN
QUITE LOW, WE SUSPECT MAYBE
BECAUSE OF SHORTER DETECTION
WINDOW, AGAIN 2 TO 4 DAYS
COMPARED TO WEEKS IN THE DRIED
BLOODSPOT CARDS.
I'LL PASS TO JANANI.
>> THANKS, WE WANTED TO END OUR
PRESENTATION BY TALKING ABOUT
OUR RESULTS BASED ACCOUNTABILITY
APPROACH.
THIS REFLECTS THE MONITORING
APPROACH.
WE DO THIS BY USING REALTIME
DATA FROM MULTIPLE SOURCES TO
ENSURE WE MEET OUR STUDY
OBJECTIVES AS A CONSORTIUM.
SO, ONE OF THE WAYS WE DO THAT
--
>> I HAVE A QUESTION.
HAS THIS PATIENT HAD ANYTHING
THAT FLAGS G-12 C AND ARE YOU
TREATING ON A RAS INHIBITORS?
NO?
OKAY.
>> PLEASE MUTE.
>> METASTATIC, OKAY.
>> PLEASE MUTE.
>> I THINK WE'RE MUTED.
ALL RIGHT.
SO, YEAH, GOING BACK, ONE OF THE
WAYS IN WHICH WE APPROACH OUR
MONITORING IS THROUGH THE METRIC
MONITORING WORK GROUP, RECENTLY
ESTABLISHED.
THIS WORK GROUP HAS A CHARGE TO
MONITOR SITE PROGRESS, AND
REALLY UNDERSTAND SITE CAPACITY
SO WORK WITH OUR INVESTIGATORS
AND OUR SITES TO UNDERSTAND WHAT
IS WORKING, WHAT ARE THE
CHALLENGES, AND WHAT CAN WE DO
TO HELP THEM AND REALLY
IMPORTANTLY SUGGEST REALISTIC
EXPECTATIONS FOR STUDY PROGRESS
OR MONITORING OF STUDY PROGRESS.
AND THIS WORKING GROUP WORKS
DIRECTLY WITH SITES THAT ARE
LAGGING BEHIND AND FACING
CHALLENGES, IN ORDER TO
ESTABLISH STRATEGIES AND PROVIDE
RESOURCES TO HELP THEM CATCH UP.
SO NIH'S PARTICIPATION ALLOWS US
TO WORK IN COLLABORATION WITH
MEMBERS OF THE WORKING GROUP AND
SITES TO ENSURE WE MEET OUR
OBJECTIVES.
AND I WOULD LIKE TO INTRODUCE
OUR CO-CHAIRS OF THIS WORKING
GROUP, DR. ALTHOFF, JERNIGAN,
AND DR. BRENDA JONES HARDEN WITH
OVERSIGHT IN GENERAL.
ONE WAY WE'RE ABLE TO MONITOR
SITE PROGRESS IS THROUGH OUR
DASHBOARDS.
SO WE HAVE TWO DASHBOARDS, ONE
IS THE ENROLLMENT DASHBOARD, AND
THIS IN REAL TIME PROVIDES US
THE TOTAL NUMBER OF ENROLLED
PARTICIPANTS IN OUR STUDY.
IT SHOWS ENROLLMENT PROGRESS
TOWARDS SEVERAL GOALS THAT WE
HAVE INCLUDING TRACKING OF THE
NUMBER OF PARTICIPANTS WHO USE
SUBSTANCES, AND ACROSS OTHER
PARTICIPANT CHARACTERISTICS AS
WELL.
THIS IS UPDATED IN REAL TIME AS
I SAID, ALLOWS US TO TRACK HOW
SUCCESSFUL WE ARE AND WHERE WE
NEED TO MAKE CHANGES.
ONE COOL THING ABOUT THIS
DASHBOARD IS THAT IT ALLOWS
US -- ALLOWS SITES TO TITRATE
RATES OF ENROLLMENT, TO PROJECT
FORWARD AND BE FORWARD PLANNING,
IF YOU CHANGE NEXT WEEK OR
SEVERAL YEARS FROM NOW WHERE
DOES THAT TAKE US TO OUR END
GOAL IN THE OTHER DASHBOARD IS
METRICS DAB BOARD, SHOWING
COMPLETION OF STUDY MEASURES AND
STUDY VISITS.
THIS ALLOWS US TO HAVE A CLEAR
MEASURE OF OUR STUDY OR VISIT
BURDEN AND MAKE CHANGES.
SO TAKING ALL OF THESE
APPROACHES TOGETHER ALLOWS US TO
BE FLEXIBLE AND NIMBLE IN TERMS
OF WHAT WE NEED TO BE ABLE TO DO
AT ANY GIVEN POINT TO MEET OUR
GOALS AND ALSO ALLOWS US TO SET
REALISTIC EXPECTATIONS THAT ARE
ACHIEVABLE AT THE END OF THE
DAY.
THAT CONCLUDES OUR PRESENTATION
AND WE ARE HERE FOR QUESTIONS.
>> DO WE HAVE TIME FOR SIX?
>> SIX MINUTES FOR QUESTIONS,
MORE TIME AT THE TIME OF
DISCUSSION.
PLEASE.
>> THANK YOU.
THIS IS VERY EXCITING.
I HAVE TO SAY THAT EVEN IN THIS
EARLY PHASE THAT THE POSITIVE
URINES ARE PRETTY DRAMATIC FOR
PREGNANT WOMEN.
I WANT TO ACKNOWLEDGE THAT, WITH
THE DRIED SPOT VERSUS THE URINE
ALCOHOL LEVEL, THE LEVELS, NOT
SURPRISING AS GEORGE SHOWED, BUT
CANNABIS LEVELS BEING THAT HIGH
AND THAT'S BEEN SHOWN ALSO THE
BIG KAISER STUDY AND THINGS.
AND I GUESS PART OF ME JUST
WONDERING WHETHER THERE IS A
RESPONSIBILITY OR SOME EDUCATION
INFORMATION IMPARTING OF THAT
GOING ON TO THE MOTHER, TO THE
PREGNANT WOMEN HERE, BECAUSE IT
JUST FEELS LIKE THIS IS HIGH
NUMBERS AND OF COURSE WE OUR
GOAL IS TO FIND OUT AND DEVELOP,
YOU DON'T WANT TO MESS WITH
THAT, BUT THERE'S A
RESPONSIBILITY HERE, THAT I
WANTED TO SEE HOW YOU'RE
ADDRESSING.
>> THANK YOU VERY MUCH FOR THAT
QUESTION.
I THINK THE CONSORTIUM HAD A BIG
DISCUSSION ABOUT WHAT TYPE OF
RESOURCES WE WANT TO PROVIDE TO
MAKE SURE WE'RE INFORMATIVE BUT
NOT BEING INTERVENTIONAL.
WE DECIDED TO CREATE A FLYER,
PREGNANCY HEALTHS FLYER THAT HAS
A LOT OF INFORMATION THAN
INCLUSIVE OF SUBSTANCE USE
DURING PREGNANCY.
AND SOME RISKS.
AS WELL AS CREATING AN
ASSOCIATED WEB PAGE SO THAT
PARTICIPANTS CAN VIEW IT AS A
FLYER OR ON A WEB PAGE.
AND INFORMATION FOR THESE IS
REALLY TAKEN FROM A LOT OF
DIFFERENT NATIONAL RESOURCES,
IT'S NOT SPECIFIC OR TARGETED TO
OUR POPULATION BUT IS POINTING
THEM TO ADDITIONAL RESOURCES.
I THINK ONE OF THE CONCERNS WAS
WANTING TO RECRUIT PARTICIPANTS
AND HAVING THEM BE HONEST ABOUT
THEIR SUBSTANCE USE, AND IN NO
WAY STIGMATIZING THEM OR THAT
SUBSTANCE USE, BUT STILL BEING
INFORMATIVE.
SO I THINK THROUGH MANY
DISCUSSIONS THAT WENT THROUGH
MANY OF THE DIFFERENT WORK
GROUPS I THINK THAT'S HOW WE
DECIDED TO THREAD THE NEEDLE,
INFORMING BUT TRYING NOT TO
STIGMATIZE.
>> I'M SORRY IF I MISSED THIS,
CAN YOU TELL ME IF YOU'RE
DISTINGUISHING BETWEEN METHADONE
THAT'S PRESCRIBED FOR PAIN
VERSUS METHADONE FOR TREATMENT
DISORDER AND IN YOUR OPIOID
SECTION IF YOU'RE SEPARATING OUT
BUPRENORPHINE.
>> I'LL TAKE A FIRST PASS AT
THIS.
I ENCOURAGE CHLOE TO COME OFF
MIC AND ANSWER.
FOR RIGHT NOW OPIOIDS ARE
WRAPPED UP INTO ONE OPIOID USE.
THAT ONE OPIOID USE CRITERIA SO
THAT DOES INCLUDE METHADONE
PRESCRIBED OR NOT.
SO IN TERMS OF OUR OPIOID
NUMBERS, THAT INCLUDES A GREATER
CATCHMENT OF DIFFERENT TYPES OF
OPIOIDS.
WHEN THE DATA ARE RELEASED,
WE'LL HAVE THAT SPECIFIC
INFORMATION BUT IN TERMS OF OUR
ENROLLMENT GOALS WE'RE TRYING TO
LOOK AT OPIOID USE IN GENERAL.
AND THEN, CHLOE, I DON'T KNOW IF
YOU HAVE ANYTHING MORE TO ADD.
>> CAPTURED PRESCRIPTION USE FOR
PAIN AND OPIOID USE DISORDER AND
WE'LL HAVE MORE GRANULARITY IN
TERMS OF WHAT SUBSTANCE OR
MEDICATIONS USING AND WHY, FOR
THE ACTUAL DATA, BUT SPECIMENS
DON'T GIVE US THAT INFORMATION
BUT WE DO HAVE SEVERAL
SELF-REPORT SECTIONS WITH THAT
LEVEL OF DETAIL.
>> WE'RE ALREADY TEN MINUTES
LATE SO WE CAN RETAKE THE
QUESTIONS LATER ON, ON THE
DISCUSSION IN THE AFTERNOON.
AND MEANWHILE THE OTHER THING IS
OUR AGENDA HAS A BREAK UNTIL
1:10, WE'RE GOING TO SPEND TO
1:20 TO GIVE EVERYONE A CHANCE
TO GET FOOD AND EAT IT AND COME
BACK.
1:20.
>> AND YOU HAVE A MAP ON WHERE
TO GO TO GET FOOD.
BUT IF YOU FOLLOW ONE OF THE
NIAAA COUNCIL MEMBERS THEY WERE
THERE YET SO THEY KNOW WHERE THE
FOOD IS.
YOU CAN BE AMBASSADORS TO LUNCH.
WE'RE GOING TO START NOW WITH
THE AFTERNOON SESSION.
IT'S A PLEASURE FOR ME TO
INTRODUCE DR. GAYA DOWLING, TO
GIVE US AN UPDATE ON THE ABCD
STUDY, ALONG WITH DR. ELIZABETH
HOFFMAN, DR. KIM LEBLANC.
GAYA, TAKE IT OVER.
>> THANK YOU.
IT'S A PLEASURE TO BE HERE AGAIN
TO GIVE YOU AN UPDATE ON THE
STUDY.
WE'RE GOING TO DO THINGS
DIFFERENTLY.
I'M GOING TO GIVE A BRIEF
OVERVIEW, ALONG WITH MY TEAM,
AND THEN WE HAVE INVITED SOME
SPECIAL GUESTS TO TALK MORE
ABOUT ABCD, DR. MICAH JOHNSON
WILL TALK ABOUT THE START
PROGRAM DESIGNED TO BRING IN
SCHOLARS FROM UNDERREPRESENTED
BACKGROUNDS TO LEARN ABOUT HOW
TO USE THE ABCD DATASETS.
FAITH ADAMS IS A SCHOLAR FROM
THE FIRST YEAR TO PRESENT THE
DATA.
AND NATHANIEL HARNETT, NOT PART
OF THE CONSORTIUM BUT DOING
IMPORTANT WORK USING ABCD DATA.
I WANTED TO START WITH A BRIEF
OVERVIEW, AND TALK ABOUT
RETENTION.
I KNOW MOST OF YOU KNOW A LOT
ABOUT ABCD, BUT THERE ARE A FEW
NEW COUNCIL MEMBERS SO I THOUGHT
I WOULD GIVE A VERY BRIEF
INTRODUCTION TO THE STUDY.
SO, ABCD IS A LONGITUDINAL
STUDY, CLOSE TO 12,000 YOUTH,
THAT BEGAN WHEN THEY WERE 9 TO
10 YEARS OLD, CONTINUING FOR A
DECADE, AT LEAST.
TO LOOK AT THE VARIOUS FACTORS
THAT INFLUENCE VARIOUS
DEVELOPMENTAL TRAJECTORIES.
WE COLLECT A VAST AMOUNT OF DATA
SO I'M GOING TO TOUCH QUICKLY ON
ALL THE DIFFERENT DOMAINS.
SO, WE HAVE INFORMATION IN THE
PHYSICAL HEALTH DOMAIN, SO
INCLUDES ANTHROPOMETRICS, SLEEP,
ACTIVITIES.
WE HAVE QUESTIONNAIRES IN THE
MENTAL HEALTH DOMAIN.
AND THESE ARE ASKED OF BOTH THE
YOUTH AS WELL AS CAREGIVER.
WE ASK ABOUT SUBSTANCE USE,
CULTURE AND ENVIRONMENT,
INCLUDING NEIGHBORHOOD SAFETY,
SCHOOL ENVIRONMENT, FAMILY
ENVIRONMENT, ALSO INCLUDES
ACCULTURATION, DISCRIMINATION,
VARIOUS OTHER MEASURES.
WE COLLECT BIOSPECIMENS WHICH
YOU'LL HEAR ABOUT MORE LATER ON.
ABOUT TWO YEARS INTO THE STUDY
WE BEGAN TO INTRODUCE FITBIT TO
GET OBJECTIVE DATA ON ACTIVITY
AND SLEEP AND HEART RATE.
AND THEN WE ALSO ADDED ANOTHER
TECHNOLOGY WHICH IS AN APP FOR
THE YOUTH CELL PHONES TO BE ABLE
TO CAPTURE SOME OBJECTIVE DATA
ON THEIR CELL PHONE USE.
AND THEN OF COURSE WE HAVE
NEUROCOGNITIVE TASKS, AND WE DO
BOTH STRUCTURAL AND FUNCTIONAL
MRI.
AND ALL OF THESE -- THE
PROTOCOL, IT'S A BIG PROTOCOL
THAT INCLUDES THE MRI EVERY
OTHER YEAR.
INTERVENING YEAR HAS DIFFERENT
COGNITIVE TESTS, AND
QUESTIONNAIRE DATA BUT NO MRI.
EVERY SIX MONTHS WE HAVE A TOUCH
BASE, WAS PHONE, NOW MORE
ONLINE.
AND YOU CAN BARELY SEE AT THE
BOTTOM THERE THE TIMELINE.
NO, IT DOESN'T SHOW THERE.
OH WELL.
IT SHOWS THE TIMELINE SO THE
IDEA WAS FOR THIS TO GO FOR TEN
YEARS OF DATA COLLECTION.
IN ADDITION TO PRIMARY DATA
COLLECTED FROM PARTICIPANTS, WE
ALSO HAVE RESIDENTIAL HISTORY
DERIVED GEO CODES THAT WE'VE
LINKED TO A LOT OF EXTERNAL
DATASETS.
THIS HAS BEEN REALLY IMPORTANT
BECAUSE IT ALLOWS INVESTIGATORS
TO CONTEXTUALIZE DATA THEY ARE
COLLECTING FROM PARTICIPANTS
BASED ON WHAT'S GOING ON AROUND
THEM SO IT HAS INFORMATION ABOUT
AIR POLLUTION, ABOUT PROXIMITY
TO ROADS, NOISE POLLUTION, ALSO
HAS INFORMATION ABOUT STATE
LEVEL POLICIES, SO REALLY HELPS
EVERYBODY USING THE DATA TO PUT
IT IN THE CONTEXT OF WHERE THE
YOUTH ARE ACTUALLY LIVING.
SO THAT'S VERY, YOU KNOW, BREEZY
OVERVIEW, I'M HAPPY TO TALK TO
ANYBODY WHO WANTS MORE DETAILS
LATER.
ONE OF THE THINGS WE HAVE BEEN
FOCUSED A LOT IS DIVERSITY IN
THE COHORT, AND YOU MAY KNOW
THAT THE "ALL OF US" RESEARCH
PROGRAM HAS USED AN EXPANDED AND
MORE ENCOMPASSING DEFINITION OF
DIVERSITY.
WE WANTED TO INCLUDE ALL THESE
CATEGORIES, SO "ALL OF US" HAS
RACE AND ETHNICITY, ACCESS TO
CARE, HOUSEHOLD INCOME,
EDUCATIONAL ATTAINMENT, GENDER
IDENTITY, GEOGRAPHY, SEX
ASSIGNED AT BIRTH, SEXUAL
ORIENTATION, AND THEY ALSO
INCLUDE AGE WHICH ISN'T REALLY
RELEVANT TO US SINCE THEY ARE
ALL THE SAME AGE.
AND DISABILITY WHICH WE DON'T AT
THE MOMENT HAVE A GOOD QUESTION
THAT CAN BE USED TO ADDRESS
THAT.
SO HERE YOU CAN SEE FOR EACH
INDIVIDUAL CATEGORY THE
PROPORTION OF THE COHORT THAT
FALLS INTO IT.
BUT I THINK WHAT'S MOST
INTERESTING WHEN WE LOOK AT THE
COHORT AS A WHOLE, SO 70% OF THE
SAMPLE IS REPRESENTED IN AT
LEAST ONE CATEGORY OF PEOPLE WHO
ARE UNDERREPRESENTED IN
BIOMEDICAL RESEARCH.
WHAT I THINK IS INTERESTING IS
THAT WE'VE GOT MORE THAN 3,000
THAT ARE REPRESENTED IN TWO
CATEGORIES, ALMOST A THOUSAND
REPRESENTED IN THREE CATEGORIES.
THIS IS IMPORTANT BECAUSE WE'RE
SEEING A LOT MORE RESEARCH BEING
DONE LOOKING AT
INTERSECTIONALITY.
IN TERMS OF WHERE WE ARE TODAY
IN ABCD, SO WE ARE -- WE'VE JUST
BEGUN OUR 7-YEAR FOLLOW-UP
PROTOCOL, THAT BEGAN LAST FALL.
YOU CAN SEE HERE KIND OF THE
PROGRESS FROM YEAR TO YEAR.
SO THE BLUE INDICATES THE
COMPLETED VISITS, THE BLACK ARE
THOSE THAT ARE WITHDRAWN.
THE WITHDRAWAL RATE IS STILL
VERY SMALL.
THE ORANGE ARE THE PEOPLE WHO
HAVE MISSED VISITS.
AND THE GRAY ARE PENDING VISITS.
THEY ARE NOT DUE TO COME IN YET
FOR THEIR VISITS.
I HIGHLIGHT THERE THE COVID
PANDEMIC BECAUSE IT WAS QUITE
DISRUPTIVE TO THE PROCESS OF A
LONGITUDINAL STUDY.
THANKFULLY WE WERE ABLE TO
CONTINUE TO COLLECT DATA.
YOU WILL SEE THE MISSINGNESS
RATES ARE HIGHER DURING THAT
PERIOD.
THE PANDEMIC HIT WHEN WE WERE
ABOUT THREE-QUARTERS OF THE WAY
THROUGH WITH TWO-YEAR FOLLOW-UP.
VERY MUCH IMPACTED OUR THREE AND
FOUR-YEAR FOLLOW-UP TIME POINTS.
AND THEN AS THINGS STARTED TO
GET BACK TO NORMAL WE RECOGNIZED
THAT OUR WINDOW OF BRINGING
PEOPLE IN HAD SHIFTED BECAUSE
THINGS HAD BEEN DELAYED.
AND SO WITH THE FIVE-YEAR
PROTOCOL WE HAD SITES TRY TO
REANCHOR PARTICIPANTS TO
ORIGINAL DATE REQUIRING SOME TO
SKIP THE FIVE YEAR AND JUMP TO
THE SIX-YEAR.
THAT'S THE TAN BAR.
SIX-YEAR FOLLOW-UP, WE'RE BACK
ON TRACK, IS GOING MUCH BETTER
AND MISSINGNESS IS MUCH SMALLER,
SIMILAR TO WHAT IT WAS IN THE
BEGINNING.
BUT WHAT WE'RE PARTICULARLY
AWARE OF IS DESPITE THE FACT OUR
WITHDRAWAL RATES ARE VERY LOW WE
DO HAVE PARTICIPANTS THAT HAVE
MISSED SEVERAL VISITS IN A ROW,
THAT ARE AT RISK OF WITHDRAWAL.
SO WE HAVE ON OUR DASHBOARD THE
ABILITY TO LOOK AT VISIT
PATTERNS, HOW MANY PARTICIPANTS
COME IN FOR ALL OF THEIR VISITS,
HOW MANY MISSED A VISIT AND COME
BACK, SO THE FIRST THREE ROWS,
ABOUT 7800 PARTICIPANTS HAVE
NEVER MISSED A VISIT.
THEY HAVE ATTENDED ALL OF THEIR
VISITS.
AND THEN YOU'LL SEE SOME
PARTICIPANTS THAT HAVE MISSED A
VISIT, THAT'S THE RED DOT, BUT
THEN COME BACK FOR SUBSEQUENT
VISITS.
SO THAT'S REALLY IMPORTANT, THAT
OUR SITES ARE DOING A GOOD JOB
BRINGING PEOPLE BACK EVEN IF
THEY HAVE MISSED A VISIT.
ONES WE'RE MOST CONCERNED ABOUT
ARE THESE WHERE THEY HAVE MISSED
VISITS, THEY HAVEN'T COME IN
SINCE THE TWO-YEAR FOLLOW-UP.
THIS IS THE GROUP OF
PARTICIPANTS THAT WE'RE MOST
FOCUSED ON.
AND IF WE LOOK AT THE DATA ON
THE EXTENDED ABSENCES, THIS IS
ALL DONE BY DIANA ALKIRE ON THE
TEAM, WE HAD 750 LAST MARCH THAT
WERE IN THIS EXTENDED ABSENCE
CATEGORY.
AND AS OF THIS APRIL, THAT'S
GONE DOWN TO 550.
SO, ONE OF THE THINGS WE DID AT
THIS TIME IS WE LOOKED AT THE
SITES THAT WERE NOT HAVING THIS
EXTENDED ABSENCE PROBLEM BECAUSE
THERE'S SOME SITES JUST DOING AN
AMAZING JOB BRINGING EVERYBODY
IN.
AND WE TALKED TO THEM ABOUT WHAT
THEIR TRICKS WERE.
AND WE HEARD A LOT OF THINGS,
ESSENTIALLY WHAT WE CAME UP IS
THERE IS NO SECRET SAUCE, A LOT
OF THINGS SITES DO TO MAKE
EASIER FOR FAMILIES TO
PARTICIPATE, AND MARIA DUBINSKY
AT THE UNIVERSITY OF MICHIGAN
PUT TOGETHER THIS GRAPHIC TO
HELP THE SITE COORDINATORS,
SCHEDULERS, TO FIGURE OUT WHAT
THEY CAN DO TO ENHANCE THE
EXPERIENCE FOR THEIR
PARTICIPANTS, SO THIS INCLUDES
THINGS LIKE TRANSPORTATION AND
CHILD CARE, SOME SITES GIVING
BONUS PAYMENTS.
A NUMBER OF STRATEGIES SO WE CAN
TRY TO BRING BACK IN BOTH THE
PEOPLE THAT WE MAY HAVE LOST
DURING THE PANDEMIC AS WELL AS
SOME OF THOSE EXTENDED ABSENCE
FOLKS.
I'D LIKE TO GIVE A BRIEF UPDATE
ON OUR JEDI ACTIVITIES.
LAST YEAR YOU HEARD FROM
LIEUTENANT COMMANDER TRACY
MURRAY, ABOUT EFFORTS TO ENHANCE
DIVERSITY, EQUITY, INCLUSION,
AND ACCESSIBILITY IN ABCD, USING
RESET, RESTRUCTURE, REENGAGE.
WE CONDUCTED A CLIMATE SURVEY,
I'LL TALK MORE ABOUT THAT ON THE
NEXT SLIDE.
TO REALLY UNDERSTAND HOW PEOPLE
IN THE CONSORTIUM WERE FEELING
AT VARIOUS LEVELS.
IN TERMS OF RESTRUCTURING, ONE
OF THE THINGS WE WANTED TO DO IS
ALSO EXPAND EFFORTS BEYOND
RACIAL DISCRIMINATION TO OTHER
MARGINALIZED GROUPS, AS PART OF
THAT WE'VE ALSO EXPANDED THE
MEMBERSHIP OF OUR JEDI ADVISORY
COUNCIL.
WE STARTED HAVING DIFFERENT
EVENTS THROUGHOUT THE YEAR, TO
FOCUS ON JEDI FACTORS.
SO FOR EXAMPLE WE HAVE NOW THESE
QUARTERLY JEDI ALL-HANDS
MEETINGS, AND THEY FOCUS ON
DIFFERENT TOPICS.
ONE WAS LOOKING AT THE FEDERAL
RACIAL AND ETHNIC CATEGORIES, WE
BRING IN OUTSIDE SPEAKERS TO
TALK ABOUT THAT.
ONE WAS ON MEDICAL MISTRUST.
AND MOST RECENT WAS AUTISM
AWARENESS.
AND THEN TRACY ALSO DOES THESE
TRAININGS FOR ALL OF OUR
INVESTIGATORS AS WELL AS RAs
ON VARIOUS TOPICS, AND WE'VE
DONE -- WHICH WE'RE GOING TO BE
DOING MORE OF IN THE COMING
YEAR.
AND WE'VE DONE A LITTLE BIT MORE
INTEGRATION AMONG SOME OF OUR
JEDI FOLKS INTO ALL OF THE
DIFFERENT WORK GROUPS THROUGHOUT
THE CONSORTIUM.
SO, FOR THE CLIMATE SURVEY, WE
HAVE THE JEDI ADVISORY COUNCIL
IN OUR COORDINATING CENTER WORK
TOGETHER TO BRING IN EXTERNAL
CONSULTANT TO DO A SURVEY OF THE
ENTIRE CONSORTIUM.
SO THIS INVOLVED ALL THE
INVESTIGATORS, R.A.s, SITE
COORDINATORS AT ALL LEVELS TO
LOOK AT CLIMATE AT THE
INDIVIDUAL SITES AND CLIMATE IN
THE CONSORTIUM AS A WHOLE,
SIMILAR FOR HBCD, WE HAVE MANY
WORK GROUPS AND WE'VE GOT PEOPLE
PARTICIPATING IN ALL THOSE WORK
GROUPS SO WE WANTED TO LOOK BOTH
AT HOW PEOPLE ARE FEELING AT
THEIR SITES AS WELL AS IN
CONSORTIUM-WIDE ACTIVITIES.
SHOWN HERE 92% AGREED ABCD HAS A
STRONG COMPLIMENT TO JEDI
VALUES, WHICH IS WONDERFUL.
IT ALSO RAISED SOME CONCERNS IN
DIFFERENT LAYERS, SOME AT THE
SITES, SOME AT CONSORTIUM LEVEL,
AREAS WE MIGHT NEED IMPROVEMENT,
TAKING RECOMMENDATIONS AND
MAKING CHANGES.
I NOW WANT TO TALK ABOUT HOW
PEOPLE ARE LEVERAGING ABCD.
SO I BELIEVE I MENTIONED LAST
YEAR OUR PARTICIPATION IN THE
NIH RECOVER INITIATIVE, THE
RESEARCH IN COVID, LONG COVID
INITIATIVE AT NIH.
WE THOUGHT IT WAS PARTICULARLY
IMPORTANT FOR ABCD TO BE PART OF
THIS BECAUSE WE WERE ONE OF THE
FEW COHORTS THAT IT BRAIN
IMAGING, COGNITIVE TESTING,
MENTAL HEALTH MEASURES PRIOR TO
THE PANDEMIC, INFORMATION DURING
THE PANDEMIC ABOUT THEIR
EXPERIENCES, AND WE'RE
CONTINUING TO FOLLOW THEM FOR AT
LEAST SOME YEARS AFTER ACUTE
PHASE OF PANDEMIC.
WHAT WE MISSED WAS WE DIDN'T
HAVE ANTIBODY TESTING, RECOVER
HAS GIVEN US ANTIBODY TESTING.
ANOTHER SURVEY TALKED ABOUT LONG
COVID SYMPTOMS.
FOR THOSE WHO SHOW EVIDENCE OF
LONG COVID THERE'S ABILITY TO
PARTICIPATE IN THE TIER 2 OF
RECOVER INITIATIVE, MORE
IN-DEPTH ASSESSMENTS.
WE MADE AN OFFER TO PARTICIPANTS
WHO WANTED TO PARTICIPATE TO
PARTICIPATE IN RECOVER.
6400 ABCD PARTICIPANTS HAVE
JOINED THE RECOVER INITIATIVE SO
THEY'VE GOTTEN ANTIBODY TESTING
AND ARE DOING THE SURVEYS.
AND THIS IS REALLY AMAZING.
IN FACT, THE RECOVER PEDIATRIC
COHORT, 45% OF THEM ARE ABCD
PARTICIPANTS.
SO WE'VE DONE A LOT TO ALSO
ENHANCE THEIR COHORT AS WELL.
THIS DATA WILL BE RELEASED NOT
WITH THE UPCOMING DATA RELEASE
BUT SUBSEQUENT DATA RELEASE.
WE WERE ALSO APPROACHED BY
NIDA'S HIV RESEARCH PROGRAM TO
LOOK AT HOW ABCD MAY BE USED TO
STUDY HIV.
AND SO RELA GONZALEZ FROM
FLORIDA INTERNATIONAL UNIVERSITY
ORGANIZED A MEETING BRINGING
TOGETHER THOSE THAT DOMAINS THAT
MAY BE RELEVANT TO HIV, OUTSIDE
INVESTIGATORS TO TALK ABOUT WHAT
WE MIGHT BE MISSING, AND REALLY
IMPORTANTLY WE HAD A PANEL OF
YOUNG PEOPLE WHO WERE -- YOUNG
ADULTS WHO CONTRACTED HIV WHEN
TEENAGERS.
SO THEY COULD GIVE US THEIR
PERSPECTIVE AND WHAT THEY HEARD,
WHAT THEY WISHED THEY HAD KNOWN,
IT WAS A RICH DISCUSSION.
SO COMING OUT OF THAT WE HAVE
KIND OF AN ASSESSMENT OF WHAT WE
ALREADY HAVE.
WE HAVE A LOT OF INFORMATION ON
MENTAL HEALTH AND GENDER AND
SEXUAL ORIENTATION,
DISCRIMINATION, STRUCTURAL
POLICY, STATE LEVEL POLICIES.
WE HAVE SOME AREAS THAT WE ARE
COLLECTING SOME INFORMATION ON
BUT IT WOULD BE -- MAYBE USEFUL
TO BROADEN THAT, SO SOCIAL
SUPPORT, FOR EXAMPLE,
RELATIONSHIP OF DRUG AND ALCOHOL
USE, AND SEXUAL ENCOUNTERS.
AND THEN THERE'S SOME AREAS WE
DON'T HAVE ANY COVERAGE IN.
A LOT OF THIS DISCUSSION WAS
FOCUSED ON IF ABCD IS TO
CONTINUE WHEN THE KIDS BECOME
ADULTS, THESE ARE SOME AREAS WE
MAY WANT TO FOCUS ON IN THAT
NEXT PHASE.
SO NOW I'M REALLY EXCITED TO
TURN IT OVER TO ELIZABETH
HOFFMAN TO TALK ABOUT RESOURCE
SHARING, BEGIN TO TALK ABOUT
RESOURCE SHARING, AND WE'LL TURN
IT OVER TO KIM TO FINISH THAT
DISCUSSION.
ELIZABETH, ARE YOU THERE?
>> I'M HERE.
HOPING YOU CAN HEAR MY CLEARLY.
SORRY I'M NOT THERE IN PERSON.
NEXT SLIDE.
GREAT, THANKS.
I THOUGHT WHERE I WOULD START IS
JUST WITH A QUICK SNAPSHOT OF
WHERE WE ARE WITH DATA
AVAILABILITY.
DATA HAS BEEN RELEASED THROUGH
THE DATA ARCHIVE THAT INCLUDES
CURRENT DATA RELEASE, ABCD 5.1.
THIS INCLUDES DATA ON THE FULL
PARTICIPANT COHORT, THROUGH
THREE-YEAR FOLLOW-UP TIME POINT
AS WELL AS A PORTION OR
SIGNIFICANT PORTION OF THE
FOUR-YEAR FOLLOW-UP DATA AS
WELL.
AND THESE ARE ALL AVAILABLE,
TABULATED DATA AS A DOWNLOADABLE
ZIP FILE, RAW IMAGING FILES ARE
AVAILABLE VIA THE DOWNLOAD TOOL.
WE MADE AVAILABLE A COLLECTION
OF DATA RESOURCES, WHICH ARE NEW
WITH THIS LATEST RELEASE.
AND THESE ARE LISTED HERE ON THE
RIGHT.
WE HAVE AN ABCD WIKI, AN AMAZING
RESOURCE THAT GIVES UPDATED AND
TIMELY INFORMATION ABOUT THE
DATA AVAILABILITY AND SPECIFIC
DATA RELEASE NOTES COVERING
EVERY DOMAIN IN THE ASSESSMENT
PROTOCOL, AND IMPORTANTLY THESE
RELEASE NOTES CAN BE UPDATED
REGULARLY.
SO IN CONTRAST TO THE PAST
AVAILABLE ONLY THROUGH THE NIMH
DATA ARRIVE AS A STATIC DOCUMENT
THESE ARE DOCUMENTED WITH
UPDATES SO THE COMMUNITY CAN BE
INFORMED AS THINGS ARE SHIFTING
AND CHANGING.
SO THAT'S ON THE WIKI.
WE ALSO HAVE NEW WITH THIS DATA
RELEASE A DATA DICTIONARY
EXPLORER APPLICATION WHICH I'LL
SHOW YOU IN JUST A MOMENT.
AND THIS IS A WAY TO
INTERACTIVELY EXPLORE THE RICH
DATA RESOURCE AND UNDERSTAND THE
FULL EXTENT OF THE CONSTRUCTS
THAT ARE MEASURED DOWN TO THE
INDIVIDUAL DATA ELEMENTS
INCLUDED IN EACH OF THE
CONSTRUCTS, AND YOU CAN EXPLORE
THE DATA CONSTRUCTS WITHOUT
HAVING ACCESS TO THE DATA SO NO
DATA ARE INCLUDED HERE, JUST THE
CONSTRUCTS THEMSELVES, I THINK
REALLY USEFUL FOR FOLKS WHO MAY
BE NEW TO ABCD AND WANT TO GET
SORT OF A LANDSCAPE VIEW OF
WHAT'S CONTAINED IN THIS
RESOURCE.
THE LAST THING I WANT TO TELL
YOU ABOUT ALSO NEW IS A
DISCUSSION FORUM HOSTED ON A
REPOSITORY CALLED NOW I KNOW MY
ABCDs, WHICH IS MANAGED OUT OF
FLORIDA INTERNATIONAL UNIVERSITY
BY ANDREA LAIRD, SOME OF HER
POSTDOCS DEVELOPED THIS FORUM,
WHICH IS INTERACTIVE AND UP TO
THE MOMENT SO FOLKS CAN COME IN
AND ASK QUESTIONS OF ABCD DATA
AND THE COMMUNITY IS THEN
RESPONDING.
SO OTHER USERS CAN THEN WEIGH IN
ON SOME OF THE QUESTIONS THAT
ARE ASKED AND WE ALSO HAVE KEVIN
LYE WHO IS ROUTINELY VISITING
THE FORUM AS MANY OF US ARE TO
SEE WHAT KINDS OF QUESTIONS ARE
BEING ASKED AND WHERE
APPROPRIATE BRINGING OVER THOSE
QUESTIONS TO THE WIKI, PROVIDING
ANSWERS FROM ABCD EXPERTS.
SO THAT'S SORT OF THAT NICE KIND
OF INTERACTIVE BACK AND FORTH
RELATIONSHIP WITH ABCD AN THE
DISCUSSION FORUM.
AND THIS IS JUST A QUICK EXAMPLE
OF WHAT THE WIKI PAGE LOOKS
LIKE, THIS IS THE MAIN PAGE.
YOU'LL SEE HERE ON THE LEFT-HAND
COLUMN THESE ARE INDIVIDUAL
RELEASE NOTES, ORGANIZED BY
DOMAIN.
YOU CAN CLICK ON -- WE'LL
PRETEND WE'RE WALKING THROUGH
THIS DYNAMICICALLY.
IF YOU CLICK ON FOR EXAMPLE
NEUROCOGNITION IN BLUE, YOU
WOULD THEN BE BROUGHT TO A LIST
OF ALL OF THE INSTRUMENTS THAT
ARE AVAILABLE IN THAT DOMAIN.
AND THEN IF YOU CLICK ON
INSTRUMENT, NIH TOOLBOX, FOR
EXAMPLE, YOU GO TO THE NEXT,
MANY MORE DETAILS ABOUT THAT
INSTRUMENT HERE ON THE RIGHT.
YOU CAN SEE DESCRIPTIONS OF THE
MEASURE, AND LINKS TO TECHNICAL
MANUALS, IN SOME CASES RESEARCH
ARTICLES ABOUT THE USE OF THOSE
DATA.
AND THEN IF YOU WERE TO CLICK ON
THE TABLE NAME WHICH IS THE
THIRD COLUMN YOU'RE BROUGHT TO
THE ABCD DATA DICTIONARY THAT I
MENTIONED EARLIER, A GREAT WAY
TO INTERACTIVELY LOOK AT THE
ABCD CONSTRUCTS THROUGH THIS
TREE STRUCTURE ON THE LEFT
DRILLING DOWN INTO DOMAINS AND
INDIVIDUAL INSTRUMENTS OR
THROUGH A QUERY SEARCH FEATURE
HERE ON THE RIGHT WHERE YOU CAN
QUERY THE TABLE NAME, VARIABLE
NAME, CONSTRUCT, AND THAT WILL
POP UP WITH INFORMATION.
NEXT SLIDE.
AND THE REALLY EXCITING NEWS,
BEST FOR LAST, AS GAYA
MENTIONED, A NEW DATA SHARING
PLATFORM COMING THIS SUMMER.
AND THIS WILL HOST DATA RELEASE
6.0, THIS IS ON THE LASSO DATA
INFORMATICS SYSTEM, ALL DATA ARE
AT LEAST THE MOST RECENT COUPLE
RELEASES WILL BE MOVED OVER OH
ALL DATA USE WILL BE THROUGH THE
LASSO PLATFORM AND NO LONGER
THROUGH THE NDA, EXCITING
BECAUSE IT WILL REALLY BE A
FLEXIBLE PLATFORM THAT WILL
ACCOMMODATE USERS WITH DIFFERENT
LEVELS OF EXPERTISE AND MULTIPLE
WAYS TO ANALYZE DATA, WILL
INCLUDE UP THROUGH 50% OF THE
SIX-YEAR FOLLOW-UP DATA AND MOST
OF THE FIVE-YEAR FOLLOW-UP DATA.
IMPORTANTLY, IT WILL BE -- THIS
WILL EVENTUALLY PROVIDE A
HOMOGENOUS SOLUTION FOR
HARMONIZING WITH PLANNED DATA
FROM HBCD, ONE-STOP SHOPPING FOR
ALL OF THE DATA AVAILABLE IN
THESE TWO PROGRAMS, AND HERE
BELOW IS JUST A HIGH LEVEL DATA
FLOW OF HOW THIS SYSTEM WILL
WORK.
MUCH MORE INFORMATION ABOUT THIS
COMING SOON, BUT A QUICK SENSE,
THE LASSO, MAIN LASSO PLATFORM
WHICH HAS USER-FACING
FUNCTIONALITY, USER
AUTHENTICATION PORTAL FOR
CERTIFICATION TO TAKE PLACE,
KNOWLEDGE BASE, A QUERY, SEVERAL
KINDS OF QUERY TOOLS OF THE
DATA, AND THEN THE FINAL STORED
AT THE UNIVERSITY OF MINNESOTA,
LINKAGES OUT TO THE UNIVERSITY
OF MINNESOTA, WHERE THE DATA
WILL ACTUALLY BE.
THE THIRD COMPONENT WHICH SOME
MAY BE FAMILIAR WITH FROM PAST
DATA RELEASES IS DATA
EXPLORATION AND ANALYSIS PORTAL,
ANOTHER TOOL FOR USERS TO
ANALYZE THE DATA, TO TAKE
ADVANTAGE OF SOME OF THE COMPLEX
MODELING THAT IS INCLUDED IN
ABCD AND THAT WILL BE AVAILABLE
AS WELL.
ALL OF THIS INTRAOPERABILITY
WILL BE CRITICAL I THINK FOR
PROVIDING FLEXIBLE WAYS FOR
USERS TO ACCESS AND USE THE
DATA.
THE OTHER THING I WANTED TO
POINT OUT IS, NEXT SLIDE, A NEW
TRAINING MODULE THAT WILL BE
PART OF THIS NEW DATA RELEASE
PROCEDURE AND MOVING FORWARD,
AND THIS IS PART OF THE USER
AUTHENTICATION PART OF THE USER
EXPERIENCE.
SO WHEN A USER COMES IN TO
ACCESS THE DATA, THIS IS ANY
USER, EVEN SOMEBODY CURRENTLY --
WHO HAD A DATA USE AGREEMENT
WITH THE NDA, THEY WILL COME IN
AND NEED TO COMPLETE A
RESPONSIBLE DATA AND BIOSPECIMEN
USE TRAINING.
THIS IS A REQUIREMENT, NEED TO
COMPLETE ASSESSMENT AND PASS
RATE IS 90% SO WE'RE EXPECTING
PEOPLE WILL TAKE THIS TRAINING
SERIOUSLY, GO THROUGH, THEY
CAN'T SKIP AHEAD, THEY WILL DO
ASSESSMENT AT THE END TO
DEMONSTRATE KNOWLEDGE.
ON THE RIGHT BRIEFLY, HIGH-LEVEL
TOPICS THAT ARE COVERED IN THIS
TRAINING MODULE, SO DESCRIPTION
OF ETHICAL PRINCIPLES FOR DOING
SECONDARY DATA ANALYSIS, WE
DON'T ASSUME USERS NECESSARILY
KNOW ABOUT THIS, DESCRIBING
HISTORICAL AND CONTEMPORARY
CONTEXT FOR UNDERSTANDING RACE
AND RACISM IN SCIENCE AND
MEDICINE, UNDERSTANDING HOW TO
CONDUCT SCIENCE ETHICALLY AND
RESPONSIBLY, INCLUDING
COMMUNICATING, INTERPRETING THE
SCIENCE.
AND UNDERSTANDING THE DATA USE
TERMS AND CONDITIONS FOR
ACCESSING DATA AND FOR USING
BIOSPECIMENS AND HOW TO MITIGATE
RISK OF PARTICIPANT
IDENTIFICATION WHICH IS
ESPECIALLY IMPORTANT NOW THAT WE
HAVE INCREASING AMOUNTS OF DATA
AVAILABLE AT ABCD, AND PERHAPS
MORE OPPORTUNITIES FOR
TRIANGULATING IF SOMEBODY WERE
SO INCLINED TO DO THAT.
THIS HAS NOT BEEN BUILT INTO NDA
SO WE'RE EXCITED THIS WILL BE
AVAILABLE AS PART OF THIS NEW
DATA SHARING PLATFORM.
AND AS WITH EVERYTHING ELSE MORE
ON THIS LATER IN THE COMING
WEEKS AND MONTHS, AS WE RAMP UP.
SOME FUNCTIONALITY I THINK I
FORGOT TO MENTION ON THE DATA
SHARING PLATFORM WON'T BE
AVAILABLE IMMEDIATELY WITH THE
ROLLOUT BUT RAMPED UP, AND WE'LL
KEEP YOU INFORMED ABOUT UPDATES
AS THEY HAPPEN.
THAT'S IT FOR ME.
>> THANKS, ELIZABETH.
NOW OVER TO KIM LEBLANC TO TALK
ABOUT OUR BIOSPECIMEN ACCESS
PROGRAM.
>> THANK YOU.
IN ADDITION TO MAKING OUR DATE
WE'LL MAKE BIOSPECIMENS IDEA.
THE IDEA WAS FUTURE USE OF THEM.
YOU CAN SEE WHAT WE COLLECT IN
THE BOTTOM RIGHT.
SOME OF THESE ALREADY GO FOR
SOME PRE-DETERMINED ANALYSES
PART OF OUR PROTOCOL BUT THE
REST REMAIN AVAILABLE FOR
ADDITIONAL STUDY.
SO WE'RE NOW STARTING THIS
ACCESS PROGRAM TO ALLOW ABCD
CONSORTIUM INVESTIGATORS AND THE
ENTIRE SCIENTIFIC COMMUNITY TO
APPLY TO USE THEM.
THE IDEA IS TO EXPAND THE
SCIENTIFIC RESEARCH WORK DONE ON
ADOLESCENTS TO EXPAND WHAT WE
HAVE GETTING FROM THE ABCD STUDY
AND OUR KNOWLEDGE ABOUT HEALTH
MORE GENERALLY.
THEY HAVE TO DEPOSIT RESULTS OF
ANALYSES FURTHER ENRICHING ALL
THE DATA, THROUGH AN X01
RESOURCE ACCESS AWARDS, THEY
HAVE TO GET THEIR OWN FUNDS TO
DO THE ANALYSES.
DEMONSTRATION OF THE PROCESS FOR
APPLYING, MOSTLY TO SHOW A LOT
OF TOOLS ARE AVAILABLE THAT I'LL
WALK THROUGH IN JUST A MOMENT TO
HELP RESEARCHERS FIGURE OUT WHAT
WE HAVE AVAILABLE, WHAT SUITS
THEIR NEEDS, WHETHER IT MEETS
WHAT THEY ARE TRYING TO STUDY
AND GOES ALONG WITH OTHER DATA
THEY ARE TRYING TO LOOK AT FROM
ABCD STUDY PARTICIPANTS.
AND IMPORTANTLY THEY HAVE TO DO
AVAILABILITY INQUIRY TO SEE
WHAT'S AVAILABLE AND PART OF
THAT GET BACK THE RESOURCE
AVAILABILITY AND IMPACT REPORT,
SHOWING HOW MUCH WHAT THEIR
ASKING FOR WILL DEPLETE WHAT WE
HAVE REMAINING.
WE'LL BE ABLE TO CAREFULLY
ASSESS WHAT PEOPLE ARE ASKING TO
DO AND MAKE SURE THE SCIENTIFIC
VALUE OF WHAT THEY ARE ASKING TO
DO MEETS HOW MUCH THEY ARE GOING
TO BE DEPLETING WHAT WE HAVE
LEFT.
SO HERE A BRIEF PSEUDOTOUR, ALSO
A QR CODE THERE IF YOU WANT TO
TAKE A LOOK FOR IT YOURSELF.
THERE'S A NUMBER OF TOOLS
AVAILABLE.
FIRST IS KIND OF WALKING THROUGH
WHAT I JUST DID FOR YOU THERE,
THE PROCESS OF APPLYING SO
PEOPLE WITH CLICK THROUGH, SEE
HOW THE PROCESS IS SUPPOSED TO
WORK, ADDITIONAL DETAILS ON WHAT
THEY NEED TO KNOW.
HERE'S A SNAPSHOT OF THE
RESEARCHER GUIDES, ALL SORTS OF
DETAILS ON HOW THINGS ARE
COLLECTED, STORED, PROCESSED,
WHAT SORT OF AMOUNTS THEY MIGHT
WANT TO USE FOR ANALYSIS TO
FIGURE OUT IF WE HAVE WHAT THEY
NEED.
WE HAVE THIS NICE TOOL,
BIOSPECIMEN EXPLORER TOOL.
PEOPLE WITH GO IN AND FILTER
WHAT WE HAVE AVAILABLE BASED ON
TIME POINTS OF INTEREST,
BIOSPECIMEN TYPES, DEMOGRAPHIC
FEATURES, WE'RE ADDING SAMPLE
CONDITIONS, BEING ABLE TO SEARCH
BY PARTICIPANT I.D.s TO MAKE
SURE IT MATCHES OTHER DATA FOR
CERTAIN PARTICIPANTS.
WHAT YOU'LL GET BACK IMMEDIATELY
IS NUMBER OF PARTICIPANTS IN
THESE DIFFERENT CATEGORIES THAT
HAVE SPECIMENS AT THOSE TIME
POINTS.
AGAIN, IF IT DOES MEET THEIR
NEEDS THEY CAN START INQUIRY AND
GET THAT REPORT BACK HOW MUCH OF
IT'S GOING TO DEPLETE RESOURCES,
WE'LL SEE THE APPLICATION TO
MAKE SURE IT'S A GOOD USE OF THE
RESOURCES.
THERE'S MORE INFORMATION ON OUR
WEBSITE, MOSTLY MORE ABOUT THE
PROCESS FOR APPLYING.
AND IT'S ACTIVE RIGHT NOW.
HERE ARE UPCOMING DATES, THREE
CYCLES, MORE DATES COMING FOR
THIS.
WE'VE ALREADY HAD ONE
APPLICATION, NUMEROUS
AVAILABILITY INQUIRIES SO WE'RE
EXCITED TO ADD THIS TO THE
REPERTOIRE OF ALL THE GREAT
THINGS PEOPLE CAN BE DOING WITH
THE ABCD STUDY TO ALSO START
ANALYZING OUR BIOSPECIMENS AND
ADDING THAT DATA BACK INTO THE
DATA RESOURCE.
>> THANKS, KIM.
I AS LIKE TO END THIS
PRESENTATION TALKING ABOUT WHAT
IS COMING OUT OF ABCD.
I WANT TO START, AND THESE
ANALYSES WERE DONE BY DIANA
ALKIRE, WITH THE NUMBER OF
GRANTS FUNDED TO USE ABCD DATA,
MORE THAN 200 GRANTS FUNDED TO
USE THE DATA.
FY 24 IS SMALL BECAUSE WE'RE NOT
THROUGH WITH FY 24 YET.
MOST OF THESE ARE RESEARCH
PROJECT GRANTS, INDIVIDUAL
TRAINING GRANTS.
BUT THERE ARE ALSO SOME
EDUCATION GRANTS, WHICH IS
IMPORTANT BECAUSE IT'S A WAY TO
DISSEMINATE ABCD TO THE BROADER
SCIENTIFIC COMMUNITY.
AND YOU'LL SEE IN PINK SHE
SEPARATED OUT THE GRANTS THAT
HAVE BEEN AWARDED TO PEOPLE PART
OF THE CONSORTIUM SO THAT WOULD
BE IN THE GREEN OR BLACK VERSUS
THOSE NOT PART OF THE
CONSORTIUM, SO YOU CAN SEE THE
DATA IS BEING USED BY MANY
OUTSIDE OF THE CONSORTIUM.
I THINK ONE OF THE THINGS THAT'S
BEEN EXCITING FOR ME IS TO SEE
THAT THE INSTITUTES AND CENTERS
SUPPORTING THESE GRANTS, SO WE
HAVE 10 INSTITUTES AND CENTERS
THAT SUPPORT THE ABCD
CONSORTIUM, BY 15 INSTITUTES,
PEOPLE ARE LOOKING AT THINGS WE
HADN'T THOUGHT OF, OF VALUE TO
OTHER I.C.s AT NIH AND FUNDING
FROM NON-NIH ORGANIZATIONS, AS
WELL.
ONE THING WE WANTED TO LOOK AT
THIS YEAR WAS WHAT THE CONTENT
OF THESE GRANTS ARE.
SO, DIANA DID ANALYSIS LOOKING
AT THE PRIMARY FOCUS OF THE
GRANTS AND THEY ARE ORGANIZED BY
DOMAIN AS WE DESCRIBED THEM
THROUGH OUR WORK GROUP
STRUCTURES.
YOU CAN SEE NEUROIMAGING AND
MENTAL HEALTH HAS THE LARGEST
NUMBER OF GRANTS IN THOSE AREAS.
YOU CAN SEE ON PREVIOUS SLIDE
NIMH IS FUNDING THE MOST GRANTS
USING ABCD DATA.
BUT I THINK WHAT'S INTERESTING
IS TO LOOK AT CROSS-CUTTING.
EACH OF THESE BARS IS FOR
EXAMPLE FIRST BAR IS OUT OF THE
NEUROIMAGING GRANT, WHAT OTHER
DOMAINS ARE THEY LOOKING AT?
YOU CAN SEE THAT PEOPLE ARE
PULLING DATA ACROSS DOMAINS TO
ANSWER THEIR QUESTIONS.
AND AS A RESULT, WE HAVE -- THIS
IS 972 BUT DIANA TOLD ME YET
WE'RE AT 986, RAPIDLY
APPROACHING 1,000 PAPERS COMING
OUT OF ABCD WHICH IS REALLY
EXCITING.
AND IF YOU LOOK AT THE -- THIS
IS JUST THE EMPIRICAL PAPERS, NO
COMMENTARIES OR REVIEWS, YOU
LOOK AT THE BREAKDOWN BETWEEN
ABCD AUTHORS THAT ARE MEMBERS OR
FORMER MEMBERS VERSUS NOT, 60%
OF THE PAPERS COMING OUT ARE BY
PEOPLE WHO ARE NOT AFFILIATED
WITH THE ABCD CONSORTIUM,
EXCITING TO SEE AS WELL.
WE'RE STARTING TO LOOK AT OTHER
METRICS OF IMPACT, SO HERE YOU
CAN SEE AN ANALYSIS OF THE ABCD
PUBLICATIONS USING RELATIVE
CITATION RATIO, WHICH IS A WAY
TO LOOK AT CITATIONS OF THE
PAPER NORMALIZED BY FIELD, YEAR,
NIH-FUNDED PAPERS.
SO THAT THE MEAN NIH-FUNDED
PAPER IS 1, AND WHAT YOU SEE
HERE IS THAT THE AVERAGE RCR FOR
ABCD PAPERS RANGES BETWEEN 2.5
TO 7 TIMES THE CITATIONS OF THE
AVERAGE NIH-FUNDED PAPER.
SO THAT'S REALLY EXCITING TO SEE
AS WELL.
BUT IT IS ONLY ONE MEASURE.
IT'S REALLY ONLY ONE AUDIENCE,
TALKING ABOUT THE SCIENTIFIC
AUDIENCE.
SO WE'RE ALSO USING ALT METRIC
TO SEE WHAT THE CONVERSATION IS
IN OTHER SPACES, AROUND ABCD
DATA.
THE MOST MENTIONS HERE ARE
THROUGH TWITTER, OR X, WHERE
THERE ARE QUITE A FEW, 29,000 OR
SO.
BUT THERE ARE A LOT OF OTHER
AREAS THAT ARE MENTIONED.
SO THERE'S NEWS STORIES, BLOGS,
OTHER TYPES OF SOCIAL MEDIA, AND
REALLY OF INTEREST IS SEVERAL
POLICY DOCUMENTS NOW THAT ARE
STARTING TO CITE ABCD DATA.
SO, BECAUSE OF ALL THIS GREAT
WORK THAT IS HAPPENING WITH ABCD
DATA, WE WANTED TO FIND A WAY TO
SHOWCASE IT.
SO PRESENTATIONS OF ABCD DATA,
MANY CONFERENCES THROUGHOUT THE
YEAR, THEY TEND TO BE FOCUS,
NONE SHOW BREADTH OF THE
RESEARCH THAT'S BEING DONE WITH
ABCD DATA.
SO, IN MARCH WE HELD OUR FIRST
ABCD INSIGHTS AND INNOVATIONS
MEETING, AND THIS WAS LED BY
TRACY MURRAY, WHO DID A
PHENOMENAL JOB ORGANIZING THIS
MEETING, SUPPORTED BY NIDA,
NIAAA, NIMH, OBSSR, NICHD, IF
YOU CLICK ON THE QR CODE WE HAVE
RECORDINGS OF ALL THE
PRESENTATIONS ON THE WEBSITE.
IT WAS REALLY AN EXCITING
MEETING.
WE HAD OVER 400 ATTENDEES, IN
PERSON AND VIRTUALLY.
AND 90% OF THEM WERE FROM
OUTSIDE THE ABCD CONSORTIUM.
WE ALSO RECEIVED 171 ABSTRACTS
THAT WERE -- MOST TURNED INTO
POSTERS AT THE MEETING, WE
SELECTED FROM THOSE THE BEST TO
GIVE FLASH TALKS DURING THE
MEETINGS AND WANTED TO
PRIORITIZE EARLY-STAGE
INVESTIGATORS AT THIS MEETING SO
WE CREATED OPPORTUNITIES FOR
THEM, IN ADDITION TO POSTERS AND
FLASH TALKS, TO HAVE SOME
MENTORING OPPORTUNITIES.
SO WE HAD SOME GROUP SESSIONS.
THEY WERE ABLE TO IMMEDIATE WITH
PROGRAM OFFICIALS.
BUT WE ALSO WERE ABLE TO ARRANGE
ONE-ON-ONE MENTORING SESSIONS IF
THERE WERE PARTICULAR AREAS THEY
WERE INTERESTED IN, PARTICULAR
PEOPLE THEY WANTED TO TALK TO.
AND THEN WE ALSO HAD A LUNCH
SESSION WHERE WE HAD EXPERTS
FROM THE ABCD CONSORTIUM
AVAILABLE FOR PARTICIPANTS IN
THE MEETING TO ASK QUESTIONS
ABOUT THE DATASETS SO WE HAD
SUSAN PAPER WHO OVERSEES OUR
ASSESSMENT PROTOCOLS WAS THERE
TO ANSWER ANY QUESTIONS THEY HAD
ABOUT THE ASSESSMENT PROTOCOLS.
DAMIAN WAS THERE TO ANSWER ABOUT
IMAGING, WES THOMPSON TO ANSWER
STATISTICS, SO PEOPLE COULD GET
IMMEDIATE INFORMATION FROM THE
EXPERTS IN THE ROOM WHICH WAS
REALLY EXCITING.
AND RESULTING FROM THAT WE GOT
GREAT FEEDBACK.
I ENJOYED THIS MORE THAN ANY
OTHER MEETING I CAN REMEMBER,
AND THEY HOPED THIS WOULD BE THE
FIRST OF MANY MEETINGS, WHICH SO
DO WE.
I THINK IT WAS A UNIQUE
ENVIRONMENT.
PEOPLE TOLD ME PARTICULARLY THE
YOUNGER FOLKS TOLD ME THAT IT
WAS GREAT TO BE IN A ROOM WHERE
EVERYBODY WAS USING ABCD, PEOPLE
WERE WERE THERE TO HELP AND
GUIDE THEM, A FUN EXPERIENCE.
ON THE OTHER SIDE IN TERMS OF
DISSEMINATION WE'VE ALSO MADE IT
A PRIORITY IN THE LAST YEAR TO
TAKE THE FINDINGS COMING OUT OF
ABCD, SYNTHESIZE THEM AND
PRODUCE INFOGRAPHICS THAT CAN
TRANSLATE THAT INFORMATION FOR
THE LAY AUDIENCES, REALLY
DESIGNED TO BE ABLE TO GIVE BACK
TO OUR PARTICIPANTS AND THEIR
FAMILIES SO THEY KNOW WHAT IS
COMING OUT OF THEIR IMMENSE
CONTRIBUTION TO THE STUDY.
SO WE STARTED WITH SCREEN USE
AND SLEEP COORDINATED BY
ELIZABETH HOFFMAN, RECENTLY ON
THE COVID-19 PANDEMIC.
THE SLEEP INFOGRAPHIC HAS WON
AWARDS FOR PLAIN LANGUAGE
DISSEMINATION.
IN ADDITION TO THE INFOGRAPHICS,
IN CONJUNCTION WITH EACH
INFOGRAPHIC WE'VE HERALD A
WEBINAR WHERE WE INVITE THREE OF
THE AUTHORS OF PAPERS THAT ARE
CITED IN THE INFOGRAPHIC TO GIVE
A SHORT PRESENTATION OF THEIR
FINDINGS, AND THEN WE HAVE ABOUT
A HALF HOUR FOR QUESTION AND
ANSWER FROM THE AUDIENCE, SO
THIS HAS BEEN EXCITING.
PEOPLE HAVE SO MANY QUESTIONS,
THE OPPORTUNITY TO BE ABLE TO
ASK EXPERTS THAT ARE
CONTRIBUTING TO THESE
INFOGRAPHICS HAS BEEN REALLY
WONDERFUL FOR THEM.
AND LAST THING I WANT TO MENTION
AS I SAID WE'RE STARTING TO SEE
ABCD PAPERS CITED IN POLICY
DOCUMENTS, I THINK THAT IS
REALLY IMPORTANT, REALLY
IMPORTANT VENUE FOR BEING ABLE
TO USE THE RESULTS OF ABCD DATA
TO CHANGE THE LIVES OF
ADOLESCENTS, SO HERE YOU SEE A
COUPLE EXAMPLES, THERE WAS A
PAPER THAT CAME OUT LOOKING AT
SUBSTANCE USE DURING THE
PANDEMIC, AND IT'S BEEN CITED BY
THE URBAN INSTITUTE.
A PAPER A BRAIN CHARTS CITED BY
WORLD HEALTH ORGANIZATION.
AND THIS PAPER THAT I THINK I
PRESENTED LAST YEAR ON
MACROECONOMIC FACTORS THAT
INFLUENCE ASSOCIATION BETWEEN
INCOME AND BRAIN STRUCTURE, AND
IT WAS ALSO CITED BY THE URBAN
INSTITUTE.
JUST DEMONSTRATING THAT WE ARE
ACHIEVING THE GOALS WE SET OUT
FOR, TO DO GREAT SCIENCE BUT
ALSO HAVE THAT SCIENCE USED.
AND WITH THAT I WOULD LIKE TO
THANK -- THIS IS AN ENORMOUS
EFFORT WITH HUNDREDS OF PEOPLE
WHO ARE INVOLVED IN COLLECTING
THE DATA AND INTERACTING WITH
PARTICIPANTS AND THE RESEARCH
STAFF WHO HAVE DONE AN AMAZING
JOB GETTING US THROUGH THE COVID
PANDEMIC AND KEEPING THE
EXPERIENCE ONE THAT PARTICIPANTS
WANT TO COME BACK FOR AND OF
COURSE THE 12,000 PARTICIPANTS
AND FAMILIES WHO HAVE GIVEN AN
INORDINATE AMOUNT OF TIME TO THE
STUDY TO MAKE IT A SUCCESS.
WITH THAT, WE'RE HAPPY TO TAKE
QUESTIONS.
>> THAT WAS GREAT PRESENTATION,
HOW MUCH THIS GENERATED.
YOU MENTIONED CONCEPTS YOU
HADN'T YET THOUGHT ABOUT.
AND I WAS LOOKING THROUGH THE
DATA DICTIONARY AND I SEE
THERE'S APPROPRIATELY A LOT ON
SOCIAL MEDIA USE.
BUT I COULDN'T FIND IF THERE WAS
INVERSE OF THAT, WHICH MIGHT NOT
ADD UP, BECAUSE PEOPLE ARE GOOD
AT ESTIMATING THESE THINGS,
WHAT'S THE PERCENTAGE OF TIME
THAT KIDS ARE ABLE TO SPEND IN
FACE-TO-FACE CONTACT WITH THEIR
PEERS BECAUSE I THINK THAT IS
SORT OF EMERGING AS DRIVING A
LOT OF ISOLATION AND DEPRESSION
AND ANXIETY, ESPECIALLY AMONG
GIRLS.
>> YEAH, IT'S A REALLY GOOD
QUESTION.
WE HAVE INFORMATION ABOUT WHAT
THEY ARE DOING BUT I DON'T THINK
WE HAVE THAT MUCH INFORMATION
ABOUT HOW MUCH TIME THEY ARE
SPENDING IN THOSE DIFFERENT
ACTIVITIES.
SO WE DO COLLECT INFORMATION
ABOUT PLACES THEY SPEND TIME, AS
WELL AS DIFFERENT ACTIVITIES
THAT THEY PARTICIPATE IN, SPORTS
ACTIVITIES, AND THERE WE DO GET
INFORMATION IN TERMS OF, YOU
KNOW, HOW OFTEN, IF THEY ARE
PART OF A CLUB OR INDEPENDENTLY,
HOW MUCH TIME PER WEEK, SO WE
COULD LOOK AT THAT OVER TIME TO
SEE IF THERE ARE CHANGES.
AND WE COULD ALSO LOOK TO SEE
WHAT THAT RELATIONSHIP BETWEEN
THE AMOUNT OF TIME THEY ARE
SPENDING IN THOSE ACTIVITIES
VERSUS AMOUNT OF TIME THEY ARE
SPENDING ON SCREENS AND WHETHER
THERE'S A RELATIONSHIP THERE AS
WELL.
BUT ONE OF THE THINGS THAT AS
WE'RE STARTING TO THINK ABOUT
THE NEXT PHASE OF ABCD, I THINK
THE SOCIAL INTERACTION PIECE IS
GOING TO BE AT THE CENTER OF
EVERYTHING THAT WE DO.
I THINK IT'S ONE THAT WE
HAVE SOME INFORMATION BUT SO
MUCH MORE PARTICULARLY AS THEY
START TO AGE OUT OF HIGH SCHOOL
AND GO ON TO DIFFERENT PATHS,
UNDERSTANDING THEIR SOCIAL
ENVIRONMENTS IS GOING TO BE
REALLY IMPORTANT.
>> THANK YOU.
YOU'RE DOING SO MUCH, SO WELL, I
WOULD DARE SUGGEST CAN WE DO
EVEN MORE.
SO, WHAT I KEEP THINKING, RIGHT,
SO THE ABCD KIDS ARE NOT GOING
TO BE KIDS ANYMORE VERY SOON.
AND IN THE ABCD WE HAVE THIS
AMAZING OPPORTUNITY OF LOOKING
AT WHAT HAPPENS IN PREGNANCY,
UNDERSTANDING VULNERABILITY
EARLIER BUT CAN WE UNDERSTAND IT
EVEN EARLIER?
AND START THINKING ABOUT
INFLUENCES THAT ARE
INTERGENERATIONAL BY BEING ABLE
TO RECRUIT THE KIDS OF ABCD, NEW
PREGNANCIES THAT ARE GOING TO
START HAPPENING, IN THE NEXT TEN
YEARS OR SO, AND SHARING QUICKLY
THE EXPERIENCE THAT WE HAVE
DOING THAT AS PART OF STUDY OF
2500 PUERTO RICAN CHILDREN IN
WHICH WE -- DURING YOUNG
ADULTHOOD HAD CONVERSATIONS WITH
OUR KIDS ABOUT SEXUAL RISK
BEHAVIORS.
AND THAT ACTUALLY FACILITATED TO
TALK ABOUT PREGNANCY AND SCREEN
PREGNANCY REGULARLY WHICH IS
WHAT YOU NEED TO DO IN ORDER TO
BE ABLE TO BUILD AN
INTERGENERATIONAL COHORT.
SO JUST, YOU KNOW, PLANTING THE
SEED BECAUSE WE DON'T HAVE A LOT
OF TIME.
PREGNANCIES ARE GOING TO START
VERY, VERY SOON IN THE ABCD.
I SAID THAT IN OTHER FORUMS BUT
I'LL SAY IT HERE AS WELL.
>> YEAH, WE'VE HAD A COUPLE
PREGNANCIES IN THE COHORT
ALREADY.
BUT IT'S A GREAT POINT, IT'S ONE
WE'RE TALKING ABOUT AT LUNCH
YESTERDAY AS WELL THAT, YOU
KNOW, WE HAVE A UNIQUE ABILITY
IF WE CONTINUE TO FOLLOW THEM
THROUGH THESE NEXT TEN YEARS OR
MORE TO BE ABLE TO LOOK AT THAT
INTERGENERATIONAL BECAUSE WE
HAVE SO MUCH INFORMATION ABOUT
THEIR YOUTH TO SEE WHAT IS
INFLUENCING THOSE TRAJECTORIES.
I DON'T KNOW IF WE'LL BE ABLE TO
DO THAT, THAT'S MORE OF A
QUESTION FOR NORA AND GEORGE,
SOMETHING WE WANT TO DO.
THE OTHER POSSIBILITY IS THAT WE
DO HAVE SOME OF OUR SITES
CO-LOCATED WITH HBCD SO IF
THERE'S A WAY WE CAN ENROLL
PEOPLE IN HBCD, PULL THAT DATA
SHARED THROUGH THE SAME
PLATFORM.
>> I THINK THAT THE NATURAL
ANSWER IS OF COURSE WE WANT IT,
SCIENTIFICALLY IT MAKES SENSE.
THE DECISION IS NOT UP TO GEORGE
AND MYSELF, IT'S WHAT LEVEL OF
FUNDING WE GET AND THE SUPPORT
WE HAVE BECAUSE WE HAVE BEEN
KARAOKE -- CARRYING MOST OF THE
BUDGET.
THE MAIN BURDEN HAS COME REALLY
TO BOTH OF OUR INSTITUTES SO WE
WOULD ABSOLUTELY -- WE'RE
COMMITTED TO THE STUDY AND WANT
IT TO BE SUCCESSFUL AND BE ABLE
TO DO MORE BUT WITHOUT
RESOURCES, SO I THINK I'M
BRINGING IT UP, QUITE OBVIOUS
BOUGH I THINK OF -- BECAUSE ALL
OF YOU CAN COMMUNICATE THE VALUE
OF THE STUDY SO THERE'S
RECOGNITION AND SUPPORT TO KEEP
IT GOING BECAUSE IT WOULD BE A
BIG, BIG LOSS IF WE COULD NOT
FOLLOW THESE CHILDREN, WELL,
THESE TEENAGERS, INTO ADULTHOOD.
YES, THAT'S THE INTENT AND I
HOPE THAT MONEY ARRIVES TO OUR
INSTITUTES.
>> THANK YOU.
>> YEAH, THANKS VERY MUCH, AS
ALWAYS.
AND THE NEXT PRESENTATION IS
GOING TO BE GIVEN BY DR. MICAH
JOHNSON ON THE START PROGRAM,
AND HE'S A SOCIOLOGIST, RESEARCH
INVESTIGATES SYNERGISTIC EFFECTS
OF PSYCHOLOGICAL TRAUMA, SOCIAL
DETERMINANTS, SUBSTANCE MISUSE
AND SERVICES FOR THE PEDIATRIC
POPULATIONS, WORKS ON DEATH ROW
TO UNDERSTAND RELATIONSHIP
BETWEEN TRAUMA, SUBSTANCE USE,
INCARCERATION.
DR. JOHNSON LEADS TWO
COMPREHENSIVE INITIATIVE THAT
RECRUITS, TRAINS, CULTIVATES
UNDERREPRESENTED MINORITY AND
DISADVANTAGED, TO BECOME THE
NEXT GENERATION OF SUBSTANCE
MISUSE AND ADDICTIVE SCIENTISTS,
HIS WORK CITED BY THE "NEW YORK
TIMES," ESPN, SENATOR BERNIE
SANDERS, AND OTHERS, RECIPIENT
OF 2023 OUTSTANDING RESEARCH
AWARD FROM UNIVERSITY OF SOUTH
FLORIDA, 2023 COMMUNITY RIVER
PHOENIX CENTER, AND 2024
OUTSTANDING MENTOR AWARD FROM
THE FLORIDA EDUCATION FUND.
DR. JOHNSON, WELCOME.
>> THANK YOU.
I'M PRE-SENTING ON MYSELF AND I
COULD ON CO-P.I.S, DR. POTTER
AND GARRAGAN.
I'LL DESCRIBE START, THE
INITIATIVE WAS DESIGNED TO BE A
MODEL THAT CAN BE REPLICATED AND
ADOPTED FOR VARIOUS OTHER
CONSORTIA AND RESEARCH
COMMUNITIES.
I'LL START BY SAYING THAT THE
START PROGRAM SUPPORTED BY NIDA
AND THIS PROGRAM WOULD NOT BE
POSSIBLE WITHOUT THE NIDA
COUNCIL, NIDA PROGRAM OFFICERS.
CERTAIN GROUPS HAVE FEWER
RESOURCES DUE TO HISTORICAL
FACTORS, MANY FOLKS FACE
BARRIERS, POTHOLES, ON ACADEMIC
JOURNEYS, THAT DETER THEM FROM
PURSUING RESEARCH CAREERS.
NOT SURPRISINGLY CERTAIN GROUPS
ARE GROSSLY UNDERREPRESENTED IN
ACADEMIA ESPECIALLY AMONG VERY
PRESTIGIOUS RESEARCH
COMMUNITIES.
THIS TYPE OF CULTURAL AND
ETHNIC -- RESEARCH TRAINING
PROGRAMS ARE ESSENTIAL TO
ADDRESS THESE ISSUES.
HUGH AND ALEXEI ARE THE
CO-P.I.s AT THE UNIVERSITY OF
VERMONT, PARTNERED WITH ME, IN
DESIGNING RESEARCH EDUCATION
PROGRAMS FOR DIVERSE
POPULATIONS, AND I HAVE A LONG
HISTORY WITH PEDAGOGY AND
CURRICULUM DESIGNED.
WE LAUNCHED A FULL PROGRAM, THE
GOAL OF THE START PROGRAM TO
RECRUIT, TRAIN, MENTOR GIFTED
JUNIOR SCHOLARS, FOLKS WITH
DIVERSE PERSPECTIVE AND
BACKGROUNDS TO ACCESS, ANALYZE,
DISSEMINATE DATA FROM ABC D
STUDY.
START EMBRACES FIVE PILLARS,
RECRUITMENT OF FOLKS WHO FIT THE
NIH CRITERIA FOR
UNDERREPRESENTATION, GIFTED, MAY
NEED A PUSH OR LACK FOR
RESOURCES, WE BELIEVE IN EARLY
CAREER ENRICHMENT AND NOURISHING
ENVIRONMENT.
THE PROGRAM WAS DESIGNED TO
ADDRESS NIDA'S KEY AREAS,
EXPANDING WORKFORCE PREPARATION,
TO MEET NATIONAL AND GLOBAL
NEEDS, ENCOURAGE
UNDERREPRESENTED GROUPS TO
PURSUE CAREERS IN RESEARCH,
ADVANCE SCIENCE ON CONSEQUENCE
AND TREATMENT OF SUBSTANCE
ISSUES, BUT ALSO ENHANCE
RESEARCH ON UNDERREPRESENTED
POPULATIONS.
SO WE START WITH RECRUITMENT.
WE EXECUTED A TARGETED STRATEGY
LEVERAGE PROFESSIONAL TECHNIQUES
FROM FORTUNE 500 COMPANIES,
SOCIAL CAPITAL IN COLLABORATION
WITH ORGANIZATIONS THAT SERVE
DIVERSE COMMUNITIES.
WE RECEIVED WELL OVER HUNDREDS
OF APPLICATIONS INDICATING THERE
WAS INTEREST, AND NEED IN THESE
SORTS OF OPPORTUNITIES.
WE'RE WORKING WITH -- WE PLAN
WITH WORK WITH R25S AND PROGRAMS
TO EXPAND TO MEET THAT NEED.
I'LL TELL YOU ABOUT THE PILOT
COHORT.
FOUR PRE-DOCS, FOUR POSTDOCS,
FOUR EARLY CAREER MEMBERS,
STAGGERED ENROLLMENT APPROACH SO
WE COULD FACILITATE PEER MENTOR
SHIP, REFLECTING A DOZEN
DISCIPLINES, TEN UNIVERSITIES,
SIX COUNTRIES OF ORIGIN,
ACCOMPLISHED OVER 160
PUBLICATIONS, NOW CLOSE TO 200,
HIGH-IMPACT JOURNALS, OVER 200
PRESENTATIONS AT SCIENTIFIC
MEETINGS, 12 ORIGINAL ABCD
PROJECTS RELATED TO SUBSTANCE
ISSUES, ALSO NOW UP TO 15.
30% OF THE PILOT COHORT HAVE
PUBLISHED THEIR RESEARCH IN
PEER-REVIEWED JOURNALS,
ACCOLADES INCLUDE K01 AND AWARDS
AND PROMOTIONS AND
ACKNOWLEDGMENT MILESTONES AND
HONORS.
ONE OF THE MEMBERS WON THE ABCD
INVESTIGATOR OF THE YEAR.
SO IN A SHORT AMOUNT OF TIME
WE'VE ALREADY TRAINED 24
SCHOLARS, MANY WOULD NOT ONLY
CONTINUE TO CONTRIBUTE TO THE
ABCD CONSORTIUM BUT BE FUTURE
LEADERS IN THEIR FIELDS.
THIS IMAGE DEMONSTRATES THE
POTENTIAL TO DRAMATICALLY
ENHANCE REPRESENTATIVE OF JUNIOR
SCHOLARS FROM ARRAY OF
BACKGROUNDS ESPECIALLY
HISTORICAL UNDERREPRESENTED, WHO
ARE HISTORICALLY
UNDERREPRESENTED IN FIELDS.
THIS IS THE PILOT AND FIRST
COHORT.
BY THE END WE WOULD HAVE TRAINED
AND MENTORED 60 SCHOLARS IN FOUR
YEARS.
SO START ENHANCES DIVERSITY AND
SERVES TO ENHANCE DIVERSITY IN
ADVANCED SCIENCE, BIOMEDICAL
SCIENCES MORE BROADLY.
THE START PROGRAM HAS THREE
PHASES.
I'LL GO THROUGH EACH.
PHASE 1 IS A ONE-WEEK INTENSIVE
ORIENTATION AND TRAINING
CONFERENCE AT UNIVERSITY OF
VERMONT.
PHASE 2 IS VIRTUAL, MONTHLY
TWO-HOUR GROUP SESSIONS.
PHASE 3 IS A THREE TO FOUR-DAY
DISSEMINATION CONFERENCE ON
PUBLICATIONS, PRESENTATIONS,
PROFESSIONAL DEVELOPMENT, ALSO
GRANTSMANSHIP AND OTHER ASPECTS
OF PROFESSIONAL DEVELOPMENT.
SO WE FLY TRAINEES TO THE SITE
AT UVM, FOR ONE WEEK INTENSIVE
ORGANIZATION, RECEIVING
INSTRUCTION IN HISTORY,
RECRUITMENT, PROCEDURES, DAILY
COLLECTION PROCESSES,
PARTICIPATE IN DATA COLLECTION
DEMONSTRATIONS AND TOUR DATA
COLLECTION FACILITIES, RECEIVE
INSTRUCTION ON ALL ASPECTS OF
THE STUDY, WHAT'S POSSIBLE, WE
GIVE THEM IDEAS, SHOW
DEMONSTRATIONS AND ASK THEM WHAT
IS POSSIBLE FOR IDEAS AS WELL.
THEY PARTICIPATE AND WE MOVE
FORWARD.
EVERYTHING IS ACTUAL PICTURES OF
THE START PILOT PROGRAM
INAUGURAL COHORT.
WE VALIDATE TRAINEES EXPERIENCES
IN EMPOWERING THEM TO BE PART OF
THE SOLUTION, ONE OF THE FIRST
ACTIVITIES IS A POWERFUL
DISCUSSION ABOUT THE CHALLENGES
THESE SCHOLARS MAY FACE, AND A
DISCUSSION OF PERSONAL AND
SOCIAL SOLUTIONS TO HELP THEM
OVERCOME AND THRIVE.
WE VALIDATE EXPERIENCES, EMPOWER
THEM WITH TOOLS AND RESOURCES
AND ALSO BRAINSTORM WAYS WE CAN
ADDRESS THESE ISSUES MORE
STRUCTURALLY AND SOCIALLY.
NEXT WE FACILITATE MENTOR-MENTEE
COLLABORATION TO DEVELOP
RESEARCH STUDIES LEVERAGING
DATASETS.
THIS IS ONE OF THE RESEARCH
FORUMS WE USE.
THIS FORUM HERE EVOLVED FROM
CHICKEN SCRATCH AND DOODLES TO A
TANGIBLE ANALYTICAL PLAN THAT
EVENTUALLY TRANSFORMED INTO A
RESEARCH STUDY.
THE CORE OF THIS PROGRAM IS
MENTORSHIP.
WE EMPLOY MULTI-LEVEL MENTORING
MODEL INCLUDING ONE-ON-ONE AND
SMALL GROUP, PEER MENTORING,
COMMUNITY MENTORING, AND FLIPPED
MENTORSHIP.
WE FACILITATE THE PANEL LED BY
SENIOR SCHOLARS TO DISCUSS
EFFECTIVE MENTORSHIP PRACTICES,
AND THEN WE FLIP THE PANEL SO
TRAINEES LEAD THE DISCUSSION AND
GIVE US ACTUAL TIPS AND GUIDE US
ON WHAT WORKS FOR THEM, WHAT
THINGS HAD WE NOT THOUGHT ABOUT,
WHAT CAN WE LEARN ABOUT
MENTORSHIP FROM THEM.
THIS WAS ALSO A GREAT
OPPORTUNITY FOR THEM TO EDUCATE
SENIOR COLLEAGUES AND MENTORS ON
THEIR UNIQUE EXPERIENCES IN
ACADEMIA THAT MOST FOLKS MAY NOT
BE AWARE OF.
IT'S IMPORTANT TO NOTE FOR TWO
YEARS WE HAVE HAD A SURPLUS OF
MENTORSHIP INCLUDING MEMBERS OF
THE ABCD CONSORTIA AND
COMMUNITY, THIS YEAR WE'VE HAD
AN ALL-STAR CAST INCLUDING
SEVERAL SITE P.I.S AND LEADERS.
BECAUSE OF THE SUPPORT WE WERE
ABLE TO PAIR MENTORS AND MENTEES
BASED ON FEEDBACK, TANGIBLE DATA
WE COLLECT, AND PREFERENCE FROM
MENTEES AND MENTORS.
THIS INVESTMENT IN MENTORSHIP
PAIRING PAID GREAT DIFFERENCE AS
INDICATED IN SURVEY DATA,
ANECDOTAL DATA, PROGRAM AND
TRAINING GOALS AND BONDING WE
EXPERIENCED.
WE FACILITATE MEANINGFUL
INTERACTIONS FOCUSED ON RESEARCH
AND PROFESSIONAL DEVELOPMENT BUT
AGAIN WE ALSO EMPHASIZE THIS
ONE-ON-ONE MENTORSHIP IS
SUPPORTED IN MORE BROAD SMALL
GROUP, COMMUNITY AND FLIPPED
MENTORSHIP.
THESE ARE SOME SMALL GROUP AND
PEER MENTORSHIP GROUPS WE
FACILITATED.
WE KNOW FROM RESEARCH AND
ANECDOTAL EVIDENCE THAT HELPED
DEVELOP STRONGER BONDS AND SENSE
OF COMMUNITY THAT WE THINK IS
ONE OF THE THINGS THAT MAKES
THIS PROGRAM SPECIAL AND ONE OF
THE THINGS WE WOULD ADVOCATE
FOR, FOR RESEARCH PROGRAMS
MOVING FORWARD, RESEARCH
EDUCATION PROGRAMS MOVING
FORWARD, SENSE OF BELONGING AND
COMMUNITY.
WE MADE INVESTMENT IN COMMUNITY
BUILDING, THE MOTIF OF THIS
PROGRAM.
AND I'LL SPEAK MORE ABOUT THAT
LATER.
AFTER THE INTENSIVE ONE-WEEK
TRAINING WE GO VIRTUAL, THE
SECOND PHASE INCLUDES NINE
MONTHLY GROUP SESSION, 30
INDIVIDUALS, INCLUDING TRAINEES,
MENTORS AND ADMINISTRATORS
ATTEND SESSIONS, WE DESIGNED
THIS TO SUSTAIN THE SAME LEVEL
OF PEDAGOGY ENGAGEMENT AND
COLLABORATION WE WERE ABLE TO
ACHIEVE DURING THE IN-PERSON
CONFERENCE.
YES, WE GO OVERBOARD WITH THE
BACKGROUNDS A LITTLE BIT.
THE MONTHLY SESSIONS INCLUDE
GROUP MEETINGS, COMMUNITY
BUILDING ACTIVITIES AND BONDING
ACTIVITIES, 45 TO 60 MINUTES OF
ONE-ON-ONE PROTECTED TIME WITH
THEIR MENTORS, ALSO TIME TO
PRESENT RESEARCH AND PROVIDE
STATUS UPDATES.
WE HAVE OPEN DISCUSSIONS WITH
PEERS AND SENIOR COLLEAGUES
WHERE THEY CAN PROVIDE FEEDBACK,
GUIDANCE, RESOURCES,
ENCOURAGEMENT.
THESE SESSIONS, THE START
SCHOLARS PROGRESS FROM JUST
AGAIN THAT VERY ELEMENTARY
ANALYTICAL PLAN FOR FOUR
RESEARCH STUDIES ACROSS EIGHT
MONTHS.
EACH SESSION HAS SPECIFIC
LEARNING OBJECTIVES, SPECIFIC
DELIVERABLES TO MEASURE MASTERY
OF THOSE OBJECTIVES.
THE THIRD AND FINAL PHASE IS
DISSEMINATION AND PROFESSIONAL,
DEMONSTRATING RIGOR, MERIT,
POTENTIAL FOR PUBLIC IMPACT.
THEY PRESENT RESEARCH AT THE
INTERNAL START SESSIONS AS WELL
AS AT THE PUBLIC START
DISSEMINATION CONFERENCE WHERE
WE INVITE COMMUNITY MEMBERS,
COLLEAGUES, FOLKS TO SEE WHAT
WE'RE DOING AND HOW WE'RE USING
OUR RESOURCES AND ABILITYING TO
SERVE REAL FAMILIES AND REAL
COMMUNITIES.
THEY ALSO PRESENT RESEARCH AT
OTHER CONFERENCES SUCH AS CPDD,
APA, AIMS, ABCD, AND OTHER
CONFERENCES AROUND THE COUNTRY
AND THE WORLD.
THIS FEATURES GRANTSMANSHIP
TRAINING, DATA INDICATED THAT
PARTICIPATION FROM NIH OFFICERS
WAS ONE OF THE MOST IMPACTFUL
AND VALUABLE COMPONENTS OF THE
PROGRAM ACCORDING TO THE
TRAINEES.
I WANT TO TAKE A MOMENT SAY WE
REALLY APPRECIATE THESE SPECIFIC
OFFICERS WHO SUPPORTED THIS
PROGRAM WHO VOLUNTEERED GIVE
SOME TRAINING.
BUT ALL THE OTHER OFFICERS AND
PERSONNEL WHO ENGAGED IN THIS,
EARLY CAREER SCHOLARS.
THIS WAS ONE OF THE TOP POINTS
OF FEEDBACK WE GOT THAT THEY
APPRECIATED ABOUT OUR PROGRAM.
THEY REALLY VALUED THE
OPPORTUNITY TO INTERACT WITH NIH
OFFICERS.
AND A PART OF THIS PROGRAM IS
CONSTANT EVALUATION.
WE FREQUENTLY COLLECT AND
ANALYZE DATA, IN FORMAL FEEDBACK
AS PART OF CONTINUING
IMPROVEMENT PLAN, INFORMING
IMPLEMENTATION OF THE PROGRAM
BUT ALSO MODIFICATIONS, IT
GUIDES OUR LONG-TERM DEVELOPMENT
OF THIS PROGRAM.
DATA INDICATED THE PROGRAM
ENHANCED KNOWLEDGE AND SKILLS,
ANTICIPATED THAT, BUT ALSO
HELPED TO ADDRESS SOME OF THE
INTERNAL AND SOCIAL BARRIERS
THAT MANY SCHOLARS FACE AND FEEL
WHEN THEY PURSUE RESEARCH
CAREERS.
I WANT TO SHARE SOME OF THE
FEEDBACK WITH YOU.
THE FORMAL SURVEY DATA PROVIDES
INVALUABLE INFORMATION.
HOWEVER, THE MOST COMPELLING
FEEDBACK CAME FROM VOLUNTARY
INFORMAL NOTES TRAINEES FROM THE
PROGRAM TOOK IT UPON THEMSELVES
TO CREATE AND SEND US.
UNPROVOKED, THEY DECIDED TO
CREATE REFLECTION NOTES AND
POINTS OF FEEDBACK.
WE WERE NERVOUS BUT THEY WERE
POSITIVE.
I'LL READ RAW NOTES TO GIVE A
GLIMPSE INTO VARIOUS EXPERIENCES
AND POTENTIAL FOR THIS PROGRAM
TO MAKE A LASTING IMPACT ON THE
SCHOLARS THAT MATRICULATE
THROUGH AND FOLKS THAT
PARTICIPATE IN IT, THE MENTORS,
OURSELVES, EVERYONE.
THIS WEEK EMBODIED AUTHENTIC
MENTORSHIP, COLLABORATION,
SHARED OPPORTUNITIES FOR THOSE
OF US WHO OFTEN FEEL FORGOTTEN,
UNDERVALUED, INVISIBLE.
YOU CULTIVATED SAFETY, RENNE --
RENNE REINFORCED OUR VALUE.
I CONSIDER MY SCIENTIFIC FAMILY
NOW WITH THIS NEW FAMILY THAT
YOU'VE ALLOWED US TO BUILD, I
FEEL SUPPORTED, INSPIRED, AND
MORE CONFIDENT IN NAVIGATING THE
INTIMIDATING ACADEMIC WORLD
WE'RE WORKING IN.
AND THIS ONE-YEAR PROGRAM HAD
NOT ONLY ACCESS TO DATA HANDS-ON
TRAINING, KNOWLEDGE ON DATA
COLLECTION, BUT ALSO MORE
IMPORTANTLY HAD A CHANCE TO
BECOME PART OF THIS BRILLIANT
COMMUNITY, HAD PROFOUND SENSE OF
BELONGING THIS WEEK, WHICH I
RARELY EXPERIENCE.
EACH YEAR FOR THE NEXT FOUR YEAR
WE'LL BE ENROLLING TRAINEES,
MENTORS, FOCUSING ON
DISSEMINATION, PUBLISHING
RESEARCH, DISSEMINATING BEST
PRACTICES WE'RE LEARNING FROM
THIS PROGRAM.
WE WILL CONTINUE TO IMPROVE AND
REFINE THIS PROGRAM TO MAKE SURE
WE'RE MARCHING TOWARD A WORLD
CLASS RESEARCH EDUCATION
PROGRAM.
WE HOPE TO EXPAND THIS MODEL,
IMPLEMENT SIMILAR PROGRAMS IN
OTHER RESEARCH COMMUNITIES AND
CONSORTIA.
JUST A SHORT WHILE WE'VE
OBSERVED THE POTENTIAL FOR THE
START PROGRAM TO ENHANCE ABCD
COMMUNITY AND SUPPORT SCIENTIFIC
INNOVATION.
WE ANTICIPATED THAT, BUT WE DID
NOT ANTICIPATE THIS REALLY
DEEPLY PROFOUND SENSE OF
CONNECTION.
THERE WAS UNMEASURABLE
METAPHYSICAL QUALITY THAT WAS
PRESENT, IT WAS THIS HUMAN
CONNECTION, SENSE OF COMMUNITY.
CREATED A SPACE WHERE FOLKS
BELONGED, FELT VALUED,
SUPPORTED, PROVIDED TOOLS TO BE
SUCCESSFUL, SPACE WHERE THEY
WERE ALLOWED TO GROW, ALLOWED TO
BE IMPERFECT, BUT ALSO ALLOWED
TO BE BRILLIANT.
WE CREATED A FACE FOLKS COULD DO
RIGOROUS INTENT IMPACTFUL
RESEARCH WITH JOY, RELATIVE
BALANCE, CONNECTION, COMMUNITY,
AND CARE.
WE'RE STILL IN THE EARLY STAGES
OF THIS PROGRAM.
WE STILL HAVE MUCH WORK TO DO
BUT WE'VE ALREADY MADE
SIGNIFICANT STRIDES AND I HAVE A
DEEP PASSION FOR THIS WORK AND
MY COLLEAGUES AND I AGAIN ARE
DETERMINED TO CREATE A WORLD
CLASS RESEARCH EDUCATION PROGRAM
THAT EQUIPS GIFTED SCIENTISTS
WITH THE TOOLS NEEDED TO
SAFEGUARD HEALTH AND WELLNESS
FOR FUTURE GENERATIONS.
AGAIN, AN IMPORTANT ASPECT OF
THIS MODEL IS COMPASSION AND
COMMUNITY SO THERE'S CONFLICT IN
THE WORLD, SUFFERING,
UNCERTAINTY, IN OUR OWN LIVES
AND LIVES OF THE FAMILIES
COMMUNITIES WE SEEK TO SERVE.
THIS PROGRAM HAS POTENTIAL TO
HELP FOLKS FROM DIVERSE
BACKGROUNDS AND PERSPECTIVES TO
GET ENGAGED, TO GET INVOLVED, TO
USE THEIR TALENTS AND ABILITIES
AND EXPERIENCES TO SUPPORT
COMMUNITIES THAT LOOK LIKE THEM,
SUPPORT THE COMMUNITIES THEY
COME FROM.
SO I BELIEVE THAT COMMUNITY MAY
BE A SECRET INGREDIENT IN
UNLOCKING POTENTIAL, ELIMINATING
DISPARITIES, IMPROVING QUALITY
OF LIFE FOR SCIENTIFIC
COMMUNITY.
AS WELL AS COMMUNITIES AND
FAMILIES WE SERVE.
IN CLOSING I WANT TO SAY THAT
THE NEXT GENERATION IS WATCHING.
THEY ARE EXCITED.
ENCOURAGED, EAGER TO GET
INVOLVED.
THIS IS A GROUP OF STUDENTS FROM
THE SCIENTIFIC ADDICTION
RESEARCH TRAINING, R25 SUPPORTED
BY NIDA, ATTENDED THE START
SYMPOSIUM, ABCD START SYMPOSIUM
AND THEY WERE COMPLETELY
CONVINCED THAT THEY WERE CAPABLE
OF WRANGLING THE ABCD DATASET
AND GET INVOLVED IMMEDIATELY.
THEY WANT OPPORTUNITIES TO LEARN
MORE ABOUT THIS STUDY AND BE
MORE INVOLVED WITH THE DATA.
SO WE NEED TO THINK ABOUT WAYS
TO INVOLVE FUTURE SCHOLARS IN
THIS STUDY VERY EARLY IN THEIR
CAREERS, ESPECIALLY THOSE WHO
IDENTIFY AND REPRESENT
POPULATIONS DISPROPORTIONATELY
IMPACTED BY SUBSTANCE ISSUES.
I'LL BE THINKING ABOUT WAYS TO
DO THAT.
AND WAYS WE CAN GET THEM
INVOLVES.
INVOLVED.
I THANK NIDA, DR. DOWLING, DR.
LOPEZ, START CO-P.I.S, DR.
POTTER AND GARAVAN, THE ABCD
CONSORTIUM, ARIA CRUMP, I'M AN
ALUMNUS OF THE NIDA DIVERSITY
SCHOLARS NETWORK PROGRAM AND
NONE OF THIS WOULD HAVE BEEN
POSSIBLE WITHOUT MY
PARTICIPATION IN THAT PROGRAM.
ARE THERE ANY QUESTIONS?
>> GO AHEAD, TINA.
>> MICAH, THAT WAS FANTASTIC.
I LOVE THE PROGRAM.
CAN YOU SAY HOW YOUR FIRST
COHORT OF PILOT TRAINEES MIGHT
CONTRIBUTE TO THE NEXT COHORT OR
FUTURE COHORTS?
>> REALLY GOOD QUESTION.
100 PER CENT SIGNED UP TO BE
MENTORS FOR THE NEXT COHORT.
AND SO AS OF RIGHT NOW THEY ARE
SERVING AS PEER MENTORS,
INFORMAL CAPACITY.
IN THE FUTURE WE SEE THEM
SERVING AS MENTORS.
THERE'S BEEN A LOT OF
COLLABORATION NOT JUST BETWEEN
PILOT COHORT AND INAUGURAL,
FIRST COHORT IN THE FULL PROGRAM
BUT ALSO THERE'S BEEN
COLLABORATIONS BETWEEN THE PILOT
COHORT AND THE UNDERGRADUATE
STUDENTS WHO ATTENDED.
THIS IS HAPPENING IN A WAY
THAT'S REALLY AWESOME AND
MAGICAL.
>> THAT WAS GREAT.
I WAS WONDERING IF YOU CAN SAY
MORE ABOUT HOW YOU RECRUIT,
WHERE YOU RECRUIT THE CANDIDATES
AND ALSO WHAT HAPPENS AFTER.
YES, THEY ALL WANT TO BE MENTORS
BUT IN TERMS OF THEIR OWN CAREER
DEVELOPMENT, BECAUSE I'M
WONDERING IF THERE'S A WAY TO
INTERDIGITATE WITH NIDA, THE TWO
PROGRAMS, K PROGRAMS, THOSE
KINDS OF THINGS, BECAUSE WE
WOULD LOVE TO ENGAGE SCIENTISTS
IN THE BROADER COMMUNITY BEYOND
ABCD AS WELL.
>> EXCELLENT, EXCELLENT
QUESTION.
OKAY.
NUMBER ONE, WE THINK A LOT ABOUT
FOLLOW-UP AND WHAT COMES NEXT
FOR THE FOLKS WHO COME THROUGH
THE PROGRAM.
WE SEE START AS A FEEDER
PROGRAM, SOME GOING INTO T32
PROGRAM, SOME PURSUING K01S AND
R01S AND THINGS OF THAT NATURE.
FOR EACH PERSON IT'S MORE
INDIVIDUALIZED THAN TAILORED BUT
WE SEE OURSELVES AS A FEEDER
PROGRAM.
WE'RE MAKING SURE WE HAND THEM
OFF TO THE ABCD CONSORTIUM AND
COMMUNITY.
WE TRY TO FACILITATE THEIR
PARTICIPATION IN WORK GROUPS
THAT WOULD GIVE THEM MORE ACCESS
TO BE MORE ENGAGED AND BE
INVOLVED IN ABCD COMMUNITY.
SO THOSE ARE THE TWO
PROFESSIONAL WAYS WE DO THINGS.
WE HELP THEM ACHIEVE THEIR GOALS
AND HAND THEM OFF TO A
COMMUNITY.
BEYOND THAT, WE SERVE AS
LIFELONG PEERS, COLLABORATORS,
MENTORS FOR THEM.
WE STILL MEET REGULARLY WITH
ALUMNI, COLLABORATE ON PAPERS,
WE'RE PART OF THAT PROFESSIONAL
COMMUNITY.
>> THAT WAS SUPERB BUT I THINK
WE'RE GOING TO MOVE ON AND WE
WILL HAVE A HALF AN HOUR AT THE
END FOR DISCUSSION SO SAVE YOUR
QUESTIONS FOR OUR SPEAKERS AT
THAT TIME.
>> I WANT TO SAY WE WANT TO
PERPETUATE THIS EVERY PROGRAM,
CAN'T JUST BE ABCD, WE NEED TO
CLONE MICAH.
>> MY PLEASURE TO INTRODUCE
FAITH ADAMS, A FOURTH YEAR
NEUROSCIENCE Ph.D. CANDIDATE
AT THE ICAHN SCHOOL OF MEDICINE,
MOUNT SINAI, INFLUENCE OF EARLY
LIFE EXPERIENCES ON ADOLESCENT
NEURODEVELOPMENT, PARTICULARLY
HOW LIFESTYLE, HOME ENVIRONMENT,
CULTURE, NEIGHBORHOOD, AND
SCHOOL FACTORS AFFECT THE ONSET
OF ADOLESCENT SUBSTANCE USE,
PARTICULARLY ALCOHOL USE,
EXPLORES THOUSAND NEUROBEHAVIOR
CORRELATES MEDIATE THESE
ENVIRONMENTAL IMPACTS ON
SUBSTANCE USE.
FAITH WAS AWARDED F31 GRANT FOR
THIS IMPACTFUL WORK, IN THE
FUTURE AIMS TO LEVERAGE HER
EXPERIENCE AND EXPERTISE IN A
CAREER IN SCIENCE POLICY,
FOCUSING ON EVIDENCE-BASED
STRATEGIES TO ENHANCE ADOLESCENT
HEALTH OUTCOMES.
SO, FAITH IS GOING TO TALK ABOUT
ADVANCING PREDICTION OF
ADOLESCENT ALCOHOL USE ONSET BY
DERIVING POLYEXPOSURE ALCOHOL
RISK SCORES.
>> THANK YOU FOR THIS
INVITATION, IT'S WONDERFUL BEING
IN THIS ROOM.
AND LEARNING MORE ABOUT BEHIND
THE SCENES OF WHAT EVERYTHING
LOOKS LIKE AS A Ph.D. STUDENT,
SOMETIMES YOU DON'T KNOW WHAT
GOES ON BEHIND THE SCENES SO
THIS HAS BEEN A VERY GREAT
INTRODUCTION TO THAT.
MY PROJECT IS NOT ONLY GOING TO
FOCUS ON ALCOHOL USE ONSET BUT
SUBSTANCE USE ONSET SO INCLUSION
OF DIFFERENT LEGAL SUBSTANCES
WITHIN THE ABCD STUDY.
SO, DR. VOLKOW GAVE A GREAT
DESCRIPTION, STATISTICS OF WHERE
WE ARE WITH SUBSTANCE USE IN
ADOLESCENTS.
I'M NOT GOING TO BELABOR THIS
TOO MUCH BUT IN 2023 DATA SHOWED
THAT 8.3% OF 12 TO 17 YEAR OLDS
NATIONWIDE REPORTED USING AT
LEAST ONE DRUG IN THE LAST
MONTH, AND WHILE ALCOHOL USE HAS
REMAINED STABLE AMONG EIGHTH
GRADERS, TENTH GRADERS, AND
TWELFTH GRADERS, DECLINED FOR
TWELFTH GRADERS, AND ALSO
INFORMATION ON NICOTINE VAPING
WHERE WE'VE SEEN IT REMAINS
STABLE EVEN THOUGH IT WAS
RELATIVELY HIGH AND FOR CANNABIS
USE THIS ALSO REMAINS STABLE.
SO OVERALL WE SEE THAT
ADOLESCENTS ARE USING SUBSTANCES
AND A VERY SMALL PERCENT
TRANSITION TO SUBSTANCE USE
DISORDER.
EVEN THOUGH IT'S A VERY SMALL
PERCENT, STUDIES DO SHOW EARLIER
ONSET OF SUBSTANCE USE IS LINKED
TO INCREASED RISK FOR SUBSTANCE
USE DISORDERS AND DEPENDENCE.
I'M GOING TO GO PAST THESE.
OVERALL, THE IMPORTANCE OF WHAT
WE'RE SEEING IN TERMS OF THE
TRENDS OF SUBSTANCE USE IN
ADOLESCENTS IS INDICATING
THERE'S AN IMPORTANCE IN
PRIORITIZING RESEARCH EFFORTS
AIMED AT DELAYING AGE OF
SUBSTANCE USE ONSET, TAKELY
AMONG VULNERABLE YOUTH.
SO EXTENSIVE RESEARCH HIGHLIGHTS
GENETICS AND ENVIRONMENT AS
INFLUENTIAL CONTRIBUTORS TO
SUBSTANCE USE ONSET AND
SUBSEQUENT PROBLEMS, GENETIC
STUDIES SPECIFICALLY SHOW FAMILY
HISTORY OF SUBSTANCE USE DOUBLES
RISK OF ONSET AND HIGHER
POLYGENIC LIABILITY TENDS TO
PREDICT FASTER TRANSITION TO
MORE DISORDERED USE.
ENVIRONMENTAL FACTORS INCLUDE
LOW PARENTAL MONITORING, SCHOOL
ENGAGEMENT, NEIGHBORHOOD
STRESSORS, CULTURAL NORMS, JUST
TO NAME A FEW.
AND DESPITE CONTINUING
ADVANCEMENTS IN UNDERSTANDING OF
SUBSTANCE USE IN YOUTH THERE'S
STILL IMPORTANT LIMITATIONS TO
ADDRESS.
GENETIC STUDIES LACK
GENERALIZABILITY GO DUE TO FOCUS
ON PARTICIPANTS OF EUROPEAN
ANCESTRY, AND TO DATE SEVERAL
GENETIC STUDIES OFTEN FOCUS ON
MORE PROBLEMATIC DRUG USE
PATTERNS.
THEREFORE THEY ARE NOT AS
GENERALIZABLE TO LOW AND
EXPERIMENTATION TYPE OF USE
THAT MIMIC YOUTH FIRST ONSET OF
SUBSTANCE USE, LIMITING
EXPLORATION OF UNDERSTUDIED
FACTORS, AND LASTLY USING COMMON
ANALYTICAL APPROACHES THE
CO-OCCURRING AND INTERACTIVE
EFFECT OF ENVIRONMENTAL FEATURES
ARE OFTEN OVERLOOKED.
SO NOW WE'RE GOING TO EXPLORE
SOME POTENTIAL SOLUTIONS TO
ADDRESS LIMITATION WITHIN THE
FIELD.
IT'S CRITICAL WE USE DATA DRIVEN
STRATEGIES TO EXPLORE TOTALITY
OF THE ENVIRONMENT AND THIS IS
DEFINED AS EXPOSOME, INCLUDING
ALL NON-GENETIC FACTORS THAT MAY
BE INFLUENCING ADOLESCENT HEALTH
OUTCOMES.
AND MUCH LIKE STUDYING GENOME
UTILIZING THIS DISCOVERY BASED
APPROACHES LIKE THE
EXPOSOME-WIDE ASSOCIATION STUDY
ALLOWS FOR SYSTEMATICALLY
ASSOCIATED MULTIPLE NON-GENETIC
EXPOSURE TO WHATEVER PHENOTYPE
OF HAVE YOU MAY D. - - THEREOF
YOU MAY BE INTERESTED IN.
WE CAN ADDRESS LIMITATION OF
ONLY EXPLORING THESE EFFECTS OF
INDIVIDUAL EXPOSURES BY
COMPUTING NON-GENETIC RISK
SCORES WHICH GIVE A SINGLE
PREDICTIVE INDEX, ALLOWING YOU
TOES CAPTURE CONTRIBUTION OF
MULTIPLE EXPOSOMIC VARIABLES.
AND THIS IS RELATIVELY NEW
STUDIES USING THIS APPROACH
FOUND THAT IT IMPROVED
PREDICTIVE ACCURACY OF TYPE 2
DIABETES BY THREE-FOLD COMPARED
TO POLY POLYGENIC RISK SCORES.
THE GOAL OF MY WORK IS TO
IMPLEMENT NOVEL APPROACHES IN
ABCD STUDY TO ROBUSTLY
CHARACTERIZE ENVIRONMENT OF
FIRST USE AND DEVELOP WHAT WE'RE
CALLING POLY EXPOSURE RISK
SCORES.
SO THERE ARE TWO MAIN AIMS OF MY
WORK, ONE TO CONDUCT
EXPOSOME-WIDE ASSOCIATION STUDY
TO EVALUATE EXPOSOMIC
ASSOCIATIONS WITH SUBSTANCE USE
ONSET IN YOUTH.
AND AIM TWO, DERIVE POLY
EXPOSURE RISK SCORES TO ASSESS
ADDITIVE AND CUMULATIVE RISK ON
SUBSTANCE USE ONSET.
SO NOW I'M GOING TO GIVE YOU A
WALK-THROUGH OF THE STUDY DESIGN
WORK FLOW.
FIRST I STARTED CLASSIFYING TIME
TO SUBSTANCE USE ONSET IN THE
COHORT.
WE INCLUDED LEGAL SUBSTANCES SO
THIS SPECIFICALLY INCLUDED
DIFFERENT TYPES OF NICOTINE AND
TOBACCO, WHETHER THEY VAPE,
DIFFERENT TYPES OF CANNABIS,
EDIBLES, BLUNT, AND ALCOHOL.
FOR EACH DRUG, QUESTIONS FOR
EACH DRUG WERE ASKED SEPARATELY.
AND JUST GENERAL UNDERSTANDING
WHAT THE QUESTION ASKED WAS HAVE
YOU HAD A FULL DOSE OF THIS DRUG
OR HAVE YOU HAD A FULL DRINK OF
ALCOHOL, AND THAT QUESTION WAS
FOLLOWED BY WHEN WAS YOUR FIRST
USE.
SO FOR PARTICIPANTS WHO ENDORSED
YES TO HAVING A FULL DRUG,
SORRY, YES, SO FOR PARTICIPANTS
WHO ENDORSED HAVING YES TO
HAVING A FULL DRUG THERE WERE
SEVERAL PARTICIPANTS WHO
ENDORSED YES TO MULTIPLE
DIFFERENT DRUGS.
BUT IN THIS CASE WE'RE ONLY
INTERESTED IN TIME TO SUBSTANCE
USE ONSET SO WE ONLY TOOK THE
FIRST DRUG THAT THEY ENDORSED
YES TO.
FOR SOME PARTICIPANTS THEY
PROVIDED THEIR AGE OF FIRST-TIME
OF ONSET, FOR PARTICIPANTS WHO
DID NOT PROVIDE THEIR AGE WE
USED WHAT'S CALLED A TIME TO
EVENT ANALYSIS, AND WITHIN THIS
ANALYSIS WE USED THEIR AGE OF
THE LAST -- AGE THEY ENDORSED
YES, AT FIRST INTERVIEW DATE.
FOR EXAMPLE, IF A PARTICIPANT
SAID YES TO HAVING ALCOHOL AT
YEAR ONE, AND ALSO SAID YES AT
YEAR TWO, WE TOOK THEIR AGE AT
YEAR ONE.
AT YEAR ONE THOSE PARTICIPANTS
WERE ABOUT 10 TO 11 YEARS OLD.
AND THEN FOR PARTICIPANTS WHO
ENDORSED NO TO HAVING NONE OF
THE DRUGS WE ALSO USED THE
SIMILAR TECHNIQUE BUT TOOK THE
AGE AT THEIR LAST WAVE OF DATA
COLLECTION.
SO IF A PARTICIPANT ENDORSED NO
AT YEAR FOUR, WE TOOK THEIR YEAR
FOUR AGE.
AND TO CLARIFY WITHIN THIS
POPULATION I LOOKED AT ALL OF
THE AVAILABLE SUBSTANCE USE
DATA, AT THE CURRENT TIME SO
THAT TAKES US UP TO YEAR FOUR.
THE TIME TO SUBSTANCE USE ONSET
RANGED FROM APPROXIMATELY AGE 4
TO 15 YEARS OLD, AND THE EARLIER
AGES THAT WE'RE SEEING WERE
BASED ON PARTICIPANT
SELF-REPORT.
SO FOLLOWING THE SUBSTANCE
USE -- FOLLOWING PUTTING
TOGETHER SUBSTANCE USE
POPULATION, I WENT THROUGH ABCD
DATA TO IDENTIFY EXPOSOMIC RISK
FACTORS.
SO BECAUSE THIS WAS DATA-DRIVEN
APPROACH WE WANTED TO INCLUDE
ALL POSSIBLE NON-GENETIC
FACTORS.
SO WE CHARACTERIZED GROUPS INTO
LIFESTYLE, HOME, PARENTAL
HEALTH, CULTURE, NEIGHBORHOOD,
AND SCHOOL.
AND WITHIN OUR LIFESTYLE DOMAIN
LOOKED AT VARIABLES RELATED TO
SCREEN MEDIA EXPOSURE AS WELL AS
THE NUMBER OF SPORT ACTIVITIES
THEY WERE INVOLVED IN, I
REMEMBER SOMEONE ASKED THE
QUESTION REGARDING THAT.
AND HOW MUCH SLEEP -- WHETHER
THEY HAD ANY SLEEP DISORDERS OR
SLEEP THE PATTERNS AND LOOKED AT
PARENTAL MONITORING IN THE HOME.
THE WAY PARENTS TREATED THEM
WITHIN THE HOME.
WHETHER THEY HAD FAMILY
CONFLICT, ADVERSE CHILD EVENTS.
WITHIN THE PARENTAL HEALTH
DOMAIN WE LOOKED AT WHETHER THE
PARENTS HAD ANY HISTORY OF
PSYCHOPATHOLOGY, IN ABCD THERE'S
ADULT SELF-REPORT WHICH LOOKS AT
PARENTAL PSYCHOPATHOLOGY SO
THERE WAS THAT INCLUSION, ALSO
IF THE PARENTS HAD HISTORY OF
PSYCHOLOGICAL PROBLEMS.
WITHIN THE CULTURE DOMAIN WE
LOOKED AT TWO -- THERE WERE TWO
SPECIFIC QUESTIONNAIRES WITHIN
ABCD THAT FELL INTO THIS
CATEGORY.
THAT WAS THE MEXICAN AMERICAN
CULTURAL VALUE SUBSCALE WHICH
LOOKED AT DIFFERENT ASPECTS OF
THE FAMILY ENVIRONMENT.
SO THAT ALSO INCLUDED THEIR
RELIGIOUS BELIEFS, HOW CLOSE
THEY WERE TO THEIR FAMILY.
AND ALSO THEIR CULTURAL
IDENTITY.
IN THE NEIGHBORHOOD DOMAIN ABCD
DOES A WONDERFUL JOB COLLECTING
SELF-REPORT MEASURES BUT ALSO
GEO CODED MEASURES, AND THESE
MEASURES ARE DERIVED BASED ON
PARTICIPANTS' RESIDENTIAL
ADDRESS, WE ALSO TOOK A LOOK AT
SOME OF THOSE MEASURES AND THEN
WITHIN THE SCHOOL DOMAINS THERE
WAS ONE QUESTIONNAIRE THAT HAD
AVAILABLE DATA FOR -- AT
BASELINE, AND THIS QUESTIONNAIRE
LOOKED AT SCHOOL ENGAGEMENT,
SCHOOL DISENGAGEMENT, SCHOOL
ENVIRONMENT, AND SCHOOL
INVOLVEMENT.
AND THEN FOLLOWING THE
IDENTIFICATION OF OUR EXPOSOME
AND SUBSTANCE USE ONSET GROUP WE
THEN WENT INTO OUR ANALYSES.
FOR THESE I CONDUCT -- WHAT I
REFERRED TO BEFORE, WHAT THIS
IS, THESE ARE UNIVARIATE
ANALYSIS, SINGLE EXPOSURE
ANALYSES.
INSTEAD OF LOOKING AT ALL OF THE
VARIABLES SIMULTANEOUSLY IN ONE
MODEL WE FIRST START BY LOOKING
AT ONE SINGLE EXPOSURE,
ASSOCIATED TO SUBSTANCE USE
OUTCOME.
WITHIN THIS MODEL BECAUSE WE'RE
LOOKING AT TIME TO SUBSTANCE USE
ONSET WE'RE USING WHAT'S CALLED
SURVIVAL ANALYSIS, COST
REGRESSION, AND WITHIN THAT
MODEL WE CONTROLLED FOR SEX,
SOME MODELS WE RAN THESE A
COUPLE TIMES, SOME OF THOSE WE
RAN CONTROLLING FOR RACE
ETHNICITY BUT WHAT I'M SHOWING
TODAY WE CONTROLLED FOR PUBERTY
SCORE AND FAMILY ID SINCE THERE
ARE FAMILIES WITHIN THE ABCD
STUDY AS WELL.
FOLLOWING THE IDENTIFICATION --
SORRY, TO GO BACK WE THEN NOT
CONTROLLED, SORRY, CORRECTED FOR
MULTIPLE COMPARISONS.
AND THEN FOLLOWING THAT WE THEN
APPLIED A MULTIVARIATE MODEL,
WANTED TO IDENTIFY MOST
INDEPENDENT ASSOCIATIONS SO
SIGNIFICANT VARIABLES FROM OUR
FIRST MODEL WE BUILT A
MULTIVARIATE MODEL AND FOLLOWING
THAT THE FINAL SIGNIFICANT
VARIABLES WERE USED TO BUILD OUR
POLY EXPOSURE RISK SCORE.
AND THIS SCORE IS A WEIGHTED SUM
OF ALL OF THE ESTIMATES OF THE
VARIABLES THAT SIGNIFICANT
WITHIN OUR FINAL MODEL.
NOW I'LL GO INTO RESULTS FROM
OUR AIM ONE.
SO I FORGOT TO MENTION WE
IDENTIFIED 200 QUALITY
CONTROLLED EXPOSOMIC VARIABLES,
ABCD HAS MANY MORE BUT THESE
WERE THE ONCE WE QUALITY
CONTROLLED.
AND AMONG THOSE 200 WE
IDENTIFIED 74 EXPOSOMIC FEATURES
THAT WERE INDEPENDENTLY
ASSOCIATED WITH TIME TO
SUBSTANCE USE ONSET.
SO THE FOLLOWING MANHATTAN PLOT
SHOWS SIGNIFICANT VARIABLES
IDENTIFIED IN OUR ANALYSES, AND
I ONLY LABELED A FEW OF THEM
SINCE THEY WERE QUITE A LOT AND
I DIDN'T WANT TO MAKE THE SLIDES
TOO CONFUSING.
AND THEN AMONG THOSE 74
VARIABLES, WE SAW THEY
REPRESENTED BOTH PROTECTIVE AND
RISK FACTORS FOR SUBSTANCE USE
ONSET.
AND MORE CLOSELY, SOME OF THE
INTERESTING RESULTS THAT WE
FOUND I DIDN'T GET A CHANCE TO
HIGHLIGHT THEM BUT WHAT WE FOUND
WAS THAT DIFFERENT TYPES OF
EXPERIENCE OF THIS
DISCRIMINATION, R RATED MOVIE
AND R RATED VIDEO GAME EXPOSURE,
ADVERSE HOME EXPERIENCES,
PRENATAL DRUG EXPOSURE BOTH
BEFORE PARENTS WERE AWARE THEY
WERE PREGNANT AND AFTER THEY
WERE AWARE, PARENTAL
PSYCHOPATHOLOGIES, ASSOCIATED
WITH INCREASED LIKELIHOOD OF
SUBSTANCE USE ONSET.
AND ALSO ONE THAT I FORGOT TO
MENTION BUT WE ALSO SAW KIDS
THAT CAME FROM HOMES WHERE THEY
HAD NO RULES REGARDING CANNABIS
USE WAS ALSO SIGNIFICANT.
WAS ALSO SIGNIFICANTLY
ASSOCIATED WITH INCREASED RISK
FOR SUBSTANCE USE ONSET.
AND WITHIN OUR PROTECTIVE
FACTORS WHICH YOU SEE AT THE
BOTTOM HERE WE SAW THAT -- I'M
GOING TO TAKE A STEP BACK.
AMONG RISK FACTORS WE IDENTIFIED
TWO OF THE GEO CODED MEASURES
THAT WERE SIGNIFICANTLY
ASSOCIATED WITH INCREASED RISK
AND THOSE TWO FACTORS WERE
PERCENT OF POPULATION THAT WAS
BELOW POVERTY LEVEL AND FROM THE
AREA DEPRIVATION INDEX
IDENTIFIED PERCENT OF THE
POPULATION THAT HAD NO
TELEPHONE.
SO EVEN THOUGH WE HAVE NOT MADE
ASSUMPTION OF WHAT THESE
VARIABLES MEAN, IT'S INTERESTING
THAT WE'RE SEEING SOME VARIABLES
THAT DOES SHOW UP IN OTHER
STUDIES AND THESE ADDITIONAL
UNIQUE VARIABLES FROM THE
GEOCODED MEASURES.
I'M GOING TO DISCUSS OUR
PROTECTIVE FACTORS.
FOR PROTECTIVE FACTORS WE'RE
SEEING PROSOCIAL BEHAVIORS,
BETTER SCHOOL ENVIRONMENT, MORE
PARENTAL MONITORING, YOUTH WHO
SAW RELIGIOUS BELIEFS WERE VERY
IMPORTANT AS WELL AS HIGHER
SOCIOECONOMIC INDICES WERE
ASSOCIATED WITH DECREASED RISK
OF SUBSTANCE USE ONSET.
FOLLOWING IDENTIFICATION OF THE
SIGNIFICANT VARIABLES AS I
MENTIONED BEFORE WE BUILD
MULTI-VARIATE MODEL AND FINAL
RISK SCORE INCLUDED VARIABLES
SIGNIFICANT FROM THAT MODEL PXS
SCORES FROM LIFESTYLE, HOME,
NEIGHBORHOOD DOMAINS.
WE SAW THAT ALL TYPES OF R-RATED
MOVIE EXPOSURE, YOUTH WHO HAD NO
CANNABIS USE RULES, PRENATAL
CANNABIS EXPOSURE AND PRENATAL
TOBACCO EXPOSURE AND GEO CODED
MEASURES PERCENTAGE OF
POPULATION BELOW POVERTY AND
PERCENTAGE OF HOUSEHOLDS WITHOUT
TELEPHONE WERE RETAINED IN OUR
FINAL POLY EXPOSURE SCORE.
AND THEN WE COMPARED TO SEE
WHETHER SCORES WERE DIFFERENT
FOR SUBSTANCE USE NAIVE AND
SUBSTANCE USE EXPOSED.
AND WE SAW THAT THERE WERE
SIGNIFICANTLY HIGHER IN OUR
ALCOHOL-EXPOSED -- IN OUR
SUBSTANCE-EXPOSED GROUP WHICH IS
THE RED LINE.
AND WHEN WE LOOK AT PREDICTIVE
POWER WITH ADDITION OF THESE
EXPOSOMIC VARIABLES, WE ACTUALLY
SAW THERE WAS A 3% INCREASE IN
OUR PREDICTION ACCURACY.
SO, IT'S NOT SUPER DUPER HIGH.
HOWEVER, WITH THE FURTHER
PREDICTIVE ACCURACY BECAUSE IT'S
ABOVE .5 AND IT'S PRETTY CLOSE
TO 1, WE CAN ASSUME THAT THESE
FACTORS ARE INDEED INFLUENCING
SUBSTANCE USE ONSET.
THERE'S SOME LIMITATIONS TO KEEP
IN MIND.
ONE MAJOR LIMITATION IS COMMONLY
WITH OBSERVATIONAL STUDIES
THERE'S MEASUREMENT ERROR AND
RECALL BIAS.
FOR INSTANCE WE SAW FOR YOUTH
SOME OF THEM ENDORSED ALCOHOL
USE AS EARLY AS 4 YEARS OLD.
WE DON'T KNOW HOW TRUE THAT IS
BUT WE HAVE TO USE THE
INFORMATION AS PROVIDED.
ALSO ANOTHER THING, THERE MIGHT
BE SOME STYING IN A WHETHER --
STIGMA, THERE'S AN ABCD STUDY
THAT LOOKED AT HAIR TOXICOLOGY,
AND THEY FOUND THAT MORE YOUTH
ACTUALLY WERE USING SUBSTANCES
THAN THEY ACTUALLY REPORTED.
THERE MAY POTENTIALLY BE AN
UNDERREPORTING.
FOR FUTURE DIRECTIONS, SIMILAR
TO POLYGENIC RISK SCORES
OFTENTIMES WHEN YOU LOOK AT
STUDIES WITH POLYGENIC RISK
SCORES THEY TEND TO STRATIFY BY
RISK SO THERE'S LOW RISK,
MEDIUM, HIGH RISK.
I'M INTERESTED IN DOING
SOMETHING SIMILAR WITH THE PXS
SCORES AND LOOK TOCK SEE WHETHER
THERE ARE ANY ASSOCIATIONS WITH
DIFFERENT NEUROBEHAVIORAL
CORRELATES FOR REWARD
PROCESSING, RESPONSE INHIBITION,
EMOTION REGULATION.
AND THAT'S SOMETHING THAT I'M
CURRENTLY WORKING ON IN MY
THESIS SPECIFICALLY FOR RESPONSE
INHIBITION, AND LASTLY I WOULD
LIKE TO COMPARE THESE
NON-GENETIC RISK SCORES TO
GENETIC SCORES LIKE THE
POLYGENIC RISK SCORE AND ALSO
POTENTIALLY FAMILY HISTORY OF
SUBSTANCE USE DENSITY.
THERE ARE BROADER IMPLICATIONS
TO KEEP IN MIND, IDENTIFICATION
OF EXPOSOME FACTORS ALLOW US TO
DO SOME WORK -- TO PUT THIS
INFORMATION INTO CLINICS WHERE
IT MAY BE MODIFIABLE.
THAT'S SOMETHING WE CAN CONSIDER
MORE IN THE FUTURE AND LIKE DR.
DOWLING WAS TALKING ABOUT THE
POLICY INTERVENTION,
ADDITIONALLY MORE ON TECHNICAL
SIDES IT WOULD BE IMPORTANT TO
SEE THE APPLICATION OF THIS
TECHNIQUE FOR DEVELOPING
EXPOSOME RISK SCORES FOR OTHER
BEHAVIORAL OUTCOMES IN THE ABCD
STUDY.
AND FINALLY I WOULD LIKE TO
THANK THE START COHORT.
DR. MICAH JOHNSON, FOR HIS BRAIN
CHILD BASICALLY.
I DON'T THINK I'D BE STANDING IN
THIS ROOM IF IT WERE NOT FOR THE
START PROGRAM.
AND THE START PROGRAM IS A LARGE
PART OF WHY I WAS FUNDED MY F31.
DR. GARVIN MADE IT A DUTY TO
CONNECT ME WITH PEOPLE WHO CAN
BE MENTORS AND BEFORE START I
HAD NOT ENVISIONED MYSELF
APPLYING FOR F31 WITHOUT THE
NETWORK AND COMMUNITY TO START
MY APPLICATION BUT AFTER START
THAT BECAME POSSIBLE.
DR. TRACY MURRAY HAS BEEN A
WONDERFUL NON-SCIENTIFIC MENTOR,
AND IT'S BEEN AMAZING CONNECTING
WITH HER, HAVING HER GUIDE ME
THROUGH THE NON-SCIENCE PORTION.
DR. WES THOMPSON WHO DEDICATED
SO MUCH TIME, HE DOESN'T HAVE TO
BUT BECAUSE OF THE START PROGRAM
I NOW HAVE THIS WONDERFUL
SUPPORT TEAM AND ONE OF THE
THINGS THAT THEY DID FOR THE
PILOT COHORT WAS THEY ACTUALLY
CREATED A PLAQUE WITH NAMES.
I WAS FINISHING UP MY SECOND
YEAR AND ALREADY HAD DR. FAITH
ADAMS ON THERE.
AND AT THE TIME IT WAS SO FAR
AWAY, NOW THAT I'M IN MY FOURTH
YEAR IT FINALLY FEELS REAL THAT
I'M GOING TO BE DR. FAITH ADAMS.
AND AGAIN I JUST WOULD LIKE TO
THANK YOU ALL FOR LISTENING.
THANK YOU TO NIDA FOR FUNDING
THIS PROGRAM.
THANK YOU, DR. JOHNSON, FOR
THINKING OF US.
THANK YOU, GAYA, FOR THIS
INVITATION.
THANK YOU ALL FOR LISTENING.
>> WE HAVE TIME FOR ONE OR TWO
QUESTIONS FOR FUTURE DR. FAITH
ADAMS.
>> IMPRESSIVE.
WHAT YOU'VE DONE WITH THE
EXPOSOME IS FANTASTIC.
NOT THAT YOU NEED ANOTHER THING
TO DO WHEN YOU'RE GETTING READY
TO GRADUATE, SOME OF THE
VARIABLES ARE POTENTIALLY
HERDABLE, SO THERE'S TWO THINGS
YOU COULD DO POTENTIALLY.
ONE WOULD BE TO LOOK AT
GENE/ENVIRONMENT CORRELATION,
ABCD IS A GREAT PLACE.
ER - THE OTHER TO DO POLY
MULTI-EXPOSOME THAT CORRELATE
WITH PGS, A REALLY INTERESTING
FINDING, PARENTAL MONITORING,
COMBINE GENE/ENVIRONMENT
CORRELATIONS AND INTERACTIONS,
WONDERING IF HAD YOU THOUGHTS
ABOUT THAT BEING A FUTURE
PATHWAY.
>> YES, THAT'S A GREAT QUESTION.
THERE ARE FACTORS WITH GENETIC
COMPONENT.
I HAD DECIDED TO REMOVE ACTUALLY
IF THEIR PARENTS REPORTED -- THE
QUESTION I REMOVED WAS IF
THEY -- FROM THE FAMILY HISTORY
QUESTIONNAIRE REGARDING DRUG
USE.
DRUG USE PROBLEMS AND ALCOHOL
USE PROBLEMS.
AND THE REASON FOR THAT WAS
BECAUSE I WANTED TO SEE IF I
COULD COMPARE THIS MORE GENETIC
FACTOR THAT STILL HAS SOME
ENVIRONMENTAL IMPLICATIONS TO
THESE VARIABLES THAT ARE MORE
ENVIRONMENTAL.
THERE'S STILL INCLUSION OF
VARIABLES WITH GENETIC COMPONENT
BUT WOULD BE INTERESTING TO SEE
THAT GENETIC AND GENE
ENVIRONMENT, SOMETHING I HAVEN'T
PHYSICALLY DONE BUT THOUGHT
ABOUT THE PROCESS AND INCLUSION
OF VARIABLES WITHIN THE
EXPOSOME.
>> ANOTHER QUICK QUESTION?
THAT WAS REALLY FANTASTIC,
REALLY INTERESTING.
ANYBODY ELSE HAVE A QUICK ONE?
YEAH, GO AHEAD.
SORRY, ONLINE.
GO AHEAD.
>> YEAH, CONGRATULATIONS.
THIS IS REALLY GREAT WORK AND
ROLE MOD EL FOR RESEARCH IN MANY
HEALTH CONDITIONS, INCLUDING THE
ONE YOU STUDIED.
I WAS WONDERING YOU MENTIONED
SECONDHAND SMOKE EXPOSURE DURING
PREGNANCY OR EARLY IN LIFE.
WONDERING OTHER NEURO TOXICANT
EXPOSURE THAT COULD BE RELEVANT
WITHIN THE ENVIRONMENTAL TEAM IF
YOU HAVE ANY ACCESS FOR INSTANCE
LEAD EXPOSURE, HOW INFLUENCE
THESE NEUROTOXICANT EXPOSURES IN
EARLY LIFE COULD BE RELEVANT AND
WITHIN THE IDEA OF THE EXPOSOME
IT COULD BE SUPER INTERESTING TO
INCLUDE BUT I'M NOT SURE IF THAT
TYPE OF INFORMATION IS AVAILABLE
IN THIS STUDY.
>> YES, THAT TYPE OF INFORMATION
IS AVAILABLE WITHIN THE GEO
CODED MEASURES, SO ONE OF THE
SIGNIFICANT VARIABLES WE SAW WAS
THE PERCENT OF THE POPULATION
BELOW POVERTY.
AND THAT WAS ACTUALLY BASED ON A
LEAD-RISK QUESTIONNAIRE, WELL, A
LEAD-RISK CENSUS TRACT.
SO, YES, IT'S POSSIBLE TO LOOK
AT MORE OF THOSE NEUROTOXIC
VARIABLES AND GEO CODED MEASURES
DO INCLUDE THEM.
WE JUST HAPPEN TO SEE ONLY THESE
TWO VARIABLES THAT I EMPHASIZED
WERE SIGNIFICANT.
AND THEN JUST THEY
USED TOBACCO OR NOT WHILE
PREGNANT.
>> YEAH.
IT WAS INCREDIBLE.
UNFORTUNATELY TIME KEEPS ON
GOING.
WE CANNOT STOP IT.
WE HAVE TO GO NOT NEXT
PRESENTER, DR. NATHANIEL
HARNETT, NEUROSCIENTIST,
RESEARCH ON UNDERSTANDING THE
BRAIN BASIS FOR WHY SOME PEOPLE
ARE MORE LIKELY TO DEVELOP
STRESS-RELATED DISORDERS SUCH AS
PTSD AFTER TRAUMA, CURRENT WORK
LEVERAGES MAGNETIC RESONANCE
IMAGING TECHNIQUES INCLUDING
fMRI, STRUCTURAL fMRI,
DEFUSION WEIGHTED IMAGING FOR
SUSCEPTIBILITY, ELUCIDATING
NEURAL CIRCUITRY LINKED TO ACUTE
AND LONG-TERM DEVELOPMENT OF
PTSD AND IDENTIFYING ROBUST AND
GENERALIZABLE NEUROBIOLOGICAL
TARGETS FOR EARLY INTERVENTIONS
AND TREATMENTS, ULTIMATELY GOAL
TO DEVELOP PREDICTIVE AND
PREVENTIVE NEUROSCIENTIST BASED
TECHNIQUES TO REDUCE PREVALENCE
AND TRAUMA AND STRESS RELATED
DISORDERS.
DR. HARNETT, WELCOME.
TAKE IT OVER.
>> THANK YOU FOR THE
INTRODUCTION.
I HOPE YOU CAN HEAR ME, I'M
SORRY I CAN'T BE THERE IN
PERSON.
I HAD SOME ALTERNATIVE TRAVEL I
COULDN'T GET OUT OF.
I'M EXCITED TO PRESENT AS
SOMEONE WHO IS NOT REALLY AN
ABCD CONSORTIUM APPROACHING
STRUCTURALIZED INEQUITY IN THE
UNITED STATES IMPACTING WITHIN
ABCD AND OTHER STUDIES THAT
MIGHT BE IMPORTANT TO OUR
UNDERSTANDING OF THE
NEUROBIOLOGY OF DIFFERENT
PSYCHIATRIC DISORDERS.
IN MY LAB WE FOCUS ON
NEUROSUBSTRATES TO UNDERLIE
LEARNING, EXPRESSION,
REGULATION.
WE THINK THIS CIRCUIT IS
IMPORTANT FOR UNDERSTANDING OF
WHO IS GOING TO GO ON TO DEVELOP
PSYCHIATRIC DISEASES.
WE FOCUS ON AMYGDALA, REALLY
INVOLVED IN THREAT LEARNING,
FORMATION OF CUE THREAT
ASSOCIATION.
HIPPOCAMPUS IMPORTANT IN
MODULATING THE CONTEXTUAL
INFORMATION WE TAKE IN ABOUT OUR
ENVIRONMENT TO HELP MODULATE
AMYGDALA EMOTIONAL RESPONSE.
DIFFERENT COMPONENTS OF THE
PRE-FRONT CORTEX TO FACILITATE
EMOTIONAL RESPONSE OR DAMPEN
DEPENDING ON THE NEEDS WE HAVE
WITHIN ANY PARTICULAR SITUATION.
WE KNOW THIS IS TRANSDIAGNOSTIC
IMPORTANT FOR UNDERSTANDING
PSYCHIATRIC DISORDERS SO IF YOU
LOOK AT META-ANALYSES OVER, SAY,
MOSTLY THE LAST FIVE YEARS YOU
SEE THIS CIRCUIT IS IMPLICATED
IN GENERALIZED ANXIETY DISORDER,
MAJOR DEPRESSIVE DISORDER AND
PTSD, OFTEN WHAT WE FOCUS ON IN
MY LAB.
I THINK THAT PTSD IS A REALLY
GOOD EXAMPLE THOUGH FOR
HIGHLIGHTING HOW FOCUSING ON
STRESS AS A GENERAL PRINCIPLE
REALLY MISSES IMPORTANT CAVEATS
AND DETAILS ABOUT HOW DIFFERENT
TYPES OF STRESSORS, DIFFERENT
TYPES OF EXPERIENCES MIGHT SORT
OF HAVE THIS MULTI-FACTORIAL
IMPACT ON THE BRAIN.
SO WE OFTEN THINK ABOUT FOR
EXAMPLE PTSD AS PEOPLE ARE
RELATIVELY HEALTHY, THEY
EXPERIENCE DISCRETE TRAUMATIC
EVENT AND DEVELOP PTSD.
REALITY IS THAT THERE ARE THINGS
THAT HAPPEN AROUND AND BEFORE
AND AFTER TRAUMATIC EVENT THAT
CAN MODULATE HOW PEOPLE RESPOND.
IF SOMEONE IS IN A CAR ACCIDENT
AND CAN'T GO BACK TO WORK THERE
ARE OTHER POSTTRAUMATIC
STRESSORS THAT OCCUR SUCH AS NOT
BEING ABLE TO PAY BILLS, THAT
CAN MODULATE HOW YOUR BRAIN AND
BODY REACTS TO DIFFERENT
STRESSORS AND HOW PEOPLE SHOW UP
WHEN THEY PARTICIPATE IN OUR
STUDIES, ASPECTS OF THE
TRAUMATIC EVENT, WHETHER THEY
WERE THE DRIVER, PASSENGER,
PEDESTRIAN, HOW THEY INTERPRET
THE EVENT THAT OCCURRED.
WE KNOW DIFFERENT STRESSORS LIKE
CHILDHOOD EXPERIENCES MODULATE
FURTHER EXPERIENCES TO STRESS
AND TRAUMA.
A REALLY IMPORTANT ASPECT ABOUT
ALL OF THESE DIFFERENT DISCRETE
EVENTS THEY ARE NOT RANDOMLY
DISTRIBUTED.
THAT THE ENVIRONMENTS WE LIVE
IN, THAT CONTRIBUTE TO THE
EXPOSURES OF STRESS ARE IN MANY
WAYS DESIGNED, IN SPECIFIC WAYS,
AS I THINK AN IMPORTANT EXAMPLE
I DID MY GRADUATE TRAINING AT
UNIVERSITY OF ALABAMA
BIRMINGHAM.
IF YOU KNOW ANYTHING ABOUT IT,
IT HAS A STORIED CIVIL RIGHTS
HISTORY.
THIS MAP OF REDLINE TO SEGREGATE
BLACK INDIVIDUALS FROM WHITE
INDIVIDUALS WITHIN THE CITY.
WHAT'S INTERESTING THOUGH IS
THAT IF YOU COMPARE A MAP OF
REDLINING IN BIRMINGHAM TO FOOD
DESERTS IN BIRMINGHAM IT MATCHES
REALLY, REALLY WELL.
SO USDA FOOD DESERTS ARE ON THE
NORTH SIDE WHERE THE LARGEST
CONCENTRATION OF BLACK
INDIVIDUALS IN BIRMINGHAM LIVE.
MAP TO OTHER NEIGHBORHOOD
FACTORS, FOR EXAMPLE A MAP OF
THE AREA DEPRIVATION INDEX,
NEIGHBORHOOD DISADVANTAGE WHERE
THE WARMER COLORS ARE MORE
DISADVANTAGED NEIGHBORHOODS,
BLUE ARE MORE ADVANTAGED.
A LOT OF DISADVANTAGE IS
CLUSTERED IN THE NORTH WHERE
MAJORITY OF BLACK INDIVIDUALS
LIVE IN BIRMINGHAM.
THERE'S AN IMPORTANT CONTEXTUAL
MODULATION OF WHAT ENVIRONMENT
IS CREATED AND WHO LIVES THERE,
NOT JUST AN EXAMPLE TO
BIRMINGHAM OR BALTIMORE OR OTHER
AREAS, IT REALLY IS A NATIONWIDE
PROBLEM.
SO THIS IS DATA FROM CHILD
TRENDS, PERCENTAGE OF CHURN, ONE
OR TWO OR MORE CHILDHOOD ADVERSE
EXPERIENCES, IT DOESN'T MATTER
IN NEW ENGLAND AREA,
MID-ATLANTIC, PACIFIC,
INDIVIDUALS WHO COME FROM
RACIALLY MARGINALIZED ARE
EXPOSED TO STRESSORS, THIS IS
JUST WHAT THE DATA ARE.
COMPARED ACROSS OTHER DATASETS,
WORK THAT WE'VE DONE WITH AURORA
STUDY, NIMH, WE'VE BEEN ABLE TO
SEE OTHER FACTORS LIKE
NEIGHBORHOOD DISADVANTAGE OR
EVEN AMOUNT OF GREEN SPACE
AROUND PARTICIPANTS IS PARTIALLY
DEPENDENT ON ETHNIC AND RACIAL
GROUP OF.
THIS IS GOING TO HAVE DOWNSTREAM
INDIVIDUALS ON INDIVIDUALS'
HEALTH.
ANOTHER INTERESTING MICROCOSM
EXAMPLE THERE'S AN INTERESTING
STUDY DONE BY NANCY KRIEGER'S
GROUP, LOOKING AT PREMATURE
DEATH RATES BY WHERE PEOPLE --
IF YOU'VE BEEN TO BOSTON WE HAVE
THE T, OUR VERY WONDERFUL PUBLIC
TRANSIT SYSTEM.
IF YOU MAP WHERE PEOPLE GET OFF
ON THE T BY PREMATURE DEATH,
AREAS LIKE MAVERICK HAVE HIGHEST
RATES.
IF YOU OVERLAY RACIAL AND ETHNIC
DEMOGRAPHICS YOU SEE THE AREAS
LIKE MAVERICK, HISPANIC, DUDLEY
SQUARE BLACK, THERE'S AN OVERLAP
IN TERMS OF NEIGHBORHOODS
DESIGNED, WHAT TYPE OF
PARTICIPANTS ARE, WHAT
SOCIODEMOGRAPHICS OF PEOPLE LIVE
THERE AND ASSOCIATED HEALTH
OUTCOMES THAT ARE REALLY
IMPORTANT.
AND SO THE KEY LYNCH POINT FOR
US IS THAT THESE SAMPLES THAT
WE'RE ABLE TO DRAW, WHERE WE'RE
DOING NEUROIMAGING STUDIES HAS
DOWNSTREAM IMPACTS TO GENERATE
PHENOTYPES AND ABILITY TO
UNDERSTAND JUST HOW
GENERALIZABLE NEURO PHENOTYPES
ARE IF WE WANT TO MOVE TOWARD
IMPORTANT PRECISION MEDICINE
APPROACHES FOR PREDICTION AND
PREVENTION OF THINGS LIKE PTSD,
DEPRESSION, ANXIETY.
WE'VE BEEN LOOKING TO SEE HOW
SOON IN TERMS OF NEUROIMAGING
CAN WE SEE BIOLOGICAL EMBEDDING
OF RACIAL INEQUITIES AND
DOWNSTREAM IMPACTS OF THAT.
NATALIE DEMORENAY WANTED TO LOOK
HOW INEQUITY WAS TRIED TO
DIFFERENCE IN BRAIN STRUCTURE
BETWEEN WHITE AND BLACK
CHILDREN.
THE ABCD STUDY WAS PICKING UP
STEAM.
NATALIE LEVERAGED THIS TO GET AN
INDEX OF TIME SEVERAL COURSE
METRICS OF EXPERIENCES AND
CONTEXTS THAT PARTICIPANTS HAD
WHILE PARTICIPATING.
SHE LOOKED AT FAMILY CONFLICT,
HARDSHIP, AMOUNT OF TRAUMA THAT
PARTICIPANTS WERE ENDORSING,
CAREGIVER INCOME AND EDUCATION,
EMPLOYMENT, AS WELL AS AREA OF
DEPRIVATION INDEX TO GET A
MEASURE OF NEIGHBORHOOD
DISADVANTAGED.
WE LOOKED AT GRAY MATTER VOLUME
OF THE SAME NEUROCIRCUIT,
SUBCOMPONENTS OF PREFRONTAL
CORTEX, AMYGDALA AND
HIPPOCAMPUS.
BEFORE WE GO FURTHER, I THINK
IT'S IMPORTANT TO CONTEXTUALIZE
WHEN WE TALK ABOUT DIFFERENCES
IN NEUROBIOLOGY WE'RE NOT TALK
BECOME SKIN COLOR.
WE'RE TALKING ABOUT A VARIED
COLLECTION OF DIFFERENCES REALLY
OWING TO MAJOR HISTORICAL
INFLUENCES THAT IMPACT ECONOMIC,
ENVIRONMENTAL, OTHER TYPES OF
FACTORS ASSOCIATED WITH BRAIN
DEVELOPMENT.
IF YOU LOOK AT ABCD STUDY DATA
FROM 2.01, WHAT NOW IS ABLE TO
SHOW IS COMPARED TO WHITE
CHILDREN, BLACK CHILDREN OF THE
STUDY HAD CAREGIVERS WITH LESS
EDUCATION AND WERE MORE OFTEN
UNEMPLOYED, LOWER FAMILY INCOME,
AND WERE COMING FROM
DISADVANTAGED NEIGHBORHOODS,
EXPERIENCES MORE FAMILY
CONFLICT, FINANCIAL HARDSHIP,
ALSO ENDORSING GREATER NUMBER OF
TRAUMATIC EVENTS.
THIS IS ABOUT 9 TO 10 YEARS OLD,
NOT SEEING A HUGE NUMBER, EVEN
AT THAT AGE SEEING RACE-RELATED
DIFFERENCES, IN THE NUMBER OF
TRAUMATIC EVENTS ENDORSED BY
BOTH CHILDREN AND PARENT.
SO WHEN WE WENT TO LOOK AT
NEUROIMAGING DATA, VERY FIRST
THING WE WANTED TO SHOW IF WE
BREAK THINGS DOWN BY THESE
DIFFERENT ASPECTS OF THREAT
NEUROBIOLOGY WE DO SEE
DIFFERENCES IN VOLUME AS
PROPORTION OF THE GENERAL BRAIN
SIZE BETWEEN WHITE AND BLACK
CHILDREN IN THE STUDY.
I LIKE TO SHOW THIS GRAPH TO
ACKNOWLEDGE THEY ARE NOT
DIFFERENT EXPERIENCE OF
INDIVIDUALS.
THERE'S OVERLAP BETWEEN THE
GROUPS.
I'LL SHOW DATA TO SUGGEST THIS,
THAT WE THINK WE'RE LOOKING AT
INFLUENCE OF EARLY LIFE
INEQUITIES HAVING SMALL IMPACTS
NOW BUT MIGHT HAVE LARGER
IMPACTS AS THESE INDIVIDUALS
CONTINUE TO LIVE IN THESE
ENVIRONMENTS AND REAP THE
DETRIMENTS OF THE STRESSOR
EXPOSURES.
WE THINK THESE ARE SMALL BUT
STILL SIGNIFICANT.
SO THE NEXT THING THAT NATALIE
LOOKED AT WAS BECAUSE WE'RE SO
INTERESTED IN PTSD, WE THINK
BRAIN REGIONS ARE TIED DO THESE
SORT OF EARLY LIFE INEQUITIES
ALSO CONTRIBUTE TO PTSD
SYMPTOMS?
WE DO SEE THAT.
IF WE ADD ALL THE COURSE METRICS
OF ADVERSITY INTO THE MODEL WE
SEE SIGNIFICANT PREDICTION OF
PTSD SYMPTOMS IN THESE KIDS 9 TO
10 YEARS OLD, SIGNIFICANT
EFFECTS LIKE FAMILY INCOME,
MATERIAL HARDSHIP, FAMILY
CONFLICT AND TRAUMA HISTORY.
WE ALSO LOOKED AT HOW BRAIN
VOLUMES WE MEASURED -- THAT YOU
ALL MEASURED WERE ASSOCIATED
WITH PTSD SYMPTOMS IN THESE
INDIVIDUALS SO LOOKING AT
CINGULATE CORTEX, FRONTAL GYRUS.
WHAT NATALIE DID WAS RUN A
SERIES OF PARALLEL MEDIATION
ANALYSES.
WHAT IF WE LIVED IN A WORLD WE
COULD NORMALIZE EMPLOYMENT,
EDUCATION, INCOME, ET CETERA
DIFFERENCES, SHOWING THAT THIS
DOES ATTENUATE SOME ASSOCIATIONS
THAT WE SEE WITH PTSD SUGGESTING
THAT THE SORT OF IMPACT OF THESE
INEQUITIES IS MULTI-FACETED.
SHE ALSO LOOKED AT THIS IN TERMS
OF TRYING TO EXPLAIN RACIAL
DIFFERENCES IN BRAIN VOLUME
WITHIN THESE INDIVIDUALS.
SO ON THE GRAPH ON THE TOP, YOU
CAN SEE AREAS WHERE WE ACTUALLY
WERE ABLE TO SHOW SIGNIFICANT
PARTIAL MEDIATION OF THESE
RACE-RELATED DIFFERENCES BY
ACCOUNTING FOR RACIAL
INEQUITIES, ON THE TABLE AT THE
BOTTOM, SOME REGIONS UP TO 50%
DIFFERENCES -- WOULD YOU MIND
MUTING?
THANK YOU.
WE WERE ABLE TO SEE SOME OF
THESE UP TO 50% OF THE RACIAL
DIFFERENCES ACCOUNTED FOR BY
LOOKING AT AND ACCOUNTING FOR
RACIAL INEQUITIES.
WE THINK TO US AT THE VERY BASIS
THIS SUGGESTION ASPECTS OF
INEQUITY, STRUCTURAL RACISM
WE'VE BEEN INTERESTED, I'LL SO
UNPUBLISHED DATA, HOW THIS MIGHT
CONTINUE LONG TERM.
WHAT HAPPENS AS THESE
INDIVIDUALS MOVE FROM 9 TO 10 TO
SAY 11 TO 12, 13 TO 15 AND SO
ON.
WE'VE BEEN LOOKING AT DATA FROM
4.0 TO HONE ON IMPACTS AT
INDIVIDUAL LEVELS OF INNOVATES,
LIKE INCOME, GENERAL EXPOSURE TO
INTERPERSONAL DISCRIMINATION,
ALSO AT THE NEIGHBORHOOD LEVEL
IF WE UTILIZE NEWLY RELEASED
MEASURES LIKE INDEX OF
STRUCTURAL STIGMA, STATE LEVEL
MEASURES OF NEIGHBORS TO ASK DO
WE STILL SEE RACE-RELATED
DIFFERENCES AS INDIVIDUALS GET
OLDER, ARE WE ABLE TO ATTENUATE
BY ACCOUNTING FOR MEASURES OF
INEQUITY, ALSO LEVERAGENING NEW
COMPUTATIONAL TECHNIQUES LIKE
NORMATIVE MODELING TO TRY TO
ACCOUNT FOR INTERGEOGRAPHICAL
DIFFERENCES, ALSO ACCOUNTING FOR
OTHER TIMES OF GLOBAL GEOGRAPHY
THAT MIGHT HAVE IMPACT ON
NEUROIMAGING FINDINGS.
I WANTED TO SHOW THESE QUICKLY
TO HIGHLIGHT THAT REGARDLESS OF
HOW WE CHOOSE TO MODEL DATA,
WHETHER STANDARD UNIVARIATE, OR
IF WE USE POPULATION LEVEL
NORMATIVE MODELS, WE DO SEE
RACE-RELATED DIFFERENCES START
TO CREEP UP, IN THIS CASE,
CORTICAL THICKNESS DATA 11 TO 12
YEARS OLD, ASSOCIATIONS WITH
INDIVIDUAL LEVELS OF INCOME OR
NATIONWIDE MEASURES, RESOURCE
AVAILABILITY, INDIVIDUAL
DISCRIMINATION, ALSO LOOKING AT
MEASURES OF STATE LEVEL RACISM.
IN THE SUBSET INDIVIDUALS WE'VE
BEEN ABLE TO FOLLOW WE ARE
SEEING THESE SAME SORTS OF
RACE-RELATED INEQUITIES.
WE'VE LOOKED IN TERMS OF VOLUME
AND AGAIN DOESN'T REALLY MATTER
WHAT MODALITY OR MODEL WE CHOOSE
TO RUN, WE REALLY CAN SEE
IMPACTS ACUTELY WITHIN THREAT
NEUROBIOLOGY.
ONCE WE ACCOUNT FOR DIFFERENCES
IN INCOME, DIFFERENCES IN STATE
LEVEL EXPOSURES OF
DISCRIMINATION, RESOURCE
AVAILABILITY, A SIGNIFICANT
AMOUNT IN MORPHOLOGY, EVEN MORE
THAN WHEN THEY WERE EARLY, 9 TO
10 YEARS OLD.
AS A LITTLE BIT OF DATA, BEYOND
FOCUSING ON T1 DATA WE KNOW
THESE REGIONS ARE IMPORTANT FOR
THREAT NEURAL PROCESSING BUT WE
ALSO KNOW THEY ARE CONNECTED
FUNCTIONALLY AND STRUCTURALLY BY
DIFFERENT SORTS OF ANATOMICAL
TRACK, LOOKING AT DORSAL
CINGULUM, WHITE MATTER MEASURES,
THAT MIGHT SUPPORT DIFFERENT
SORTS OF COGNITIVE AND EFFECTIVE
PROCESSES THAT MIGHT CONTRIBUTE
TO DOWNSTREAM EMOTIONAL
DIFFERENCES BETWEEN GROUPS.
ONE OF THE THINGS I WANT TO
HIGHLIGHT, WE'VE BEEN SHOWING
DATA THAT IS BLACK INDIVIDUALS
MIGHT HAVE LOWER VOLUME OR THICK
N ESS COMPARED TO WHITE,
REGARDLESS OF TIME POINT,
COMPARED TO WHITE INDIVIDUALS,
THIS MIGHT BE RELATED TO
DIFFERENCES IN EMOTIONAL COPING
STRATEGIES AS FUNCTION OF LIVING
IN MORE DISADVANTAGED
BACKGROUND.
SO JUST TO MAKE SURE WE'RE BACK
ON TIME, I'LL WRAP UP QUICKLY.
PART OF THE REASON WE'RE TRYING
TO UNDERSTAND WHAT'S HAPPENING
IN A LONGITUDINAL DEVELOPMENTAL
FRAMEWORK WHEN WE LOOK AT OLDER
ADULTS AND EMOTIONAL PROCESSES
WE STILL SEE RACE-RELATED
EFFECTS.
WE LOOKED AT NEUROPHYSIOLOGIC
RESPONSES TO THREAT IN WHITE AND
BLACK INDIVIDUALS, DURING
PAVLOVIAN TASK, HOW ARE THEY
RESPONDING TO THE THREAT, WE SEE
THIS EMOTIONAL BLUNTING IN BLACK
INDIVIDUALS COMPARED TO WHITE
INDIVIDUALS ALMOST COMPLETELY
MEDIATED BY DIFFERENCES IN
VIOLENCE EXPOSURE, AND FAMILY
INCOME.
IN THE AURORA STUDY WE SEE THESE
RESTING STATE CONNECTIVITY
DIFFERENCES BETWEEN BLACK,
WHITE, HISPANIC TRAUMA
SURVIVORS, THOSE CONNECTIVITY
PROFILES ARE DIFFERENTIALLY
PREDICTIVE OF PTSD SYMPTOMS IN
THOSE GROUP.
IN YOU'RE IN HISPANIC, WHITE OR
BLACK, SO DIFFERENT ASSOCIATION
WITH THREE-MONTH PTSD SYMPTOMS,
TRYING TO THINK ABOUT HOW THESE
EARLY EXPOSURES OF INEQUITY MAY
DRIVE DOWNSTREAM CHANGES IN
BRAIN DEVELOPMENT IS REALLY
IMPORTANT SPECIALLY AS WE THINK
ABOUT NATIONAL PREVALENCE OF
MENTAL ILLNESS OR SUBSTANCE ABU.
I THINK WE HIT ACROSS THE
PRESENTATIONS AN IMPORTANT
POINT, THE ABCD STUDDIE IS SO
RICH IN TERMS OF DATA COLLECTED,
WE HAVE SUCH A UNIQUE
OPPORTUNITY TO LOOK AT HOW THESE
INFLUENCES THAT SHAPED
INEQUITIES WE SEE TODAY MIGHT
BRAIN DEVELOPMENT.
IF WE DON'T DO THAT WE RUN THE
RISK OF CREATING MODELS OF
DISEASE AND SUSCEPTIBILITY NOT
APPLICATION TO POPULATIONS WE
WANT TO STUDY.
I'M MOSTLY ON TIME AND WILL PUT
MY ACKNOWLEDGMENT SLIDE UP AND
HAPPY TO TAKE QUESTIONS IF
THERE'S TIME.
>> THANKS ARE PRESENTATION.
BEFORE GENERAL DISCUSSION I WANT
TO GIVE PEOPLE AN OPPORTUNITY TO
ASK A QUESTION.
THERE'S ONE THAT I'M TAKING THE
PREROGATIVE BECAUSE I READ YOUR
PAPER MANY TIMES.
IT MAKES MY BRAIN HURT BECAUSE
ONE OF THE ISSUES IS YOU HAVE
THE BLACK MATTER OF ALL OF THOSE
REGIONS, DIFFERENCES BETWEEN
RACES JUST INCOME AND ECONOMIC
VARIABLES NOT ACCOUNTING, IT
HURTS MY BRAIN, THE CHALLENGE TO
UNDERSTAND VARIABLES WE'RE
UNABLE TO CAPTURE.
SO WHAT ARE YOUR THOUGHTS ON
THAT?
AND THIS IS LINKED TO THE NOTION
OF ALL OF THE VARIABLES ARE
INTERMINGLED IN COMPLEX WAYS
SUCH AS WHAT WE CAN UNDERSTAND
FOR EXAMPLE STRESS AND RACE AND
DISCRIMINATION ACCELERATES
PUBERTY AND DECREASED LENGTH OF
TIME FOR THE BRAIN TO
NEURODEVELOP.
COULD IT BE FOR EXAMPLE
STRUCTURAL CHANGES YOU'RE SEEING
THAT FIGURE IN THE BLACK
CHILDREN MAY RELATE TO SOME OF
THOSE PROCESS, HOW TO
DISENTANGLE COMPLEX INTERACTIONS
BETWEEN VARIABLES SO WE CAN
EXTRACT THAT BLACK MATTER.
>> YOU'RE HITTING THE NAIL ON
THE HEAD THERE.
A LOT OF MODELS WE RUN, YEAH, I
WOULD SAY MAYBE ADVANCED BUT NOT
REALLY COMPLEX.
WE'LL LOOK AT UNIQUE
ASSOCIATIONS WITH INCOME BUT WE
DON'T LOOK AT, SAY, INCOME BY
EDUCATION INTERACTIONS.
I THINK THAT -- THERE WAS A
GREAT PAPER ON SOME OF THEIR
PERINATAL IMAGING DATA, SHOWING
THAT THESE HIGHLY ADVANCED
MACHINE LEARNING ABLE TO CAPTURE
MANY TYPES OF INTERACTIONS AMONG
THESE VARIABLES REPRESENTING
INEQUITY ARE REALLY IMPORTANT
FOR EXPLAINING RACE-RELATED
DIFFERENCES IN BRAIN VOLUME AND
DEVELOPMENTAL ASPECTS.
PART OF WHAT WE'LL HAVE TO DO IN
ORDER TO DISENTANGLE AS YOU'RE
SAYING IS ACTUALLY GO DOWN THE
RABBIT HOLE THINKING ABOUT WE'RE
THINKING ABOUT HOW TO DO THIS IN
TERMS OF FOR REGIONS THAT MIGHT
HAVE A PARTICULAR SORT OF
HISTORICAL INFLUENCE HOW DO WE
START TO MODEL THE DATA THAT WE
HAVE FROM THAT.
I THINK THAT IN REGARDS TO
DIFFERENCES BETWEEN GRAY MATTER
VERSUS WHITE MATTER TO ME THAT
READS THE HYPOTHESIS WOULD BE
THAT AGAIN THESE TYPES OF
DIFFERENTIAL EXPOSURES THAT
PEOPLE HAVE PROMPT DIFFERENT
TYPES OF EMOTIONAL REGULATION
AND EMOTIONAL COPING STRATEGIES.
PART OF THE REASON WE SEE
DIFFERENCES IS NEED FOR
EMOTIONAL -- THERE WAS QUITE A
BIT IN BLACK ADULTS FROM THE
GRADY TRAUMA PROJECT SHOWING
DISCRIMINATION POTENTIATES BRAIN
RESPONSES, YOU SEE RACIAL
DISCRIMINATION IS ASSOCIATED
WITH GREATER VMPSC ACTIVITY,
LOWER ERRORS IN COGNITIVE
EFFECTIVE TASK THAT SEEMS TO BE
RELATED TO IN SOME CASES LOWER
WHITE MATTER VARIABILITY SO I
THINK THE PROBLEM IS IT'S
COMPLEX AND WE HAVE TO THINK HOW
TO MODEL THESE DIFFERENT THINGS.
>> CONGRATULATIONS.
IT'S GREAT WORK.
ANY QUESTIONS HERE?
BEFORE WE JUMP INTO GENERAL
DISCUSSIONS.
I DON'T SEE HANDS RAISED.
>> I'M REALLY CURIOUS, TO FOLLOW
UP WHAT NORA SAID, WHAT YOU JUST
ARE ALLUDING TO, IS THERE ANY
POSSIBILITY SOME OF THIS CONVEYS
RESILIENCE, THAT THERE WOULD BE
A SUBGROUP OF THE AFFLICTED THAT
ACTUALLY FOR WHATEVER REASON
HAVE SOME CIRCUITRY THAT HELPS
THEM DEAL WITH THIS ADVERSITY?
I'M CURIOUS WHAT YOU THINK OF
THAT.
>> YEAH, NO, I AGREE WITH THAT
COMPLETELY.
I WOULD TAKE IT A STEP FURTHER,
I THINK A LOT OF WHAT WE'RE
SEEING IS RESILIENCE.
I THINK THERE IS A LITTLE BIT OF
REACTION TO LOOK AT SORT OF THE
BRAIN IMAGING FINDINGS AND
CONCLUDE WHAT EMOTIONAL STATE
MUST BE BUT ACTUALLY I THINK
THAT TO BORROW ANALOGY, WHEN
YOU'RE CONSTANTLY EXPOSED TO
THESE STRESSORS YOU STILL HAVE
TO GO THROUGH LIFE, GO TO WORK,
THEY ARE STILL ABLE TO DO THAT,
RIGHT?
IT'S SOMETHING THEY ARE ABLE TO
DO.
IN SOME WAYS MAYBE WE'RE LOOKING
AT DIFFERENT NEURAL PROFILES OF
RESILIENCE OR NEUROADAPTABILITY.
IT MAY BE THE CASE THERE'S NO
SUCH THING AS A FREE LUNCH,
MIGHT BE OTHER CASES SUCH AS THE
WORK THAT DR. ADAMS WAS
PRESENTING WHERE THIS MIGHT HAVE
SORT OF DETRIMENTAL IMPACTS
WHILE TRYING TO HAVE PROTECTIVE
IMPACTS IN OTHER AREAS.
YEAH, I AGREE WITH THAT.
>> THERE'S ONE LAST QUESTION.
TRISH?
>> THANKS.
SO, IT BUILDS ON NORA'S QUESTION
FROM THE OPPOSITE DIRECTION.
DO YOU HAVE CHILDREN WHO ARE NOT
OF MINORITIZED POPULATIONS WHO
HAVE THESE ADVERSITIES, THAT YOU
CAN LOOK DOWN THAT LIST AND SAY,
THE ADVERSITIES CORRELATE IN
BRAIN VOLUME, DISENTANGLING,
KNOWING YOUR MISSING SOMETHING
IF THEY DON'T LOOK THE SAME, AND
MAYBE REINFORCERS ACROSS LIFE OF
DISCRIMINATION, RACISM, OR ARE
THESE FACTORS ENOUGH TO GIVE
DIFFERENCES IN BRAIN VOLUME, ET
CETERA?
>> YEAH, I THINK I GOT THAT
QUESTION.
IF I ANSWER INCORRECTLY JUMP IN.
WE DO TRY TO LOOK AT THE
INDIVIDUAL PREDICTORS BY
THEMSELVES WITHOUT JUST
ACCOUNTING RACE-RELATED
DIFFERENCES BECAUSE WE WANT TO
SEE IF JUST USING THEM ALONE,
THOSE PREDICTING VARIANTS, OFTEN
WE FIND RACE IS STILL A MORE
SIGNIFICANT PREDICTOR THAN JUST
USING INDIVIDUAL FACTORS.
THAT GOES BACK TO THE WIDER
POINT RACE IS NOT JUST SKIN
COLOR.
IT'S THESE THINGS WE'VE LOOKED
AT PLUS THE INTERACTING FACTORS
PLUS A LOT OF PROBABLY
UNMEASURED THINGS WE'RE NOT ABLE
TO DO EVEN WITH ABCD, HAVEN'T
THOUGHT ABOUT HOW TO CORRECTLY
DO YET.
I THINK THAT TO DELVE FURTHER, I
WANT TO BE CLEAR THAT I'M NOT
SAYING THAT PEOPLE FROM
DIFFERENT GROUPS ARE NOT EXPOSED
TO DIFFERENT TYPES OF STRESSORS
LIKE POVERTY OR TRAUMA OR THINGS
LIKE THIS.
I THINK THAT WHAT MY POINT IS
THAT INEQUITIES THAT EXIST ARE
VERY PRESENT AND VERY
OBSERVABLE, AND SO TRYING TO
THINK ABOUT WHEN WE DO WANT TO
TALK ABOUT THE IMPACTS OF
POVERTY, IMPACTS OF VIOLENCE,
CONTEXTUALIZING THERE'S A
DISPROPORTION EXPOSURE.
>> GREAT TALK.
ALL THE TALKS WERE OUTSTANDING.
WE HAVE OPEN DISCUSSION UNTIL
3:45.
AND THEN WE'RE GOING TO ADJOURN.
I GET TO ADJOURN US.
SO, I WAS GOING FIRST ASK THE
ONLINE PARTICIPANTS BECAUSE
WE'VE NEGLECTED YOU, WHETHER YOU
HAVE ANY QUESTIONS FOR ANY ONE
OF THE SPEAKERS, ANY OF THE
ITEMS THAT CAME UP TODAY, WHAT
WE COVERED, QUESTIONS FOR ABCD
OR HBCD, ANY -- OKAY.
GO AHEAD.
>> MARK, GO AHEAD.
>> OH, THANK YOU, GEORGE.
I WANTED TO SAY THIS HAS BEEN AN
IMPRESSIVE SESSION, AND IT'S
SORT OF EXPANDED MY BRAIN FROM
MY NARROW FOCUS, FROM THE THINGS
WE PARTICULARLY WORK ON.
I'VE HAD THIS THOUGHT, IT'S NOT
ATTACHED TO A SINGLE
PRESENTATION, THERE HAVE BEEN A
NUMBER THAT HAVE BROUGHT UP THIS
THOUGHT FOR ME.
I'M THINKING ABOUT THE AMOUNT OF
DATA THAT FOLKS HAVE BEEN ABLE
TO COLLECT, THE RICHNESS OF THE
DATA IS REALLY PRETTY EXCITING,
AND I WONDER IF IT WOULD MAKE
SENSE, AND I DON'T KNOW IF THIS
IS STATISTICALLY POSSIBLE,
BECAUSE I DON'T REALLY HAVE A
FEELING FOR HOW MUCH DATA THERE
IS, BUT WOULD IT BE WORTH
CONSIDERING AND MAYBE PEOPLE ARE
DOING THIS AND I COULD HAVE
MISSED THIS, TAKING UNBIASED
SORT OF CLUSTERING AND DATA
REDUCTION STRATEGIES, SO RATHER
THAN HYPOTHESIS-DRIVEN QUESTIONS
BUT ACTUALLY ASKING ABOUT DO
THESE THINGS CLUSTER IN SOME
UNBIASED WAY, THINKING ABOUT THE
METHODS THAT HAVE BEEN SORT OF
PIONEERED AND REALLY VALIDATED
FOR GENOME EXPRESSION, FOR
TRANSCRIPT EXPRESSION, AND FOR
GENE CLUSTERING STUDIES REALLY.
SO I'M WONDERING IF ANY OF THAT
UNBIASED LIKE CLUSTERING STUFF
MIGHT BE USEFUL FOR EXAMPLE IN
THESE BRAIN MEASUREMENTS OR
PERHAPS MANY OF THE BEHAVIORAL
MEASURES THAT HAVE BEEN SO
ELEGANTLY DESCRIBED.
THANK YOU.
>> MARK, I'M GOING TO ASK GAYA
TO RESPOND.
WHILE SHE'S FINDING A MICROPHONE
I'M GOING TO MENTION THAT IN A
SMALL SUBAREA THAT I WORK IN,
WE'VE BEEN DOING PHARMACO
EPIDEMIOLOGICAL STUDIES.
WE ACTUALLY TAKE HUGE COHORTS
AND FIND OUT WHETHER SPIRALACTON
IS CORRELATED WITH DECREASES IN
DRINKING EVEN THOUGH IT'S USED
FOR TREATING HYPERTENSION, I
THINK.
I THINK THERE'S THIS BEGINNING
OF A SPEED THERE, EVEN IN
PHARMACO EPIDEMIOLOGY, WHAT
YOU'RE TALKING ABOUT.
>> A COUPLE PAYMENTS HAVE
CLUSTERING ANALYSIS, IDENTIFIED
GROUPS OF VARIABLES THAT SHOWED
DISTINCT PHENOTYPES.
THAT'S SOMETHING THAT IS GOING
ON IN THE FIELD.
HAPPY TO SHARE, I DON'T HAVE
DETAILS OFF THE TOP OF MY HEAD.
>> NANCY BARNETT HAS A QUESTION?
>> THANK YOU.
I DIDN'T FEEL IGNORED, GEORGE.
IT WAS A FANTASTIC SET OF TALKS
TODAY THAT HIGHLIGHTS COMMITMENT
TO AND BENEFIT OF THESE LARGE
SCALE LONGITUDINAL STUDIES.
I LEARNED A LOT.
MY QUESTION IS A VERY BROAD ONE,
I HOPE IT'S APPROPRIATE TO BRING
UP HERE.
THERE HAVE BEEN HISTORICAL
CIRCUMSTANCES THAT HAVE
HAPPENED, YOU KNOW, OF LATE, THE
PANDEMIC BEING A MAJOR RECENT
ONE WHERE WE'VE SEEN CLEAR
EFFECTS ON SUBSTANCE USE, MENTAL
HEALTH, SOCIAL HEALTH, ET
CETERA.
AND I'M WONDERING TO THE EXTENT
THAT WE CAN WOULD THIS BE THE
CORRECT VENUE TO RAISE THE ISSUE
OF ANTICIPATING RESCHEDULING OF
CANNABIS?
ARE WE ABLE TO THINK ABOUT THAT
AS -- I HAVE FURTHER QUESTIONS.
>> I'LL GIVE THAT ONE TO NORA.
>> WELL, I'VE BEEN TOLD, I COULD
NOT COMMENT ON RESCHEDULING
ITSELF BUT WHAT I CAN TELL YOU
THAT MARIJUANA AS SCALE 1 HAS
JEOPARDIZED RESEARCH AT SO MANY
LEVELS, CLARIFYING SCALING
DOESN'T MEAN LEGALIZING OR
CRIMINALIZING BUT WOULD ALLOW
RESEARCH, I CANNOT COMMENT
EXCEPT I'VE BEEN VERY EXPLICIT
ABOUT THE FACT THAT HAVING
MARIJUANA AS A SCALE 1 HAS BEEN
A DETERRENT FOR ADVANCING
RESEARCH.
>> THANK YOU.
THAT'S KIND OF -- I WASN'T
REALLY THINKING THERE WOULD BE
COMMENTARY ON WHETHER OR NOT IT
WILL HAPPEN BUT JUST
ANTICIPATING THAT IT VERY WELL
COULD HAPPEN.
IN EXPECT IT WOULD MAKE RESEARCH
LESS RESTRICTED, THAT COULD
SPEED UP THE INFORMATION ABOUT
SO MUCH FROM CANNABIS EFFECTS ON
THE BRAIN TO DETECTION AND
MEASUREMENT OF DRIVING
IMPAIRMENT WILL ALLOW FOR
IMPROVED RESEARCH ON MEDICAL
USE.
WHAT DO YOU THINK IT WILL HAVE,
WHAT EFFECT IN TERMS OF
PREVENTION AND INTERVENTION
IMPLICATIONS, SHOULD HAVE
IMPLICATIONS FOR CO-USE WITH
ALCOHOL AND TOBACCO, RELEVANT
FOR CRAN.
I WONDER IF THERE ARE THOUGHTS
IN THE AUDIENCE ABOUT WHAT WE
MIGHT ANTICIPATE AND WHAT WE
MIGHT WANT TO PLAN TO RESEARCH.
>> I THINK IT IS AN EXTREMELY
IMPORTANT QUESTION THAT WE WILL
NEED TO FIND OUT THERE'S A
SCALING AND IMPORTANTLY HOW THAT
SCALING MAY HAVE A CASCADE
EFFECT IN THE PATTERNS OF
MEDICAL CANNABIS AND
RECREATIONAL CANNABIS AND PEOPLE
ARE EQUATING SAYING WE'RE
LEGALIZING CANNABIS IN OUR
COUNTRY.
ABSOLUTELY NOT.
ONE OF THE ISSUES THAT IS TO ME
COULD BE VERY IMPORTANT IS
EXTENT TO WHICH THEY ARE MORE
WELL ORGANIZED, REGULATION OF
THE PRODUCTS GOING OUT THERE.
WHICH RIGHT NOW IS BASICALLY THE
WILD WEST, SOME STATES HAVE MORE
OR LESS REGULATION.
THAT PUTS DIFFERENT LEVELS OF
RISK.
I WOULD SEE ONE OR LESS EFFECTS.
I DO HOPE SCALING WILL MAKE IT
MUCH EASIER FOR RESEARCHERS TO
WORK INTO THESE FIELDS AT
MULTIPLE LEVELS, THAT'S ALL I'M
GOING TO SAY.
I WANT TO HEAR OTHER COMMENTS
AND QUESTIONS.
>> SO THANK YOU, NANCY.
I ADMIRE YOUR WILLINGNESS TO ASK
A QUESTION THAT'S NOT ONE
STANDARD ONE WE WERE TALKING
ABOUT.
SO I URGE THE REST OF YOU THE
SAME THING.
IF YOU HAVE OTHER QUESTIONS FOR
ANY OF US.
HOWARD??
>> CAN YOU START MY VIDEO?
>> SOMEONE HAS TO, YES.
I DON'T KNOW, BECAUSE SOMETIMES
IT IS --
>> I'LL START MY QUESTION TO
MICAH.
THANK YOU FOR THE PRESENTATION
ABOUT THE START.
I'M INTRIGUED BY THE FOCUS ON
UNMET NEED INDICATIONS IN
POPULATIONS, HOW FROM MY
PERSPECTIVE WORKING IN GLOBAL
INDUSTRY, HOW THERE ARE BOTH
REGULATORY OTHER ORGANIZATIONS,
BOTH PUBLIC AND PRIVATE, ALSO
TRYING TO ADDRESS THESE ISSUES.
NOT ALWAYS IN ABCD KIND OF GOALS
BUT JUST, YOU KNOW, IN TERMS OF
DEVELOPING WORKFORCE AND PROPER
RESEARCH, I'M WONDERING IF
YOU'VE CONSIDERED HOW TO NETWORK
WITH THOSE, IS MY VIDEO ON?
OKAY.
AND BY THE WAY I HAPPEN TO BE
WEARING MY START SHIRT TODAY,
BEING A GRADUATE OF ANOTHER
START PROGRAM THAT HAS BEEN
GOING ON IN EUROPE.
EUROPEANS HAD SOMETHING CALLED
THE STARS INITIATIVE, AGAIN,
TRYING TO ADDRESS THE SAME TYPE
OF PROGRAM FOR DEVELOPMENT IN
UNMET NEED INDICATIONS OF
VARIOUS TYPES, NEUROLOGIC AS
WELL AS ONCOLOGIC.
BUT THAT'S A QUESTION, BECAUSE,
YOU KNOW, I SEE THE GOALS YOU
HAVE, MIGHT BESTING SERVED,
LONG-TERM GOALS, BY MY
COLLABORATIVE WORK IN LEARNING
ACROSS BORDERS.
>> YES, THANK YOU FOR THAT
QUESTION.
I JUST WANT TO SAY START IS
GOING GLOBAL SO THANK YOU.
WE HAVE SITES EVERYWHERE.
THAT SHIRT WILL BE USEFUL.
I THINK YOU'RE SPOT ON.
I THINK THAT'S THE FUTURE.
THE FUTURE IS THESE
COLLABORATIONS, NOT JUST ACROSS
FIELDS IN RESEARCH BUT ACROSS
THE INDUSTRIES, HOW DO WE TACKLE
THIS ISSUE OF WORKFORCE
DEVELOPMENT BUT ALSO MAKING SURE
SOCIAL IMPEDIMENTS DON'T PREVENT
TALENT FROM BEING ABLE TO
FLOURISH.
AGAIN, WE'RE STILL PRETTY EARLY
IN THE PROCESS BUT RIGHT NOW
WHAT WE DO IS STUDY FOLKS WHO DO
IT WELL.
SOME RECRUITMENT STRATEGIES, A
GREAT QUESTION EARLIER, WE'VE
ADOPTED BASED ON WHO DOES THIS
VERY WELL, WHERE ARE FOLKS WHO
HAVE THE BEST TALENT, WHO SEEM
TO HAVE OVERCOME THESE BARRIERS,
SOCIAL HISTORICAL BARRIERS, WE
STUDY FOLKS WHO DO IT WELL AND
EVENTUALLY WHAT WE WANT TO DO IS
JUST THAT.
SEE IF WE CAN REPLICATE THESE
BEST PRACTICES AND THESE
APPROACHES IN DIFFERENT SPACES
BUT THEN BEGIN TO COLLABORATE
WITH DIFFERENT INDUSTRIES ABOUT
HOW DO WE BEGIN TO ALSO APPLY
THESE SAME TOOLS AND TECHNIQUES
TO ACHIEVE THEIR GOALS IN THEIR
RESPECTIVE FIELDS.
>> WE CAN TALK MORE OFFLINE,
I'LL SHARE EXAMPLES I LIVED
THROUGH AND WORK WITH IN
DIFFERENT ORGANIZATIONS LIKE THE
STARS CONSORTIUM WHICH YOU CAN
LOOK UP OP LINE, I CAN EXPLAIN
THE BACKGROUND, EUROPEAN GROUP
18 REGULATORY AUTHORITIES TO TRY
AND DEVELOP WORKFORCE OUT OF
ACADEMIA, WHAT YOU'VE BEEN
DOING, TAKING PEOPLE FROM
ACADEMIA AND GIVING THEM THE
RIGHT KIND OF LET'S SAY
REGULATORY SCIENCE ENABLEMENT TO
MOVE FORWARD IN DEVELOPING NEW
TREATMENTS ARE FOR UNMET NEED
INDICATIONS.
>> EXCELLENT.
THANK YOU.
LET'S CHAT.
MICAH JOHNSON.
>> MICAH SAID THAT HE'S HAPPY TO
CHAT WITH YOU.
MAYBE YOU CAN CONNECT BY E-MAIL
OR TEXT OR SOMETHING LIKE THAT.
ANY OTHER QUESTIONS?
THERE'S ONE.
KATIE?
>> YEAH, THANK YOU.
I REALLY APPRECIATED ALL THE
DISCUSSION OF SOCIAL
DETERMINANTS OF HEALTH TODAY.
I THINK THAT'S SO IMPORTANT.
TYING IT BACK, GEORGE, TO YOUR
CALL FOR TRANSLATIONAL, BACK
TRANSLATIONAL RESEARCH I
CHALLENGE COLLEAGUES DOING BASIC
SCIENCE WORK TO THINK ABOUT
ENVIRONMENT IN WAYS OF MODELING
ENVIRONMENTAL ENRICHMENT,
ENVIRONMENTAL ASPECTS, IN ANIMAL
MODELS BECAUSE I THINK IF WE'RE
NOT MODELING THAT AND INCLUDING
THAT, I KNOW IT GETS
COMPLICATED, I WOULD ADVOCATE
FOR A LOT OF THE RECENT WORK ON,
FOR EXAMPLE, SOCIAL CHOICE
HAVING THE CHOICE OF SOCIAL CUE
INSTEAD OF ALCOHOL CUE OR OTHER
WORK THAT HAS TRIED TO BRING IN
MORE OF SOCIAL ENVIRONMENTAL
FACTORS INTO ANIMAL MODELS AND
WE NEED MORE OF THAT.
AND SO I'M JUST GOING TO PUT OUT
THAT CHALLENGE.
>> I HAD THE SAME THOUGHT WHEN
NATHANIEL WAS TALKING, WHICH IS
THAT YOU MIGHT BE ABLE TO BREAK
DOWN SOME OF THE THREATS AT
LEAST, THREAT IN A BROAD SENSE
OF THE TERM, IN ANIMAL MODELS
DEVELOPMENT.
WE DO SOME OF THAT BUT, AGAIN,
IT'S NOT USUALLY SOME SPECIFIC
THREAT SO, YOU KNOW, IT WOULD BE
INTERESTING TO LOOK AT NEURAL
CIRCUITRY.
PARTICULARLY IF SOME OF THESE ON
MARMOSETS TAKE OFF BECAUSE THEY
HAVE A MUCH BETTER DEVELOPED
FRONTAL CORTEX THAN YOUR AVERAGE
MOUSE.
I MEAN, THERE MAY BE SOME VERY
SPECIAL MOUSE OUT THERE THAT I
DON'T KNOW ABOUT.
DAVID?
>> I ALSO RECALL SOME WORK DONE
A NUMBER OF YEARS AGO ON
PRIMATES, SOCIAL DOMINANCE.
SHOWING DIRECT EFFECTS ON --
>> MICHAEL NADER, YES.
>> YEAH.
>> REALLY EXCELLENT WORK,
MICHAEL NADER, DOPAMINE SYSTEM,
FRONT CORTEX AS WELL.
>> THERE IS A LOT OF WORK IN
TERMS OF ISOLATION, STRESS,
TRYING TO UNDERSTAND HOW IT
AFFECTS VULNERABILITY TO TAKE
DRUGS BUT VULNERABILITY FOR
RELAPSING.
SO, EVEN THOUGH, YES, NON-HUMAN
PRIMATE APPROXIMATE US BETTER
THERE ARE MANY THINGS WE CAN DO
IN THE RODENT, IN WAYS THAT CAN
THEN INFORM.
I DO BELIEVE YOUR POINT IS WELL
TAKEN BECAUSE IN GENERAL WE TRY
TO ISOLATE THE PHARMACOLOGICAL
AGENT AS IF IT WAS BY ITSELF.
>> CHANGE OF TOPIC, IF ANYBODY
HAS ANYTHING ELSE ON THAT GO
AHEAD.
>> GO AHEAD, BILL.
WE CAN GO BACK AND FORTH.
>> I WANTED TO MAKE AN
OBSERVATION.
THAT IS COVID CAME UP A FEW
TIMES TODAY.
BUT IT GOT PUSHED TO THE
BACKGROUND.
WE'RE ALL CELEBRATING THAT
BECAUSE WE PROBABLY HAVE COVID
FATIGUE.
BUT I DO THINK IT'S WORTH JUST
HAVING ON THE RADAR SCREEN THAT
THE FURTHER AWAY IT GETS FROM
US, THE MORE WE'RE AT MEETINGS
LIKE THIS NOT WEARING MASKS AND
SO ON THE MORE WE NEED TO
REMEMBER LONG-TERM IMPACT ON
BEHAVIOR.
I TALKED TO COLLEAGUES AT NCI
VERY HAPPY ABOUT THE FACT THAT
CANCER SCREENING IS GOING BACK
UP AGAIN, HEALTH CARE DELIVERY
IS RETURNING TO WHERE IT SHOULD
BE, WHERE IT WAS PRE-PANDEMIC.
BUT BEHAVIORS, ADDICTIVE
BEHAVIORS IN PARTICULAR, DON'T
JUST SWITCH OFF AND ON, AS WE
ALL KNOW.
SO I'VE BEEN VOCAL ABOUT THE
FACT THAT I NEED -- WE NEED TO
BE TRACKING WHAT THE IMPACT OF
COVID IS ON ADDICTIVE BEHAVIORS
AND OTHER BEHAVIORS INDEPENDENT
OF TRENDS WE MIGHT HAVE BEEN
SEEING BEFORE THE PANDEMIC.
OBESITY, BY THE WAY, IS ON THAT
LIST, RATES HAVE GONE UP
DRAMATICALLY BUT DURING THE
PANDEMIC EVEN MORE SO, THAT
ACCELERATED.
SO IT'S MORE OF AN OBSERVATION,
SOMETHING WE'RE THINKING ABOUT
AND PERHAPS CAN MODEL OVER TIME
>> WE HAVE FOLLOWING AND SO IS
NIDA WITH OUR DIFFERENT
MONITORING IN THE FUTURE SOME OF
THESE THINGS BUT YOU'RE
ABSOLUTELY RIGHT.
I HAVEN'T FORGOTTEN ABOUT THE
PANDEMIC BY ANY MEANS.
>> AND ABCD, VERY THOROUGH
ANALYSIS WITH SUPPLEMENT TO HAVE
VARIABLES THAT RELATE TO COVID
PANDEMIC SO IT WILL ALLOW US TO
LOOK AT IT AS CHILDREN GROW,
UNDERSTANDING DOWNSTREAM
EFFECTS.
WE HAVE AN OPPORTUNITY BECAUSE
THIS WAS AN EXPERIMENT THAT
HAPPENED.
WE WERE LUCKY TO HAVE THE STUDY
IN THE MIDDLE SO IT ALLOWS US TO
UNDERSTAND LONG-TERM
CONSEQUENCES.
>> I FEEL LUCKY I SURVIVED THE
EXPERIMENT.
I'M IN THE AGE GROUP THAT MANY
DIDN'T, JUST FOR THE RECORD.
TINA?
>> QUESTION IS FOR NATE IF HE'S
STILL ON.
SO, I WAS REALLY INTRIGUED BY
YOUR PRESENTATION AND THOUGHT
THAT HPCD WOULD BE A GREAT PLACE
TO REPLICATE WHAT YOU'VE DONE IN
ABCD TO SEE IF THE ASSOCIATIONS
THAT YOU FIND IN BRAIN SHOULD BE
ATTRIBUTED TO RACE, DO YOU SEE
AT YOUNGER AGES, BUT CURIOUS IN
THE ABCD DATASET IF IT'S LARGE
ENOUGH TO BE ABLE TO LOOK AT
RELOCATION, SO DO YOU HAVE
INDIVIDUALS WHO MOVE FROM ONE
PLACE TO ANOTHER WHERE THEIR
CIRCUMSTANCES WERE DIFFERENT AND
WOULD YOU BE ABLE TO PERHAPS
LOOK AT THAT AS A COVARIATE IN
TERMS OF THE RELATIONSHIP
BETWEEN BRAIN AND RACE?
>> YEAH, BOTH ARE GREAT
QUESTIONS.
WORKING BACKWARDS, WE HAD A
SIMILAR THOUGHT THINKING ABOUT
AT LEAST LOOKING AT POTENTIAL
CHANGES IN, SAY, ADI BETWEEN
BASELINE YEAR 2 DATA SINCE WE
HAVEN'T LOOKED AT 5.0 AND 6.0
ISN'T OUT YET.
MY RECOLLECTION AND ACTUAL
PEOPLE CAN CORRECT ME, THERE
WASN'T CHANGE IN TERMS OF ADI,
WHEN WE LOOKED THERE WAS A VERY
SMALL NUMBER.
WE INITIALLY LOOKED AT
HIPPOCAMPAL VOLUME, CONTEXTUAL
MODULATION, STRESS SENSITIVE
NEUROBIOLOGY, I THINK THAT'S
REALLY MORE OF A POWER ISSUE AS
YOU WERE GETTING AT.
SO PERHAPS AS MORE YEARS GO ON,
MORE PEOPLE MIGHT MOVE AROUND,
MIGHT BE MORE OPPORTUNITY TO DO
FINE GRAIN ANALYSES.
THE OTHER QUESTION ABOUT HBCD,
SOUNDS GREAT.
THAT WOULD BE COOL TO DO.
HAPPY TO FIND AN R.A. TO WORK
THROUGH THE ABILITY TO GET
ACCESS TO DATA AND START THAT
PROCESS.
>> WE HAVE TIME FOR PROBABLY ONE
OR TWO MORE QUESTIONS IF ANYONE
HAS THEM.
OR WE CAN GIVE YOU BACK TWO
MINUTES OF YOUR LIVES.
ANYBODY OUT THERE?
GO AHEAD.
>> MORE OF A COMMENT.
I KEEP THINKING ABOUT -- I AGREE
COMPLETELY WITH BILL'S POINT
ABOUT THE PANDEMIC.
I THINK THERE'S A COLLECTIVE
TRAUMA ABOUT THE PANDEMIC AND
THERE'S A LOT OF SUPPRESSION OF
EVEN THINKING BIT.
I THINK YOUR POINT IS WELL TAKEN
BECAUSE I THINK WE'LL SEE
EFFECTS FOR A LONG TIME.
I WAS THINKING ABOUT WITH ALL
THE AMAZES PRESENTATIONS ABOUT
RESILIENCE FACTORS, TRYING -- WE
ALREADY KNOW WHAT SOME ARE BUT
TRYING TO ELUCIDATE RESILIENCE,
NOT ONLY THAT WE KNOW WHAT THOSE
ARE BUT THEN ARE THERE WAYS WE
TRANSLATE THAT INTO
IMPLEMENTATION LIKE WHAT DO WE
DO?
SO THERE ARE STUDIES ABOUT
NEIGHBORHOOD COHESION, BEING
RESILIENCE FACTOR FOR PEOPLE WHO
HAVE HAD OTHER ADVERSE
CIRCUMSTANCES, THERE ARE A WHOLE
RANGE OF THINGS THAT WE THINK
ABOUT IN TERMS OF FRIENDSHIPS,
MULTIPLE DIFFERENT INTERACTIONS,
WHAT DO WE DO WITH THAT
INFORMATION AND IS THERE A WAY
FOR US TO CONSIDER, YOU KNOW,
FROM A SCIENCE PERSPECTIVE WHAT
WE DO HOW DO WE PROVIDE
IMPLEMENTATION AND INCENTIVIZE
FOR SOME OF THOSE THINGS TO
PROTECT PEOPLE, YOU KNOW, AND
TRY TO, YOU KNOW, INCREASE
RESILIENCE.
WE KNOW WHAT SOME FACTORS ARE.
WE KNOW THAT INCOME, HOUSING
SECURITY, FOOD SECURITY, WE KNOW
WHAT A LOT OF THESE THINGS ARE.
SO WHAT DO WE DO FOR
IMPLEMENTATION SCIENCE TO
DEMONSTRATE THAT WE HAVE
ACTUALLY TAKEN CARE OF THOSE
THINGS, SO IT'S JUST A THOUGHT
BECAUSE WE'VE BEEN TALKING ABOUT
THE STRESSORS, AND SOME OF THE
FACTORS THAT PREDISPOSE PEOPLE
TO ADDICTION BUT WHAT CAN WE DO
IN ELUCIDATING AND IMPLEMENTING
THING WE KNOW HELP PEOPLE BUILD
RESILIENCE?
>> THERE ARE STUDIES AS YOU KNOW
PROBABLY THAT HAVE RANDOMIZED
INTERVENTIONS THAT IMPROVE THE
INCOME OF FAMILIES THAT ARE
VERY, VERY POOR.
ACTUALLY HAVE SHOWN SIGNIFICANT
IMPROVEMENTS IN BRAIN FUNCTION
OF THE NEONATES AND CHILDREN.
SO I GUESS PERHAPS YOUR QUESTION
GOES, YES, WE KNOW, BUT HOW DO
WE BUILD AT THE STRUCTURAL LEVEL
TO IMPACT THE POPULATION AT
LARGE.
THAT IS A QUESTION WE ALL NEED
TO THINK ABOUT.
>> OR CAN WE REVERSE SOME OF THE
CHANGES.
>> EXACTLY.
>> THAT'S A BIGGER CHALLENGE.
THAT'S A GOOD PLACE TO STOP AT
MAYBE CONSIDER AT NEXT CRAN.
I HAVE THE PRIVILEGE OF
ADJOURNING THE MEETING.
THE MEETING IS ADJOURNED.
[END OF PROGRAM]