>> I'M SUZANNE WEISS, AND I'M
THE DIRECTOR OF THE DIVISION OF
EXTRAMURAL RESEARCH AT NIDA.
I'M STANDING IN FOR --
NORKOFF, SHE CAN'T BE WITH US,
SHE IS TESTIFYING BEFORE
CONGRESS AS PART OF THE NIAAA
APPROPRIATIONS MEETING.
SHE SENDS HER REGARDS AND ALSO
SENT A VIDEO WITH HER
PRESENTATION, YOU WILL AT LEAST
HEAR FROM HER VIRTUALLY, SORT
OF.
I WANT TO WELCOME EVERYBODY TO
THE 10th JOINT MEETING OF THE
NATIONAL ADVISORY COUNCILS FOR
NYAH, NCI AND NIDA AND THE 9th
MEETING OF THE COLLABORATIVE
RESEARCH ON ADDICTION AT NIH.
IN ADDITION TO DR. VOLKOFF NOT
BEING HERE, COUNCILMEMBER
PRIASS CAN'T JOIN US, SHE ISN'T
FEELING WELL, WE HOPE SHE
RECOVERS QUICKLY.
WE REARRANGED THE AGENDA TO
GIVE SOME ADDITIONAL TIME TO
OUR SPEAKERS AND ALLOW FOR MORE
QUESTIONS AND THE AGENDA SHOULD
BE UPDATED IN YOUR INVITATION.
BEFORE WE START TODAY, I WANT
TO DO A LAND ACKNOWLEDGMENT.
JULIE, WILL YOU SHARE MY SLIDE.
SO WE ACKNOWLEDGE THAT THE NIH
IS ON THE TRADITIONAL LANDS OF
THE PISCATAWAY AND ANACOSTAN
PEOPLE, PAST AND PRESENT.
WE HONOR THE LAND ITSELF AND
THE PEOPLE WHO HAVE STEWARDED
IT WITH GRATITUDE.
THANK YOU.
THIS IS BEING VIDEOCAST AND
ARCHIVED ON THE NIH VIDEOCAST
SITE.
I THINK WE CAN NOW START WITH
THE NIDA DIRECTOR'S
PRESENTATION AND NORA'S VIDEO.
>> GOOD MORNING, EVERYONE.
I'M NORA VORKOFF, I CAN'T BE
HERE TODAY BECAUSE I HAVE TO
TESTIFY ON THE NIH HEARING AT
THE HOUSE.
I WAS ABLE TO VIDEOTAPE THIS
PRESENTATION TO HIGHLIGHT SOME
ISSUES MOST RELEVANT AND
SUZANNE WEISS WILL BE THERE TO
ANSWER ANY QUESTIONS YOU MAY
HAVE.
MANY THINGS HAVE HAPPENED SINCE
WE LAST MET ONE YEAR.
WE ALWAYS LIKE TO GIVE AN
UPDATE IN TERMS OF WHERE WE
ARE, PARTICULARLY AMONG
TEENAGERS BECAUSE IT'S CHANGED
SIGNIFICANTLY.
STUDENTS REPORTING FOR 8th,
10th AND 12th GRADERS SINCE
2011.
YOU CAN SEE THE SIGNIFICANT
DECLINE THAT'S HAPPENED THROUGH
THE COVID PANDEMIC,
PARTICULARLY WITH THE EMERGENCY
DECLARATION ON MARCH 13th THAT
LED TO THE SOCIAL ISOLATION
WHICH WE BELIEVE ACCOUNTS FOR
WHY WE ARE SEEING SUCH A
SIGNIFICANT REDUCTION.
TO THE EXTENT THAT THE PEER
PRESSURE AND SOCIAL BEHAVIOR AT
THIS STAGE IN LIFE.
ACTUALLY BEING IN ISOLATION
DECREASE THE OPPORTUNITIES TO
INTERACT WITH ONE ANOTHER,
DECREASE THE OPPORTUNITIES TO
TAKE DRUGS.
LOOKING AT HOW LARGE THE
DECREASES ARE.
THAT INCLUDES BASICALLY ALL OF
THE DRUGS WENT DOWN, INCLUDING
VAPING WHICH HAD SOME OF THE
HIGHEST RATES OF USE JUST
BEFORE THE PANDEMIC.
SO THIS SHOWS THIS DATA FOR
ALCOHOL, FOR 8th GRADERS FIRST.
SHOWING INITIALLY THE YEAR 2020
VERSUS 2021.
SIMILARLY FOR 10th GRADERS AND
12th GRADERS AND SAME FOR THE
OTHER DRUGS.
IT DECREASES FROM ONE YEAR TO
THE NEXT.
EVERY SINGLE DROP GOES DOWN.
WE INTERPRET THIS TO INDICATE
TO THE EXTENT THAT THESE
TEENAGERS WERE STARTING FROM
HOME, THEY DIDN'T HAVE THE
OPPORTUNITY TO GET EXPOSED TO
THESE DRUGS.
AT THE END OF THE YEAR, THE
UPDATE FOR 2022, WHICH WILL
GIVE US INFORMATION ABOUT WHAT
HAS HAPPENED TO THESE RATES OF
DRUG USE NOW THAT TEENAGERS ARE
BACK AT SCHOOL.
THE FOURTH AND NEW INITIATIVE
WE STARTED LAST YEAR SINCE WE
LAST MET FOLLOWING ON THE
SUCCESS OF THE HBCD STORY,
ALCOHOL AND DRUG NIDA, IF YOU
OPEN UP OPPORTUNITIES TO THIS
GAP TO UNDERSTAND AND
TRAJECTORIES THAT PUT TEENAGERS
AT HIGHER RISK.
AND TODAY, DR. DEARING WILL BE
GIVING AN UPDATE.
SUFFICE TO SAY IT'S BEEN VERY,
VERY SUCCESSFUL.
IT INSPIRES US TO DO EQUIVALENT
STUDY STARTING IN INFANCY.
A THREE-YEAR PILOT.
THE FINAL AWARDS THROUGH THE
FULL PROJECT WERE GIVEN LAST
YEAR THE SELECTION WAS MADE IN
SEPTEMBER AND OCTOBER, THEY
WERE FUNDED.
IT IS 7500 INFANTS.
WITH BRAIN IMAGING, AND
BEHAVIORAL ASSESSMENTS AND
COGNITIVE ASSESSMENTS AND TO
ASSURE IN THESE PARTICULAR
STORIES WE ARE ONLY ROWE
RECRUITING FOR THOSE INFANTS
THAT WERE EXPOSED TO OPIATE
DRUGS DURING PREGNANCY.
THE PATTERN OF CHEIRO
CHARACTERISTICS OF THESE
PREGNANCIES, WE WILL ENSURE
THERE WILL BE A SIGNIFICANT
GROUP OF INFANTS THAT WILL BE
BORN OF MOTHERS TAKING ALCOHOL,
CANNABINOIDS.
THIS ALLOWS A BETTER
PERSPECTIVE WHAT ARE THE
HARMFUL EFFECTS OF DRUG DURING
PREGNANCY.
THESE WERE THE SITES SELECTED
AND THESE ARE THE DEMOGRAPHICS,
AS YOU SEE WITH THE HBCD, WE
ALSO ENSURE THAT WE HAVE A
HIGHER REPRESENTATION OF
MINORITIES THEN THAT OF GENERAL
POPULATION.
SO THAT THE SAMPLE SIZES ON
WHAT ARE THE EFFECTS ON
MINORITY CHILDREN.
JUST LIKE THE HBCD, WE WILL BE
USING A VARIETY OF TOOLS,
TECHNOLOGIES, ASSESSMENTS TO
ENSURE WE CAN GET THE
PHENOTYPING OF PHYSIOLOGICAL
PROCESSS IN THESE NEONATAL
INFANTS FORMED TO ADOLESCENTS
TO ADD PROSPECTIVELY.
BUT ALSO TO BE ABLE TO
UNDERSTAND HOW ULTIMATELY THEIR
ENVIRONMENT INFLUENCES THOSE
TRAJECTORIES.
AS THE UPDATE I WANTED TO GIVE
YOU, THE OVERDOSE CRISIS.
I THINK THE NEWS HAS BEEN
COVERING VERY MUCH HOW THE
OVERDOSE DEATHS HAVE BEEN
INCREASING AND ACTUALLY
DISCUSSED WITH SIGNIFICANT
OVERDOSE DEATHS FROM ALCOHOL,
IN THE CASE OVER THOSE CRISIS
INITIATED WITH OPIOID OVERDOSES
IT EXACERBATED MARKEDLY.
THIS IS THE LATEST DATA WE HAVE
NOVEMBER 2021.
WHICH THERE WERE CLOSE TO 1007
PEOPLE DYING FROM OVERDOSES.
16% RISE ALL THE WAY FROM
EXTREMELY THE HIGHEST NUMBERS
EVER WE HAD SEEN, OF OF COURSE.
WHEN WE SAW A 30% INCREASE
OVERDOSE MORTALITY FROM 2019.
SO WE SEE THE INCREASES ARE
CONTINUING AND WE ALSO SEE
DRUGS ASSOCIATED WITH THE
OVERDOSES ARE ACTUALLY
DIVERSIFYING, HEROIN ARE
REDUCED SIGNIFICANTLY.
SO ARE OVERDOSES THAT ARE
ACTUALLY ASSOCIATED WITH
PRESCRIPTION OPIOIDS.
WE ARE NOT SEEING INCREASES IN
OVERDOSES WITH METHADONE.
WHICH IS IMPORTANT, BECAUSE THE
CHANGES IN POLICIES TO TAKE
HOME METHADONE THIS WAS CONCERN
THIS WOULD RESULT IN DIVERSION
IN OVERDOSES.
THE DATA IS NOT SHOWING THAT.
ON THE OTHER HAND YOU CAN SEE
THERE'S A SIGNIFICANT RISE IN
OVERDOSES, CONTINUE TO SEE,
FENTANYL.
THIS HAS BEEN DRIVING THE RISES
IN OVERDOSES IN 2015 AND 2016
AND ACCELERATED THE LAST THREE
YEARS.
COCAINE THERE WERE SIGNIFICANT
INCREASES, VERY SIGNIFICANT
INCREASES WITH METHAMPHETAMINE
OVERDOSES.
WE KNOW THESE OVERDOSES HAD
CONTAMINATION WITH FENTANYL.
20% WITH METHAMPHETAMINE.
WE DON'T KNOW THIS IS NOT
RECORDED IN THESE DATA SETS,
WHAT PERCENTAGE OF THESE ONES,
FOR EXAMPLE, HAD ALSO
INTOXICATION WITH ALCOHOL.
ONE WOULD EM PEKT AT LEAST 15%
OF THOSE OVERDOSES OVERALL ARE
ASSOCIATED WITH ALCOHOL.
SIMILARLY, THERE IS ESTIMATED
15% CONTRIBUTION OF BENZO
DIAZEPINES.
THESE INCREASED THE PEOPLE
AFFECTED BY THE OVERDOSE CRISIS.
AMERICANS IN THE DARK BLUE
CURVE WERE MORE LIKELY TO BE
PRESCRIBED OPIOIDS IN THE
OVERDOSE CRISIS FROM OPIATES.
THE NUMBERS WERE EQUIVALENT FOR
THE AMERICAN INDIANS, ALASKA
NATIVES, THEY WERE VERY MUCH IN
PARALLEL.
IN 2015 WHEN WE START TO SEE
THE EMERGENCE AND 2016 OF
FENTANYL ACTUALLY CONTAMINATING
COCAINE AND METHAMPHETAMINE, WE
THEN SEE THE SHARP RISE IN THIS
UNDER-REPRESENTED GROUPS.
RIGHT NOW, THE GROUP WITH THE
FASTEST RATE OF OVERDOSE DEATHS
IS AMONG BLACK AMERICANS.
THIS IS LARGELY TO REFLECT, IN
FACT, THAT NOW WE HAVE TO START
WITH MUCH HIGHER LIKELIHOOD
THAT HEROINE IS CONTAMINATED
WITH FENTANYL.
BUT COCAINE BE CONTAMINATED
WITH FENTANYL.
CERTAINLY COCAINE IS ONE OF THE
DRUGS THAT HAS BEEN FAVORED BY
SOME OF THE BLACK COMMUNITIES.
IN THE CASE OF AMERICAN
INDIANS, ALASKA NATIVES, ONE
DRUG FAVORED BY THIS POPULATION
HAS BEEN METHAMPHETAMINE.
TO THE EXTENT THAT
METHAMPHETAMINE IS CONTAMINATED
THAT, OF COURSE, RISES THE RISK.
WE WANTED TO PAY A TENSION
ATTENTION TO THE NUMBERS
BECAUSE IT TELLS US THE MOTE.
42.9.
COMPARE THAT WITH WHITE
AMERICANS WHICH IS HIGH
COMPARED TO 32.8.
DISPARITIES WE HAVE BEEN ALSO
AWARE DURING THE COVID PANDEMIC.
BUT NOW ARE EMERGING REALLY
FAST, AND UNACCEPTABLE AMONG
MINORITY GROUPS.
WE DON'T CLAIM WE UNDERSTAND
THESE DYNAMICS AND WE CAN
PROVIDE INTERVENTIONS AND
THERAPEUTICS FOR THESE GROUPS.
AND THE FINAL DATA SLIDE IS
THIS ONE, THAT SHOWS FOR THE
FIRST TIME EVER, SINCE IN 2019,
OVERDOSE DEATHS FROM
METHAMPHETAMINE TEENAGERS YOU
CAN SEE THE SECOND PART OF
2019, LOOK AT THIS HUGE RISE IN
OVERDOSE MORTALITY AMONG
TEENAGERS.
15-19 YEARS OF AGE.
THIS RISE IS SOMETHING THAT OF
COURSE WE HAVE NEVER SEEN AND
IT CONTINUES.
IT WAS TOTALLY SURPRISING
BECAUSE TEENAGERS AND CERTAINLY
MONITORING THEM AND MONITORING
THEM IN THE FUTURE HAVE THE
LOWEST RATES OF HEROIN USE.
THIS LIKELY INCREASE THIS VERY
DRAMATIC INCREASE IS LIKELY TO
REFLECT CONTAMINATION OF DRUGS
TEENAGERS ARE GOING TO BE
FAVORING.
IN THE CASE OF TEENAGERS, WE
KNOW THEY FAVOR, AGAIN, NOT
JUST ALCOHOL AND VAPING AND
THEY ALSO FAVOR PRESCRIPTION
DRUGS.
PRESCRIPTION DRUGS CAN BE
STIMULANT, THEY CAN BE BENZO
DIAZEPINE, OPIOID PAIN PILLS.
TO THE EXTENT THESE ARE
CONTAMINATED WITH FENTANYL, WE
BASICALLY, THIS IS LIKELY TO BE
ONE OF THE REASONS WHY THAT
INCREASED RISK IS HAPPENING.
AND IN FACT, DURING THE THREE
YEARS OF 2018-2021, WHEN THEY
HAVE BEEN MONITORING
MANUFACTURE DRUGS THAT CONTAIN
FENTANYL, THESE HAVE INCREASED
IN THREE YEARS, 404.
WE ARE GETTING ILLICITLY
MANUFACTURED MEDICATION FROM
THE WEB IT MAY CONTAIN FENTANYL
IS MUCH HIGHER.
UNDERSTANDING THIS HIGHLIGHTS
NOW, MAY BE OF SERVICE AMONG
TEENAGERS FOR OVERDOSING.
SO HOW DO WE TAKE THIS
INFORMATION IN TERMS OF HOW WE
MOVE FORWARD.
WE STARTED WITH THE OVERDOSE
CRISIS AND TREATMENT WAS
CRUCIAL.
STILL CRUCIAL.
AND WE STILL NEED TO ADVANCE
THE SCIENCE AND PROVIDE THE
TREATMENT THAT IS NOT
SUFFICIENT.
INDISPENSABLE AND CRUCIAL.
THE NOT SUFFICIENT.
THE CLEAR THAT WE ALSO NEED TO
DEPLOY TREATMENT FOR OTHER
SUBSTANCE USE DISORDERS BECAUSE
OF THE HIGH RISK OF
CONTAMINATION OF THE DRUGS,
LEADING TO OVERDOSE.
OVERDOSE TREATMENTS WE USE,
NALOXONE MAY NOT WORK WITH
COMBINATION OF DRUGS INDUCING
DEATH.
IT'S ALSO EVIDENT WE NEED TO
LAUNCH PREVENTION AS A MAJOR
INITIATIVE, IT SHOULD IMPROVE
TEENAGERS THAT MAY BE
EXPERIMENTING WITH DRUGS OR OWE
CAIG ALLEY TAKING DRUGS OR
TAKING OCCASIONAL DRUGS TO
SLEEP BETTER.
THE RISK CURRENTLY EXCEEDS
BECAUSE OF THIS DISPERSION AND
MANUFACTURING OF ILLICITLY
MANUFACTURED DRUGS.
IN ADDITION TO THE SCREENING
AND APPROPRIATE TREATMENT
INTERVENTIONS FOR THOSE TO
PREVENT THEM TO ESCALATING TO
DRUG TAKING.
IT'S CLEAR WE NEED MUCH, MUCH
BETTER DATA.
THE VERY FRUSTRATING TO TRY TO
MAKE DECISIONS WHAT HAPPENS IN
7 MONTHS.
I DON'T KNOW THE SITUATION
RIGHT NOW IN TERMS OF OVERDOSES.
IT'S ALSO CLEAR THAT WHEN WE
SPEAK ABOUT ADDICTION AND WE
UNDERSTAND BIOLOGICAL
COMPONENTS, WE ALSO UNDERSTAND
THAT SOCIAL DETERMINANTS OF
HEALTH ARE CRUCIAL IN
DETERMINING THE RISK OF
VULNERABILITY OF PEOPLE
EXPERIENCING WITH DRUGS.
IF THEY HAVE ADDICTION, SOCIAL
DETERMINANTS OF HEALTH IS
IMPORTANT WHETHER THEY CAN
RECOVER.
I WANT TO THANK YOU VERY MUCH
FOR YOUR ATTENTION.
I'M NOT GOING TO BE THERE TO
ANSWER THE QUESTIONS, BUT AS I
MENTIONED EARLIER ON, DR.
WILSON AND DR. WEISS WILL BE
THERE TO ANSWER ANY QUESTIONS
YOU MAY HAVE.
THANKS VERY MUCH.
>> OKAY, ARE THERE ANY
QUESTIONS THAT WILSON OR I CAN
ANSWER FOR THE GROUP?
I'M NOT SEEING ANY HANDS RAISED.
OH, I DO NOW.
HOWARD?
>> YEAH.
TWO QUESTIONS.
ONE IS, ARE THERE ANY DATA
AVAILABLE ABOUT REGIONAL
DIFFERENCES THAT MIGHT BE
INFORMATIVE ABOUT REGIONAL, YOU
KNOW, HEALTH PRACTICES, MAYBE
STATE-BY-STATE, ETC.
THE SECOND, I'M INTRIGUED WITH
THE RECENT NATURE ARTICLE ON
MAY 5th ABOUT DRIVERS OF HEALTH.
AND I'M WONDERING IF THERE'S A
WAY, IF YOU UNDERSTAND THE
SOCIAL, JUST METHODLOGICALLY
THE SOCIAL DETERMINANTS BEHIND
THE DRIVERS OF, LET'S SAY THE
ADDICTION, CAN YOU ALSO
LEVERAGE THAT KNOWLEDGE TO
UNDERSTAND THE DRIVERS OF THE
SAME KIND OF DRIVERS THAT
PEOPLE THAT ARE NOT ADDICTED?
AND IS THAT A METHODOLOGY THAT
YOU CAN LOOK TO, OR YOU ARE
LOOKING TO?
I'M FAMILIAR WITH SOME OTHER
APPROACHES AT NINH WHERE THAT'S
BEEN USED AND SUCCESSFUL.
>> OF COURSE YOU ARE OPENING A
BROAD RANGE OF SCIENCE IN TERMS
OF SOCIAL INFLUENCES ON HEALTH.
THIS HAS BEEN A MAJOR PART OF
OUR PORTFOLIO FOR AS LONG AS
I'VE BEEN AT NIDA, PROBABLY 20
YEARS AND PROBABLY MUCH LONGER.
LET ME ADDRESS YOUR FIRST
QUESTION, WHICH HAD TO DO WITH
REGIONAL DATA THAT MAY BE
AVAILABLE.
CERTAINLY, THE OVERDOSE DEATH
DATA CAN BE DECOMPOSED DOWN TO
MUCH SMALLER GRANULAR ASPECTS
DOWN TO THE COUNTY LEVEL.
YOU RUN OUT OF CASES, SO THE
ABILITY TO DO A CAREFUL
ANALYSIS AT THOSE VERY LOCAL
LEVELS BECOMES QUITE DIFFICULT
BECAUSE OF THE SMALL NUMBER IN
ANYONE JURISDICTION.
THESE ARE STILL RARE EVENTS,
EVEN THOUGH AS A COUNTRY, AS A
WHOLE, THEY ARE UNFORTUNATELY
ALL TOO COMMON.
BUT WHEN YOU DIVIDE BY THE
3,000 COUNTIES THAT'S MORE
DIFFICULT.
THAT'S ALLOWED US TO LOOK AT
HOTSPOTS LIKE APPALACHIAN
REGION OR UNDERSTANDING HOW THE
SPREAD OF FENTANYL SHIFTED FROM
THE EAST COAST AND MIDWEST TO
THE WEST COAST HAS BEEN HARD
HIT IN THE LAST YEAR AND A HALF.
FENTANYL WASN'T AS PREVALENT
BECAUSE OF THE BLACK TAR
HEROIN, IT TOOK DRUG DEALERS A
LITTLE WHILE TO FIGURE OUT HOW
TO MIMIC WHAT WAS TYPICALLY
USED IN THOSE AREAS WITH
FENTANYL COMPOUNDS OR OTHER
SYNTHETIC OPIOIDS.
THE OTHER ISSUE, AS YOU HEARD
WITH THE OVERDOSE DEATHS IN
TEENAGERS, THE INCREASING
COUNTERFEIT MEDICATIONS HAS
BEEN A PROBLEM IN MANY
JURISDICTIONS.
THE REGIONAL VARIATION BECOMES
AN IMPORTANT CLUE.
I REALLY LIKE YOUR SECOND
QUESTION ABOUT SOCIAL
DETERMINANTS OF HEALTH.
WE ARE PARTNERING WITH GROUPS
LIKE OUR OFFICE OF BEHAVIORAL
AND SOCIAL SCIENCES RESEARCH AT
NIH.
PARTNERS AT NIAAA AND NCI TO
EXAMINE THESE ISSUES WHERE WE
CAN.
BUT THERE ARE ALWAYS
DIFFICULTIES IN MERGING DATA
SETS.
WHILE WE ARE THRILLED WITH
STUDIES LIKE HBCD THAT CAN
COLLECT THIS INFORMATION IN A
LARGE SCALE BASIS FOR A
PARTICULAR POPULATION, IT'S
BEEN MORE DIFFICULT TO LINK,
YOU KNOW, CENSUS DATA OR OTHER
SOCIAL DETERMINANTS OF HEALTH
DATA WITH OUR LARGE SCALE
SURVEYS TO DO THIS IN THE
ADDICTION FIELD.
SO THAT'S AN AREA WE ARE
WORKING TO SOLVE BUT WE HAVEN'T
COMPLETELY ADDRESSED YET.
>> I WAS JUST GOING TO ADD
ABOUT HBCD AND YOU WILL HEAR
MORE ABOUT THIS LATER, BUT I
THINK IT OFFERS US AN
OPPORTUNITY TO BE LOOKING AT
SOCIAL DETERMINANTS OF HEALTH
IN THIS LARGE GROUP AND BE
THINKING OF PREVENTION AND
TRAJECTORIES PEOPLE ARE ON IN
TERMS OF THE IMPACT OF
SUBSTANCE USE OR EVEN THEY ARE
EXPERIMENTING WITH SUBSTANCES.
AS I SAID, YOU WILL HEAR MORE
ABOUT IT, BUT IT'S AT LEAST ONE
WAY OF STARTING TO GET AT THAT
QUESTION FROM THE PREVENTION
SIDE OF IT, RATHER THAN
NECESSARILY FROM THE RECOVERY
SIDE.
>> THE OTHER DATA SYSTEM THAT
WE MIGHT LOOK AT IN THE FUTURE
WILL BE THE ALL OF US COHORT.
WHICH, BECAUSE OFITY SIZE, IF
WE CAN GET GOOD INFORMATION
ABOUT SUBSTANCE USE WITHIN THAT
COHORT, THAT MIGHT PROVIDE AN
OPPORTUNITY TO LOOK AT SOME OF
THESE REALLY ESSENTIAL
QUESTIONS TO REALLY IMPROVE
HEALTH.
>> TRAVIS?
>> YEAH, APOLOGIES FOR NOT
BEING ON CAMERA AGAIN, I'M
STILL UNDER THE WEATHER, SO I
WON'T EXPOSE YOU TO THAT
REALITY.
ONE QUESTION I HAVE IS THIS
TURN TOWARDS STIMULANT
OVERDOSE, WHICH I SEE, YOU
KNOW, THAT FENTANYL IS STILL
THE REAL DOMINANT KIND OF
SCARING EVERYONE OUT THERE,
POLY SUBSTANCE USE IN OVERDOSE.
FOR SOMEONE LIKE ME MUCH MORE
FAMILIAR WITH OPIOIDS, I HAVE
THIS SENSE OF EVERY SINGLE
PERSON WHO DIES FROM AN OPIOID
OVERDOSE DIED A FULLY
PREVENTABLE DEATH BECAUSE WE
HAVE NALOXONE AND IF THEY WERE
USING IN PUBLIC WITHOUT FEAR OF
CALLING FOR RESCUE, ETC., WE
COULD SAVE EVERY SINGLE ONE OF
THEM.
I HAVE THIS REALLY SOLID
NARRATIVE IN MY HEAD WHAT HARM
REDUCTION COULD DO WHEN IT
COMES TO OPIOIDS.
I HAVE TO ADMIT I DON'T HAVE AS
GOOD OF A PICTURE OF WHAT HARM
REDUCTION FOR STIMULANTS LOOKS
LIKE.
AND SO I KNOW THERE ARE
PHARMACEUTICALS, THERAPEUTICS
BEING STUDIED RIGHT NOW.
AND I'M SURE THAT THERE IS
STILL A LOT OF ADVANTAGES OF
USING WITH OTHER PEOPLE AND
AROUND FOLKS WHO ARE TRAINED
MEDICALLY.
BUT I JUST WONDER IF THERE'S
ANYTHING YOU CAN TELL US ABOUT
WHAT WE COULD BE DOING TO
ADVOCATE FOR HARM REDUCTION AND
WHAT SORTS OF DIRECTION RESOIX
RESEARCH NEEDS TO BE GOING AS
THIS TURN TOWARD STIMULANT GETS
WORSE AND WE NEED TO THINK OF
TREATMENT AND HARM REDUCTION
FOR A DIFFERENT CLASS OF DRUGS
THAT RESPONDS DIFFERENTLY.
>> IT'S INTERESTING, BECAUSE
THE TERM OVERDOSE DOESN'T SEEM
RELATABLE TO A POISONING
RELATED TO METHAMPHETAMINE OR
COCAINE.
TYPICALLY THE DEATHS WOULD BE
RELATED TO CARDIOVASCULAR
COMPLICATIONS, STROKES,
SEIZURES AND OTHER ACUTE EVENTS
I THINK OF AS AN OVERDOSE, MORE
OF AN IDIOSYNCRATIC REACTION TO
THE INGESTION ITSELF.
I WOULD POINT OUT THAT NALOXONE
AND THE OPIOID ANTAGONIST COULD
BE VERY HELPFUL, EVEN IN
STIMULANT SITUATIONS.
BECAUSE OF THE CO-MORBIDITY AND
OVERLAP OF THESE SUBSTANCES IN
SO MANY CASES.
EVEN THOUGH PEOPLE ARE TAKING
COCAINE AND THAT MAY CONTRIBUTE
TO IT.
IF WE CAN RESCUE THEIR
RESPIRATORY DEPRESSION THAT MAY
BE ENOUGH TO SAVE THEIR LIFE.
YOU BRING UP THE CASE WHAT IF
IT'S NOT DUE TO OVERLAP.
THIS IS WHERE WE HOPE
MEDICATION WILL PLAY A KEY ROLE.
THERE'S INTERESTING WORK MONO
CLONAL ANTIBODIES THAT MAY HAVE
A RAPID ENOUGH ON SET THEY
COULD BE USEFUL IN OVERDOSES OF
METHAMPHETAMINE.
THAT'S WHERE WE PUT A LOT OF
OUR EFFORT.
I'M NOT SURE HOW THAT WILL
APPLY IN A HARM REDUCTION
SITUATION, BECAUSE I DOUBT WE
WILL BE DISTRIBUTING THAT TO
THE COMMUNITY HARM REDUCTION
GROUPS, BUT WE WILL START WITH
THE CLINICAL APPLICATION AND
EXTEND IT FROM THERE AS
POSSIBLE.
I THINK THERE MAY BE BEHAVIORAL
APPROACHES THAT COULD HELP PLAY
A ROLE IN HARM REDUCTION, BUT
CERTAINLY WE ARE OPEN TO NOVEL
IDEAS ABOUT HOW TO ADDRESS THIS
EMERGING OVERDOSE CRISIS
RELATED TO NON-OPIOIDS.
>> THAT'S JUST REALLY HELPFUL
TO HEAR YOU SAY.
AND SUSAN, IF YOU WANT TO ADD
ANYTHING.
I WILL JUST ADD THAT SORT OF
RESPONSE MAKES ME THINK THIS
REALLY IS AN IMPORTANT AREA FOR
MORE PEOPLE TO BE THINKING
ABOUT, LIKE WHAT'S THE STORY WE
TELL PEOPLE TO PREPARE FOR THE
COMMUNITIES TO THINK ABOUT THE
FUTURE OF RESEARCH, ETC.?
SO THANKS FOR THAT, APPRECIATE
IT.
>> YEAH, THE ONLY THING I WAS
GOING TO ADD IS WE ARE MAKING
THIS A RESEARCH PRIORITY IN
TERMS OF MEDICATIONS
DEVELOPMENT AND LOOK AT BOTH
STIMULANTS AND OPIOIDS.
SO I THINK WE RECOGNIZE THAT.
AND WE ALSO RECOGNIZE THE
IMPORTANCE OF REALLY DEFINING
WHAT AN OVERDOSE WITH A
STIMULANT LOOKS LIKE, WHICH
ISN'T ALL THAT CLEAR EITHER.
AS WILSON SAID IT COULD BE A
CARDIO TOXIC EVENT BUT IT MAY
NOT BE.
I THINK WE HAVE A LONG WAY TO
GO, IT'S VERY IMPORTANT
RESEARCH PRIORITY FOR US.
>> IT IS INTERESTING THAT WE
CALL THESE THINGS OVERDOSES BUT
TECHNICALLY IN THE NATIONAL
CENTER FOR HEALTH STATISTIC
THESE ARE CALLED DRUG
POISONINGS AND IN MY MIND THAT
LABEL ACTUALLY FITS IN THIS
CASE.
WESLEY?
>> YEAH, AS YOU KNOW, THERE
AREN'T VERY GOOD BEHAVIORAL
STRATEGIES TO WORK WITH
STIMULANTS.
THE ONE STRATEGY --
THAT SEEMS TO HAVE THE LOWEST
EFFECT IS INCENTIVE-BASED
CONTINGENCY MANAGEMENT.
AND THAT'S NOT WIDELY USED.
SO THE QUESTION IS, WHY DOES
THE ADMINISTRATION LAG?
LAST WEEK HBCD CAME OUT WITH A
STIMULANT DOCUMENT THAT SEEMED
MORE LAW ENFORCEMENT ORIENTED
THAN CLINICALLY AND RESEARCH
BASED.
BUT THAT'S ANOTHER STORY.
BUT THE KEY ISSUE IS WE HAVE
BEEN TALKING ABOUT CONTINGENCY
MANAGEMENT FOR OVER A YEAR.
AND THE LIMITATIONS ON IT
CONTINUE TO EXIST.
YET, WE NOW HAVE AN UPTICK IN
OVERDOSE DEATHS.
I'M PARTICULARLY STRUCK BY
NORA'S DATA ON AFRICAN
AMERICANS.
WE HAVE TREATMENT THAT'S
AVAILABLE.
WE HAVE TO TRANSFORM THE
DELIVERY SYSTEM AND NOTHING IS
HAPG.
-- HAPPENING.
I KNOW THAT'S NOT NIDA'S
PRINCIPLE ROLE BUT IT WOULD BE
NICE TO HAVE MORE RESEARCH FROM
NIAAA AND NIDA FOR DEMAND THAT
COME FROM STIMULANTS AND OTHER
DRUGS, ACTUALLY.
>> I CERTAINLY HAVE OBSERVED
YOUR ENCOURAGEMENT OF THE
FEDERAL GOVERNMENT TO CHANGE
THE BARRIERS TO THE
IMPLEMENTATION OF AN EFFECTIVE
BEHAVIORAL APPROACH TO REDUCING
DRUG CONSUMPTION AND DRUG USE.
NAMELY CONTINGENCY MANAGEMENT
APPROACHES AND I APPLAUD YOUR
EFFORTS TO HELP CHANGE THE
DIALOGUE REGARDING THESE.
I CAN ASSURE YOU, WE HEAR YOU.
TO THE EXTENT WE ARE ABLE TO
PARTNER WITH MULTIPLE HEALTH
AND HUMAN SERVICES GROUPS TO
COME UP WITH SOLUTIONS TO SOME
OF THE FINANCIAL,
ADMINISTRATIVE AND TECHNICAL
BARRIERS TO IMPLEMENTATION, WE
ARE DOING EVERYTHING WE CAN.
I'M HOPEFUL THAT WE WILL SEE
SOME SOLUTIONS SOON.
>> THANK YOU.
>> BUT JUST LIKE YOU, YOU KNOW
THAT UNTIL YOU SEE THEM OUT
THERE ON THE STREET, IT'S A
THEORETICAL ADVANCE SO FAR, BUT
WE ARE PUSHING FOR IT.
>> THANKS, APPRECIATE IT.
>> I CAN CERTAINLY SPEAK THAT
NORA IS A STRONG ADVOCATE FOR
ENCOURAGING THE IMPLEMENTATION
OF EFFECTIVE INTERVENTIONS AND
THIS IS ONE OF THE WELL-KNOWN
EFFECTIVE INTERVENTIONS.
>> THANKS, AGAIN.
>> I DON'T SEE ANY FURTHER
QUESTIONS RIGHT NOW.
SO GEORGE, DO YOU WANT TO TAKE
OVER AND DO YOUR PRESENTATION?
>> SURE, THANK YOU, SUSAN.
IT'S A REAL PLEASURE TO BE WITH
YOU ALL.
I DECIDED TODAY THAT I WOULD
TALK ABOUT A TOPIC THAT'S
LOOMING LARGE IN THE ALCOHOL
COMMUNITY AND THE ALCOHOL FIELD.
AND THAT'S CLOSING THE
TREATMENT GAP.
WE WILL BE DEVOTING A LOT OF
ENERGY TO THIS.
NIAAA DURING THIS YEAR.
AND IT WILL ALSO BE THE
SUBJECT TO GETTING A BIT OF A
PREVIEW WITH MY TALKS TO RSA,
CPDP AND EVEN ASCP, AMERICAN
SOCIETY OF CLINICAL PSYCHO
PHARMACOLOGY.
NEXT SLIDE, JOHN?
SO I'M GOING TO QUICKLY TALK
ABOUT THE SCOPE OF ALCOHOL
RELATED PROBLEMS IN THE UNITED
STATES AND AN UPDATE DURING THE
COVID-19 PANDEMIC.
SIMILAR TO WHAT NORA SHOWED.
I WILL TALK ABOUT DRINKING TO
COPE DURING THE PANDEMIC AND
ALCOHOL-RELATED HARMS DURING
THE PANDEMIC.
THE REST WILL BE NIAAA'S
EFFORTS TO CLOSE THE TREATMENT
GAP.
TOO FEW PEOPLE WHO NEED HELP,
GET HELP.
AND ADVANCING MEDICATIONS, NEW
RESOURCES INCLUDING THE HEALTH
PROFESSIONALS CORE RESOURCE,
WHICH WE LAUNCHED YESTERDAY.
RECOVERY, TELEHEALTH, STIGMA
AND DIVERSITY.
NEXT SLIDE.
SO WHAT ARE THE SCOPE OF
ALCOHOL-RELATED PROBLEMS, AND
WHAT IS THE UPDATE DURING THE
PANDEMIC?
YOU HEARD A LITTLE BIT ABOUT
THIS FROM NORA.
NEXT SLIDE.
YOU KNOW, DEATHS INVOLVING
ALCOHOL HAVE BEEN INCREASING
FOR SOME TIME.
THE LATEST FIGURES FROM THE CDC
ARE 140,000 ANNUAL DEATHS IN
THE LAST FEW YEARS.
DEATH CERTIFICATES THEMSELVES,
WE SAW AN INCREASE OF 25% IN
THE FIRST YEAR OF THE PANDEMIC,
THAT'S BEING SUSTAINED THE
SECOND YEAR OF THE PANDEMIC.
ALCOHOL WAS LISTED AS NORA
SAID, ONE OUT OF SIX OVERDOSE
DRUGS.
SITUATION AND WHY IS THAT
EXACERBATING WHAT'S GOING ON
DURING THE PANDEMIC?
FOR US, YOU HAVE PROBABLY SEEN
THE OTHER SIDE BEFORE, ALCOHOL
AND MENTAL HEALTH IS THE
ELEPHANT IN THE ROOM.
OF COURSE I'M RIGHT HERE IN THE
ROOM AND NO ONE EVEN
ACKNOWLEDGES ME.
PAUL SUMMER GUARD SAID IT YEARS
AGO, IF YOU HAVE NEVER SEEN AN
INDIVIDUAL SEVERE ALCOHOL USE
DISORDER IN YOUR PRACTICE, YOU
ARE DILUTIONAL.
IT CORRELATES WITH POOR MENTAL
HEALTH.
COMMONLY USED IN AN EFFORT TO
COPE WITH SYMPTOMS.
IN THE END IT MAKES PROGNOSES
WORSE.
MENTAL HEALTH CONDITIONS
COMPLICATE TREATMENT FOR
ALCOHOL USE DISORDER.
THE COVID-19 PANDEMIC
CONTRIBUTED TO A DECLINE IN
MENTAL HEALTH.
THE WORLD HEALTH ORGANIZATION
ESTIMATES THE FOLLOWING GLOBAL
CHANGES, 28% INCREASES IN CASES
OF MAJOR DEPRESSIVE DISORDER,
26% INCREASE IN CASES OF
ANXIETY DISORDERS.
WE ARE SEEING INCREASES IN THE
DEATHS AND DESPAIR PRIOR TO THE
PANDEMIC.
THE PANDEMIC BROUGHT INCREASES
IN ANXIETY AND DEPRESSION FOR
PEOPLE OF ALL AGES, BUT
PARTICULARLY ADOLESCENTS AND
YOUNG ADULTS.
AMONG 9-12th GRADERS, 37%
REPORTED SYMPTOMS OF POOR
MENTAL HEALTH.
44% REPORTED PERSISTENT
FEELINGS OF SADNESS OR
HOPELESSNESS.
20% SERIOUSLY CONSIDERED
SUICIDE, AND 9 ATTEMPTED
SUICIDE, ALL WORSE FOR FEMALES.
THE TREATMENT GAP GREW.
MORE NEEDED IT BUT DIDN'T
RECEIVE IT.
IN A SENSE, I LUMP THIS IN WITH
SOCIAL DETERMINANTS OF HEALTH
IS THE MENTAL HEALTH STATUS AND
ENVIRONMENTAL CHANGES THAT
OCCURRED AND STRESS THAT
OCCURRED DURING THE PANDEMIC,
IT CONTRIBUTES TO ALL OF THESE
CHANGES.
AND GIVEN THE LENGTH BETWEEN
POOR MENTAL HEALTH AND ALCOHOL
USE, ONE MIGHT EXPECT MORE
DRINKING TO COPE DURING THE
PANDEMIC.
NEXT SLIDE.
IN FACT, THAT'S WHAT WE HAVE
SEEN.
STUDIES SUGGEST ABOUT ONE IN
FOUR PEOPLE BEGAN DRINKING MORE
DURING THE PANDEMIC, ONE IN
FOUR DRANK LESS.
DRINKING TO COPE WAS A COMMON
REASON FOR THOSE INCREASING
CONSUMPTION.
LONGITUDINAL STUDY FOUND RIGHT
BEFORE THE PANDEMIC PEOPLE WERE
48% MORE LIKELY TO INDICATE
THEY DRANK TO FORGET THEIR
WORRIES EARLY IN THE PANDEMIC.
THE ODDS OF DRINKING WERE
HIGHER WHEN RESPONDENTS COPE TO
DEAL WITH DEPRESSION AND OONK
IET.
ANXIETY.
OTHER STUDIES SUGGESTED HAVING
A PSYCHOLOGICAL WELL-BEING
IMPACTED NEGATIVELY BY THE
PANDEMIC WAS ASSOCIATED WITH
MORE DRINKING.
SO ALL THIS PUT TOGETHER IS
CONCERNING, GIVEN THE DRINKING
TO COPE INCREASES THE
LIKELIHOOD OF ALCOHOL USE
DISORDER AND RELATED HARMS.
IF ANYTHING, THE PANDEMIC HAS
REALLY SHOWN A LIGHT ON THIS
ASPECT OF THE ADDICTION CYCLE
THAT DRIVES ALCOHOL MISUSE AND
ALCOHOL USE DISORDER.
NEXT SLIDE.
I WILL GO THROUGH THIS QUICKLY.
WE ARE SEEING 25% INCREASE IN
ALCOHOL DEATHS AND THIS IS
DIRECTLY ATTRIBUTED TO DEATH
CERTIFICATES.
AND IT'S BEING, THE LATEST DATA
INDICATE THIS IS PERSISTING
INTO 2021.
THE NEXT SLIDE JUST SHOWS YOU
THAT THERE'S AN INCREASE IN A
VARIETY OF ALCOHOL-RELATED
HARMS THAT PARALLEL THESE
INCREASES IN DEATHS.
INCREASES IN THE PERCENTAGES OF
EMERGENCY DEPARTMENT VISITS AND
INVOLVE ACUTE ALCOHOL
CONSUMPTION.
AS I SAID, GOING TO ANY MAJOR
MEDICAL CENTER IN THE UNITED
STATES ON A FRIDAY OR SATURDAY
NIGHT, HALF OF THE PEOPLE THERE
ARE BECAUSE OF ALCOHOL.
INCREASING THE INCIDENTS OF
ALCOHOL WITHDRAWAL IN
HOSPITALIZED PATIENTS,
INCREASES OF DEATH WITH ALCOHOL
ASSOCIATED LIVER DISEASE,
GREATER THAN PRIOR YEARS.
HALF OF LIVER DISEASE IN THIS
COUNTRY IS NOW CAUSED BY
ALCOHOL.
14% IN ALCOHOL RELATED FATALITY
ACCIDENTS.
AND ALCOHOL-RELATED HEPATITIS.
PARTICULARLY FOR WOMEN AND
YOUNGER PEOPLE UNDER THE AGE OF
40.
AT LEAST IN MY BOOK, THAT'S A
YOUNGER PERSON.
NEXT SLIDE.
SO WHAT ABOUT A DIRECTION SOME
OF THESE ISSUES IN A WAY THAT
MAYBE WILL HAVE AN IMPACT ON
DISCOURAGING TRENDS.
SOMEONE NEEDS TO MUTE.
CLOSING THE TREATMENT GAP, I
WILL TALK ABOUT QUICKLY,
MEDICATIONS, RESOURCES,
RECOVERY DEFINITION, SCREENING
AND BRIEF INTERVENTION,
TELEHEALTH, DIVERSITY AND
EQUITY.
THIS IS A BIG PROJECT.
THIS IS A LARGE PART OF OUR
PORTFOLIO.
NEXT SLIDE.
SO YOU KNOW, WE HAVE
EFFECTIVE-EVIDENCE-BASED
BEHAVIORAL TREATMENTS,S
COGNITIVE BEHAVIORAL THERAPY,
MOTIVATIONAL INTERVIEWING.
AND LES CLARKE, I FORGOT TO ADD
THE SLIDE THAT HAS CONTINGENCY
MANAGEMENT ON IT, SO THAT'S A
THIRD.
WE HAVE THREE FDA APPROVED
MEDICATIONS FOR TREATMENT OF
AUD, MOST OF YOU ARE FAMILIAR
WITH, BUT I'M NOT SURE
PHYSICIANS ARE FAMILIAR WITH.
BUT LESS THAN 10% OF PEOPLE
WITH ALCOHOL USE DISORDER GET
ANY TREATMENT WHAT SO OFFER.
SO THE GOALS ARE UP, SIMILAR TO
THOSE OF NIDA, WE ARE IN THE
SAME BOAT DEVELOPMENT AND
REFINEMENT OF BETTER BEHAVIORAL
TREATMENTS, IDENTIFYING NOVEL
TARGETS, IDENTIFY SUPPORT
MEDICATIONS DEVELOPMENT TRIAL
POINTS.
SUPPORT RESEARCH TO DEFINE
RECOVERY, I WILL SHOW YOU A
SLIDE ON THAT.
HEALTH SERVICES, INTEGRATING
PREVENTION, EARLY DETECTION,
INTERVENTION AND TREATMENT.
AND DISSEMINATE PROFESSIONAL
CORE RESOURCE I WILL TALK ABOUT
IN A MINUTE.
NEXT SLIDE.
NORA MENTIONED SCREENING AND
BRIEF INTERVENTION WITH
SUBSTANCE USE DISORDERS.
THIS IS A BIG ISSUE WITH
ALCOHOL.
THE GOOD NEWS IS WE ARE DOING
SCREENING.
THE BAD NEWS IS WE ARE NOT
DOING INTERVENTIONS FOR
TREATMENT.
THAT'S WHAT THIS SLIDE SHOWS
80% PLUS PEOPLE SAW A CLINICIAN
IN THE LAST YEAR, THAT'S GOOD.
70% WERE ASKED AT LEAST ONE
QUESTION ABOUT THEIR ALCOHOL
CONSUMPTIONS, THAT'S GOOD.
ONLY 12% WERE OFFERED
INTERVENTION INFORMATION.
ONLY 5% WERE ADVISED ABOUT
TREATMENT OPTIONS OR OTHER
RESOURCES.
EVEN THOSE WITH SEVERE ALCOHOL
USE DISORDER IS STILL ABYSMAL,
23% GETTING ADVICE AND 12% FOR
REFERRAL.
IMPORTANTLY, SCREENING FOR
ALCOHOL MISUSE CAN HELP
CLINICIANS SPOT OTHER
HEALTH-RELATED ISSUES.
THERE ARE 20 DIFFERENT DISEASES
EXACERBATED OR CAUSED BY
ALCOHOL.
ADULTS WHO BINGE DRINK ARE MORE
LIKELY TO REPORT SUICIDAL
IDEATIONS.
NEXT SLIDE.
WE HAVE ENGAGED IN THE LAST 3-4
YEARS IN A NUMBER OF OUTREACHES
TO THE PUBLIC OF RESOURCES, OF
KNOWLEDGE WE ACTUALLY HAVE IN
THE ALCOHOL FIELD.
WE HAVE A WEBSITE THAT'S
POPULAR CALLED RETHINKING
DRINKING THAT HELPS INDIVIDUALS
ASSESS THEIR DRINKING HABITS
AND FIND WAYS TO MAKE A CHANGE.
WE LAUNCHED THE NIAAA TREATMENT
NAVIGATOR, THIS IS AN ONLINE
RESOURCE TO HELP YOU UNDERSTAND
TREATMENT OPTIONS.
WHAT IS AN ALCOHOL USE DISORDER.
WHAT IS THE SPECTRUM OF AN
ALCOHOL USE DISORDER.
BUT YOU CAN ALSO LOCATE TYPING
IN YOUR ZIP CODE USING SAMSA
NEARBY TREATMENT, INCLUDING
TELEHEALTH OPTIONS.
THIS NOW INCLUDES A PORTAL FOR
HEALTHCARE PROFESSIONALS TO
EXPAND, INCLUDE PROVIDERS
OFFERING SCIENCE-BASED AND
BACKED ALCOHOL USE DISORDER
TREATMENTS TO MEET THE VERY
NEEDS OF PATIENTS.
I WANT TO SPEND A LITTLE TIME
HERE ON OUR HEALTHCARE
PROFESSIONALS, WE LAUNCHED THIS
YESTERDAY, THE WEBSITE IS UP
AND RUNNING.
AN EDUCATIONAL TOOL INCLUDES
MODULES ON EDUCATION AND
PRIMARY CARE, ADDRESSING
STIGMA, MEDICATION INTERACTIONS
AND MORE.
THE NEXT SLIDE.
SHOWS YOU, IT WAS LAUNCHED
YESTERDAY.
NEXT SLIDE.
WHAT IS IN OUR HEALTHCARE
PROFESSIONALS CORE RESOURCE?
WHAT EVERY HEALTHCARE
PROFESSIONAL NEEDS TO KNOW
ABOUT ALCOHOL.
WHEN I SAY EVERY HEALTHCARE
PROFESSIONAL, PHARMACISTS,
PHYSICIAN ASSIST APT, NURSES,
CLINICAL PSYCHOLOGISTS, AIMED
AT PRIMARY CARE DOCS BUT ALSO
BOARD CERTIFIED ADDICTION
SPECIALISTS.
IT WAS DEVELOPED BY NIAAA WITH
GUIDANCE FROM PRACTICING
PHYSICIANS AND CLINICAL
PSYCHOLOGISTS WITH BUSY
CLINICIANS IN MIND.
THE HEALTHCARE PROFESSIONAL
CORE RESOURCE ARTICLES PROVIDE
USER-FRIENDLY PRACTICAL
OVERVIEWS OF FOUNDATIONAL
KNOWLEDGE FOR UNDERSTANDING
ALCOHOL-RELATED PROBLEMS.
FOUR ARTICLES OF THAT, CLINICAL
IMPACTS OF ALCOHOL, FOUR
ARTICLES.
HOW TO PUT IT ALL TOGETHER TO
PROMOTE PRACTICE CHANGE IN YOUR
PRACTICE.
THEY ARE ALL LIVING DOCUMENTS
THAT COULD BE UPDATED REGULARLY.
I WOULD LOVE YOUR INPUT,
EVERYONE OF YOU, ON BOTH
COUNCILS.
AND WE ALSO, YOU CAN RECEIVE
CONTINUING EDUCATION CREDIT.
IT'S FREE.
IT CAN RANG FROM 0.7 TO 1
CREDIT HOUR, WHICH COULD LEAD
TO ALMOST 11 CREDIT HOURS TOTAL.
NEXT SLIDE.
SO THIS IS WHAT IT LOOKS LIKE,
IF YOU WERE TO CLICK ON THE
LINK.
THERE'S THE BASICS.
THERE ARE TAKE-AWAYS WHICH
SUMMARIZE THE ARTICLE AND
RESOURCES, REFERENCES AND
SEEING THE CREDIT AT THE END OF
THE THIS IS THE ONE ON DEFINING
HOW MUCH ALCOHOL IS TOO MUCH.
NEXT SLIDE.
THIS IS THE ONE ON SUPPORT
RECOVERY, IT'S A MARATHON, NOT
A SPRINT.
TAKE AWAYS, RESOURCES, CME.
NEXT SLIDE.
I WANT YOU TO SEE HOW MANY
PEOPLE WE ENLISTED TO HELP
PRODUCE THIS ENORMOUS EFFORT.
LED BY RAY LYTTON, THEIR WORK
ON THIS WAS PROINDIGENOUS.
MANY ARE LISTENING TO THIS
PRESENTATION.
NEXT SLIDE.
AND THE CONTRIBUTORS AROUND
NIAAA RAY LYTTON AND LAURA WERE
OUR LEADERS AND JUST DID A
FANTASTIC JOB.
THERE IS A LOT OF HELP FROM
EVERYONE IN THE INSTITUTE.
NEXT SLIDE.
THIS IS WHERE YOU CAN DPIEND IT.
-- FIND IT.
BRIDGET WILL PUT IT IN THE LINK
IN THE CHAT FOR YOU ALL.
NEXT SLIDE.
SO WHAT ABOUT OTHER ISSUES AND
THINGS THAT WE HAVE ADVANCED ON
CLOSING THE TREATMENT GAP?
ONE IS WE PUBLISHED IN AMERICAN
JOURNAL OF PSYCHIATRY JUST A
FEW WEEKS AGO, THE DEVELOPMENT
OF AN NIAAA DEFINITION OF
RECOVERY.
WE KNOW THAT PEOPLE GET TO
TREATMENT.
WE KNOW THEY CAN GO TO A 28-DAY
REHABILITATION PROGRAM.
THEY CAN DO OUTPATIENT PROGRAMS.
BUT WHAT WE DON'T KNOW IS WHAT
IN THOSE PROGRAMS ACTUALLY
ALLOWED THEM TO RECOVER AND
STAY RECOVERED FOR A YEAR OR
THREE YEARS?
SO MOST PEOPLE WHO NEED
TREATMENT RECEIVE NO TREATMENT
OF ANY KIND.
LITTLE IS KNOWN ABOUT WHAT
SUSTAINS LONG-TERM RECOVERY.
TO ENHANCE HEALTH, WE ARE
EXPANDING THE FOCUS ON
LONG-TERM RECOVERY.
NIAAA IS DEFINE RECOVERY FROM
SUBSTANCE USE DISORDER,
FEEDBACK FROM KEY QUALITY
RESEARCHERS.
RECOVERY IS VIEWED BOTH A
PROCESS OF BEHAVIORAL CHANGE
AND OUTCOME, INCORPORATES TIME
PERIODS FOR TWO KEY COMPONENTS.
REMISSION FROM DSM-5, AUD AND
CESSATION FROM HEAVY DRINKING,
A NON-ABSTINENT RECOVERY
OUTCOME.
IT ALSO EMPHASIZES THE
IMPORTANCE OF BIO PSYCHO SOCIAL
FUNCTIONING, QUALITY OF LIFE
AND ENHANCING RECOVERY OUTCOMES.
NEXT SLIDE.
WE ARE ALSO RECOGNIZED THERE'S
BEEN A HUGE INCREASE IN
COVID-19 PANDEMIC CAUSED A
RAPID EXPANSION IN THE USE OF
TELEHEALTH.
EVIDENCE SUGGESTS TELEHEALTH
CAN BE EFFECTIVE FOR ADDRESSING
ALCOHOL MISUSE AND CAN REACH
PEOPLE WHO CAN'T OTHERWISE GET
SUPPORT.
SUPPORTING A VARIETY OF
TELEHEALTH SUPPORT, SCREENING
BY CLINICIANS BY PHONE OR VIDEO
CHAT.
CBT WITH CLINICIAN OR SELF
GUIDED, TELEHEALTH TO ADDRESS
PTSD AND ALCOHOL USE FOLLOWING
SEXUAL A SUELT.
VIDEO CONFERENCING BASED MI FOR
ALCOHOL MISUSE AND MEDICATION.
YOU CAN LINK UP WITH THESE IN
THE TREATMENT NAVIGATOR.
WE ANTICIPATE A LARGER ROLE
FORETELL HELIth FOR ALCOHOL
PREVENTION GOING FORWARD.
I BELIEVE THERE WILL BE FURTHER
DEVELOPMENT AND VALIDATION OF
SOME OF THESE APPROACHES.
WHEN YOU THINK OF RURAL
COMMUNITIES, WHEN I TOURED
ALASKA THREE OR FOUR YEARS AGO
NOW, YOU KNOW, THERE WAS A
DRAMATIC NEED FOR THE ABILITY
TO UTILIZE TELEHEALTH AND
TELEMEDICINE FOR DIAGNOSIS AND
FOR SOME ASPECTS OF TREATMENT.
SO WE WILL SEE HOW THIS FALLS
OUT.
THE NEXT SLIDE.
WORDS MATTER.
NORA VOLKOW AND JOSH GORDON AND
I WROTE A PAPER FOR
NEUROPSYCHOPHARMACOLOGY.
WE CAN HELP BY CONSISTENTLY
USING NON PEJORATIVE,
NON-STIGMATIZING LANGUAGE TO
DESCRIBE THESE CONCERNS AND THE
PEOPLE WHO ARE AFFECTED BY THEM.
I'VE TRIED AT LEAST TO USE
WORDS LIKE ALCOHOLIC AND
ALCOHOL ABUSE, WHICH ARE
STIGMATIZING.
USE ALCOHOL USE DISORDER
INSTEAD OF ALCOHOL ABUSE,
ALCOHOL DEPENDENCE AND
ALCOHOLISM.
USE ALCOHOL MISUSE.
USE FIRST-PERSON LANGUAGE TO
DESCRIBE PEOPLE WITH ALCOHOL
RELATED PROBLEMS.
A PERSON WITH ALCOHOL USE
DISORDER INSTEAD OF ALCOHOLIC.
USE ALCOHOL-ASSOCIATED LIVER
DISEASE, INSTEAD OF ALCOHOLIC
LIVER DISEASE.
NEXT SLIDE.
CAN WE MORE EFFECTIVELY ADDRESS
DIVERSITY AND HEALTH DISPARITIS
IN THE ALCOHOL FIELD?
MOST OF YOU KNOW THIS IS A HUGE
ENTERPRISE AND EFFORT AT THE
NIH NOW.
IT'S A VERY HIGH PRIORITY.
WE SHARE THAT HIGH PRIORITY AT
NIAAA.
WE FULLY SUPPORT AND ARE
CONTRIBUTED TO THE INITIATIVE,
COORDINATED EFFORT TO PROMOTE
RACIAL EQUITY AND INCLUSION IN
NIH AND LARGER ENTERPRISE.
WE ARE FOCUSING ON THREE AREAS,
IMPROVING THE NIAAA WORKPLACE
AND CULTURE, INCREASING
DIVERSITY AND EQUITY IN THE
NIAAA SCIENTIFIC AND
ADMINISTRATIVE WORKFORCE AND
THE RESEARCH PORTFOLIO.
NEXT SLIDE IS SOME QUICK
EXAMPLES OF THINGS WE ARE DOING
IN THE HEALTH SERVICES PROJECTS
TO ADDRESS HEALTH DISPARITIES.
WE KNOW THAT HEALTH DISPARITIES
ARE CONTRIBUTING TO HEALTH
DISPARITIES AND SUBSTANCE USE
DISORDERS AND ALCOHOL USE
DISORDERS IN PARTICULAR.
ONE PROJECT WE ARE DOING IS
ASSISTING THE EFFECTIVENESS OF
FEEDBACK INTERVENTION AMONG
LATIN-X AND INDIVIDUALS WITH
ALCOHOL MISUSE AND ANXIETY
WITHIN COMMUNITY-BASED HEALTH
CLINICS.
ANOTHER IS FOLLOW-UP ENGAGEMENT
AFTER ALCOHOL-RELATED
HOSPITALIZATIONS AND ASSESSING
ALCOHOL-RELATED OUTCOMES ACROSS
RACIAL AND ETHNIC GROUPS,
INCLUDING ANALYSIS OF SOCIAL
DETERMINANTS OF HEALTH.
AND A THIRD STUDY IS EXAMINING
BARRIERS TO ALCOHOL USE
DISORDER CARE BY SURVEYING
MEDICAID HEALTH PLAN POLICIES
RELATED TO DELIVERY AND
MANAGEMENT OF TREATMENT, AND
RELATIONSHIP WITH ACCESS TO AND
OUTCOMES OF CARE FOR
RACIAL/ETHNIC MINORITIES WOMEN
AND RURAL AMERICANS.
I KNOW NIDA IS ENGAGED IN
SIMILAR EFFORTS.
AND SO FINALLY, CAN I GO BACK
ONE?
I DID THAT ONE.
NEXT SLIDE.
AND THAT'S IT.
THIS IS MY LAST SLIDE.
TO SUMMARIZE WHAT I SAID, THE
PANDEMIC HAS HAD DRAMATIC
IMPACTS ON GLOBAL MENTAL HEALTH
ESPECIALLY AMONG FEMALES AND
YOUNGER PEOPLE, NEARLY A
QUARTER OF PEOPLE INCREASED
DRINKING DURING THE PANDEMIC.
NEWFOUNDLAND/LABRADOR INCREASES
REPORTED AMONG WOMEN AND SOME
MINORITY GROUPS.
INDIVIDUALS WHO INCREASED THEIR
DRINKING WERE MORE LIKELY TO
DRINK TO COPE WITH STRESS.
THERE'S EVIDENCE FOR INCREASED
HARMS, PARTICULARLY RELATED TO
LIVER DAMAGE AND DEATH, RELATED
TO ALCOHOL USE DURING THE
PANDEMIC.
CLOSING THE TREATMENT GAP IS
CRITICAL FOR ADDRESSING THE
CHALLENGES OF ALCOHOL MISUSE.
AND MULTIPLE STRATEGIES ENGAGED
TO CLOSE THE TREATMENT GAP.
ADVANCING MEDICATIONS,
SCREENING AND BRIEF
INTERVENTION, REFERRAL TO
TREATMENT.
SO THANK YOU VERY MUCH.
I WANT TO THANK RACHEL ANDERSON
FOR THE INITIAL SLIDES AND
AARON WHITE AND RICHARD SIMMONS
AND TRISH POWELL FOR HELP WITH
THIS PRESENTATION.
I'M HAPPY TO ANSWER ANY
QUESTIONS, IF THERE'S TIME FOR
COMMENTS.
I THINK I DID IT WITHIN MY 20
MINUTES, ALMOST.
SUSAN?
>> YEAH, WE HAVE ABOUT TEN
MINUTES FOR QUESTIONS.
>> I NOTICED PEOPLE DID TALK
ABOUT SOCIAL DETERMINANTS BOTH
WITH NIDA AND NIAAA.
BUT I REALLY HAVEN'T HEARD MUCH
ABOUT HOMELESSNESS AS A
VARIABLE AND RESEARCH PARADIGM.
IT WOULD BE NICE IF I COULD
HEAR SOME COMMENTS ABOUT
HOMELESSNESS AS A FOCUS, BOTH
NIAAA AND NIDA, IN TERMS OF
HELPING US DEVELOP STRATEGY
THAT'S ARE MORE APPROPRIATE FOR
THE HOMELESS POPULATION.
>> THAT'S A REALLY GOOD
QUESTION, WEST.
I'M NOT AT ALL SURE WHETHER WE
HAVE ANYTHING IN OUR PORTFOLIO
THAT SPECIFICALLY ADDRESSES
THAT.
AND IT'S SOMETHING THAT WE
SHOULD LOOK INTO.
WE CERTAINLY WORK WITH DELICIO
CHABLY ON SOME OF THESE ISSUES.
TRISH, MAYBE YOU WOULD LIKE TO
MAKE A COMMENT?
BECAUSE YOU MAY BE MORE AWARE
OF WHAT'S IN OUR PORTFOLIO THAN
I AM.
>> GEORGE, I JUST WANTED TO
COMMENT, WE HAD A GRANT SEVERAL
YEARS AGO NOW THAT LOOKED AT
HOMELESSNESS AND ALCOHOL USE
DISORDER TREATMENT AND FOUND
THAT IT WAS VERY EFFECTIVE TO
GET PEOPLE'S HOME SITUATIONS
STABILIZED FIRST.
AND THAT THEY DIDN'T NEED TO BE
AB STIN NENT WHICH WAS OFTEN A
REQUIREMENT FOR HOUSING FOR
PEOPLE.
SO THAT WAS JUST ONE PROJECTD
THAT INDICATED EXACTLY YOUR
POINT.
ADDRESSING HOMELESSNESS AND NOT
REQUIRING ABSTINENCE FIRST WAS
EFFECTIVE.
>> NOW I REMEMBER COMMUNITY
COMMUNITY REINFORCEMENT
APPROACHES THAT WE DO STUDY AND
SUPPORT, ADDRESSING PEOPLE
HAVING A HOME, A SAFE PLACE TO
BE AND A JOB ARE KEY PARTS OF
OF THAT KIND OF APPROACH.
AND WE CERTAINLY SUPPORT THAT.
BUT YOU KNOW, YOU HAVE RAISED
AN ISSUE I THINK WE COULD LOOK
AT IN A LITTLE MORE DETAIL,
BECAUSE YOU ARE RIGHT.
HOMELESSNESS IS A BIG ISSUE IN
ALL OUR MAJOR CITIES IN THE
UNITED STATES NOW.
>> PARTICULARLY, DURING THE
PANDEMIC, SO IT'S BECOME AN
ISSUE.
>> POINT WELL TAKEN.
>> YEP.
>> WE AGREE.
I WOULD JUST WANT TO ADD FROM
NIAAA'S PERSPECTIVE, WE HAVE
WORK IN THIS FIELD.
WHAT ABOUT PERSONS WHO ARE HIV
INFECTED AND HAVE SUBSTANCE USE
DISORDERS AND NEED TO MAINTAIN
TREATMENT FOR A CHRONIC
HEALTHCARE CONDITION.
THAT'S A NOTORIOUS ISSUE AS
WELL THAT WE HAVE A LITTLE
RESEARCH ON THAT SHOWS
PROMISING APPROACHES.
>> THANK YOU.
THANK YOU, BOTH.
>> WE ARE VERY INTERESTED IN
TOBACCO USE AND HOMELESS AND
HAVE A COUPLE GRANTS IN OUR
PORTFOLIO LOOKING AT THAT AND
THERE ARE WAYS TO ADDRESS
CESSATION.
TOBACCO USE IS VERY HIGH, AS
YOU CAN IMAGINE.
>> YEAH.
THANK YOU, BILL.
>> I LOVE THAT EFFORT PUT
TOWARDS PUTTING THE RESOURCES
TO EDUCATE THE HEALTHCARE
PROFESSIONALS ABOUT ALCOHOL
MISUSE.
I'M WONDERING WHETHER YOU ARE
CONSIDERING BRINGING THAT
RESOURCES TO PEOPLE, BY HAVING
WORKSHOPS AND CONFERENCES TO
LET MORE OF OF THE SCIENTISTS
KNOW ABOUT THESE RESOURCES?
I KNOW THAT RESOURCES, ONE HAS
TO GO THERE TO GET IT, BUT TO
SORT OF BRING THEM TO GROUPS
THAT MIGHT ALREADY BE USING
THEM.
>> THAT'S A VERY GOOD IDEA.
YOU MADE ME THINK OF WCBR.
>> YEAH, EXACTLY.
A PAROCHIAL GROUP, I MIGHT ADD.
BUT NEVERTHELESS THEY DO AN
OUTREACH TO COMMUNITIES IN
THEIR MEETING.
THE LUNCH WAS YESTERDAY, SO WE
PLAN ON GETTING EVERYBODY
INVOLVED FROM A.P.A.
BOTH A.P.A.'S, A.P.S.
A.T.N.P.
WE WILL BE TAPPING INTO A
NUMBER OF OF ORGANIZATIONSMENT
ONE OF THE THINGS I MEANT TO
MENTION IS OUR CLINICIANS AND
OUR AAA CLINICAL PROGRAM,
NOTABLY, IT NANCY DEESCANARDOS
IS PASSIONATE CONVERTING THE
CORE RESOURCE INTO A CORE
CURRICULUM FOR SCHOOLS.
THAT'S UNDER WAY.
THERE'S A GROUP ALREADY MEETING
TO WORK ON THAT.
BECAUSE THEY ARE PICKING UP
WITH THE YOUNGER DOCTORS THAT
THERE IS JUST A CRYING NEED FOR
MORE INFORMATION.
AND SO, WE HOPE IT WILL, IT
WILL PROVIDE, I THINK YOUR
POINT IS REALLY WELL TAKEN
THOUGH.
WE NEED TO ADJUST IT FOR THE
PUBLIC AS WELL AS FOR THE
HEALTHCARE PROFESSIONALS.
AND FOR RESEARCHERS, FOR THAT
MATTER.
I WILL BE PRESENTING AT R.S.A.
SHELLY?
>> THANKS.
>> SHELLY, YOU ARE MUTED.
>> YOU SLIPPED ONTO MUTE,
SHELLY.
>> SORRY ABOUT THAT.
THANK YOU, GEORGE FOR THAT
PRESENTATION.
I APPRECIATED SO MANY ASPECTS
OF IT.
THERE'S LOTS TO DISCUSS.
ONE THING I AGREE COMPLETELY,
THE DISSEMINATION YOU NOW DO
FOR THIS WONDERFUL CORE
RESOURCES WILL BE REALLY
IMPORTANT AND SOMEHOW LETTING
MAYBE STATE, PEOPLE WHO HAVE TO
QUALIFY FOR C.M.E.'S FOR, YOU
KNOW, STATE MEDICAL LICENSES,
LETTING STATE BOARDS KNOW THESE
ARE NOW AVAILABLE FOR PEOPLE.
THERE'S A WHOLE RANGE OF
THINGS, WE DON'T HAVE TO
OUTLINE THEM ALL HERE.
BUT GETTING THAT WORD OUT FOR
DISSEMINATION ACROSS MULTIPLE
SPECIALTIES THESE COULD BE USED
WOULD BE REALLY IMPORTANT.
WE HAVE BEEN TALKING FOR
DECADES HOW POORLY INFORMED
CLINICIANS ARE REGARDING
ALCOHOL USE DISORDERS AND
INDICATIONS EARLIER ON IN THE
PROCESS.
SO THIS IS GREAT.
I ALSO REALLY APPRECIATE THE
EMPHASIS THAT NIAAA IS TAKING
ON CO-CURRENT DISORDERS.
THIS IS SOMETHING THE PEOPLE IN
THE FIELD HAVE BEEN TALKING
ABOUT FOR YEARS, GENDER
DIFFERENCES, WOMEN WITH
ALCOHOL-RELATED PROBLEMS
INCLUDING PTSD AND ANXIETY AND
DEPRESSION.
WHICH ARE OFTEN DRIVERS.
AND IT'S BEEN VERY HARD FOR
WOMEN TO GET THE TREATMENT.
SO I THINK, I THINK GRANT
ANNOUNCEMENTS WILL FOLLOW, IN
TERMS OF LOOKING AT THE
CO-OCCURRING MENTAL HEALTH
CONDITIONS WE KNOW ARE
INCREDIBLY IMPORTANT IN
TREATING PEOPLE WITH
ALCOHOL-USE DISORDERS AND
ESPECIALLY WE CAN INTERVENE
SOONER RATHER THAN LATER WITH
PEOPLE WITH PSYCHIATRIC
DISORDERS.
BECAUSE WE SEE ALCOHOL-USE
DISORDERS BEGINNING TO EVOLVE
IN PEOPLE WHO HAVE OTHER
CO-OCCURRING PSYCHIATRIC
DISORDERS REALLY ACROSS THE
WHOLE AGE SPECTRUM.
I WANTED TO COMMENT ON THE
HORRIBLE, TERRIBLE RISING RATES
YOU SHOWED, EPIDEMIOLOGICKLY,
AND ESPECIALLY IN WOMEN AND
GIRLS.
THIS IS SOMETHING WE SAW BEFORE
THE PANDEMIC WAS ACCELERATING
AND WORSE DURING THE PANDEMIC
FOR ALL THE REASONS YOU
OUTLINED.
ONE THING NOT MENTIONED PERHAPS
AS A THIRD RAIL IS THE
INCREDIBLE ADVERTISING CAMPAIGN
THAT'S GONE ON FOR YEARS AND
DECADES PRIOR TO THE PANDEMIC
TARGETING WOMEN AND THE
MULTIPLE BEVERAGES THAT HAVE
BEEN MARKETED, WE HAD VODKAS,
BEERS AND WINES MARKETED TO
MOMS.
THIS HAS BEEN GOING ON PRIOR TO
THE PANDEMIC FOR YEARS.
WE KNOW ADVERTISING CAN
ACTUALLY BE A RESPONSE TO
BEHAVIORAL CHANGE IN THE
POPULATION.
AS WE KNOW, WE HAVE EXPERTS ON
THIS, ON THIS CALL.
IT'S BEEN A DRIVER OF
BEHAVIORAL CHANGE INCLUDING
TOBACCO.
THAT'S BEEN CONCERNING.
I KNOW THERE'S A LOT TO BE SAID
ABOUT THAT ASPECT OF THINGS.
AND FINALLY, YOU GAVE A GREAT
CARTOON OF THE ELEPHANT IN THE
ROOM.
ANOTHER ELEPHANT IN THE ROOM
THAT'S REALLY HARD TO DISCUSS
IS HOW WE REALLY MANAGE OUR
HEALTHCARE SYSTEM, WHICH REALLY
DOES NOT PROVIDE ADEQUATE
INCENTIVES FOR ALL OF OUR
CLINICIANS ACROSS MULTIPLE
SPECIALTIES TO BE DOING CASE
IDENTIFICATION EARLY ON DOING
THE INTERVENTIONS NEEDEDMENT
THAT'S AN ALL OF US SITUATION.
THAT'S AN ALL OF US CONCERN,
ACROSS ALL OF OUR INSTITUTE
THAT'S ARE TOGETHER TODAY.
I JUST WANTED TO MAKE THESE FEW
COMMENTS.
I REALLY APPLAUD, REALLY ALL OF
THESE INSTITUTES AND THE AMOUNT
OF AMAZING ACTIVITY IS REALLY,
YOU KNOW, JUST DESERVES A LOT
OF CONGRATULATIONS FROM US IN
THE FIELD.
I JUST WANTED TO CALL ATTENTION
TO SOME OF THESE OTHER AREAS,
SO THANKS.
>> THANKS, I WROTE IT ALL DOWN.
I COULD RESPOND TO ALL THAT,
BUT I THINK WE WILL LET OTHER
PEOPLE ASK OTHER QUESTIONS.
YOU MEAN, WE -- YOU KNOW, I
DO WANT TO MAKE ONE COMMENT,
WHICH IS THAT NORA WILCOFF AND
TOM McLELLAN AND I ARE
INTERESTED IN WHAT TOM LIKES TO
CALL AND WE ARE STARTING TO USE
THE TERM PRE-ADDICTION.
THE WORKING TO INTERVENE,
PREVENT, TREAT INDIVIDUALS WHO
HAVE LOW TO MODERATE ALCOHOL
USE DISORDER OR SUBSTANCE USE
DISORDER AS OPPOSED TO WAITING
FOR THE SEVERE CASE.
I THINK YOU TOUCHED ON THAT ON
A NUMBER OF YOUR POINTS.
THAT'S SOMETHING WE ARE QUITE
INTERESTED IN, YOU WILL SEE
MORE ABOUT THAT COMING DOWN.
WES, YOU HAD ANOTHER QUESTION?
>> BASICALLY, I WANTED TO
PIGGYBACK ON WHAT SHELLY WAS
SAYING.
DON'T FORGET COMMUNITY HEALTH
CENTERS AND HRSA'S AGENDA TO
PROMOTE ADDICTION IN TERMS OF
THE CORE CURRICULUM.
THIS WILL BE GREAT.
AND FOR COUNSELLORS THEY MIGHT
BENEFIT FROM THE SAME TYPE OF
MATERIAL, IN PART, ESPECIALLY
AS WE ARE USING COUNSELORS AS
FIRST LINE INTERVENTION AND
COMMUNITY HEALTH CENTERS AND
MENTAL HEALTH CENTERS, AS WE
MOVE TOWARD AN INTEGRATED
PARADIGM.
HAVING THIS INFORMATION
AVAILABLE AS SHELLY IS POINTING
OUT TO EVERYONE WHO IS DEALING
WITH ANYONE WHO PRESENTS WITH
ANY KIND OF BEHAVIORAL HEALTH
ISSUE WOULD BE TERRIBLY HELPFUL.
HRSA'S COMMUNITY HEALTH CENTER
THING IS A MAJOR DELIVERY
MECHANISM FOR PRIMARY CARE IN
AMERICA.
>> YEAH, THANKS, WES.
SO I WOULD URGE ALL OF YOU WHO
HAVE OTHER IDEAS OF
DISSEMINATION TO SEND US AN
EMAIL.
HAPPY TO RECEIVE IT.
YOU CAN SEND IT TO ME AND I
WILL PASS IT ON OR RAY LITEN,
MANY OF YOU KNOW RAY.
I SEE CHARLIE HAS ONE MORE
COMMENT.
>> I JUST WANTED TO REMIND
PEOPLE, WE ALSO HAVE THE ROUND
TABLE DISCUSSION AT THE END OF
THE DAY.
SO IF WE DON'T GET TO COVER
EVERYTHING AT THIS TIME, WE CAN
COME BACK TO IT.
BUT CHARLES?
>> YES, GEORGE, I REALLY
APPRECIATE THE IDEA NORA
INTRODUCED YESTERDAY AND
PRE-ADDICTION AND NECESSITY TO
IDENTIFY THOSE QUALITIES.
BUT SOMETHING ABOUT THE DSM
CRITERIA, THEY ARE KIND OF
BINARY, NOT QUANTITATIVE IN THE
SENSE -- CAN YOU EXPAND A
LITTLE MORE WHAT YOU THINK
PRE-ADDICTION IS OR REFER ME TO
A PUBLICATION, GIVE US A SENSE
OF WHAT ARE THE QUALITIES THAT
ENABLES SOMEONE TO GO FROM A
MILD ALL THE WAY TO A SEVERE
SUBSTANCE USE DISORDER THAT ARE
PREDICTED.
>> CHARLIE, THAT'S A REALLY
GOOD QUESTION.
BUT I WOULD TAKE UP THE REST OF
OUR TIME TO ANSWER IT CAREFULLY.
THERE IS A PAPER IN PRESS ON
LANCE PSYCHIATRY ON THIS.
I DON'T KNOW THAT IT'S
COMPLETELY ACCEPTED.
LET'S PUT IT THIS WAY, IT'S IN
PROGRESS, WITH NORA, TOM AND I.
YOU KNOW, I WOULD JUST SAY DSM
V IS NOT PERFECT BY ANY STRETCH.
BUT IT WOULD BE A START.
WHAT OUR ARGUMENT WOULD BE, IF
YOU MEET ANY OF THE TWO
CRITERIA.
WHETHER YOU WANT TO AMPLIFY
THAT.
>> I THINK IT'S ALWAYS HARD TO
QUANTIFY THINGS IN DSM.
AS I SAID YESTERDAY, THE MILD
TO MODERATE TO SEVERE IS AN
IMPROVEMENT OVER THE LAST ROUND.
IT ENABLES, LIKE A PICK 2, IT'S
ANY TWO THAT SHOW UP IN A
PATIENT COULD BE THE TWO, YOU
WOULD SAY THIS IS A MILD AND AN
INDICATOR THAT MAYBE SOME
APPROPRIATE LEVEL INTERVENTION.
COULD BE APPLIED HERE.
JUST TO ENGAGE SOMEONE, THAT'S
NOT SOMETHING WE HAVE.
THAT WOULD ALREADY BE AN
IMPROVEMENT, JUST A SINGLE
SESSION OF A CONVERSATION BASED
ON TWO SYMPTOMS THAT SHOW UP ON
A SCREENER.
I MEAN, THAT'S ALREADY
SOMETHING.
BUT I UNDERSTAND WHAT YOU ARE
SAYING ABOUT THE QUANTIFICATION.
THE ONLY WAY WE QUANTIFY IS A
TWO, AS A THREE, FOUR AND A
FIVE, ACROSS-THE-BOARD AND THE
THRESHOLD CUT POINTS.
>> THANK YOU.
>> BILL, WE CAN CONTINUE
TALKING ABOUT THIS MORE IN THE
AFTERNOON ROUND TABLE.
BUT I JUST WANTED TO TURN IT
OVER TO BILL KLEIN FROM NCI TO
TALK TO US NOW.
>> ALL RIGHT.
GOOD MORNING, GOOD AFTERNOON,
WHERE R YOU ARE, LET ME SHARE
MY SCREEN.
CAN EVERYONE SEE THAT?
>> YES.
>> OKAY, TERRIFIC.
SO I WANTED TO GIVE YOU A SENSE
WHERE WE ARE AT NCI, A NUMBER
OF DIFFERENT TOPICS.
TOPICS RELATIVE TO KRANS,
TOBACCO, ALCOHOL AND CANNABIS.
I JUST WANT TO START BY TALKING
A LITTLE ABOUT LEADERSHIP AT
NCI.
I THINK YOU PROBABLY HAVE HEARD
OUR NCI DIRECTOR RECENTLY
DEPARTED.
AS YOU MAY OR MAY NOT KNOW, THE
NCI DIRECTOR IS A PRESIDENTIAL
APPOINTEE.
SO OUR DIRECTORS DON'T LAST
QUITE AS LONG AS DIRECTORS OF
OTHER INSTITUTES.
AND NED OUR DIRECTOR WHO HAS
DONE A TERRIFIC JOB, AND BY THE
WAY VERY SUPPORTIVE OF OUR WORK
ON TOBACCO AND OTHER SUBSTANCES.
NED DECIDED IT WAS TIME TO STEP
DOWN.
HE HAS MOVED ONTO DIFFERENT
THINGS.
WE ARE AWAITING THE APPOINTMENT
OF A NEW DIRECTOR, WHICH OFTEN
CAN TAKE SOME TIME.
THIS IS A PRESIDENTIAL
APPOINTMENT BUT NOT ONE THAT
NEEDS TO BE CONFIRMED BY THE
SENATE.
THAT'S ONE HOOP WE DON'T HAVE
TO JUMP THROUGH.
BUT WE AWAITING THE APPOINTMENT
OF A NEW DIRECTOR.
MOREOVER, AS YOU MAY OR MAY NOT
BOB CROW RETIRED LAST YEAR.
HE RETIRED AT THE END OF 2021.
AND OUR NEW DIRECTOR, LISTED ON
THE SLIDE IS KATRINA GODDARD,
GENETIC EPIDEMIOLOGIST, I'VE
BEEN DOING MY BEST TO KEEP HER
UP TO SPEED WHAT'S GOING ON
WITH KRAN, ABCD AND OTHER
PROJECTS WHICH WE COLLABORATE
WITH OTHER INSTITUTES.
SHE IS SUPPORTIVE OF OF THE
WORK WE ARE DOING AS WELL.
IF YOU DON'T KNOW OUR DIVISION
OR CHART, WE HAVE FOUR PROGRAMS
IN OUR DIVISION.
I LEAD THE BEHAVIORAL RESEARCH
PROGRAM, ONE ON HEALTHCARE, AND
EPIDEMIOLOGY AND GENOMICS.
HERE IS AN OUTLINE WHAT I WOULD
LIKE TO COVER IN MY TIME.
I WILL TALK ABOUT TOBACCO,
ALCOHOL AND CANNABIS WORK.
I WANT TO SAY A BIT ABOUT OUR
INVESTMENTS IN NATIVE AMERICAN
AND ALASKAN WORK.
STARTING WITH TOBACCO, I WANTED
TO GIVE YOU A FLAVOR FOR WHERE
WE ARE IN OUR PORTFOLIO.
OUR TOBACCO BRANCH IN OUR
DIVISION IS ONE OF THE LARGEST
BRANCHES, BOTH IN TERMS OF
DOLLARS AND STAFF.
WE HAVE PROBABLY THE MOST
PROGRAM DIRECTORS IN THAT
BRANCH RELATIVE TO OTHER
BRANCHES IN OUR DIVISION.
AND WE THINK THAT'S
APPROPRIATE, GIVEN THE FACT
THAT TOBACCO IS THE LEADING
CAUSE OF PREVENTABLE DEATH AND
PREVENTABLE CANCER AS WELL.
WE HAVE OVER 100 GRANTS IN OUR
PORTFOLIO, TOTALING OVER $54
MILLION IN DIRECT FUNDING.
RIGHT NOW WE ARE ENGAGED IN A
PORTFOLIO ANALYSIS FOR OUR 2021
PORTFOLIO.
I WANTED TO GIVE YOU AN EARLY
PEEK WHAT THIS LOOKS LIKE, WE
ARE STILL IN PROCESS.
THESE NUMBERS ARE SQUISHY.
BUT WANTED TO GIVE YOU A FEEL.
AS YOU CAN SEE HERE, WE HAVE A
BIG FOCUS ON CESSATION.
THAT'S ONE OF OF OUR BREAD AND
BUTTER TOPICS AT NCI.
P OF OUR GRANTS FOCUS ON MANY
TYPES OF GRANTS FOR CESSATION.
MOST OF THESE GRANTS ARE FOR
ADULTS.
WE ALSO DO A LOT OF WORK ON
POLICY RESEARCH, BECAUSE A LOT
OF TOBACCO POLICY INFLUENCES
TOBACCO-RELATED BEHAVIOR AND
FUNDED RESEARCH LOOKING AT
INDUSTRY DOCUMENTS IN THE PAST.
WE HAVE DONE A LOT OF WORK IN
THIS SPACE.
YOU CAN SEE SOME OF THE OTHER
TOPICS HERE AS WELL.
THIS SLIDE IS INTERESTING
BECAUSE IT SHOWS YOU A BIT
WHERE THE FOCUS IS ON PRODUCTS.
MOST OF FOCUS IN PASSPORT
PORTFOLIO HAS BEEN ON
COMBUSTIBLES BUT YOU CAN SEE
OTHERS ARE CATCHING UP.
WE ARE FOCUSING A GREAT DEAL
LATELY ON POLY USE OF TOBACCO
PRODUCTSMENT THIS SLIDE SHOWS
WHERE THE FOCUS IS, YOU CAN SEE
AT THE TOP, YOUTH AND YOUNG
ADULTS.
THAT'S WHEN CIGARETTE USE AND
TOBACCO USE IN GENERAL TENDS TO
BEGIN.
THAT'S A BIG FOCUS OF OUR
PORTFOLIO.
BUT ONE THING THAT IS NOT
STRONG IN OUR PORTFOLIO, WE ARE
LOOKING TO BUILD IS, AN
UNDERSTANDING HOW TO ADDRESS
CESSATION IN THE YOUTH AND
YOUNG ADULT POPULATION.
WHAT THE LITERATURE HAS SHOWN
IS MANY OF THE TREATMENT THAT'S
ARE SUCCESSFUL WITH ADULTS ARE
RELATIVELY SUCCESSFUL WITH
ADULTS, WHICH INCLUDES
PHARMACOLOGICAL INTERVENTIONS
LIKE BUPROPRION AND COGNITIVE
BEHAVIORAL THERAPY THEY DON'T
SEEM TO WORK AS WELL IN THIS
POPULATION.
THAT SHOULDN'T BE SURPRISING
GIVEN THEIR BRAINS ARE AT
DIFFERENT STAGE, DIFFERENT
LEVEL OF DEVELOPMENT AND ALSO
THEY TEND TO BE RESPONSIVE TO
DIFFERENT KINDS OF STIMULI.
WE REALLY NEED MORE EFFORTS TO
ADDRESS CESSATION IN THIS
POPULATION.
AND PARTICULARLY GIVEN THE
PRODUCTS THEY ARE USING ARE A
LITTLE DIFFERENT.
THERE'S MUCH MORE USE OF
E-CIGARETTES THAN COMBUSTIBLES
IN THIS POPULATION.
AND THAT PROFILE MAY LEAD TO A
DIFFERENT KIND OF THERAPY, A
DIFFERENT KIND OF APPROACH.
SO SOMETHING ELSE I WANTED TO
MENTION THAT'S A MAJOR PRIORITY
FOR US IS LOOKING AT CESSATION
IN CANCER PATIENTS.
IT MAY SHOCK YOU TO KNOW UP
UNTIL VERY RECENTLY, TOBACCO
CESSATION WAS NOT A PRIORITY AT
CANCER CENTERS.
SOME HAD IT, SOME DIDN'T, BUT
IT WASN'T SOMETHING AT THE
FRONT OF THEIR RADAR SCREEN.
WE CHANGED THAT.
WE HAD GIVEN SUPPLEMENTS TO 52
CANCER CENTERS TO DEVELOP
INFRASTRUCTURE FOR TOBACCO
CESSATION FOR THEIR PATIENTS.
THIS MONEY CAME FROM THE CANCER
MOONSHOT INITIATIVE, CAME OUT
OF THE BIDEN -- SORRY, OBAMA
ADMINISTRATION.
AND BIDEN TRYING TO KICK START
A MOONSHOT 2.0 RIGHT NOW WHICH
WILL HOPEFULLY FUND RESEARCH IN
THIS AND OTHER AREAS.
THIS CAME OUT OF CANCER
MOONSHOT.
WE HAVE BEEN FUNDING TO BUILD A
TOBACCO CESSATION
INFRASTRUCTURE FOR SEVERAL
YEARS.
WE HAVE HOPE FOR SUSTAINMENT.
WE HAVE BEEN TALKING ABOUT A
NUMBER OF DIFFERENT WAYS TO
MAKE SURE THIS INFRASTRUCTURE
IS SUSTAINEDMENT
EX TALKING ABOUT A NUMBER OF
DIFFERENT WAYS TO MAKE SURE
THIS INFRASTRUCTURE IS
SUSTAINEDMENT
INCLUDING MOTIVATIONAL
TREATMENTS FOR THOSE WHO ARE
NOT WILLING TO MAKE A QUIT
ATTEMPT.
AND AGAIN, THE COMMITMENT TO
SUSTAINING THIS PROGRAM IS VERY
IMPORTANT TO US.
I WANT TO MENTION ALSO WE
CONTINUE IN OUR LINE OF TOBACCO
MONOGRAPHS.
YOU MAY BE AWARE THIS IS ONE OF
OUR MAJOR CONTRIBUTIONS TO THE
TOBACCO LITERATURE, THESE
MONOGRAPHS.
WE ARE UP TO 23 NOW.
THIS FOCUSES ON SMOKING AND
CANCER PATIENTS IN PARTICULAR.
WE HAVE A GROUP OF EDITORS, THE
COMMITTEE YOU CAN SEE THE LIST
ON THE SLIDE HEREMENT WE HOPE
TO HAVE THIS MONOGRAPH OUT IN
THE NEXT MONTH OR SO.
YOU MAY NOT REALIZE, CANCER
SURVIVEORSHIP IS GROWING BY
LEAPS AND BOUNDS.
IF YOU LOOKED AT CANCER 50
YEARS AGO, IT WAS OFTEN THOUGHT
OF AS A DEATH SENTENCE BUT
THAT'S NOT THE CASE ANY MORE,
IT'S NOW MORE OF A CHRONIC
DISEASE FOR MANY TYPES OF
CANCER, WE NEED TO ADDRESS
PREVENTION IN THE CANCER
SURVIVEORSHIP COMMUNITY, THAT
INCLUDES TOBACCO CESSATION.
I ALSO JUST WANT TO MENTION
BRIEFLY WE CONTINUE TO PUT
INVESTMENTS IN OUR
SMOKEFREE.GOV INITIATIVES.
WITH FDA AND CDC, A TOOL TO
HELP SMOKERS QUIT.
DESIGNED IN SUCH A WAY TO BE
EBB IN SPACE BUT POSITIVE IN
ITS APPROACH.
IT DOESN'T BLAME.
GEORGE MENTIONED THE IMPORTANCE
OF OF NOT USING STIGMATIZING
WORDS, THAT'S IMPORTANT IN
FRAMING THE LANGUAGE.
HE FOCUSES ON THE POSITIVE.
IT'S BEEN SHOWN TO BE VERY
EFFECTIVE.
IT HELPS OUR GRANTEE COMMUNITY.
MANY OF OUR GRANTEES USE IT IN
THEIR STUDIES.
SOMETIMES IN FACT AS A CONTROL
FOR NEW INITIATIVES OR NEW
APPROACHES THEY ARE ATTEMPTING
TO BUILD.
I ALSO WANT TO MENTION A LOT OF
OUR WORK INFORMS POLICY.
FIRST OF ALL, IF YOU ARE
READING THE NEWS LATELY, AND
WHO WANTS TO READ THE NEWS
LATELY.
YOU MIGHT HAVE NOTICED FDA NOW
HAS A PROPOSED RULE ON
FLAVORINGS AND ALSO USE OF
MENTHOL AND CIGARETTES THE AND
A LOT OF THE LANGUAGE IN THOSE
RULES COMES FROM RESEARCH WE
HAVE SUPPORTED.
INCLUDING RESEARCH THAT'S BEEN
SUMMARIZED IN SOME OUR
MONOGRAPHS.
FOR EXAMPLE, MONOGRAPH 9
FOCUSES ON CIGARS, HEALTH
EFFECTS AND TRENDS, AS YOU CAN
SEE HERE.
THERE WAS A BIG FOCUS ON THAT
MONOGRAPH IN FLAVORS AND CIGARS
AND NOW FDA IS MOVING TO GET
RID OF FLAVORED CIGARS.
ANOTHER EXAMPLE I WANT TO
MENTION, WHICH I THINK IS VERY
TIMELY AND RELATIVE TO THE
TOPIC TODAY, THE FOCUS TODAY OF
THIS MEETING IS WE FUNDED
NETWORKS TO LAY THE GROUNDWORK
FOR THE NAVAJO NATIONS ACT OF
2021.
THIS IS REALLY NOTABLE.
THE FIRST COMPREHENSIVE BAN ON
COMMERCIAL PRODUCTS ON AMERICAN
INDIAN TRIBAL LANDS.
THIS IS A REALLY BIG DEAL.
WE THANK SCOTT WIESHOU AND
HERNANDEZ WHO PUT A LOT OF TIME
MAKING THIS HAPPEN.
OF COURSE ON THE BOTTOM I
INDICATE FDA PROPOSES RULES
PROHIBITING MENTHOL CIGARETTES
AND FLAVORED CIGARS.
NOT ONLY DOES OUR MONOGRAPH DO
THIS BUT MUCH OF THE RESEARCH
IN OUR PORTFOLIO.
ALL RIGHT, SO MOVING TO ALCOHOL.
THIS IS NOT SOMETHING THAT'S
GOTTEN A GREAT DEAL OF
ATTENTION UNTIL RECENTLY.
THAT'S THE LINK BETWEEN ALCOHOL
AND CANCERMENT ALCOHOL HAS BEEN
THOUGHT TO BE RELATED TO AT
LEAST SEVEN DIFFERENT TYPES OF
CANCERS, INCLUDING G.I. CANCERS
AND TWO OF THE LEADING CAUSES
OF CANCER DEATH, BREAST CANCER
AND COLORECTAL CANCER.
IT'S UP THERE ON THE LIST FOR
CANCER-RELATED DEATH.
CIGARETTE SMOKING IS UP ON THE
TOP.
ALCOHOL IS COMPARABLE TO UV
RADIATION, SEDENTARY BEHAVIOR
AND SEVERAL OTHER RISK FACTORS.
IT'S TO BE TAKEN SERIOUSLY.
WE HAVE BEEN TAKING TIME, HAVE
BEEN IN TOUCH WITH NIAAA AND
WORKING WITH GEORGE AND OTHERS
WHAT KINDS OF THINGS WE COULD
BE DOING AT NCI TO ADDRESS THIS.
HERE ARE A COUPLE SCREEN SHOTS
OF THINGS WE HAVE BEEN DOING.
WE PUBLISHED PAPERS, INCLUDING
A DRAMA COMMENTARY ON THE LEFT
THAT FOCUSES ON THE CLINICAL
NEEDS, WITH REGARD TO ALCOHOL
AND CANCER.
WE FIND, FOR EXAMPLE, MANY
PHYSICIANS ARE NOT ADDRESSING
ALCOHOL USE WITH CANCER
PATIENTS AND WITH THE GENERAL
POPULATION DESPITE THE DATA
SHOWING ALCOHOL IS A RISK
FACTOR.
WE HAVE HAD A NUMBER OF
WEBINARS, SO THOSE ARE DEPICTED
IN THE LOWER LEFT.
AND ALSO HAD A MEETING IN LATE
DECEMBER 2020, IN WHICH WE
TRIED TO GET A SENSE WHAT THE
GAPS ARE.
AND THAT LED TO A PAPER, AS YOU
CAN SEE ON THE BOTTOM RIGHT,
CANCER EPIDEMIOLOGY BIO MARKERS
AND PREVENTION, INCLUDING MAJOR
FIGURES DOING RESEARCH BETWEEN
ALCOHOL AND CANCER.
AS YOU PROBABLY KNOW, THE
PROFILE FOR ALCOHOL JUST LOOKS
VERY DIFFERENT THAN TOBACCO.
TOBACCO TENDS TO BE A LOWER SGS
TYPE OF DRUG.
AND ALCOHOL TENDS TO BE MORE
HIGHER SCS.
THAT ENDS UP BEING AN
INTERESTING ISSUE WITH
COMMUNICATION, AND REGARD TO
HOW TO THINK ABOUT IT, BOTH
FROM A RESEARCH PERSPECTIVE AND
APPLIED POLICY PERSPECTIVE.
WE HAVE TALKED A LOT ABOUT HOW
TO ADDRESS THAT, AND THE
CONTEXT OF THE WORK THAT WE DO.
THIS IS NOT SOMETHING THAT IS
GOING TO GO AWAY.
WE KNOW FOR EXAMPLE, THERE'S A
LINEAR RELATIONSHIP BETWEEN
ALCOHOL USE AND BREAST CANCER
RISK.
THAT FLIES IN THE FACE OF THE
J-CURVE IN THE CASE WHERE
MODERATE DRINKING MAY BE
HEALTHY, THAT DOESN'T SEEM TO
BE HOLDING UP, AT LEAST IN
REGARDS TO CERTAIN TYPES OF
CANCER.
LET ME SAY A BIT ABOUT CANNABIS.
THIS IS NEW FOR US.
WE DON'T HAVE MUCH OF A
PORTFOLIO ON CANNABIS.
NIDA HAS DONE MUCH MORE WITH
CANNABIS THAN WE HAVE, BUT IT'S
SOMETHING WE NEED TODAY JUMP
INTO.
I WILL MENTION A COUPLE WAYS
WHICH WE HAVE DONE THAT.
FIRST OF ALL, WE ARE VERY
INTERESTED IN UNDERSTANDING HOW
CANNABIS IS RELATED TO TOBACCO
USE.
CLEARLY, ONE CAN CERTIFY AS A
GATEWAY FOR THE OTHER.
WE SEE A LOT OF CO-USE.
WE ARE INTERESTED IN
UNDERSTANDING WHAT THAT LOOKS
LIKE AND HAVE BEEN ENGAGED IN
PROVIDING FUNDING TO
INVESTIGATORS TO LOOK AT THIS
RELATIONSHIP.
WE ARE ALSO INTERESTED IN
UNDERSTANDING HOW CANNABIS IS
BEING USED BY OUR CANCER
PATIENTS PARTICULARLY AT CANCER
CENTERS.
RECENTLY AS YOU CAN SEE HERE,
WE GIVEN ADMINISTRATIVE
SUPPLEMENTS TO A NUMBER OF
CANCER CENTERS A IS KRO THE
COUNTRY TO DO A BETTER JOB
WHAT'S TRACKING AMONG THEIR
CANCER PATIENTS.
THERE ARE TWO WAYS TO THINK
ABOUT CANNABIS IN THE CONTEXT
OF CANCER.
ONE IS AS A PREDICTIVE RISK
FACTOR.
CANNABIS CAN BE A GATEWAY TO
TOBACCO USE, PREDICTIVE OF A
VARIETY OF CANCER OUTCOMES, OF
COURSE.
CANNABIS ITSELF IS BEING USED
IN TREATMENT.
SO WE HAD A MEETING IN LATE
DECEMBER OF 2020.
COVERING A NUMBER OF DIFFERENT
TOPICS IN THIS UNIVERSE.
SO FOR EXAMPLE, NON MEDICAL
CANNABIS USE AND CANCER
EPIDEMIOLOGY, CANCER BIOLOGY
AND PREVENTION, NAVIGATING
RESEARCH CHALLENGES FOR
CANNABIS RESEARCH.
SO TRIED TO COVER THE SPECTRUM
HERE.
AS A RESULT OF THIS, WE ARE NOW
TRYING TO THINK ABOUT WHAT KIND
OF INITIATIVES WE SHOULD PUT
OUT THERE TO GET A SENSE WHAT
THE CANNABIS LANDSCAPE WILL BE
OVER THE NEXT 10-20 YEARS,
RELEVANT TO CANCER AND CANCER
OUTCOMES.
SO HOW AND WHY ARE CANCER
PATIENTS USING CANNABIS?
WE NEED TO UNDERSTAND MODE,
DOSAGE, FREQUENCY, WHAT
PRODUCTS THEY ARE USING BECAUSE
THERE ARE SO MANY OPTIONS WHA.
ARE THE BENEFITS AND HARMS.
YOU HAVE TO THINK ABOUT THAT
WITH REGARD TO CANCER AND ITS
TREATMENTS.
DOES CANNABIS USE MODERATE
EFFECTS OF CANCER TREATMENTS
THE WAY NUTRITION AND PHYSICAL
ACTIVITY ARE NOW BEING FOUND TO
DOMENT WHAT ABOUT CO-MORBIDITY
WITH OTHER MEDICATIONS?
AGAIN, THIS IS A FAIRLY NEW
TOPIC FOR US BUT ONE WE CLEARLY
NEED TO JUMP INTO HEAD-FIRST
GIVEN THE GREATER ACCESSIBILITY
OF CANNABIS IN THE POPULATION.
LET ME MOVE TO WORK WE ARE
DOING IN THE AMERICAN INDIAN
ALASKA NATIVE SPACE.
I WANTED TO NOTE THE
INTERVENTION RESEARCH TO
IMPROVE NATIVE AMERICAN HEALTH
INITIATIVE OR THE RINA.
WE INITIATED THIS INITIATIVE IN
2011, NOW LED BY NIDA STARTING
2021.
WE HAVE A NUMBER OF IC'S
INSTITUTES AND CENTERS,
INVOLVED AND FUNDED A NUMBER OF
DIFFERENT GRANTS.
INCLUDING ONE ON SMOKING
CESSATION.
BUT THE ENTIRE FOCUS HERE IS TO
TRY TO DESIGN INTERVENTIONS TO
ADDRESS HEALTH BEHAVIORS THAT
HAVE AN IMPACT ON CANCER AND
OTHER OUTCOMES.
HERE IS ANOTHER ONE.
WE HAVE BEEN INTERESTED IN COLO
RECTAL CANCER SCREENING IN
AMERICAN INDIAN COMMUNITIES.
WE AGAIN ARE USING OUR CANCER
MOONSHOT FUNDS FOR THIS.
WE SUPPLEMENTED NCI DESIGNATED
CANCER CENTERS TO TAKE A LOOK
AT CANCER SCREENING IN SPECIAL
POPULATIONS, PARTICULARLY THE
AMERICAN INDIAN POPULATION.
THIS IS A PARALLEL EFFORT TO
ACCESS, WHICH I THINK IS A FUN
ACRONYM.
THIS STANDS FOR ACCELERATING
COLORECTAL CANCER SCREENING
THROUGH FOLLOW-UP AND SCIENCE.
CANCER MOONSHOT FUNDED
INITIATIVE THAT LOOKS AT HOW WE
CAN REALLY INCREASE COLORECTAL
CANCER SCREENING AND MAKE IT
EASIER.
THREE INVESTIGATORS ARE IN
PLACE WHERE'S THERE IS A HIGH
POPULATION OF AMERICAN INDIANS.
AND A LOT OF FOCUS ON THESE
GRANTS IS TO TRY TO INCREASE
SCREENING IN THOSE POPULATIONS.
SO JUST A BIT ABOUT FUNDING.
ONE OF THE GREAT RESOURCES WE
HAVE AT NCI IS OUR CANCER
CENTERS.
THEY DO A GREAT JOB OF
ADDRESSING MAJOR RESEARCH
PRIORITIES IN WAYS THAT
LEVERAGE OUR FUNDING BECAUSE WE
HAVE TO USE THAT INFRASTRUCTURE
TO THE BEST WE CAN.
TO ADDRESS SOME OF THE RESEARCH
QUESTIONS WE HAVE.
OBVIOUSLY MOST OF OUR RESEARCH
GOES TO INITIATOR RESEARCH AND
THAT'S THE WAY IT SHOULD BE.
BUT SOMETIMES WE HAVE QUESTIONS
THAT ARE VERY TIME-SENSITIVE
AND IT'S USEFUL TO HAVE THIS
INFRASTRUCTURE TO WORK WITH.
OVER THE LAST SEVERAL YEARS WE
HAVE BEEN PROVIDING SUPPLEMENTS
AS I INDICATED ON OTHER SLIDES
TO OUR CANCER CENTERS TO
ADDRESS TIME-SENSITIVE
QUESTIONS.
SOME HAVE CENTERED ON TOPICS
RELATIVE TO THIS GROUP.
INCLUDING TOBACCO CESSATION,
CANNABIS USE AND ALSO THE
CANCER CENTER CESSATION
INITIATIVE OR C3I I MENTIONED
BEFORE.
BRIEFLY, I WILL MENTION WE HAVE
A NUMBER OF FUNDING INITIATIVES
ON THE STREET.
YOU CAN GO TO OUR WEBSITE AND
SEE THESE AND OTHERS, OF COURSE.
WE HAVE A NO C ON MECHANISMS OF
CANNABIS AND CANNABINOID ACTION.
ANOTHER ADMINISTRATIVE
SUPPLEMENTS.
ONE ON POLICY EFFECTS ON
ALCOHOL AND CANNABIS, TOBACCO.
IF YOU DON'T REMEMBER A NOCI,
REPLACEMENT FOR PROGRAM
ANNOUNCEMENT.
JUST AN ANNOUNCEMENT OF
SOMETHING WHICH WE ARE
INTERESTED.
WE ALSO HAVE A NUMBER OF
P.A.R.'S AND R.F.A.'S IN THESE
AREAS.
I WON'T GO THROUGH ALL OF THEM
BUT THESE ARE ALL DESIGNED TO
CAPTURE MORE RESEARCH IN THE
SPACE.
BECAUSE OUR PORTFOLIO IS RATHER
WEEK IN MANY OF THE AREAS I'VE
TALKED ABOUT.
I WILL PASS THROUGH THIS AND GO
TO THIS POINT, I WANT TO MAKE,
WHICH I TRY TO MAKE IN ALL OF
OUR PRESENTATIONS, WHICH IS
THAT WE DON'T JUST HAVE GRANTS
IN OUR PORTFOLIO.
WE ALSO DEVELOP A NUMBER OF
DATA COLLECTION OPPORTUNITIES.
AND RESOURCES ONE IS THE HEALTH
INFORMATION NATIONAL TREND
SURVEY, WHICH WE DO YEARLY OR
BIYEARLY BASIS.
HENCE CONTAINS DATA ON ALCOHOL
RISK PERCEPTIONS, TOBACCO USE,
E-CIGARETTE AND SO ON.
THESE ARE PUBLIC USE DATA
AVAILABLE TO ANYONE.
COULD BE DOWNLOADED QUITE
EASILY.
WHEN I WAS A FACULTY MEMBER AT
UNIVERSITY OF PITTSBURGH BEFORE
COMING HERE TO THE NATIONAL
CANCER INSTITUTE, ONE OF THE
THINGS I DID WAS DOWNLOAD HINTS
FOR THEM.
IT'S A GREAT WAY TO GET A
FIRST-YEAR PUBLICATION.
IT'S A REALLY EASY DATA SET TO
USE.
NOT AS COMPLICATED AS SOME
OTHERS AND HAS MANY OF THE
KINDS OF QUESTIONS AND
CONSTRUCTS OF INTEREST TO THIS
GROUP, TO THIS AUDIENCE.
WE ALSO PUT A LOT OF INVESTMENT
IN THE TOBACCO USE SUPPLEMENT
CURRENT POPULATION SURVEY.
SO THIS, OF COURSE, IS A HUGE
SAMPLE.
THINK ABOUT THE CURRENT
POPULATION SURVEY, RIGHT?
WE ARE TALKING TENS OF
THOUSANDS OF PEOPLE RATHER THAN
2,000 OR 3,000.
THESE DATA HAVE BEEN
PARTICULARLY USEFUL IN TRACKING
THE USE OF DIFFERENT KINDS OF
TOBACCO PRODUCTS OVER TIME.
IN ADDITION TO THAT, WE ARE
ABLE TO LINK THOSE TOBACCO USE
DATA TO THE NATIONAL
LONGITUDINAL MORTALITY STUDY,
WHICH IS USEFUL, WE CAN UNLINK
DIFFERENT PATTERNS AND
DIFFERENT TYPES OF TOBACCO
PRODUCTS TO CANCER OUTCOMES.
AS NOTED IN THE SLIDE WE ARE
PREPARING TO FIELD THE NEXT
WAVE, REVISING THE
QUESTIONNAIRE TO REMOVE
OUTDATED ITEMS AND REVISE BASED
ON RESAANICH SOUTH AND CONSUMER
DATA.
THE TOBACCO LANDSCAPE IS
CHANGING ON A REGULAR BASISMENT
WE ARE CONSTANTLY NEEDING TO
CHANGE AND RETHINK ITEMS IN ALL
OF THESE SURVEYS.
ALSO, I HIGHLIGHT HERE WE HAVE
A FOUR-PART WEBINAR SERIES IN
2021 THAT'S STILL AVAILABLE
ALONG WITH ALL OF OUR WEBINARS
AND I ENCOURAGE YOU TO TAKE A
LOOK AT THOSE.
AND JUST BY SAYING WE HAVE A
WEBSITE AND I ENCOURAGE YOU TO
TAKE A LOOK AT THAT.
IT HAS FUNDING OPPORTUNITIES,
CAREER OPPORTUNITIES, ALL OF
OUR RESEARCH PRIORITIES.
WE HAVE A TWITTER FEED AND A
NEWSLETTER THAT GOES OUT ON A
QUARTERLY BASIS.
WE ENCOURAGE PEOPLE TO SIGN UP
FOR THAT AS WELL.
THAT WAS IT FOR ME.
I'M HAPPY TO TAKE ANY QUESTIONS
IF WE HAVE SOME TIME.
>> I HAVE A QUESTION.
THANK YOU SO MUCH FOR THAT
PRESENTATION, IT'S REALLY GREAT
TO HEAR THE COLLABORATIONS WITH
NIAAA AND EMPHASIS ON ALCOHOL
AND FOCUS ON CANNABIS.
SO BROADENING THAT PORTFOLIO.
I WANT TO JUST RAISE ONE OTHER
ASPECT WHICH WE DO QUITE A BIT
OF WORK THAT HAS TO DO WITH
TRAUMATIC STRESS AND THE
LANDSCAPE OF TRAUMA AND ITS
EFFECTS CURRENTLY.
PARTICULARLY, WE HAVE A LOT OF
INFORMATION NOW ON BRAIN
MECHANISMS BY WHICH THESE
REALLY HORRENDOUS DISASTROUS
EVENTS OCCURRING ON A DAILY
BASIS ARE AFFECTING OUR SELF
CONTROL, OUR ABILITY TO
REGULATE OUR EMOTIONS AND USE
PATTERNS.
ALMOST LIKE THE CAUSE OF CAUSES.
THE REASON I BRING IT UP, YOU
KNOW, VERY WELL LOOKS LIKE IT
COULD BE, WHEN WE TARGET
BEHAVIORS THAT ARE SORT OF DOWN
THE ROAD A LITTLE BIT.
SO THINKING ABOUT PREVENTION
AND EARLY INTERVENTION, IT
WOULD BE IMPORTANT TO RECOGNIZE
THOSE FACTORS.
THINGS LEADING TO MAJOR
DELETERIOUS EFFECTS OF TRAUMA
ON PEOPLE AND WHEN WE START TO
THINK AT WHO IS AT RISK FOR
HEALTH BEHAVIORS, OF COURSE
THOSE ADVERSITY-RELATED CANCER
RISK.
IT SEEMS LIKE IT'S AN
OPPORTUNITY THAT IS NOT -- AN
OPPORTUNITY WASTED IN TERMS OF
TARGETING AND PUTTING SOME
FOCUS ON IT.
ANY THOUGHTS OF THAT?
>> YEAH, THANK YOU.
REALLY INTERESTING THOUGHTS AND
QUESTION.
I THINK A LOT OF THE FOCUS ORE
THE LAST SAY 40-50 YEARS IN
CANCER EPIDEMIOLOGY HAS BEEN ON
SINGLE EXPOSURES.
OFTEN THEY FOCUSED ON
ENVIRONMENTAL AND BEHAVIORAL
FACTORS LIKE TOBACCO AND LESS
ON STRESS.
THERE'S BEEN MORE INTEREST THE
LAST 10-15 YEARS ON THE EFFECTS
OF STRESS AND WORK OF PSYCHO
NEUROLOGY HAS BEEN HELPFUL TO
HELP US UNDERSTAND THE LINKS
BETWEEN STRESS AND CANCER
DEVELOPMENT.
ONE OF THE INTERESTING FINDINGS
IN THAT LITERATURE IS THAT
STRESS, DOES NOT SEEM TO BE A
GREAT PREDICTOR OF CANCER
INITIATION, PER SE.
BUT IT DOES SEEM TO BE A
PREDICTOR OF TUMOR DEVELOPMENT.
SO ONCE SOMEONE DOES HAVE
CANCER, STRESS CAN ACCELERATE
THE DEVELOPMENT OF TUMORS AND
SECONDARY CANCERS AND
RECURRENCE AND THE STRESS
ITSELF COULD LEAD TO BEHAVIORS,
AS YOU ARE INDICATING, LIKE
ALCOHOL USE WHICH WILL FURTHER
ACCELERATE TUMOR DEVELOPMENT
AND SECONDARY CANCERS AND SO ON.
THESE ARE PATTERNS THAT REALLY
NEED TO BE UNDERSTOOD.
ONE OF THE FORTUNATE ASPECTS OF
HAVING A SURVIVEORSHIP
COMMUNITY LIVING MUCH LONGER IS
WE CAN DO LONGITUDINAL STUDIES
AND TRACK THIS OVER TIME AND
GET A BETTER SENSE HOW CANCER
IS INITIATED, HOW IT DEVELOPS
OVER TIME AND HOW COMBINATIONS
OF STRESS, BEHAVIORAL,
ENVIRONMENTAL EXPOSURES.
THE EPIDEMIOLOGY LITERATURE IS
MOVING AWAY FROM SINGLE
EXPOSURES AND LOOKING MORE AT
PATTERNS.
YOU READ IN THE NEWSPAPER, RED
MEAT IS BAD FOR YOU, THIS IS
BAD FOR YOU, THAT IS BAD FOR
YOU.
WELL, WHAT WE ARE LEARNING, THE
NOT ABOUT A SINGLE FOOD
EXPOSURE, IT'S ABOUT THE
COMBINATION OF FOOD EXPOSURES,
PATTERNS OF EATING.
THERE'S FOCUS ON
TIME-RESTRICTED EATING.
YOU SHOULD EAT WITHIN A CERTAIN
PERIOD OF TIME DURING THE DAY
AND THAT'S JUST AS IMPORTANT OF
WHAT YOU ARE EATING OR MAYBE
CLOSE TO AS IMPORTANT.
PUTTING EPIDEMIOLOGY IN A
DIFFERENT PLACE THAN IT WAS
BEFORE.
I THINK YOUR QUESTIONS REALLY
RAISE SOME OF THE DIFFERENT
KINDS OF CONSTRUCT THAT COULD
BE MEASURED IN EPIDEMIOLOGICAL
STUDIES AND ADDRESS
INTERVENTIONS.
>> THANK YOU.
IT'S GOOD TO HEAR.
I WOULD JUST FOLLOW-UP THIS
REALLY HAS IMPACT ON THE
INTERGENERATIONALLY TOO.
TO YOUR POINT ABOUT PATTERNS OR
ACCUMULATION OF RISK, TRAUMATIC
STRESS, WITH BEHAVIORS, WITH
CHOICES, WHICH IS REALLY WHAT I
WAS TARGETING, HEALTH CHOICES,
NOT A STATIC THING, IT'S VERY
DYNAMIC AND VERY MUCH HAPPENING
IN THE BRAIN AND THE BODY
JOINTLY ON A DAILY BASIS.
BUT AFFECTING RISK IN CHILDREN.
SO THESE ARE MODIFIABLE FACTORS
THAT WE HAVE NOT PUT ENOUGH
RESOURCES IN.
I JUST, AGAIN, URGE US TO
BROADEN OUR THINKING ABOUT
INTERVENTIONS, IN THE
PREVENTION, BOTH PRIMARY
PREVENTION BUT SECONDARY
PREVENTION LEVEL TOO, WHERE WE
ARE OFTEN READY, STILL COMING
AT THIS FROM A TREATMENT
PERSPECTIVE.
EVEN WHEN WE THINK ABOUT
PRE-ADDICTION.
WE WANT TO TREAT PEOPLE WHO ARE
ALREADY DOWN THE ROAD.
AND WE ARE NOT PAYING AS MUCH
ATTENTION TO ALL THE SIGNS AND
SYMPTOMS, NOT JUST SOCIALLY BUT
BIOLOGICALLY AND BEHAVIORALLY
THAT EXIST WE CAN START TO
ADDRESS IT AND START TO AFFECT
CHILDREN EARLY ON.
>> THANK YOU VERY MUCH.
AND BY THE WAY, I ALSO JUST
WANT TO POINT OUT, RELATED TO
YOUR COMMENTS AND GEORGE'S
COMMENTS ABOUT THE EFFECTS OF
THE PANDEMIC, WE NEED TO BE
LOOKING AT HOW ALL THESE
BEHAVIORS AND STRESS EXPOSURES,
HOW THAT IS GOING TO PLAY OUT
IN CANCER RISK SAY 20 YEARS
FROM NOW POST PANDEMIC.
ONE THING WE ARE SEEING IN THE
LITERATURE, OBESITY RATES STILL
GO UP, PERHAPS FASTER THAN WE
EXPECTED, GIVEN THE PANDEMIC.
ALCOHOL USE HAS GONE UP
APPRECIATEBLY.
IF THOSE ALL THOSE THINGS ARE
PREDICTIVE OF CANCER OUTCOMES
THEN WHAT IS CANCER GOING TO
LOOK LIKE 10-20 YEARS FROM NOW?
WE ARE CONCERNED ABOUT THATMENT
CANCER SCREENINGS ARE DOWN TOO.
THEY CAME BACK UP AGAIN WHEN
HEALTH SERVICES OPENED BACK UP.
BUT NED, OUR PREVIOUS DIRECTOR
ESTIMATED THERE MAY BE 10,000
ADDITIONAL DEATHS FROM CANCER
BECAUSE OF THE LACK OF
SCREENING IN 2020 AT THE
BEGINNING OF THE PANDEMIC.
I'M INTERESTED IN DOING SOME
MODELING HOW ALL THESE
DIFFERENT EXPOSURES ARE GOING
TO AFFECT CANCER MORBIDITY AND
MORTALITY DOWN THE ROAD.
LOOKS LIKE WE HAVE A BUNCH OF
HANDS UP.
I'M NOT SURE WHO WAS FIRST.
>> I ALSO WANT TO BE MINDFUL OF
TIME.
MAYBE IF WE CAN TAKE THE NEXT
TWO QUESTION THAT'S HAVE BEEN
WAITING AND GO BACK TO THE 45
MINUTE DISCUSSION PERIOD WE
HAVE AT THE END.
>> TERRIFIC.
>> THANK YOU SO MUCH.
BILL, THANK YOU SO MUCH FOR
THAT GREAT OVERVIEW.
AS YOU KNOW, PLACEMATERS.
PLACE MATTERS.
I WORRY ABOUT CANNABIS RESEARCH.
IT'S NOT LEGALIZED FEDERALLY
YET.
MAYBE THAT'S SOMETHING YOU CAN
ADDRESS WHERE THAT RESEARCH IS
BEING DONE.
BUT FOR ME, MORE IMPORTANTLY,
WE KNOW OFTEN TIMES THE
COMPREHENSIVE CANCER CENTERS,
THOUGH THEY MAY BE LOCATED IN
REGIONS WITH A LOT OF
DIVERSITY, THERE'S NOT A LOT OF
DIVERSITY WALKING THROUGH THE
DOOR.
I WORRY ABOUT THE WORK BEING
DONE, MY QUESTION IS WHETHER OR
NOT THE SUPPLEMENTS OR ANY
OTHER FUNDING MECHANISMS ARE
ACTUALLY BEING LEVERAGED TO
REQUIRE INCLUSIVE BEHAVIORS,
NOT ONLY INCLUDING CANCER
CENTERS THAT ARE
NON-COMPREHENSIVE, NON N.C.I.
DESIGNATED.
MORE PARTICULARLY, THOSE
CENTERS THAT ARE TREATING
PEOPLE WHO HAVE BEEN
MARGINALIZED AND
DISENFRANCHISED.
CAN YOU SPEAK TO THAT A LITTLE
BIT?
>> YES.
EVEN THOUGH THESE SUPPLEMENTS
ARE GOING TO THE DESIGNATED
CANCER CENTERS WE ARE NOW
ENGAGED WITH THE COMMISSION ON
CANCER TO TRY TO SPREAD THAT
OUT ACROSS THE COUNTRY.
IT'S NOT JUST THE NCI
DESIGNATED CANCER CENTERS BUT
ALL THE CANCER CENTERS GETTING
GUIDELINES AND RESOURCES TO
INCORPORATE SOME TOBACCO
CESSATION INFRASTRUCTURE INTO
THEIR WORK FLOW.
WITH REGARD TO DIVERSITY
ISSUES, I'M HAPPY TO SAY WE ARE
WORKING TOWARD OUR CANCER
CENTERS HAVING A D.E.I.
REQUIREMENT.
THE A REQUIREMENT THAT WOULD
INFLUENCE THEIR ABILITY TO GET
FUNDED.
AND SO THE IDEA IS TO BE ABLE
TO BRING IN STAFF MEMBERS WHO
CAN HELP BUILD THE DIVERSITY OF
THEIR STAFF AND OF THEIR
CLINICAL POPULATIONS.
IT'S PROBABLY NOT A SURPRISE
SOME OF THE SAME INDIVIDUALS
OCCUPYING THOSE ROLES ARE ALSO
THE ONES DOING THE POPULATION
SCIENCE WORK IN THE CANCER
CENTERS AND THEREFORE MIGHT BE
THE ONES INVOLVED IN THE
INITIATIVES WITH MORE
BEHAVIORAL AND POPULATION
SCIENCE FOCUS.
THAT LEADS TO SOME SYNERGISM, I
THINK THAT MIGHT BE EFFECTIVE.
BUT YOU ARE ABSOLUTELY RIGHT.
THERE'S A PROBLEM IN TERMS OF
DIVERSITY, OF NOT ONLY
DIVERSITY OF THE PATIENT
POPULATIONS BUT OF THOSE
WORKING IN THESE CANCER CENTERS
TEND TO BE MORE ACADEMIC AND
HIGHER SCS AND THAT HAS A
HIGHER IMPACT ON TREATMENT.
>> I HAVE A QUICK QUESTION.
I'M JUST WONDERING IF N.C.I.
HAS SUPPORTED OR PLANNING TO
SUPPORT STUDIES LOOKING AT THE
ASSOCIATION BETWEEN CANCER PAIN
AND ALCOHOL USE.
>> THANK YOU.
WE HAVE BEEN VERY INTERESTED IN
THE PAIN LITERATURE.
IN FACT WE HAVE BEEN SPENDING
MORE TIME LOOKING AT SOME OF
THE INEQUITIES IN PAIN
MANAGEMENT AND HOW THAT PLAYS
OUT OVER TIME.
BUT I THINK YOU ARE ABSOLUTELY
RIGHT.
ALCOHOL IS GOING TO BE
SOMETHING WE NEED TO THINK OF
IN THE PAIN CONTEXT.
BECAUSE SOMETIMES IT'S EVEN
ENCOURAGED BY PHYSICIANS AS A
WAY OF ADDRESSING PAIN.
AS A FORM OF PALLIATIVE CARE.
AND THAT'S PROBLEMATIC IF IT'S
THEN IN-TURN GOING TO INCREASE
THEIR RISK OF SECONDARY CANCERS
AND RECURRENCE.
THAT'S A BIT OF A FRAUGHT TOPIC.
I THINK IT'S INTERESTING TO
IMAGINE DOING MORE RESEARCH ON
THE LINK OF ALCOHOL USE AND
PAIN MANAGEMENT.
I DON'T THINK WE HAVE TOO MUCH
OF THAT IN OUR PORTFOLIO.
DO WE HAVE TIME FOR LAURA'S
QUESTION?
>> IF IT'S QUICK, OTHERWISE WE
CAN COME BACK.
>> SORRY, I THINK IT COULD BE A
QUICK QUESTION.
I JUST WANT TO GIVE YOU AN
OPPORTUNITY TO SPEAK TO VAPING,
AS OPPOSED TO TOBACCO USE.
IF YOU HAVE SEEN THE LANDSCAPE
OF THOSE TWO DRUGS CHANGE WITH
THE PANDEMIC?
THANK YOU FOR YOUR
PRESENTATION, REALLY
INTERESTING.
>> YEAH, SURE, I WILL JUST SAY
BRIEFLY, GIVEN THE TIME LIMB
TAIGS BECAUSE THAT'S A BIG
QUESTION, WE DO NOESIG RECEIPT
USE IS CONTINUING TO GO DOWN,
VAPING IS CONTINUING TO GO UP.
WE AREN'T SURE HOW MUCH TO
TRUST DATA.
NORA MENTIONED VAPING WENT DOWN
IN THE PANDEMIC IN ADOLESCENCE,
THAT SOUNDS LIKE A GOOD THING
BUT WE ARE NERVOUS ABOUT THE
DATA, BECAUSE THE ADOLESCENTS
WERE FILLING OUT THE SURVEYS
WITH THEIR PARENTS NEXT TO THEM.
WE ARE TRACKING THIS QUITE A
BIT, WE NEED A BETTER SENSE OF
WHAT'S GOING ON WITH VAPING.
TOBACCO INDUSTRY IS MOVING MORE
TOWARDS VAPING AND TRYING TO
GET RID OF CIGARETTES BUT IN
THE SAME BREATH THEY WANT TO
MOVE PEOPLE MORE TOWARD
E-CIGARETTES WHICH HAVE THEIR
OWN PROBLEMS SO SOMETHING WE
DEFINITELY NEED TO GET A HANDLE
ON.
>> OKAY, THANKS VERY MUCH.
WE SHOULD MOVE ON SO AS NOT TO
GIVE ABCD A SHORT --
SHE AND HER COLLEAGUES
ELIZABETH HOFMANN AND KIM
LEBLANC WILL BE PRESENTING ON
THE ABCD UPDATE TODAY.
KAIA?
>> SORRY, I WAS HAVING TROUBLE
UNMUTING.
CAN YOU HEAR ME NOW?
>> YES.
>> GREAT.
>> THANK YOU, SUSAN, I'M HAPPY
TO BE HERE.
I'M HERE TO GIVE YOU AN UPDATE
ON THE ADOLESCENT BRAIN
COGNITIVE DEVELOPMENT STUDY.
I'M ACTUALLY GOING TO KEEP MY
OVERARCHING COMMENTS BRIEF, SO
THAT WE CAN SPEND MORE TIME ON
THE SCIENCE, GOT SOME EXCITING
PAPERS TO PRESENT AT THE END OF
THE TALK.
BUT I DID WANT TO GIVE YOU ALL
AN UPDATE ON HOW THE STUDY IS
GOING, IN TERMS OF RETENTION.
SOME OF OUR ACTIVITIES RELATED
TO JUSTICE, EQUITY, DIVERSITY
AND INCLUSION.
SO THE DATA BEING COLLECTED AND
PUBLICATIONS COMING OUT ON
COVID-19, AS WELL AS DATA
SHARING IN USE, BEFORE WE
TRANSITION INTO THREE REALLY
EXCITING PAPERS BEING PRESENTED
BY ELIZABETH HOFMANN AND KIM
LEBLANC.
SO BY WAY OF RETENTION, WE ARE
REALLY PROUD TO SAY WE ARE
STILL RETAINING ABOUT, JUST
OVER 98% OF THE ABCD COHORT.
WHAT WE CONSIDER SOMEBODY --
WE CONSIDER EVERYBODY RETAIN
UNTIL THEY OFFICIALLY WITHDRAW
BECAUSE WE DO MAKE A CONCERTED
EFFORT TO BRING BACK PEOPLE WHO
HAVE, FOR EXAMPLE, MISSED
VISITS.
OUR RETENTION RATE REMAINS VERY
HIGH.
BUT ALSO WE ARE TRACKING HOW
MANY PEOPLE ATTEND EACH VISIT.
SO NOW AS YOU RECALL, ABCD
BEGAN ENROLLMENT IN 2016.
AND WE HAVE ANNUAL VISITS AS
WELL AS MID-YEAR CHECK-INS.
THIS GRAPH,WHICH YOU HAVE SEEN
OVER THE YEARS, TRACKS HOW MANY
PARTICIPANTS HAVE COMPLETED
VISITS AT EACH VISIT.
BASELINE, SIX MONTHS, ONE YEAR,
ETC..
HERE WE SEE FLAT LINE IN 2020
WHEN WE SUSPENDED OUR TWO-YEAR
FOLLOW-UP VISITS BUT HAVE SINCE
RECOVERED AND WERE ABLE TO
COMPLETE MOST OF THOSE.
SO OF COURSE, THE NICE LINES WE
HAD EARLY ON HAVE BEEN A LITTLE
BIT MORE COMPLICATED AS TIME
HAS MOVED ON.
BUT WE ARE ABLE TO BRING IN
MOST OF OUR PARTICIPANTS.
EITHER REMOTELY, IN A HYBRID
FASHION OR IN PERSON.
I WILL GET TO THAT IN A SECOND.
ONE THING YOU MAY NOTICE, THE
FOUR-YEAR FOLLOW-UPS WHICH
BEGAN AT THE END OF 2020,
THERE'S A LITTLE BIT OF A LAG
HERE.
WE ARE HOPING THAT WILL, THAT
WE ARE AT LEAST CONTINUING, THE
SLOPE IS SIMILAR TO PREVIOUS
YEARS BUT WE HAD TO DELAY
THINGS A LITTLE BIT BECAUSE OF
PANDEMIC-RELATED FACTORS.
CONTINUALLY, WE CONTINUE TO
MONITOR THE DEMOGRAPHICS OF OUR
PARTICIPANTS TO ENSURE THE
EFFORTS MADE TO RECRUIT A
DIVERSE SAMPLE ARE CONTINUED
THROUGHOUT THE COURSE OF THE
STUDY.
YOU HAVE SEEN ME PRESENT ON
THESE BEFORE.
THIS IS DATA FROM THE
THREE-YEAR FOLLOW-UP VISIT.
WHICH IS NOW LARGELY COMPLETE.
AND YOU CAN SEE THAT, AGAIN,
JUST TO ORIENT YOU, THIS INNER
CIRCLE, INNER RING IS THE
DEMOGRAPHIC BREAK DOWN WHEN
THEY WERE RECRUITED AND THE
OUTER RING IS THOSE THAT
COMPLETED THE THREE-YEAR
FOLLOW-UP.
WE HAVE PRETTY GOOD CONCORDANCE
WITH RESPECT TO RACE,
ETHNICITY, INCOME AND HOUSEHOLD
EDUCATION.
WE ARE RETAINING A DIVERSE
COHORT OF PARTICIPANTS IN THE
STUDY.
WHEN COVID HIT, WE, LIKE
EVERYBODY ELSE, EXPERIENCED
SHUT DOWNS FOR A PERIOD OF TIME.
THIS OCCURRED IN THE MIDDLE OF
COMPLETING OUR TWO-YEAR
FOLLOW-UP VISITS.
SO WE DID TRANSITION.
WE HAD ABOUT 70% COMPLETE THE
TWO-YEAR FOLLOW-UP VISITS
BEFORE THE SHUT DOWN OCCURRED.
AND THEN TRANSITIONED TO REMOTE
AND HYBRIDS FOR THE REST OF THE
TWO-YEAR FOLLOW-UP VISITS.
THESE WERE ALSO IMPACTED ARE
THREE AND FOUR-YEAR VISITS.
THAT WAS REALLY GEARING UP WHEN
THE PANDEMIC FIRST HIT.
WE HAD MANY MORE OF OUR
PARTICIPANTS HAVE TO COMPLETE
THEIR VISITS REMOTELY.
BUT BECAUSE OF THAT, WE WERE
ABLE TO COLLECT MOST OF THE
DATA, BUT WE DID MISS THE NEURO
IMAGING IN SOME OF THE BIO
SPECIMEN COLLECTION FROM A
LARGE NUMBER OF PARTICIPANTS IN
THAT FOLLOW-UP TIME PERIOD.
AS THE FOUR YEARS RESUMED, MOST
OF THE SITES HAD OPENED TO SOME
DEGREE.
BUT WE STILL CONTINUE TO HAVE
SOME PARTICIPANTS PARTICIPATE
REMOTELY, BUT LARGE GROUP
PARTICIPATED IN A HYBRID
FASHION.
MOST PEOPLE WOULD COME TO THE
SITES TO DO THE SPECIMEN
COLLECTION AND IMAGING, BUT
CONDUCT THE REST OF THE VISITS
AT HOME TO MINIMIZE THE AMOUNT
OF TIME THEY WERE IN CONTACT
WITH PEOPLE, WITH STAFF AT THE
SITES.
AND THEN WE ALSO HAD SITES THAT
TRANSITIONED TO FULLY IN PERSON.
SO THEY WERE ABLE TO DO THE
ENTIRE VISIT IN PERSON.
THE MAIN REASONS FOR THE REMOTE
VISITS, OF COURSE, VARIED OVER
TIME.
BUT IT WAS OFTEN THE CASE IF
PARTICIPANTS HAD M.R.I.
CONTRAINDICATIONS THEY JUST
OPTED NOT TO COME IN AT ALL, SO
WE DID THOSE REMOTELY.
THERE WERE STILL SOME FAMILIES
NOT WILLING TO COME INTO THE
CENTER BECAUSE OF CONCERNS
ABOUT COVID.
BECAUSE OF THIS TRANSITION,
ABCD, IN THE BEGINNING, WE
REALLY CREDIT OURSELVES ACROSS
ALL 21 SITES EVERYBODY WAS
GETTING THE SAME PROTOCOL.
BUT BECAUSE OF THIS TRANSITION
TO HYBRID AND REMOTE, THAT
INTRODUCES SOME VARIABILITY IN
HOW PEOPLE ARE COMPLETING THOSE
DIFFERENT ASPECTS OF THE
PROTOCOLS.
SO A COUPLE OF QUESTIONS THAT
THE ABCD CONSORTIUM IS
INVESTIGATING AND TRYING TO
ADDRESS IS WHAT THE IMPACT OF
THESE HYBRID ASSESSMENTS MAY BE
ON DATA QUALITY.
SO WE HAVE NEURO COGNITIVE
TESTS THAT WHEN THEY ARE DONE
IN THE CENTERS ARE VERY TIGHTLY
CONTROLLED, IN TERMS OF
ENVIRONMENT.
AND SO ABCD COGNITIVE WORKLOAD
ARE LOOKING AT WHETHER THERE
ARE DIFFERENTIAL IMPACTS ON THE
QUALITY OF DATA WHETHER
PARTICIPANTS DID THESE REMOTELY
OR IN PERSON.
WE ARE ALSO LOOKING INTO THE
IMPACT OF THE HYBRID VERSUS
IN-PERSON, VERSUS REMOTE VISITS
ON PARTICIPATION, PARTICULARLY
FOR DIFFERENT DEMOGRAPHIC
GROUPS.
WE HAVE SEEN ANECDOTALLY HAVING
REMOTE OPTIONS HAS INCREASED
PARTICIPATION AMONG SOME GROUPS
BUT ALSO MADE IT MORE DIFFICULT
TO OTHER GROUPS DUE TO, FOR
EXAMPLE, INTERNET CONNECTIVITY.
WE NEED TO DO AN IN-DEPTH DIVE
TO UNDERSTAND THAT AND WHETHER
THAT IN TURN AFFECTS THE
COMPLETENESS OF THE DATA FOR
GROUPS THAT MAY NOT HAVE BEEN
ABLE TO COMPLETE ALL OF THE
ELEMENTS IF THEY ARE NOT COMING
IN PERSON.
THESE ARE A COUPLE ISSUES WE
ARE WORKING THROUGH AND ALL OF
THIS WILL BE SHARED WITH THE
SCIENTIFIC COMMUNITY, AS PEOPLE
ARE ACCESSING THE DATA SO THEY
ARE AWARE OF WHAT THEY NEED TO
BE THINKING ABOUT IN TERMS OF
DATA ANALYSIS.
I WOULD NOW LIKE TO GIVE YOU AN
UPDATE ON OUR JEDI ACTIVITIES.
LAST YEAR, I THINK I INTRODUCED
THIS INITIATIVE WITHIN ABCD,
WHICH IS REALLY FOCUSED ON
THREE AREAS.
ONE IS LOOKING AT THE METHODS
THAT ARE BEING IMPLEMENTED,
ABCD TO MAKE SURE THEY ARE
SENSITIVE AND INCLUSIVE.
THE SECOND IS TO MAXIMIZE.
AND THE THIRD IS FOR ABCD TO
TAKE A ROLE IN ACCESSING AND
UTILIZING THE DATA ARE DOING SO
IN A RESPONSIBLE WAY.
I JUST WANT TO HIGHLIGHT A FEW
OF THE THING THAT'S HAVE
HAPPENED IN THE PAST YEAR.
SO FIRST, WE ARE SEARCHING FOR
AN ASSOCIATE DIRECTOR TO BE
PART OF THE COORDINATING CENTER
LEADERSHIP TEAM.
WE HAVE THESE ACTIVITIES THAT
HAVE BEEN ONGOING BUT THE
REALLY BEEN A GRASSROOTS EFFORT.
WE NEED TO HAVE SOMEBODY THAT
IS INTEGRAL IN THE COORDINATING
CENTER TO SERVE IN A LEADERSHIP
ROLL OVER SEEING ALL OF THIS.
SO IF YOU KNOW OF ANYONE WHO IS
INTERESTED, PLEASE HAVE THEM
REACH OUT TO US, AND I CAN GIVE
YOU MORE INFORMATION ON THAT
POSITION.
WE ALSO BROADENED OUR STEERING
COMMITTEE MEMBERSHIP.
LIKE MANY ASPECTS OF SCIENCE,
WE RECOGNIZE ABCD, WE DO NOT
HAVE A VERY DIVERSE
PARTICULARLY LEADERSHIP GROUP
WITHIN THE CONSHORT SCHUMM.
-- CONSORTIUM.
THE WAY THE STEERING COMMITTEE
WAS ORIGINALLY POPULATED IS
LIMITING IT TO P.I.'S.
WE HAVE VERY FEW P.I.'S OF
COLOR WITHIN ABCD, SO TO MAKE
SURE WE HAVE DIVERSITY, WE
BROADENED THAT MEMBERSHIP TO
INCLUDE MEMBERS OF OUR JEDI
ADVISORY COUNCIL WHO ARE NOT
P.I.'S, BUT CAN PROVIDE THAT
IMPORTANT PERSPECTIVE.
SO, WE ADDED TWO MEMBERS OF
THAT ADVISORY COUNCIL WHO ARE A
LITTLE BIT JUNIOR IN STAGE OF
CAREER, BUT VERY VALUABLE IN
TERMS OF BRINGING THIS
PERSPECTIVE TO OUR
DECISION-MAKING BODY.
WITH RESPECT TO THE DIVERSITY
SENSITIVE-METHODS GROUP.
THEY HAVE REALLY DONE AN
AMAZING JOB OF REVIEWING THE
EXISTING PROTOCOL, AS WELL AS
ANY ANCILLARY STUDIES THAT ARE
BEING PROPOSED TO ENSURE THE
LANGUAGE BEING INCLUDED IN AND
THE WAY THEY ARE BEING
IMPLEMENTED ARE SENSITIVE TO
DIVERSE PARTICIPANTS WITHIN
ABCD.
AS A RESULT OF THAT, WE HAVE
MADE CHANGES TO THE WORDING OF
QUESTIONS OR THE PLACEMENT OF
QUESTIONS IN CONTEXT WITHIN THE
ABCD PROTOCOL.
WE HAVE ALSO ADDED SOME
TRAINING ON, AS WELL AS SCRIPTS
FOR CULTURALLY SENSITIVE
COLLECTION AND OTHER ASPECTS OF
THE PROTOCOL.
WE HAD A REALLY EXCITING
PROGRAM, PILOT PROGRAM LAUNCHED
AT ONE OF THE ABCD SITES AT THE
UNIVERSITY OF VERMONT, CALLED
THE SCIENTIFIC TRAINING AND
ADDICTION RESEARCH TECHNIQUES.
THIS WAS DESIGNED -- ONE OF
THE THINGS I MENTIONED WE WANT
TO DO WITH ABCD IS INCREASE THE
DIVERSITY OF CONSORTIUM ITSELF
BUT WE ALSO WANT ABCD TO BE A
PIVOTAL PLACE FOR INCREASING
THE DIVERSITY OF SCIENTIFIC
WORKFORCE MORE BROADLY.
BECAUSE WE HAVE THIS RICH DATA
SET, WE WANT TO MAKE SURE
PEOPLE FROM UNDER REPRESENTED
GROUPS IN SCIENCE, ONE,
RECOGNIZE THEY HAVE ACCESS TO
THIS, AND UNDERSTAND HOW TO USE
IT.
SO THIS PROGRAM, WHICH WAS JUST
LAUNCHED THIS YEAR, BROUGHT IN
12 UNDER-REPRESENTED SCHOLARS
AT THE PRE-DOC, POST-DOC AND
EARLY INVESTIGATOR LEVEL TO
LEARN MORE ABOUT THE DATA SET
ITSELF.
THE A YEAR-LONG PROGRAM WHICH
BY THE END WE HOPE THEY WILL
HAVE PUBLICATIONS READY FOR
SUBMISSION.
IT WAS AN EARLY LAUNCH TO THIS
PROGRAM.
THERE WAS A LOT OF BI
DIRECTIONAL INFORMATION
COMMUNICATED.
WE GOT TO LEARN A LOT ABOUT
WHAT THEIR CHALLENGES HAVE BEEN.
AS WELL AS PROVIDING THEM, NOT
ONLY WITH INFORMATION ABOUT THE
DATA SET, BUT HANDS ON ACTIVITY
AND THEN MENTORS THAT ARE
WORKING WITH THEM TO DEVELOP
THEIR PROGRAMS.
IT WAS REALLY EXCITING TO SEE
THESE SCHOLARS TAKE SOME RISKS
IN THEIR SCIENCE TO GO INTO
AREAS THAT THEY HAD NOT BEEN
INVOLVED WITH IN THE PAST, BUT
SAW THE POTENTIAL FROM THE ABCD
DATA SET.
I'M EXCITED TO SEE WHERE THEY
TAKE IT FROM HERE.
THE LAST AREA IS RESPONSIBLE
DATA USE, THERE WAS A PAPER
PUBLISHED TALKING ABOUT HOW THE
CONSIDERATIONS THAT PEOPLE NEED
TO THINK ABOUT WHEN USING OPEN
DATA SETS LIKE THE ABCD STUDY
DATA.
YOU KNOW, I THINK THIS IS JUST
A BEGINNING.
BUT CONCRETE CHANGES THAT HAVE
HAPPENED SINCE THIS JEDI
INITIATIVE HAS BEEN LAUNCHED
WITHIN ABCD.
AND I'M REALLY PROUD WE ARE
TACKLING ISSUES YOU THINK NIH
AS A WHOLE, NEEDS TO DO MORE SO.
SO ONE AREA IN PARTICULAR, I
THINK IS THIS LOOK AT
DIVERSITY-SENSITIVE METHODS.
MANY METHODS IN ABCD WERE
INITIALLY CHOSEN BECAUSE THEY
WERE WELL-ESTABLISHED.
THAT MEANS THEY WERE OFTEN NOT
LOOKED AT FOR THE INCLUSIVITY
OF THE LANGUAGE BECAUSE THEY
HAVE BEEN AROUND FOR A VERY
LONG TIME.
TAKING THIS NEW LENS AND
LOOKING AT THESE METHODS HAS
BEEN VALUABLE FROM THE
PERIRESPECTIVE OF UNDERSTANDING
WE ARE GETTING THE DATA WE WANT
TO GET OUT OF THE MEASURES, AS
WELL AS MAKING SURE OUR
PARTICIPANTS AND STAFF ARE
COMFORTABLE WITH THE WAY THE
QUESTIONS ARE WORDED.
I THINK THAT WILL SPEAK TO
ENSURING WE HAVE DIVERSE
REPRESENTATION IN SCIENCE
MOVING FORWARD.
AND AS NIH, WE ARE ASKING
INVESTIGATORS TO USE CERTAIN
MEASURES FOR COMMON DATA
ELEMENTS, FOR EXAMPLE, IT'S
INCUMBENT ON US TO MAKE SURE
WHAT WE ARE ASKING YOU ALL TO
USE ARE MEASURES THAT MEET THIS
INCLUSIVITY.
SO I'M HOPING THAT IS SOMETHING
THAT WILL CONTINUE TO EVOLVE AT
NIH MORE BROADLY.
SO I WOULD NOW LIKE TO JUST
TRANSITION A LITTLE BIT INTO
COVID-19.
AND LAST YEAR YOU MENTIONED
THAT WE HAD LAUNCHED SOME
SURVEYS DURING THE PANDEMIC TO
COLLECT INFORMATION ON THE
IMPACT OF THE PANDEMIC ON THE
YOUTH AND ABCD STUDY.
SO THIS GOES BEYOND THE
STANDARD ANNUAL AND MID-YEAR
VISITS THAT WERE PART OF THE
REGULAR PROTOCOL.
AND AS PART OF THAT, OF COURSE,
ALONG WITH EVERYTHING ELSE IN
ABCD WE STATED TO THE PUBLIC
AND IT'S RESULTED IN A NUMBER
OF PUBLICATIONS ALREADY LOOKING
AT THE IMPACT OF THE PANDEMIC
ON THE YOUTH AND ABCD STUDIES.
LARGELY FOCUSED ON MENTAL
HEALTH OUTCOMES.
ALSO LOOK AT SUBSTANCE USE.
SCREEN TIME.
PHYSICAL ACTIVITY.
IMPACTS ON LEARNING.
SPECIFIC IMPACTS, AS WELL AS
RESILIENCY FACTORS FROM
MARGINALIZED COMMUNITIES.
IT'S BEEN EXCITING TO SEE THE
SCIENTIFIC COMMUNITY EMBRACE
THIS DATA AND REALLY LOOK AT,
NOT ONLY WHAT'S HAPPENING
WITHIN THE PANDEMIC BUT BEING
ABLE TO TAKE SOME OF THIS DATA
AND LOOK AT SOME OF THE
PRE-PANDEMIC DATA TO SEE
DIFFERENCES THAT HAVE EMERGED.
IN FACT, TO THE QUESTION THAT
WAS DISCUSSED EARLIER ABOUT
VAPING, WITHIN ABCD, WE
ACTUALLY HAVE SEEN THAT WHILE
ALCOHOL USE DECREASED FROM
PRE-PANDEMIC TO DURING THE
PANDEMIC, NICOTINE USE
INCREASED.
THOSE INVESTIGATORS ARE LOOKING
AT ADDITIONAL TIME POINTS OF
THAT DATA TO SEE IF THAT
CHANGED OVER TIME DURING THE
PANDEMIC.
IN ADDITION, ABCD HAS NOW
BECOME A PART OF THE RECOVER
INITIATIVE AT NIH, WHICH IS A
STUDY OF LONG COVID.
THAT WAS LAUNCHED A FEW MONTHS
AGO.
SO, FOR THE RECOVER INITIATIVE,
THE PEDIATRIC COHORT AIMS TO
LOOK AT THE INCIDENTS
PREVALENCE AND LONG-TERM IS
SEQUELLAE OF SARS-COV-2.
AND TO UNDERSTAND THE
PATHOBIOLOGY AND MECHANISMS OF
LONG COVID.
SO THIS A VERY LARGE INITIATIVE
AND ABCD IS JUST A SMALL PART
OF IT.
MOST IS FOCUSED ON ENROLLING
PEOPLE EITHER ACUTELY INFECTED
WITH COVID-19 OR HAD COVID-19
IN THE PAST AND ARE INVOLVED IN
THIS POST-ACUTE INFECTED COHORT.
SO THE MAIN RECOVER STUDY IS
GOING TO TAKE THESE, AS WELL AS
THOSE THAT ARE UNINFECTED, TAKE
THESE 6,000 PARTICIPANTS AND GO
THROUGH DIFFERENT TIERS OF
FACTORS, CARDIOVASCULAR,
COGNITIVE.
BUT FOR ABCD, WE THOUGHT IT WAS
IMPORTANT TO BE IN THIS
INITIATIVE TO UNDERSTAND THE
IMPACT OF COVID ON OUR COHORT
GIVEN A LOT OF THE OUTCOME WES
ARE LOOKING AT AT ABCD ARE
IMPACTED BY SARS-COV-2 AND THE
PANDEMIC ITSELF.
SO OUR GOAL IS TO GET ANTIBODY
TESTING, IDENTIFY PEOPLE WHO
HAD COVID-19 EXPOSURE AND THEN
BE ABLE TO LOOK AT THOSE WHO
MAY OR MAY NOT DEVELOP LONG
COVID.
SO WE ARE REALLY JUST GOING TO
BE INVOLVED IN THIS FIRST TIER,
BECAUSE WE HAVE SO MUCH DATA
WITHIN ABCD ITSELF THAT WE WILL
BE ABLE TO ASSOCIATE WITH THAT
DATA TO LOOK AT LONG-TERM
OUTCOMES.
THERE ARE OVERLAP BETWEEN ABCD
SITES AND SITES INVOLVED IN THE
MORE IN-DEPTH CHARACTERIZATION
OF LONG COVID.
SO THERE'S A POSSIBILITY IF WE
IDENTIFY CASES THEY MAY BECOME
PART OF THE MAIN STUDY.
FOR ABCD ITSELF, WE ARE REALLY
FOCUSED ON THE COLLECTING
ANTIBODY DATA AND SOME SURVEY
DATA ON LONG COVID SYMPTOMS TO
BE ABLE TO LOOK, FROM A
POPULATION STANDPOINT AT THE
PREVALENCE OF INFECTION AND
LONG COVID IN ADOLESCENCE.
BECAUSE WE HAVE PRE-PANDEMIC,
DURING PANDEMIC AND LONG-TERM
FOLLOW-UP, WE THINK WE ARE IN A
UNIQUE PLACE TO BE ABLE TO LOOK
AT THESE PRE-INFECTION RISK AND
RESILIENCY FACTORS.
SINCE MOST OF THE OTHER STUDIES
ARE ENROLLING CURRENTLY
INFECTED OR RECENTLY INFECTED
BUT DON'T HAVE THE PRE-PANDEMIC
PHENOTYPING WE DO.
BECAUSE OF THAT, WE THINK WE
WILL BE ABLE TO ISOLATE THE
DIFFERENCES BETWEEN THE EFFECTS
OF THE INFECTION ITSELF, AS
WELL AS PRE-PANDEMIC AND
GENERAL PANDEMIC IMPACTS.
AND OF COURSE, BECAUSE ABCD
ITSELF HAS IN-DEPTH BRAIN
COGNITIVE AND MENTAL HEALTH
PHENOTYPING THAT WILL CONTINUE
MUCH LONGER THAN ANY OF THESE
OTHER STUDIES WE THINK WE ARE
IN A UNIQUE POSITION TO
UNDERSTAND ANY CONTRIBUTORS TO
ANY LONG-TERM OUTCOMES WE SEE.
THAT'S GOING TO GET OFF THE
GROUND SOON TO COLLECT THAT
ANTIBODY DATA AND SURVEY
QUESTIONNAIRE.
I WOULD NOW LIKE TO TRANSITION
A LITTLE BIT INTO OUR DATA
RELEASES AND JUST HOW ABCD DATA
IS BEING USED MORE GENERALLY.
AS YOU KNOW WE RELEASE DATA
EVERY YEAR, WHAT WE HAVE OUT IS
4.0, INCLUDES LONGITUDINAL DATA
FOR THE BRAIN IMAGING.
WE HAVE THE TWO-YEAR COHORT
DATA AVAILABLE.
ALL OF THE COVID-19
SUPPLEMENTAL DATA THAT HAS BEEN
COLLECTED TO DATE.
WE ALSO RECENTLY RELEASED SOME
NEW FUNDING OPPORTUNITY
ANNOUNCEMENTS FOR OUR
INVESTIGATORS TO USE ABCD DATA
FOR A VARIETY OF PURPOSES.
NIDA HAS TWO RFA'S OUT.
THESE AREN'T SPECIFIC TO ABCD
BUT WE ENCOURAGE THOSE WHO WANT
TO USE ABCD DATA FOR OUTCOMES
TO APPLY FOR THESE RFA'S.
WE ISSUED A PROGRAM
ANNOUNCEMENT SPEF ECTO ABCD BUT
CAN BE FOCUSED ON OTHER
AND AS A RESULT OF THIS WE ARE
SEEING A NICE UPTICK IN PEOPLE
BEING FUNDED TO ANALYZE ABCD
DATA AND NOW FUNDED 73
LEVERAGING ABCD DATA AS OF LAST
DECEMBER.
THIS IS REALLY JUST TO SHOW THAT
WHILE MANY OF THESE ARE RESEARCH
GRANTS AND MANY ARE RO1s WE'RE
SEEING A DIVERSITY OF GRANT
MECHANISMS PEOPLE ARE LYING FOR
AND IN DIFFERENT MECHANISMS
WHICH IS REALLY EXCITING.
WE'RE SEEING DIFFERENT
INSTITUTES AND CENTERS VERY
INTERESTED IN GRANTS LEVERAGING
ABCD DATA.
WHILE NIMH HAD HAS THE MOST
THERE'S MANY NOT INVOLVED IN
SUPPORTING THE ABCD DATA ITSELF
AND ANALYZING THE DATA THERE AND
INCLUDES NIBIB, DENTAL
CRANIOFACIAL RESEARCH AND KIDNEY
DISEASES AND NIEHS.
AND THEN IN TERMS OF
PUBLICATIONS THE FIELD CONTINUES
TO BE VERY PRODUCTIVE IN ITS USE
OF ABCD DATA.
IT'S NOW UP TO ABOUT 345 AS OF
THIS MORNING AND YOU CAN SEE WE
CONTINUE TO SEE MANY NON-ABC
INVESTIGATORS USING ABCD DATA
WHICH IS REALLY EXCITING.
I NOW WANT TO TRANSITION INTO
SOME OF THE RESEARCH FINDINGS
AND I'VE MENTIONED IN THE PAST
THAT WE HAD SOME RESEARCH
QUESTIONS THAT CAME OUT WITH THE
RFA FOR ABCD QUESTIONS AND MANY
QUESTIONS USING ABCD DATA BUT
LOOKING AT HOW THE FIELD ARE
TAKING ADVANTAGE OF LARGE ABCD
DATA SETS AND LOOK AT HOW WE'RE
CONDUCTING PARTICULARLY NEURO
IMAGING RESEARCH.
THE FOCUS OF THE PRESENTATIONS
YOU'RE GOING TO HEAR NOW FROM
ELIZABETH AND KIM ARE DOING
THAT.
TAKING A LOOK AT HOW WE COMBINE
DATA WITH OTHER DATA SETS OR
LOOK AT IT ALONGSIDE OTHER DATA
SETS AND HOW THAT INFORMS HOW
WE'RE GOING TO THINK ABOUT HOW
TO DO SCIENCE MOVING FORWARD.
I THINK THIS IS SOMETHING THAT'S
BEEN EXCITING TO SEE A SHIFT
MAYBE BECAUSE OF SOME OF THESE
LARGE-SCALE ANALYSES AND HOW WE
LOOK ANEUR NEUREURA NEUR RESEARCH MOVING
FORWARD AND I'LL TURN IT OVER TO
ELIZABETH HOFFMAN.
>> I'LL TELL YOU ABOUT A COUPLE
PAPERS THAT ARE IMPORTANT THAT
SHOW ABCD USED TO INFORM FROM
MOVING THE NEURAL IMAGING FIELD
FORWARD.
THE FIRST PAPER AND COLLEAGUES A
COUPLE MONTHS AGO IN NATURE LOOK
AT THE IMPLICATIONS OF SMALL
SAMPLES IN RAIN WIDE
ASSOCIATIONS STUDIES.
THEY'RE A PARTICULAR TIME OF
PARADIGM THAT LINKS INDIVIDUAL
VARIABILITY IN BRAIN TO
VARIATION IN BEHAVIOR.
THERE'S NEURAL IMAGING STUDIES
BROADLY WHICH THOUGH WHILE
PROBLEMATIC FOR SOME THEY
CONTRIBUTE TO REPLICATION
FAILURES THAT HAVE BEEN OBSERVED
IN BRAIN WIDE ASSOCIATIONS.
PREVIOUS GWAS STUDIES WITH
RELATIVELY SMALL SAMPLE SIZES
HAVE ASSOCIATIONS THAT HAVE BEEN
EXACERBATED BY PUBLICATION BIAS.
THIS MEANS INTERPRETATIONS MAY
NOT BE TRUE.
AND THEY LEVERAGED DATA FROM
THREE OF THE LARGEST STUDIES OF
ABCD AND THE CONNECTOME STUDY
FROM YOUTH TO MIDDLE TO LATE
ADULTHOOD.
THEY BEGAN WITH ABCD AND USED
UKB TO LOOK AT NEW VARIANT
EFFECT SIZE DISTRIBUTIONS AND
EXAMINED ASSOCIATIONS BETWEEN
BRAIN AND BEHAVIORAL PHENOTYPES
AND THEY FOCUS ON THE NETWORK
YOU CAN SEE BELOW AND THE
PHENOTYPES THEY INTERROGATED
WERE MEASURES AND THE SUB SCALES
AND PERFORMED MULTIVARIATE
ANALYSIS AS A FUNCTION OF SAMPLE
SIZE AND LOOKING AT SAMPLE SIZE
AS SMALL AS 35.
I DON'T HAVE TIME GO THROUGH ALL
THE RICH INFORMATION THAT'S
CONVEYED IN THIS PAPER AND
ENCOURAGE YOU TO LOOK AT THE
PAPER AFTERWARD BUT LOOK AT THE
MAIN TAKE-HOME RESULTS FROM THE
STUDY.
THE FIRST IS THERE'S LESS
VARIABILITY IN EFFECT SIZES AS
SAMPLE SIZE INCREASES.
THIS IS AN ANALYSIS LOOKING AT
THE VARIATE ASSOCIATION STUDY.
THIS IS DATA FROM THE ABCD AND
IN THE SAMPLE SIZE AGAINST
EFFECT SIDES YOU CAN SEE THE
POSSIBLE CORRELATIONS NARROWS AS
SAMPLE SIZE INCREASES.
SO THAT A LARGER EFFECT FROM A
SMALL SAMPLE SIZE IS LIKELY A
FALSE POSITIVE.
THIS IS DRIVEN HOME FROM THE
FIGURE ON THE RIGHT SHOWING THE
COGNITIVE ABILITY.
WE SEE ONE, THE EFFECT SIZE
TENDS TO BE INFLATED IN SMALL
SAMPLE SIZE AND REMARKABLY TWO
SMALL SAMPLES PRODUCE OPPOSITE
EFFECT SO A .58 VERSUS A -.6.
AND SO THE NEXT SET OF ANALYSES
THEY LOOKED AT MULTIVARIATE
ASSOCIATIONS AND FOUND
ASSOCIATIONS AS MUCH DOUBLING IN
SIZE COMPARED TO THE
MULTIVARIATE AND FOUND GREATER
CONCORDAN
CONCORDANCE REPLICATES AND THESE
HAVE GREAT IMPLICATIONS FOR
THINKING ABOUT REPRODUCIBILITY.
IN THE PAST YEAR THE STATISTICAL
POWER INCREASES.
AND I'M SUDDENLY GETTING
FEEDBACK.
I HOPE NO ONE ELSE IS GETTING
THAT.
BUT IMPORTANTLY THIS DOES NOT
MEAN THAT SMALL AND NEURAL
IMAGING IS NOT VALID FOR OTHER
PARADIGMS AND THIS IS SUPER
IMPORTANT AND AS MANY KNOWL
IMAGING IS NOT VALID FOR OTHER
PARADIGMS AND THIS IS SUPER
IMPORTANT AND AS MANY KNOW IMAGING
IS NOT VALID FOR OTHER PARADIGMS
AND THIS IS SUPER IMPORTANT AND
AS MANY KNOWO
IMAGING IS NOT VALID FOR OTHER
PARADIGMS AND THIS IS SUPER
IMPORTANT AND AS MANY KNOWIMAGING
IS NOT VALID FOR OTHER PARADIGMS
AND THIS IS SUPER IMPORTANT AND
AS MANY KNOW NEUROIMAGING COULD
BE WRIT LARGE BAD OR THE FIELD
IS DOOMED AND THE SENIOR AUTHOR
OF THIS PAPER TWEETED OUT THIS
LAY FRIENDLY CLEAR ABSTRACT THAT
REALLY IDENTIFIES THE KEY
MESSAGE WHICH IS THE PAPER IS
ABOUT BWAS AND SAMPLE SIZES AND
NEUROIMAGING IS GREAT AND MANY
TYPES OF MRI ARE VALUABLE AT
SMALL SAMPLE SIZES AND LARGE
SAMPLE SIZE NEEDED WITH THE
BRAIN WIDE ASSOCIATION STUDIES
AND LOOKING AT ASSOCIATIONS
BETWEEN BRAIN AND NON-BRAIN
BEHAVIOR.
SO NEURO IMAGING IS NOT DOOMED
AND THAT'S THE KEY POINT FROM
THE STUDY AND I'LL MOVE ON AND
WE'LL TAKE QUESTIONS LATER.
THIS IS ANOTHER METHODOLOGICAL
PROOF OF CONCEPT PAPER AND I
DON'T HAVE TIME TO GET INTO ALL
THE DETAILS BUT I DO WANT TO
CONVEY THE OVER ARCHING
LIMITATIONS THE PAPER
IMPORTANTLY RAISES.
SO THEY LOOKED AT CIVILIZATION
AND MACHINE LEARNING ARE USED IN
POPULATION SCIENCE AND MEDICINE
AND RECENTLY CONCERNS HAVE BEEN
RAISED ABOUT THE VALIDITY OF
THESE APPROACHES FOR SPECIFIC
POPULATIONS THAT COULD INCREASE
RATHER THAN ALLEVIATE IT.
WE AND OUR COLLEAGUES
INVESTIGATED ALGORITHMICS FROM
THE PROJECT AND ABCD STUDY AND
THE CONCLUSION IS PREDICTIVE
MODELS AND PHENOTYPES FROM
FUNCTIONAL CONNECTIVITY DATA DO
NOT THE AMERICAN POPULATIONS NOW
THAT YOU KNOW THE CONCLUSIONS
THE NEXT COUPLE SLIDES WILL SHOW
YOU HOW THEY GOT THERE.
SO THEY WERE INTERESTED IN LOOK
AT PREDICTION ACCURACY AND THE
FIRST THING THEY DID IMPORTANTLY
WAS TO MATCH AFRICAN AMERICAN
AND WHITE AMERICANS ON
DEMOGRAPHICS AS WELL BEHAVIORAL
PERFORMS SOME YOU CAN SEE HERE.
THEY DID A COUPLE THINGS.
FIRST THEY LOOKED AT PREDICTION
ACCURACY AND THEN THEY COMPARED
THAT PREDICTION ACCURACY WHEN
THE MODELS WERE ON THE ENTIRE
SAMPLE WHICH MIMICS THE DOMINANT
APPROACH CURRENTLY TAKEN IN THE
FIELD.
AND THEY FOUND IN GENERAL GIVEN
THE ACTUAL SCORES ON A
PARTICULAR MEASURE PREDICTION
ERRORS WERE LARGER IN AFRICAN
AMERICANS THAN IN WHITE
AMERICANS.
AND THIS IS COGNITIVE TESTS
AGAINST THE DETERMINATION WHICH
IS A MEASURE AND INDICATES THE
PREDICTED BEHAVIORAL SCORES FROM
SCORES OF THE SAME GROUP.
YOU CAN SEE BLUE ARE AFRICAN
AMERICAN AND GREEN ARE WHITE
AMERICAN AND THE DEVIATION IS
BIGGER FOR AFRICAN AMERICAN
PARTICIPANTS.
THIS IS NOT AS GOOD FOR THESE
MEASURES.
THEY ALSO FOUND MOST MEASURES IN
THE BEHAVIOR CHECKLIST LOOKING
AT SOCIAL PROBLEMS AND BEHAVIOR
HAD HIGHER PREDICTED SCORES IN
AFRICAN AMERICAN PARTICIPANTS AS
COMPARED TO WHITE AMERICAN
PARTICIPANTS.
THIS HAS IMPLICATIONS FOR
PERPETUATING STIGMA AND BIAS
UNWHITINGLY.
AND I SHOULD ALSO POINT OUT THIS
WAS DONE IN AN ANALYSIS IN ABCD
AND SIMILAR FINDINGS WERE
OBSERVED.
IN THE NEXT SET OF ANALYSES WE
WANTED TO LOOK AT SUB SAMPLES OF
PARTICIPANTS AND SEE IF IT'S
POSSIBLE TO OBTAIN A MORE
PREDICTIVE MODEL.
TRAINING WAS PERFORMED
SEPARATELY IN THE ANALYSIS ON
WHITE AMERICAN AND AFRICAN
AMERICAN PARTICIPANTS USING DATA
FROM ABCD AND THIS IS ONLY DONE
IN ABCD BECAUSE THERE'S NOT
ENOUGH SAMPLE SIZE FOR UNDER
REPRESENTED GROUPS.
THE ANALYSIS GOING FORWARD ON
ABCD.
AND THEY FOUND FOR THE SAME ON
AFRICAN AMERICAN PARTICIPANTS
EIGHT OUT THEIR 36 MEASURES
SHOWED GREATER PREDICTION
ACCURACY FOR AFRICAN AMERICAN
PARTICIPANTS THAN WHITE AMERICAN
PARTICIPANTS AND THERE'S STILL
SOMETHING ELSE GOING ON THERE
BUT IMPORTANTLY IN CONTRAST TO
THAT FOR THE MODEL CHANGE ONLY
ON WHITE AMERICANS THERE WAS
GREATER PREDICTION ACCURACY ON
AFRICAN AMERICAN WHITE AMERICAN
IN TWO OF THE MATCHES AND ON
AFRICAN AMERICAN IT INCREASED
PREDICTION ACCURACY BUT NOT
COMPLETELY SO WE STILL DON'T
HAVE THE WHOLE STORY.
IF WE'RE GOING TO PUT ALL THIS
TOGETHER A QUICK RECAP OF THIS
THE FINDINGS SHOWED FIRSTLY BIAS
PREDICTION OF BEHAVIOR IN NEURO
COGNITION WHEN PREDICTING MODELS
FROM WHITE AMERICAN AND AFRICAN
AMERICANS USING THE STANDARD
TRAINING APPROACH.
AND THEN IN SUBSEQUENT ANALYSIS
THEY FOUND THE DIFFERENCE IN THE
TWO GROUPS WAS PARTLY RELATED TO
THE DOMINANCE OF WHITE AMERICANS
IN THE DATA SETS.
CLEARLY THE BIG CONCLUSION WAS
WE NEED MORE DATA FROM UNDER
REPRESENTED GROUPS NOT JUST IN
THE U.S. BUT GLOBALLY IN ORDER
TO ANSWER SOME OF THESE
QUESTIONS AND REALLY IN ORDER TO
DO COMPREHENSIVE ANALYSIS AND
ETHICAL MODELLING.
AND THIS IS TO SHOW YOU THE
DISTRIBUTION OF DEMOGRAPHICS OF
RACE, ETHNICITY IN THE THREE
LARGE DATA SETS AND YOU SEE THE
WHITE AMERICANS AND THE U.K. BIO
BANK HAD 80% AND MOST ARE
EUROPEAN ANCESTRY AND WE STILL
NEED MORE DATA FROM UNDER
REPRESENTED GROUPS AND NEED MORE
DATA TO UNDERSTAND WHY THE
ERRORS ARE HAPPENING IN THE
FIRST PLACE.
IT'S NOT JUST TRAINING ON SUB
POPULATIONS BUT COULD THERE BE
BIAS AT FOR EXAMPLE DIFFERENT
STAGES OF THE PROCESSING
PIPELINE ALL OF WHICH HAVE BEEN
OPTIMIZED FOR A POPULATION
DOMINATE WHITE EUROPEANS OR
WHITE AMERICANS.
BUT IN ORDER TO DO THAT KIND OF
ANALYSIS WE NEED MORE DATA FROM
UNDER REPRESENTED GROUPS TO DO
THAT KIND OF ANALYSES AS WELL AS
OTHER ANALYSES.
TAKEN TOGETHER THE PAPERS NICELY
DEMONSTRATE HOW ABCD CAN BE USED
TO EXPOSE LIMITATIONS IN WIDELY
ADOPTED METHODOLOGIES AND
APPROACHES AND INFORM
CONSIDERATION FOR HOW TO DO THIS
BETTER IN THE FUTURE.
AND THAT'S ALL I HAVE.
I'M HAPPY TO TAKE QUESTIONS AT
IS THE END BUT I'M SEND THINGS
OVER TO KIM.
>> THANKS, ELIZABETH.
I'LL BE PRESENTING ON AN
EXCITING PAPER IN NATURE
DEVELOPING BRAIN CHARTS FOR THE
HUMAN LIFE SPAN.
SO GROWTH CHARTS HAVE EXISTED
FOR HEIGHT AND WEIGHT AND HEAD
CIRCUMFERENCE AND DEMONSTRATED
THE UTILITY OF NORMS TO
BENCHMARK TRAJECTORIES IN
DEVELOPMENT.
HAVING SOMETHING LIKE THIS FOR
BRAIN DEVELOPMENT WOULD BE A
MASSIVE IMPROVEMENT IN THE
FIELD.
CONSIDERING EARLY LIFE IS
INFLUENCED BY NEURAL
TRAJECTORIES AND DISORDERS AND
LATE CHANGE IN BRAIN MORPHOLOGY
CAN INDICATE NEURODEGENERATIVE
DISORDERS.
THE CHALLENGE IS THAT
NEUROIMAGING DATA IS HIGHLY
SENSITIVE TO VARIATION AND
PLATFORMS AND SEQUENCES AND
STATISTICAL ANALYSES AND
ETCETERA.
LARGE SCALE DATA SETS LIKE ABCD
AND RECENT ADVANTAGES HAVE MADE
IT POSSIBLE TO BE ABLE TO
HARMONIZE ACROSS THE DATA SETS.
IMPORTANTLY ABCD STUDY HAS
CONTINUED TO DEVELOP FROM THESE
TRAJECTORIES FROM THE INCEPTION.
IN THE STUDY THEY HARMONIZED
ACROSS DATA FROM OVER 100
PRIMARY STUDIES, 100,000 HUMAN
PARTICIPANTS FROM 115 DAYS POST
CONCEPTION TO 100 YEARS OF AGE
AND YOU CAN SEE WHERE THE ABCD
STUDY FALLS HIGHLIGHTED IN THE
RED BAR THERE.
AND SO THEY DEVELOPED MODELS ON
GRAY MEYER VOLUME AND
SUBCORTICAL GRAY MEYER VOLUME
AND CORTICAL THICKNESS VOLUME
AND SURFACE AREA.
HERE IS THE RAW DATA AND BLUE
FOR MALES AND RED FOR FEMALES.
THE NEXT ONE DOWN IS THE
NORMATIVE TRAJECTORIES DERIVED
FROM THE RAW DATA WITH THE PEAK
VALUE THERE I'VE PUT IN THE TEXT
OF 5.9 YEAR FOR THE PEAK OF
AGREE MATTER VOLUME.
THIS WAS OBSERVED THREE YEARS
LATER THAN PREVIOUSLY REPORTED.
THAT WAS BASED ON SMALLER
EXAMPLES AND THE ONE ON THE
BOTTOM FOR VOLUME AVERAGE
GROWTH.
FOR WHITE MATTER VOLUME SLOWER
AND LONGER DEVELOPMENT THERE
WITH A PEAK AROUND 28.7 YEARS.
HOWEVER, THE PEAK RATE OF GROWTH
IS STILL AROUND 2.4 YEARS OF
AGE.
THE SUBCORTICAL GRAY MATTER
VOLUME PEAKING AROUND 14.4 YEARS
OF AGE.
AND VENTRICULAR VOLUME WHICH IS
PEAKING AT THE END OF LIFE.
INTERESTINGLY CORTICAL THICKNESS
WAS ALMOST THE OPPOSITE THAN
VENTRICULAR VOLUME WHICH PEAKS
BEFORE BIRTH AND WENT DOWN IN A
SIMILAR FASHION.
IN ADDITION THERE'S THESE
PHENOTYPES AND PEAK VOLUMES FOR
DIFFERENT BRAIN REGIONS.
ON THE LIGHT COLORS HERE EARLIER
AGE BEFORE 5 UP TO THE DEEP RED
PAST 9.
IN GENERAL WHAT THEY'RE FINDING
IS THE PRIMARY SENSORY REACHED
PEAK VOLUME EARLIEST AND SHOWED
THE FASTEST POST-PEAK DECLINE
AND OTHER THE OTHER END THE
FRONTAL TEMPORAL SHOWED SLOWER
DECLINES WITH THE LATEST BEING
THE INSULA.
IT RECAPITULATES A GRADIENT FROM
THE CORTEX PREVIOUSLY ASSOCIATED
WITH BRAIN STRUCTURE AND
FUNCTION.
THE CHART THAT PUTS THE
MILESTONES TOGETHER FROM WHAT I
MENTIONED PREVIOUSLY AND THEY
COMPARED THEM TO ALL THESE
NON-MRI MILESTONES.
ONE IS THE GRAY MATTER TO WHITE
MATTER VOLUME DIFFERENTIATION
PERIOD AND BELIEVE IT MAY
REFLECT CHANGES IN MYELINATION
AND WHAT IS OCCURS IN PEAKS IN
PUBERTY AND OTHER WHITE AND
WEIGHT DEVELOPMENT PEAKS.
THE NEXT SLIDE IS THE MORE
NEUROPSYCHIATRIC ASPECT.
YOU CAN SEE IN THE BLACK BOX THE
DIAGNOSTIC AGE RANGE FOR
PSYCHIATRIC CONDITIONS AND THIS
IS SHOWING THE ONSET OF SYMPTOMS
CAN OCCUR WAY BEFORE YOUR
ACTUALLY GETTING DIAGNOSED WITH
DISORDERS.
BEING ABLE TO CHART BRAIN
MORPHOLOGY ACROSS THE LIFE SPAN
WOULD BE AN ADVANCE TOWARDS
IDENTIFYING IMAGING MARKERS
ACROSS A MULTITUDE OF
PSYCHOLOGICAL AND NEUROLOGICAL
DISEASES.
SO THAT POINT THEY DEVELOPED
THESE SCORES.
THESE ARE SCORES THAT CAN
BENCHMARK EACH SCAN IN THE
CONTEXT OF NORMATIVE AGE-RELATED
TRENDS.
THE BLACK LINE THESE CENTILE
SCORES SHOW MAJOR DES --
DEPRESSIVE DISORDER AND
SCHIZOPHRENIA AND ALZHEIMER'S
DISEASE AND OTHERS AND SHOWING
FOR MALES AND FEMALE AND GRAY
AND WHITE MATTER VOLUME AND
VENTRICULAR VOLUME.
THE LARGEST DEVIATIONS WERE SEEN
FOR ALZHEIMER'S DISEASE, MILD
COGNITIVE IMPAIRMENT AND
SCHIZOPHRENIA AND SEX-SPECIFIC
EFFECTS.
FOR SCHIZOPHRENIA THE IMPACT ON
VOLUME WAS GREATER FOR FEMALES
THAN MALES AND REVERSE WAS TRUE
FOR ADHD WHERE THERE WERE
DIFFERENCES IN THE VOLUMETRIC
DIFFERENCES FOR MALES THAN
FEMALES.
SO IN CONCLUSION IT'S A PROOF OF
PRINCIPLE FOR DEFYING THE
NORMATIVE TRAJECTORIES OF
SEX-RELATED GENES IN PHENOTYPES
ACROSS THE LIFE SPAN AND TO BE
ABLE TO QUANTIFY THE BRAIN SCANS
COLLECTED ACROSS MULTIPLE
CLINICAL DISORDERS AND THIS OPEN
RESOURCE TO BE ABLE TO BENCHMARK
BRAIN MORPHOLOGY FOR FUTURE OR
CONCURRENT STUDIES.
I ENCOURAGE YOU TO CHECK THE
LINK LATER AND SEE WHAT YOU CAN
DO AND HOPE THEY'LL BE ADDING
FO
MORE DATA TO FILL OUT THE CHARTS
GOING FORWARD AND WITH MAJOR
CAVEATS.
AND RELATED TO WHAT ELIZABETH
MENTIONED IT'S BIASSED TOWARDS
EUROPEAN AND WHITE AMERICAN
POPULATIONS AND HIGHLIGHTING THE
IMPORTANCE OF GREATER DIVERSITY
IN OUR IMAGING STUDIES TO CREATE
BETTER TRAJECTORIES MORE
ACCURATE TRAJECTORIES.
HOPEFULLY ABCD AND OTHERS CAN
CONTRIBUTE.
AND THE FETAL AND NEONATAL
GROUPS WERE UNDER REPRESENTED
AND THESE ARE NOT IMMEDIATELY
AVAILABLE FOR USE BUT SHOWS THIS
IS ACHIEVABLE IN A GLOBAL SCALE
AND OVER THE ENTIRE LIFE COURSE.
>> THANK YOU, KIM AND ELIZABETH.
I WANT TO DO A FINAL THANK YOU
TO ALL THE FEDERAL PARTNERS THAT
WE HAVE FOR ABCD.
TO THE 21 RESEARCH SITES AND
COORDINATING CENTERS AND THE
DATA ANALYSIS AND INFORMATICS
CENTER AND HUNDREDS OF
INVESTIGATORS AND TRAINEES AND
MORE RESEARCH ASSISTANTS AND
STAFF PARTICULARLY DURING THE
PANDEMIC HAVE BEEN HEROIC IN
MAINTAINING THE COHORT AND DATA
COLLECTION AS WELL AS THEY HAVE.
AS WELL AS OF COURSE THE NEARLY
12,000 PARTICIPANTS IN AND THEIR
FAMILIES.
WE HAVE TIME FOR QUESTIONS FOR
ANY OF US I THINK.
THANK YOU.
>> THANK YOU.
THAT WAS A WONDERFUL
PRESENTATION AND OVERVIEW OF THE
ABCD STUDY.
SO EXCITING THAT IT'S AT THIS
STAGE.
I JUST WANTED TO POINT OUT A
COUPLE THINGS BECAUSE I THINK
WE'RE DEALING WITH THIS IN THE
FIELD AND YOU DID MENTION THAT
BUT I WANTED TO FOR THOSE WHO
ARE NOT NEUROIMAGERS AND DON'T
DO THIS WORK TO WALK AWAY
THINKING THESE ARE STATIC
MEASURES.
DEVELOPMENT IS VERY DYNAMIC IN
WHAT NEUROSCIENTISTS ARE TELLING
US IS A LOT OF DYNAMIC CHANGES
OCCURRING THROUGH DEVELOPMENT IN
RESPONSE TO SOCIAL AND
ENVIRONMENTAL FACTORS AFFECTING
ABILITIES AND SO TOO THAT IS A
MAJOR CONTRIBUTION OF WHY LARGER
SAMPLES ARE NEEDED AND TO
POO-POO WHAT SINGLE SITE THINGS
WHEN A LOT OF TIMES THOSE
STUDIES ARE IN FACT CONTROLLING
FOR A LOT OF THINGS WHICH YOU
CANNOT DO IN A LARGE SCALE.
THERE ARE TRADE-OFFS WHEN YOU DO
THE MULTI-SITE STUDIES AND
THAT'S IMPORTANT.
IT'S UNFORTUNATE IT'S BEEN
STATED AND COME OUT IN THE WAY
IT HAS BECAUSE THERE'S ACCURATE
REPLICABLE BRAIN BEHAVIOR
ASSOCIATIONS INFORMING CLINICAL
OUTCOMES AND TREATMENT
DEVELOPMENT AND PREVENTION
DEVELOPMENT.
I WANTED TO HIGHLIGHT THAT AND
THE OTHER THING IS THE RESTING
STATE FUNCTIONAL CONNECTIVITIES
IS ONLY ONE ASPECT AND THAT'S
WHAT WAS SHOWN AND THERE'S
GROWING LITERATURE SHOWING
RESTING STATE DOES NOT PREDICT
BEHAVIOR IN A WAY ACROSS
VALIDATED WITH SPECIFICITY
COMPARED TO TAFT AND GRAY MATTER
VOLUME IS ONLY ONE ASPECT AND IT
ALSO CHANGES WITH FOUR DAYS OF
AN INTERVENTION YOU SEE CHANGES
IN GRAY MATTER VOLUME.
I THINK WHEN WE START SAYING THE
WORD NEUROIMAGING IT'S AS IF
IT'S ONE STATIC MEASURE AND IT'S
REALLY PROBLEMATIC AND I WOULD
HOPE GIVEN ABCD INVOLVES SO MANY
INVESTIGATORS AND NOW
COLLABORATORS AND OTHERS, IT
WOULD BE REALLY IMPORTANT FOR
THEM TO BE PRESS RELEASES WIND
UP BEING A CATCHY THING BUT WILL
NOT BE USEFUL FOR OUR FIELD IF
WE'RE THROWING THIS KIND OF
THING OUT IN THE WAY IT --
>> WE TOTALLY AGREE.
WE'VE BEEN HAVING A LOT OF
CONVERSATIONS ABOUT HOW WE
CHANGE THIS MESSAGE THAT SEEMS
TO HAVE GOTTEN OUT THERE AND I
KNOW THAT NICO AND SCOTT ARE
PLANNING A COMMENTARY TO FOCUS
IN ON THE ISSUES YOU RAISED.
THIS IS NOT EVERY NEUROIMAGING
STUDY BUT WHEN THE PRESS GET
AHOLD OF SOMETHING THEY TEND TO
NOT BE AS NUANCED AS WE WOULD
HOPE THEY WOULD BE.
>> CAN I JUST FOLLOW-UP WITH ONE
THING, ONE IS A GRIPE WHICH
YOU'VE ADDRESSED AND THE EITHER
PIECE IS THE DYNAMIC CHANGES
OCCURRING EVEN IN THE AGE GROUPS
BETWEEN 5 AND 7.
IT'S NOT GETTING CAPTURED
BECAUSE YOU'RE NOT BRINGING IN
THOSE FACTORS INTO YOU'RE
MODELLING.
FOR EXAMPLE, RACE IS ONLY ONE
FACTOR.
WHAT ABOUT POVERTY AND ABOUT
ECONOMIC HARDSHIPS AND TRAUMA.
THERE'S SO MANY FACTORS DIRECTLY
AFFECTING VOLUME, RESTING STATE
CHANGES FROM DAY TO DAY, MONTH
TO MONTH.
HOW ARE THESE THINGS GOING TO
GET ACCOUNTED FOR UP THE ABCD
DATA SET?
>> RIGHT.
THAT'S A GOOD POINT.
THAT PAPER I MENTIONED IN
PSYCHOLOGICAL SCIENCE ABOUT
RESPONSIBLE DATA USE HIGHLIGHTS
THOSE VERY ISSUES.
IT FOCUSES IN ON ALL THE
CONTEXTUAL DATA WE DO COLLECT IN
ABCD THAT SHOULD BE INCORPORATED
INTO MODELS WHEN PEOPLE ARE
LOOKING AT THESE OUTCOMES AND
THE DEVELOPMENT CONTEXT LIKE YOU
SAID, THIS IS A DYNAMIC STAGE OF
DEVELOPMENT.
PEOPLE SHOULDN'T BE DRAWING
DETERMINATES TO CONCLUSIONS FROM
WHAT THEY'RE SEEING BECAUSE
THERE'S CHANGES IN THE
ENVIRONMENTS THAT CAN
POTENTIALLY CHANGE TRAJECTORIES.
WE ARE TRYING TO GET THAT
MESSAGE OUT THERE AND THEY NEED
TO LOOK AT THE FACTORS WE DO
COLLECT DATA ON IN ABCD.
I THINK MAKES IT A MUCH RICHER
DATA SET BUT OFTEN ARE LEFT OUT
A
AND PEOPLE ARE LOSING THE
RICHNESS OF THE DATA SET IN
TERMS OF ALL THE FACTORS THAT
CONTRIBUTE TO THE OUTCOMES OF
INTEREST.
I THINK THAT'S ONE OF THE THINGS
BECAUSE THE DATA EXISTS IT JUST
NEEDS TO BE INCORPORATED IN THE
MODELS.
>> ON THE POSITIVE SIDE IT'S
EXTRAORDINARY TO SEE WHAT THE
DATA ARE CAPTURING AND TO THINK
WITH SOMETHING LIKE THE GLOBAL
PANDEMIC AND AN IMPACT THAT'S A
NATURAL EXPERIMENT IN AN ENTIRE
POPULATION WE'LL BE ABLE TO LOOK
AND SEE PREDICTION THAT'S
AMAZING AND WITH ALL THE PAPERS
COMING OUT IS HOW CAN WE PREPARE
THE LAY PUBLIC EVEN OUR FELLOW
SCIENTIST FOR ALL THESE THINGS
ARE NOT THE SAME AND BASICALLY
IT'S TRUE WITH REGARD TO THE
MEASURES AND WITH REGARD TO HOW
THEY'RE HANDLED AND IT IS FILLED
WITH SUBTLETY AND FILLED WITH
POSSIBILITY AND PITFALLS, RIGHT.
HOW DO WE GET GOOD WRITERS TO
TRY HARD IN FRAMING THESE VERY
IMPORTANT PAPERS TO MAKE SOME OF
THESE DISTINCTIONS SO THAT THE
HEADLINES CAN'T BE
OVERSIMPLIFIED TO THE POINT OF
BEING A DISMISSAL OF ALL BRAIN
DATA OR ALL ABCD OR ALL
WHATEVER.
IT CAN BE QUITE EXTREME WHAT
HAPPENS.
>> AND I THINK ONE OF THE OTHER
ASPECTS OF THAT IS AND PUTTING
THE DATA OUT THERE SO PEOPLE CAN
USE IT IS GREAT BUT WITH THAT
COMES PITFALLS AS WELL BECAUSE
NOT EVERYBODY IS GOING TO
INCLUDE THE CONTEXTUAL FACTORS
THEY NEED TO BE INCLUDING IN
DEVELOPING THEIR MODELS.
SO WE ARE LEAVING UP TO THE
SCIENTIFIC COMMUNITY TO EVALUATE
THE SCIENCE THAT'S COMING OUT
BECAUSE IT'S NOT JUST THAT BUT
THE PAPERS COMING OUT AND HOW DO
YOU WEIGH THE PAPERS AGAINST
EACH OTHER.
THERE'S DIFFERENT LEVELS.
>> ABSOLUTELY.
AND LOOKING AT ABCD INVESTIGATOR
PAPERS AND OTHERS TO SEE WHAT
WE'RE SEEING AND PUT IT INTO A
PACKAGE THE LAY AUDIENCE CAN
UNDERSTAND WHAT THE TAKE-HOME
MESSAGE IS.
IT'S VERY COMPLEX.
>> IT'S A CHALLENGE WITH THE
RICHNESS OF ALL THE VARIABLES
EVEN FOR WELL-INTENTIONED PEER
INVESTIGATORS.
THERE'S SO MANY POSSIBLE THINGS
TO INCLUDE.
IT'S QUITE SOMETHING TO
NAVIGATE.
SO YES, PLENTY OF CHALLENGES.
>> AND WITH RESPECT SPECIFICALLY
TO SOME OF THE HEALTH
DISPARITIES ANALYSES IS WHEN WE
WANT TO ENCOURAGE PEOPLE TO LOOK
AT THE DATA AND ENGAGE THE
COMMUNITIES THEMSELVES TO
UNDERSTAND THE CONTEXTUAL
FACTORS MOST RELEVANT TO THE
COMMUNITIES THEY NEED TO INCLUDE
IN THEIR MODELS IF THEY'RE NOT
PART OF THOSE COMMUNITIES.
EVEN THOUGH RESEARCHERS MAY NOT
BE PART OF THE CONSORTIUM THEY
CAN STILL TALK TO THE
COMMUNITIES OF WHICH THAT DATA
REPRESENTS TO UNDERSTAND.
AHMED.
>> AS SOMEBODY WHO'S DONE A LOT
OF IMAGING OVER MY CAREER I TAKE
A DIFFERENT PERSPECTIVE.
THIS HAS SIGNIFICANT
IMPLICATIONS FOR SMALLER SAMPLE
SIZES BUT ESPECIALLY IN THE
CONTEXT OF THESE DISCUSSIONS AND
IN COUNCIL FROM A FUNDING AGENCY
PERSPECTIVE THERE'S A SIDE WE
HAVE TO CONSIDER WHICH IS THAT
REALLY ALL THE BWAS WERE ABOUT
EFFECT SIZES AND RELIABILITY AND
POWER.
DEF
>> AND THE PEOPLE IN A DIFFICULT
SPOT ARE THE TRAINEES BECAUSE
THAT'S WHERE WHAT CAN ADVANCE
YOUR CAREER LIVES ANDEF
>> AND THE PEOPLE IN A DIFFICULT
SPOT ARE THE TRAINEES BECAUSE
THAT'S WHERE WHAT CAN ADVANCE
YOUR CAREER LIVES ANDF
>> AND THE PEOPLE IN A DIFFICULT
SPOT ARE THE TRAINEES BECAUSE
THAT'S WHERE WHAT CAN ADVANCE
YOUR CAREER LIVES A D
>> AND THE PEOPLE IN A DIFFICULT
SPOT ARE THE TRAINEES BECAUSE
THAT'S WHERE WHAT CAN ADVANCE
YOUR CAREER LIVES A>> AND THE PEOPLE IN A DIFFICULT
SPOT ARE THE TRAINEES BECAUSE
THAT'S WHERE WHAT CAN ADVANCE
YOUR CAREER LIVES AND WE NEED TO
LOOK HOW WE STRUCTURE THOSE
FUNDING REQUESTS SHOULD THERE BE
AN ELEMENT OF EVERY PROPOSAL
THAT USES PUBLIC DATA WELL
POWERED AND ENSURE FOLKS
STARTING IN THEIR CAREER AND THE
LAB MEMBERS TIME WILL CONTRIBUTE
TO PUBLICATIONS TO GET THEM
THEIR NEXT POSITION AND TENURE,
AND SO FORTH, THEY'RE PUT IN A
POSITION TO SUCCEED AND NOT GET
CRUSHED BY WHAT'S COMING WHICH
IS A BWAS LIKE TRANSITION IN THE
FIELD THAT I'M PRETTY SURE HIGH
PROFILE PUBLICATIONS WILL START
ACCEPTING SMALL SAMPLE SIZES
LESS AND LESS AND FRANKLY NOT
WITHOUT A REPLICATION AND I
WORRY FOR THE YOUNGER FOLKS.
>> I AGREE BUT GOING BACK TO
REGINA'S COMMENTS IN WE HAVE A
LOT OF CONVERSATION THIS WHEN
ABCD STARTED AND THERE'S A LOT
OF WE CAN LEARN FROM ABCD AND
LARGE STUDIES LIKE ABCD BUT WE
NEED SOME SMALLER STUDIES TO GO
MORE IN DEPTH.
WE DON'T WANT TO RULE OUT
SMALLER STUDIES AND I THINK
THAT'S THE POINT ELIZABETH WAS
MAKING THERE'S STILL VALUE IN
SMALLER STUDIES BUT WE NEED TO
THINK ABOUT WHAT IS HAPPENING IN
THE FIELD AND I THINK WITH
RESPECT TO THIS FINDING IN
PARTICULAR AND WHAT WE'RE
TALKING ABOUT IN TERMS OF HOW
THE MESSAGING HAS BEEN ON IT, I
THINK TO YOUR POINT ABOUT HOW
IT'S GOING TO IMPACT TRAINEES WE
NEED TO MAKE SURE REVIEWERS ARE
ALSO THINKING ABOUT THIS VERY
SPECIFIC TO THE STUDY THE
PROPOSALS THEY'RE EVALUATING AND
WHETHER THEY CAN BE DONE IN
SMALLER SAMPLES.
I DON'T THINK -- IT IS VERY
COMPLICATED BUT I THINK WE NEED
TO RAISE THE LEVEL OF AWARENESS
ABOUT WHERE THIS DOES HAVE AN
IMPACT AND NOT AND I DON'T KNOW
ELIZABETH IF YOU WANT TO SAY
ANYTHING TO THIS KIND OF GLOBAL
ISSUE.
>> I THINK YOU SUMMED IT UP.
WE WANT TO BE CAREFUL ABOUT THE
MESSAGING AND CAREFUL ABOUT THE
MESSAGING AND IDENTIFYING WHERE
LARGE SAMPLES ARE MOST
CRITICALLY NEEDED AND
UNDERSTANDING IF THERE ARE MANY
TYPE OF PARADIGMS WHERE SMALL
SAMPLE SIZES ARE REFLECTED IN
GUIDES PUT FORWARD.
>> ONE OF THE OTHER THINGS ABCD
IS NOT ABLE TO DO AND WE'RE
COLLECTING DATA ON 10,000-FOOT
LEVEL AND SOMETIMES WE NEED THE
STUDIES TO BE DONE WITH MORE
GRANULAR LEVEL OF DETAIL WE
CAN'T DO IN A STUDY THIS LARGE.
I THINK IT'S IMPORTANT WE DON'T
LOSE SIGHT OF THAT.
THE SMALLER STUDIES ARE REALLY
IMPORTANT BECAUSE THEY'RE ABLE
TO GO INTO MORE GREATER DEPTH ON
CERTAIN AREAS.
>> JUST TO MAKE CLEAR I'M NOT
SAYING SMALL STUDIES AREN'T
VALUABLE BUT THEY'RE NOT
VALUABLE WITHOUT A REPLICATION.
AS A REVIEWER I'VE BEEN TURNING
DOWN PAPERS THAT ARE SMALLER
SAMPLE SIZE THAT DON'T HAVE
REPLICATION FOR YEARS BECAUSE
THIS TREND HAS BEEN OBVIOUS FOR
EASILY A DECADE.
THE ISSUE IS AS A FUNDING
AGENCY, WE NEED TO MAKE SURE
THAT WE LOOK ESPECIALLY AT
TRAINEE GRANTS FROM THE
PERSPECTIVE OF IF IN FIVE YEARS
THEY GENERATE THIS KNOWLEDGE
THEIR PROPOSING AND WILL THERE
BE AN OPPORTUNITY TO REPLICATION
AND WHAT CAN WE DO AS FUNDING
AGENCIES DO TO HELP THEM AND NOT
PUSH THEM TO THE VOID.
>> AND SUSAN, LET ME KNOW WHEN
WE'RE OUT OF TIME.
>> YEAH, SO WE'RE ALREADY OUT OF
TIME BUT WHY DON'T WE TAKE THE
NEXT TWO QUESTIONS AND THEN TAKE
A BREAK AND THEN AGAIN WE HAVE
TIME BUILT IN AT THE END TO
CONTINUE THIS DISCUSSION.
>> I THINK THAT'S FINE, SUSAN.
WE CAN TALK ABOUT THIS LATER.
IN FACT I WANT TO BRING UP
SOMETHING I HOPE -- I SUSPECT
WE'RE ALL THINKING ABOUT WHICH
IS SORT OF THE THEMES OF THE
LAST TWO DAYS AND I SIT ON
COUNCIL FOR NIDA AND WE HAD OUR
MEETING YESTERDAY AND ONE HAS
BEEN INEQUITY.
WE KNOW THE ISSUES WE'RE ALL
HERE TO TALK ABOUT ARE
DISPROPORTIONATELY HITTING MORE
COMMUNITIES INCLUDING MY
COMMUNITY, THE AMERICAN INDIAN
COMMUNITY AND TWO, WE'RE
INTERESTED IN THE SOCIAL
DETERMINATES OF HEALTH AND THE
CONTEXT THROUGH WHICH THE
FINDINGS YOU JUST PRESENTED MAY
UNFOLD AND THINK I HEARD OTHERS
BRINGING UP TRAUMA AND STRESS.
SO WHEN I PUT THOSE TWO THINGS
TOGETHER I'M REALLY STRUGGLING
ETHICALLY WITH THE FACT THAT
THESE DATA REPRESENT A VERY
BIASSED PRIVILEGED SAMPLE AND AT
WHAT POINT DO WE JUST SAY NO?
AT WHAT POINT DO WE DEMAND THE
RESOURCES LIKE THIS GET PUT TO
COMMUNITIES HIT THE HARDEST
RATHER THAN SAYING IT'S NOT
FUNDED WELL ENOUGH TO GET THE
GRANULAR DATA?
IT'S NOT A DISCUSSION JUST FOR
YOU ALL BUT SOMETHING THAT IS ON
MY MIND THROUGHOUT THE PAST TWO
DAYS AND WOULD LIKE TO FLAG IT
NOR ROUNDTABLE DISCUSSION LATER.
>> MINE IS QUICK AND WE CAN TALK
LATER THIS AFTERNOON BUT FROM
THE PERSPECTIVE OF A YOUNG
TRAINEE OR INVESTIGATOR THE IDEA
OF AN OVER SIMPLIFIED YOU CAN'T
GET PUBLISHED UNLESS HAVE YOU
HUNDREDS OR THOUSANDS IS
OFF-PUTTING WHEN YOU HAVE
DETRACTORS FOR PEOPLE GOING IN
THE FIELD ANYWAY WITH THE
UNCERTAINTY OF FUNDING AND
PANDEMICS AND WHATNOT AND
REPLICABILITY AND SMALL-TEST
PARADIGMS CAN TAKE YOU VERY FAR.
VERY IMPORTANT FOR THAT TO
HAPPEN.
AND IN ALL THIS SWAY AND
WONDERFUL DATA FROM 10,000 FEET.
THAT'S IT.
>> THANK YOU.
>> OKAY.
WHY DON'T WE TAKE A 10-MINUTE
BREAK NOW AND COME BACK AND HEAR
FROM DR. STACY RASMUS AND THEN
THE ROUNDTABLE.
PLEASE COME BACK AT 1:50.
THANK YOU.
>> HELLO, EVERYONE.
IT'S A REAL PLEASURE TO
INTRODUCE DR. STACY RASMUS THE
DIRECTOR OF THE CENTER FOR
ALASKAN NATIVE HEALTH AT THE
UNIVERSITY OF ALASKA FAIRBANKS
AND OVER HAS TWO DECADES OF
EXPERIENCE WORKING WITH AMERICAN
INDIAN AND ALASKAN NATIVE
COMMUNITIES AND SHE'S BUILT AN
INTERNATIONAL PROGRAM OF
RESEARCH FOCUSSING ON THE
PROMOTION OF INDIGENOUS
STRENGTHS, WELL BEING AND
RESILIENCE IN ALASKA.
THE ARCTIC AND THE PACIFIC
NORTHWEST.
DR. RASMUS LEADS A RESEARCH
PROGRAM FOR UNDERSTANDING THE
INTERSECTIONS OF SUICIDE, MENTAL
HEALTH AND SUBSTANCE USE
DISORDERS.
HE'S RECEIVED AN Ph.D. FROM
ANTHROPOLOGY FROM THE UNIVERSITY
OF ALASKA FAIRBANKS AND HAS A
FASCINATING BACKGROUND AND
PUBLICATIONS.
SHE'S GOING TO TALK ABOUT
SOLUTIONS TO END SUICIDE AND
PREVENT SUBSTANCE USE DISORDER
IN ALASKA AND BUILDING
MULTI--LEVEL STRENGTHS AND
PROTECTIVE FACTORS WITHIN THE
ALASKA NATIVE COMMUNITIES AND
CULTURES TO REDUCE RISK.
DR. RASMUS.
>> THANK YOU SO MUCH, DR. KOOB.
IT'S GOOD TO SEE YOU AGAIN.
LET ME SHARE MY SCREEN.
MY SCREEN SHOWING?
>> LOOKS GOOD.
>> I APPRECIATE THE INTRODUCTION
AND I'M HONORED TO HAVE BEEN
ASKED TO PRESENT TO THIS COUNCIL
I'M EXCITED TO SHARE WORK I
THINK WILL ILLUMINATE
DISCUSSIONS.
I'VE BEEN LISTENING ALL MORNING
TO DISCUSSIONS AND AT FIRST I
WAS CONCERNED MY PRESENTATION
MAY SEEM OFF-CENTERED FROM
DISCUSSION BUT I FEEL IT
ENVELOPS THE DATA WE'RE SEEING
AND THE EMPATHY AROUND COMMUNITY
ENGAGEMENT AND FOCUSSING ON
POPULATIONS AT HIGHEST NEED HIKE
FOUR AMERICAN INDIAN AND ALASKA
NATIVE POPULATIONS AND WANT TO
SHOW YOU YOUNG PEOPLE GROWING UP
LIVING THEIR OUR INDIGENOUS
LIVES ON THE LAND AND BECOMING
MELT THE AND WELL THROUGH
TRADITIONAL WAYS AND BUILDING
THOSE STRENGTHS TO BE ABLE TO
WELL RESIST THE IMPOSED FORCES
AND BECOME WELL IN THEIR LIVES.
SO WE'RE GOING TO LOOK AT A
PREVENTIVE INTERVENTION THAT
AGAIN HAS BEEN BASED ON
COMMUNITY AND CULTURAL PRACTS
AND PROCESSES AND SYSTEMS AND
THIS INTERVENTION HAS ALWAYS
BEEN HERE IN THE ALASKAN
COMMUNITIES WE'LL TALK ABOUT OUR
WAYS OUR PARTNERSHIP AT THE
UNIVERSITY AND OUR RESEARCH HAS
GROWN THE INTERVENTION AND
DOCUMENT THE PROCESS AND
PREDICTIVE FACTORS DO REDUCE
RISK FOR SUICIDE AND ALCOHOL
MISUSE IN PARTICULAR.
I WANT TO FIRST ACKNOWLEDGE OUR
ELDERS AND TEACHERS AND MENTORS.
WITH RESPECT TO ALL THE ELDERS
AND ALSO TO THE DENE PEOPLE OF
THE LANDS THAT ARE OWNED I STAND
UPON AND PRESENT TO YOU TODAY.
SO I WANT TO EMPHASIZE I THINK
IT'S IMPORTANT THAT WE WE CHANGE
THE PARADIGM AND NARRATIVE IN
HOW WE LOOK AT DISPARITIES AND
LOOK AT HOW WE CAN BE BUILDING
STRENGTHS AND RESILIENCE AND
ACKNOWLEDGING THAT PARTICULARLY
WITHIN SPEAKING TO OUR
INDIGENOUS COMMUNITIES OUR
INDIGENOUS COMMUNITIES IN ALASKA
AND ACROSS OUR WORLD HAVE A
HISTORY OF HEALTH, HEALING AND
STRENGTH OVERCOMING MANY PRIOR
EPIDEMICS, PANDEMICS, FLOODS AND
STARVATION AND MANY DIFFERENT
OBSTACLES AND NEED TO HAVE WAYS
TO DRAW UPON OUR STRENGTHS AS
PEOPLE IN COMMUNITIES TO BE ABLE
TO COMBAT AND REDUCE THE
INEQUITIES AND DISPARITIES.
SO WE'LL ACKNOWLEDGE THAT AND
LOOK AT THE WAYS WHERE PEOPLE IN
ALASKA ARE WORKING TO DEFINE THE
PROBLEM AND OUR SOLUTIONS MUST
COME FROM COMMUNITIES FOR
COMMUNITIES MOST IMPACTED.
WE'LL LOOK AT THE WAY THE
COMMUNITIES ARE DRIVING THOSE
SOLUTIONS AND FINALLY WE'LL LOOK
AT THE WAYS THAT RESEARCH CAN
SUPPORT COMMUNITIES AND REALLY
PRODUCE DATA THAT CAN
DEMONSTRATE THE WAY THAT
CREATING CHANGE PARTICULARLY IN
CULTURAL AND SYSTEMS-LEVEL
CHANGE CAN IMPACT INDIVIDUAL
YOUNG PEOPLE'S LIVES AND HEALTH
OUTCOMES.
SO AND CULTURE'S PROTECTIVE.
WE HEAR A LOT AND MUST
ACKNOWLEDGE THE IMPAIRMENT AND
TRAUMA EXPERIENCED BY NATIVE
PEOPLE ALSO RECOGNIZE TO COMBAT
ADVERSITY AND TRAUMA AND
CHILDHOOD EXPERIENCE WE NEED TO
ENGAGE IN WHAT'S PROTECTIVE AND
CONNECTION TO CULTURE AND
IDENTITY IS PROTECTIVE.
FINALLY, IT'S ALCOHOL AND OTHER
DRUGS WERE NOT PART OF OUR
HISTORIES.
ALASKA VERY LARGE AND WE HAVE A
VERY DIVERSE INDIGENOUS
POPULATION.
WE HAVE OVER 180,000 TRIBAL
MEMBERS ACROSS OUR STATE FROM
VERY DIVERSE CULTURAL REGIONAL
GROUPS, AND HAVE OVER 158 TRIBES
RECOGNIZED AND I'LL FOCUS ON ONE
SPECIFIC REGION THE CENTRAL
REGION AND IN OUR STATE WE HAVE
ONE OF OUR MOST REMOTE COMMUNITY
S OF OUR NATION ARE IN AALASKA
-- ALASKA AND THERE'S A
REGIONAL HUB SERVING 59
FEDERALLY RECOGNIZED TRIBES AND
COMMUNES.
THE HUB COMMUNITY IS RIGHT IN
THE MIDDLE AND YOU'LL BE SEEING
PHOTOS AND IMAGES FROM WHAT
WE'RE DOING THE RED DOTS ARE
WHERE WE HAVE OUR INTERVENTION
AND CLINICAL TRIAL ONGOING IN
THE APPLIED COMMUNITIES HERE.
THIS COMMUNITY THERE'S 350 MILES
FROM BETHEL AND YOU MUST TAKE
PLANES TO GET THERE AND THAT'S
WHERE SERVICES ARE REALLY
CENTERED.
THEY'RE VERY LIMITED, CLINICAL
AND REALLY MENTAL HEALTH
SERVICES IN THE ACTUAL
COMMUNITIES.
YOU HAVE TO GO TO BETHEL OR TO
ANCHORAGE.
AND AGAIN THERE'S OTHER
SPECIFICS OF THIS REGION AND WE
HAVE DISPARITIES AROUND ALCOHOL
BUT THERE'S LOCAL OPTIONS AND
THERE'S CERTAIN STRATEGIES FOR
ONGOING IN THE REGION BUT
HAVEN'T SEEN THE KINDS OF REAL
CHANGE THAT WE WANT TO SEE IN
COMMUNITIES AROUND DISPARITIES
AND COMMUNITIES WITH ALCOHOL USE
DISORDERS AND ACCIDENTAL DEATH
ALCOHOL RELATED ARE THE SECOND
LEADING CAUSE OF DEATH AND
SUICIDE 15 TO 29 YEARS OF AGE IS
THE LEADING CAUSE OF THIS.
WE HAVE SERIOUS HEALTH ISSUES
THAT CAME FROM THE TRANSITION
FROM LIVING A TRADITIONAL WAY OF
LIFE WHERE THERE WAS ALL THE
PROTECTIVE RESOURCES IN PLACE
AND HOW THAT BECAME FRAGMENTED.
WE'LL TALK ABOUT HOW OUR
INTERVENTION BUILDS BACK IN
THOSE PROTECTION.
WE HAVE THE HIGHEST SIDE
DISPARITIES AND RATES IN THE
NATION AND MOST IMPACTING THREE
REGIONS BUT THE REGION WE WORK
IN EXPERIENCES THE HIGHEST
SUICIDE RATES.
NATIONALLY UNFORTUNATELY SOME
COMMUNITIES OF THE 59
COMMUNITIES AND WHAT'S IMPORTANT
TO NOTE IS THAT IT'S A
PERCENTAGE OF THOSE COMMUNITIES
THAT MAKE UP THE DISPARITIES.
WE HAVE ONE COMMUNITY THAT HAS A
RATE OF SUICIDE OF 212 PER
100,000 AND THE NATIONAL RATE IS
13 PER 100,000.
SO AGAIN IT'S VERY DIRE AND
UNFORTUNATELY THE SUICIDE IS
IMPACTING MOST UPON YOUNG
PEOPLE, YOUNG ALASKAN PEOPLE AND
THE MAJORITY OF DEATHS BY
SUICIDE ARE BY YOUNG ALASKAN
NATIVE MEN.
ALCOHOL IS INVOLVED IN OUR STATS
VARY BETWEEN 55% AND 60% OF
SUICIDE AND THERE'S ALCOHOL
INVOLVED AND AGAIN THIS IS A
PROBLEM IMPACTING DATA AND THIS
IS FROM OUR OPIOID STATE
DASHBOARD AND WE SAW OVER THE
PANDEMIC AND THE LAST FEW YEARS
WE'VE SEEN ALASKA HAS SEEN SOME
OF THE HIGHEST INCREASES IN DRUG
OVERDOSE DEATHS WHERE WE HAD A
68% INCREASE JUST FROM 2020 TO
2021 AND UNFORTUNATELY IN THE
REGION WHERE WE WERE DOING OUR
WORK ALCOHOL WAS THE DRUG THAT
WAS MOST ASSOCIATED WITH THE
DEATHS AND UNFORTUNATELY WE'RE
SEEING IN THE REGION WHERE WE
WORK IS EXPERIENCING SOME OF THE
HIGHEST RATES NOW RELATED TO
OPIOID OVERDOSE.
SO INDIGENOUS KNOWLEDGE DRIVES
OUR UNDERSTANDING OF WHAT THE
PROBLEM IS RELATED TO YOUTH
SUICIDE.
IT WAS VERY IMPORTANT THAT THIS
WORK BEGAN OVER 28 YEARS AGO AND
WORKING TOGETHER WITH
COMMUNITIES.
AND THE FIRST SLIDE WITH THE
ELDERS IS WITH THE ELDERS FROM
THE COMMUNITY THE COMMUNITIES
NEXT TO IT AND ELDERS CAME
FORWARD AND I WAS A HEALTH
CLINICIAN AND SERVED THOSE
COMMUNITIES AND I DID THAT WHILE
DOING MY Ph.D. AND ELDERS CAME
FORWARD AND ASKED US AND ENGAGED
US AND SAID WE KNOW WHAT'S GOING
ON WITH ON YOU YOUNG PEOPLE.
THEY'RE DISCONNECTED FROM WHO
THEY ARE AND THIS HAPPENED TO US
IN OUR COMMUNITIES.
WE HAVE TO COME BACK TOGETHER
AROUND OUR YOUNG PEOPLE IN THE
WAYS OF OUR ANCESTORS WHERE WE
NEVER HAD HEARD.
WE NEVER KNEW OF A YOUNG PERSON
WHO DIED BY SUICIDE.
THESE ARE THE ELDERS.
THE ELDERS OF TODAY WHO GREW UP
IN THE ABORIGINAL SYSTEM AND THE
ALASKAN NATIVE ANCESTRAL WAY OF
LIFE.
ELDERS TALKED ABOUT GROWING UP
AND IT WAS A CENTRAL HOUSE AND
IT SERVED SO MANY FUNCTIONS.
IT WAS THE SPIRITUAL CENTER.
IT WAS THE UNIVERSITY.
IT WAS WHERE YOU MADE YOUR TOOLS
AND YOU FIGURED OUT WHAT TO DO
WITH THE WEATHER FRONT COMING IN
AND FIGURED OUT WHERE THE GAME
WERE AND PROCESSED MEAT AND
DISTRIBUTE RESOURCES.
THIS STRUCTURE AND IT'S A
STRUCTURE AND THIS COMMUNAL
HOUSE BUT IT'S A VERB AS WELL
IT'S A WAY OF COMING TOGETHER
AND IT WAS A SYSTEM THAT
SUPPORTED THE STRUCTURAL EQUITY.
THEY WOULD CONNECT A YOUNG
PERSONAL WITH THE RESOURCES AND
HEALING THAT NEEDED TO HAPPEN IN
THE QASGIQ.
AND IN COMPARISON THE COLONIAL
THERE WAS SETTLEMENT OF ALASKAN
PEOPLE TO VILLAGES AND
FRAGMENTATION OF THE STRUCTURAL
SYSTEM AND WAY OF LIFE IS
RELATIVELY VERY RECENT.
AND THIS THAT WAS REDRAWN.
WE HAVE YOUTH MATERIALS WE USE
TO TALK ABOUT THIS.
1960s IS WHEN THIS BEGAN TO J
CURVE AND FROM 1967 TO 19 77 THE
SUICIDE RATES FOR YOUNG PEOPLE
DOUBLE AND DOUBLE AGAIN FROM
1977 TO 1987 AND WENT UP SOME
MORE AND THEN JUST STAYED.
THEY'VE JUST STAYED AT VERY HIGH
LEVELS.
AND WE HAVEN'T ON THE SCALE WE
WANT TO SEE WE HAVEN'T SEEN THE
KINDS OF CHANGE WE WANT TO SEE
AS OF YET BUT ON A COMMUNITY
LEVEL AND WHEN COMMUNITIES TOOK
ACTION THROUGH THIS PROCESS AND
THROUGH THE DEVELOPMENT OF THE
QASGIQ AND THE MODEL
INTERVENTION WITH COMMUNITIES
TOGETHER TO COME AROUND YOUNG
PEOPLE AND BRING IN ALL THE
RESOURCES AND TRY AND HEAL SOME
OF THAT FRAGMENTATION.
AND THAT'S REALLY WHAT THIS
PROCESS IS ABOUT.
SO THIS IS OUR LOGIC MODEL AN
INDIGENOUS THEORY OF CHANGE.
WHERE REALLY THE COMMUNITY
WANTED TO MOVE UPSTREAM.
REALLY WANTED TO GO AND WORK
WITH YOUNG PEOPLE AND BUILD
THOSE STRENGTHS, GIVE YOUNG
PEOPLE REASONS FOR LIFE.
AND THE ELDERS TOLD US, IT'S NOT
JUST THAT WE DON'T WANT OUR
YOUNG PEOPLE TO DIE, WE WANT OUR
YOUNG PEOPLE TO WANT TO LIVE AND
TO HAVE A PURPOSE AND KNOW THEY
HAVE A PURPOSE AND TO KNOW HOW
NEEDED THEY ARE TO US.
AND SO THE WHOLE FIRST PART OF
THE INTERVENTION SAY -- IS A
COMMUNITY TRYING TO DRAW FROM
THE NEW AND OLD WAYS TO COME
TOGETHER AROUND YOUNG PEOPLE TO
BUILD PROTECTIVE FACTORS AND IT
STARTS AT THE COMMUNITY LEVEL.
CHANGE STARTS -- THE COMMUNITY
CHANGES FIRST.
BEFORE WE DO ANY ACTIVITIES WITH
YOUNG PEOPLE WE BUILD A
COMMUNITY PROCESS AROUND AND
THEN GAIN FAMILIES AND YOUNG
PEOPLE IN ACTIVITIES.
AND WHAT WE DO WITH OUR RESEARCH
IS WE MEASURE THE BUILDING OF
PROTECTIVE FACTORS.
WE WANT TO END SHOWING HOW AS AN
OUTCOME FOR OUR RESEARCH AND WE
DID MEASURE COMMUNITY LEVEL
OUTCOMES OF OUR RESEARCH AND HOW
COMMUNITY LEVEL OUTCOMES IMPACT
INDIVIDUAL LEVEL OUTCOMES.
SO WHEN WE'RE RECENTERING AND
HAVING QASGIQ TODAY WE SEE
MEANINGFUL CHANGE.
I KNOW I'M COMING UP AGAINST
TIME.
HERE'S IMAGING FROM THIS IS
CHANGE TAKING PLACE NOW AND OUR
RESEARCH CAN HAVE REAL TIME
IMPACTS AND WE HAVE VERY SMALL
SAMPLES SO I'M BIAS TO THE
MEANINGFULNESS OF SMALL SAMPLES
AND TO US TO DISCOUNT SMALL
SAMPLES AND SOMETIMES EVEN THE
TERM TALKING ABOUT SMALL SAMPLES
WE'RE TALKING ABOUT OUR PEOPLE
AND EVERY YOUNG PERSON'S LIFE NO
MATTER IF IT'S ONE 100 OR
100,000 MATTERS JUST THE SAME.
I WANT TO SHOW THE CHANGE
PROCESS THAT'S HAPPENING AND
THIS INTERVENTION REALLY ENGAGES
CULTURE PREVENTION.
IT BUILDS PROTECTIVE CULTURAL
EXPERIENCES AS A WAY OF
MITIGATING AND BUILD COPING AND
OTHER RESILIENT STRATEGIES TO
PROTECT AGAINST RISK.
RISK FROM TRAUMA, FROM ADVERSE
CHILDHOOD EXPERIENCES AND
EMPOWERS THE INDIGENOUS
KNOWLEDGE TO CREATE THE
SOLUTIONS AND TO DELIVER THE
SOLUTIONS.
AS I SAID IN A SERVICE REGION AT
THIS TIME IT'S JUST NOT
ACHIEVABLE TO HAVE A LICENSED
MENTAL HEALTH CLINICIAN IN EVERY
COMMUNITY ALL 59 COMMUNITIES.
THE PROCESS IS SENDING OUT
CLINICIANS TO ESSENTIALLY THE
STOP GAP PRICE HAVE NOT BEEN
WORKING.
WE MUST TRY OTHER WAYS.
AGAIN, THIS IS A
COMMUNITY-DELIVERED
INTERVENTION.
THE ELDERS IN THE COMMUNITY
EYEFIDE -- IDENTIFY PROTECTIVE
FACTORS AND IDENTIFY COMMUNITIES
THAT HAVE PROTECTIVE FACTORS.
THIS IS AN ONLINE MANUAL.
I ENCOURAGE YOU TO CHECK THIS
OUT.
THERE'S VIDEOS, THERE'S BETTER
EXPLANATIONS THAN I'M GIVING
WITHIN THE MANUAL.
THIS IS ONE OF THE COMMUNITIES
AND ALL THE IMAGES I'M GOING TO
SHOW YOU TOOK PLACE OVER THE
PANDEMIC BECAUSE THE PANDEMIC
ABSOLUTELY WE WERE HALFWAY
THROUGH OUR CLINICAL TRIAL AND
THREE COMMUNITIES FOR COVID
PROTECTIONS THE TRIBES SHUT THE
PROJECT DOWN AND ONE COMMUNITY
BY TRIBAL MANDATE, BY RESOLUTION
WANTED ACTIVITY AND RESEARCH TO
CONTINUE SO IT DID.
IT WAS TRANSFORMATIVE FOR YOUNG
PEOPLE DURING THE PANDEMIC.
AGAIN, A LOT OF THE ACTIVITIES
ARE OUT ON THE LAND AND THIS IS
A REAL KEY BENEFIT TO BEING THIS
CLOSE TO A LAND-BASED WAY OF
LIFE AND GENERATED THIS URGENCY
OF WOW, OUR WAY OF LIFE, THIS IS
WHAT WE HAVE, PLANES LITERALLY
STOPPED FLYING TO COMMUNITIES
AND ALL RESTRICTIONS WERE LIFT
AND FOODS WERE PRIMARY
RESOURCES.
THIS COMMUNITY ACTIVELY ENGAGED
YOUNG PEOPLE THE WHOLE TIME
THROUGH THE PANDEMIC.
THESE ARE RIGHTS OF PASSAGE.
GIVING YOUNG MEN AND WOMEN BOTH
BUT GIVING A SENSE OF THIS IS MY
PURPOSE NOW I'M A PROVIDER FOR
MY FAMILY.
I TAKE CARE AND REALIZING YOUR
POWER AND USEFULNESS AND GIVING
IS FUNDAMENTAL TO BUILDING THOSE
STRENGTHS AND REASONS FOR LIFE
AND HEALTHY BODIES ARE HEALTHY
MINDS AND WE KNOW THE
ASSOCIATION BETWEEN HEALTH AND
MENTAL HEALING AND WE KNOW THE
LEADER OF THIS COMMUNITY PROJECT
PUT TOGETHER WHEN THEY WERE
HAULING A WHALE UP ON SHORE SHE
REMEMBERED HANGING UP AT THE
SCHOOL ARE HISTORICAL PHOTOS AND
SHE PUT THESE PHOTOS TOGETHER
AND SAID, THIS IS HOW WE'RE
CONNECTING OUR YOUNG PEOPLE
AGAIN STRENGTHS FROM THE
ANCESTORS TODAY AND AGAIN THESE
ARE THE OTHER COMMUNITIES WHO
ARE STILL PARTICIPATING IN OUR
WORK AND INVENTION WORK AND WHAT
WE'VE SEEN FROM THE FIRST TRIAL
WE'VE SEEN WONDERFUL AND
EXCITING OUTCOMES AND THERE'S AN
EVIDENCE BASE GROWING THAT
SUPPORT BUILDING PROTECTIVE
FACTORS S A USE DISORDER
PREVENTION AND WE HAVE DONE
PILOTS AND FEASIBILITY TRIALS
AND OUR FIRST AND SECOND
PREVENTION TRIAL.
WE HAVE DATA THAT SHOWS HOW WE
GET TO ACHIEVE THESE OUTCOMES
FOR REASONS FOR LIFE AND
SOBRIETY WE CALL IT REFLECTIVE
PROCESSES ABOUT ALCOHOL.
IN CONCLUSION I WANT TO TOUCH ON
OUR OUTCOMES FROM INTERVENTION
SCIENCE AND IN MY TITLE SLIDE I
SHOULD HAVE ACKNOWLEDGED MY
PARTNER IN ALL THIS RAND MY
MENTOR DR. JAMES ALL EN AND
UNDERSTANDING HOW STRUCTURAL
FACTORS IN THIS AND IN
DEVELOPING MEASURES IS HOW TO
MEASURE AND HOW DO WE MEASURE
THESE PROTECTIVE FACTORS?
WE HAD TO CREATE THE MEASURES
AND THAT AGAIN WAS THROUGH OUR
PROCESSES OF IDENTIFYING THE
FUNDAMENTAL AND QUITE UNIVERSAL
COMPONENTS OF WHAT'S PROTECTIVE
FOR YOUNG PEOPLE AND AGAIN
LINKING IT TO CREATING REASONS
FOR LIFE AND THINKING ABOUT
RISKY ALCOHOL USE.
AND THE MEASURES WERE DEVELOP
THROUGH THE LONGITUDINAL
PROCESS.
WE CONDUCT OUR MEASURES WITH
THIS COOL SURVEY APP AND WERE
STILL ABLE TO DO SURVEYS WITH
YOUNG PEOPLE IN THE ACTIVE
COMMUNITIES OVER THE PANDEMIC
BECAUSE WE TRANSFERRED TO BE
ABLE TO SEND LINKS ON
SMARTPHONES AND WERE ABLE TO
STILL COLLECT DATA DURING THE
PANDEMIC.
THIS IS FROM THE PILOT STUDY.
WE HAVE A DYNAMIC WEIGHT LISTED
DESIGN MODEL THAT ALLOWED US TO
LOOK AT DOSE RESPONSE EFFECTS.
THAT'S HOW WE MEASURE BY THE
AMOUNT OF ACTIVITIES YOUNG
PEOPLE GO TO AND THE TYPE OF
ACTIVITIES YOUNG PEOPLE ARE
GOING TO AND WE ALSO LOOK AT
EXPOSURE TO COMMUNITY THE
COMMUNITY PROTECTIVE FACTORS.
AND WE FOUND THE HIGHER DOSE
EQUALS LARGER RESPONSE
PARTICULARLY FOR YOUNG PEOPLE
WHO COME IN WITH LOW PROTECTION
PARTICULARLY LOW COMMUNITY AND
FAMILY PROTECTION.
WE SEE THE MOST RESPONSE AND
MOST CHANGE IN YOUNG PEOPLE.
SO I REFERENCED OUR 20-YEAR
PROCESS AND I CAME HERE TO BE A
PART OF THE PEOPLE AWAKENING
PROJECT AT ALASKA FAIRBANKS FOR
MY Ph.D. AND I'VE BEEN HERE
SINCE AND A PART OF DIFFERENT
PROJECTS AND PREE RECENTLY WE'VE
BEEN AWARDED A PROJECT TO LOOK
AT DEVELOPING A BRIEF AND LOOK
AT THE PROTECTIVE FACTORS AND
TEACHINGS AND THE MODULES PUT
TOGETHER IN THE LONGER, LARGER
COMMUNITY-BASED WORK TO BE
DELIVERED IN CLINICAL SETTINGS
WITH YOUNG PEOPLE SO WE'RE
EXCITED TO START THAT AND THAT'S
OUR TEAM.
I APPRECIATE YOU TAKING TIME TO
LEARN A LITTLE BIT MORE ABOUT
OUR WORK.
I'LL STOP THERE.
>> THANK YOU.
>> I'LL LEAD OFF AND SEE HOW
MANY PEOPLE COME IN BUT DO YOU
SEE A WAY THAT SOME OF THE CORE
PRINCIPLES YOUR DEVELOPING THIS
THIS COMMUNITY CAN BE
GENERALIZED TO NOT ONLY OTHER
ALASKAN COMMUNITIES BUT OTHER
INDIGENOUS COMMUNITIES ACROSS
THE UNITED STATES THAT ARE
HIGHLY VARIED AND EXTEND TO
OTHER DISPARITY GROUPS?
WHAT DO YOU THINK IS THE
30-VIEW?
>> I REMEMBER EARLY ON IN SOME
OF OUR EARLIER PROJECT REVIEWS
WE WOULD THAT WOULD BE A CONCERN
AND THERE'S 25 PEOPLE IN THE
REGI
REGION HOW IS THIS SPECIFIC
TAILORED INTERVENTION -- WHAT
IMPACT WILL THAT HAVE FOR THE
NATION?
THERE'S A SLIDE EARLY ON THAT
SAID EVERY COMMUNITY HAS A
QASGIQ SO THEY HAVE A SYSTEM, A
STRUM -- STRUCTURE, A WAY OF
WORK TOGETHER AND EVERY
COMMUNITY AND CULTURE HAS
PROTECTIVE CULTURES AND A FAMILY
DOES AND WHAT WE HAVE BEEN
SHOWING AND PUBLISHED ON THIS IS
ABSOLUTELY THERE'S TRANSLATION
ALREADY HAPPENING AND STARTING
HERE IN THE INTERIOR WITHAGE
-- ATHBASCAN COMMUNITY AND
FACTORS AND BECOMING WHO YOU ARE
AS A PERSON AND TOOLS FOR LIFE
AND THE PROTECTIVE FACTORS
IDENTIFIED IN THIS DEMONSTRATION
AND THOSE ABSOLUTELY ARE I WOULD
SAY UNIVERSAL TO BUILD
PROTECTIONS FOR ALL YOUNG
PEOPLE.
THERE'S NO REASON AT ALL WHY THE
WHILE THE AMERICANS CAN'T LEARN
FROM LEARN FROM AND TAKE FROM
AMERICAN INDIAN ALASKAN NATIVE
PEOPLE AND HOW MANY TIMES DO WE
SEE THAT SOMETHING DEVELOPED
WITH THAT POPULATION REFERENCED
IN THE ABCD STUDY SO AND WHY
WOULD IT NOT BE TRANSFERRABLE
AND EVIDENCE-BASED PRACTICE
WE'RE FINDING IN OUR
COMMUNITIES?
YOU ALSO ARE INTERVENTION IS
ABOUT THE FUNCTION OF IT.
HOW IT WORKS, THE COMPONENTS
THAT WORK AND HOW THE COMMUNITY
WORKS TOGETHER TO DELIVER IT.
IT'S NOT SO MUCH IT'S FOR.
IT'S GOING TO BE TOUGH TO GO
SEAL HUNTING HERE IN THE
INTERIOR BUT INSTEAD WE'LL GET
GR
GRAYLING AND THAT CAN TRANSLATE
TO OTHER CULTURES AND
COMMUNITIES.
DOES THAT HELP, DR. KOOB?
>> THAT'S GREAT.
I'M NOT SURE WHO'S FIRST BUT
I'LL CALL ON MELISSA FIRST TO
ASK HER QUESTION AND THEN REG
REGITA.
>> IT'S GREAT TO HEAR UPDATES ON
YOUR WORK.
I WANTED TO ASK IF YOU CAN
ELABORATE MORE ON THE POINT I
THINK YOU MADE TWICE ON
MEASURING CONTEXTUAL OR
COMMUNITY AND HOW THEY RELATE TO
BEHAVIORS AND CHANGES.
THE QUESTION FOR MY QUESTION IS
I'M EXCITED SOME NIH FUNDED
RESEARCH ON MEASURING STRUCTURAL
RACISM THAT PREDICT HEALTH AND
WONDER IF YOU CAN TALK MORE
ABOUT THAT BECAUSE I FIND IT
REALLY EXCITING.
>> WE HAVE STRATEGIES FOR
LOOKING THE THE FACTORS
IMPACTING YOUNG PEOPLE.
THE YOUTH RESPONDENT MEASURES
AROUND YOUTH PERCEPTIONS OF
THEIR COMMUNITY AND YOUTH
ENGAGEMENT WITHIN THEIR
COMMUNITY.
WE ASK YOUNG PEOPLE IN OUR
COMMUNITY-PROTECTIVE FACTORS
MEASURES ASK YOUNG PEOPLE TO
THINK ABOUT THEIR COMMUNITY AND
HOW REPORT HOW CONNECTED THEY
ARE TO ELDERS IN THE COMMUNITY
AND INTERGENERATIONAL CONNECTS.
WE HAVE YOUTH REPORT MEASURES
ABOUT COMMUNITY-LEVEL FACTORS.
WE ASK THEM IF THEY ATTEND
TRIBAL COUNCIL MEETINGS AND
OTHER WAYS OF LOOKING AT THE
CONNECTIONS TO THE STRUCTURAL
FACTORS AND ASK THEM WHAT'S
AVAILABLE IN TERMS OF
OPPORTUNITIES FOR EMPLOYMENT FOR
HEALTH AND SUPPORT AND WE ALSO
DO SOCIAL NETWORK ANALYSIS THAT
GETS TO THE INTERGENERATIONAL
CONNECTIONS AND HOW THAT IS
BUILT THROUGH THE PROCESS AND
THEN IN THE STUDY WE HAVE A
PROTECTIVE COMMUNITY FACTORS
SCALE.
SO WE ASK ADULTS -- THIS IS THE
FIRST TIME WE GET ADULT
PERCEPTIONS OF HOW HEALTHY AND
FUNCTIONING ADULTS FEEL AROUND
LIKE THE TRIBAL GOVERNANCE
STRUCTURE, THE SPIRITUAL
STRUCTURE, ARE THERE MORE THAN
ONE CHURCH, DO PEOPLE INTERACT?
DOES THE CHURCH SUPPORT
TRADITIONAL PRACTICES?
WE ASK ADULTS ABOUT THAT AND WE
HAVE FOUND THROUGH THIS A
COLLABORATIVE HUB NOW CONNECTED
WE CONNECT THE TWO PROJECTS
TOGETHER BUT WE FOUND
COMMUNITIES WHERE ADULTS ARE
CONTRIBUTING HIGHER FUNCTIONING
MORE COHESION WITHIN SYSTEM
LEVEL FACTORS ARE LOWER RATES OF
SUICIDE FOR YOUNG PEOPLE.
THAT'S ANOTHER WAY WE MEASURE
IT.
>> THIS IS IMPORTANT WORK AND IT
WAS LOVELY TO HEAR ABOUT THE
OVERVIEW.
I WANTED TO GO IN A LITTLE BIT
DEEPER.
I LOVE THE COMMUNITY CENTER AND
YOUR ILLUSTRATION OF THAT.
THERE WERE A FEW QUESTIONS I HAD
ABOUT IF YOU CAN SPEAK TO
DRDR.
DR. KOOB'S POINT, AS WELL IF
THERE'S A MANUAL YOU HAVE AND
WHO DELIVERS THE INTERVENTION
AND ARE THERE PEER COUNSELORS?
THE REASON I'M ASKING IS IT'S
GREAT THE RESOURCES YOU HAVE.
I'M WONDERING WHAT ABOUT WE KNOW
CONNECTING AND ENGAGING THEM IS
IMPORTANT AND HAVING A HUB OF
CONNECT BUT SOMEONE REACHING OUT
AND BRINGING THEM IN WHETHER
IT'S A BUNCH OF PEOPLE OR A
FAMILY MEMBER.
IT WASN'T -- I WASN'T SURE IF
THERE WERE ACTUALLY TARGET POINT
PEOPLE WHO WERE DRAWING OUT
THOSE WHO WERE VULNERABLE.
IF YOU CAN SPEAK TO THAT SOME
MORE.
>> THIS IS A LINK TO OUR ONLINE
MANUAL OF SORTS THOUGH WE ALWAYS
EMPHASIZE THIS INTERVENTION
ISN'T A COOK BACK AND FOLLOW
STEP 123 AND YOU GET THIS
HEALTHY YOUNG PERSON SO I'LL TRY
TO BE BRIEF IN MY RESPONSE BUT I
DO ENCOURAGE YOU TO LOOK AT THE
MANUAL AND THE INTRODUCTION AND
THE MODEL.
REALLY DESCRIBE OUR
IMPLEMENTATION PROCESS BUT THIS
ESSENTIALLY THIS INTERVENTION
GOES OVER A TWO TO THREE YEAR
PROCESS AND IN THE FIRST MONTHS
IT'S CREATING THE COMMUNITY
DRIVING GROUP BECAUSE IT'S A
COMMUNITY-DELIVERED
INTERVENTIONS AND I WOULDN'T
CALL IT PEER COUNSELING PER SE
BUT DRAWING FROM OUR LOCAL
EXPERTISE BUT IT'S A COMMUNITY
APPROACH SO THE COMMUNITY ALL
COMES TOGETHER AND YES, WE HIRE
TWO COORDINATORS.
WE GENERALLY TRY TO HIRE A MAN
AND A WOMAN FOR BALANCE AND
STRUCTURE WITHIN THIS CULTURE
THAT'S APPROPRIATE.
AND SO WE HIRE TWO COORDINATORS
AND THESE ARE INDIVIDUALS WHO
HAVE KNOWLEDGEABLE AND
COMFORTABLE WITH THE TEACHINGS
OF THE CULTURE.
THAT'S THE FOREMOST
QUALIFICATION AND BEING A
RESPECTED MEMBER OF THE
COMMUNITY AND SOMEONE TO BE
CONSIDERED A GOOD ROLE MODEL FOR
YOUNG PEOPLE.
THAT'S PARAMOUNT.
WE HIRED TWO COORDINATORS.
THEY COMMUNITY TOGETHER AND HAVE
AND WE HAVE AND THEY COME UP
WITH THE ACTIVITIES THEY'LL DO
BASED ON THE SEASONAL CALENDAR
AND THERE'S A SELECT GROUP.
THERE'S TWO COORDINATORS.
THEY DON'T JUST DO ALL THE
ACTIVITIES, THEY BRING IN
EXPERTS BECAUSE THE TWO
COORDINATORS MAY NOT KNOW HOW TO
MAKE BUILD SPEAR THROWER AND
THINGS BUT OTHER MEMBERS OF THE
COMMUNITIES DO AND YOU BRING
THEM IN AS INSTRUCTORS AND THEN
WE HAVE THE ACTIVITIES WITH
YOUNG PEOPLE AND USUALLY WE DO
SO IT'S DONE THAT WAY.
>> IF I MAY, SUSAN, ONE MORE
QUESTION FROM JILL BECKER AND
LET YOU OPEN IT UP FOR
EVERYBODY.
>> IT'S WONDERFUL WORK.
THANK YOU FOR ALL YOU'RE DOING.
YOU MENTION THE INCIDENTS OF
SUICIDE IN YOUNG MEN WAS
SIGNIFICANTLY GREATER THAN FOR
YOUNG WOMEN AND YOU USE MEN AND
WOMEN AS COUNSELORS.
ARE THERE DIFFERENT STRATEGIES
YOU'RE USING FOR YOUNG MEN
VERSUS YOUNG WOMEN IN THE
COMMUNITY AND HOW DOES THAT
FACTOR INTO THE PROFESSION.
>> IT'S SUICIDE DEATHS THAT ARE
HIGHER AMONG ALASKAN MEN AND
SUICIDE ATTEMPTS AND
HOSPITALIZATIONS FOR SUICIDE
TEAMS ARE HIGHER AMONG YOUNG
WOMEN.
AND THIS IS A UNIVERSAL
PREVENTION STRATEGY.
THAT WAS ANOTHER PART OF YOUR
QUESTION ABOUT HOW WE BRING
PEOPLE IN.
IT'S ALL YOUNG PEOPLE.
THE COMMUNITY IDENTIFIED THOUGH
A FOCUS ON 12 TO 18 YEAR OLDS
BUT WE NEVER TURN PEOPLE AWAY
WHO IF YOU'RE 19 OR 20 YOU'LL
STILL BE A PART OF IT SO IT'S
UNIVERSAL INTERVENTION PROCESS
AND SO IN THAT YOUNG MEN AND
WOMEN ARE INVOLVED BUT THERE'S
TAILORING AROUND BEING A YOUNG
MAN YOU'RE TAUGHT TO BE A
POWERFUL MAN AND PROVIDER BUT
YES, TRADITIONAL GENDER ROLES
ARE AN IMPORTANT ASPECT OF THIS
TEACHING AND RECOGNIZING
TRADITIONAL GENDER ROLES AND HOW
THOSE HAVE CHANGED AND HOW
TRADITIONAL GENDER ROLES FOR
YOUNG MEN IN PARTICULAR HAVE
CHANGED SIGNIFICANTLY OR IN WAYS
THAT ARE AGAIN IMPACTING YOUNG
MEN AND THEIR SENSE OF PURPOSE
AND PLACE AND CONTRIBUTION TO
COMMUNITY.
IN THAT WAY I WOULD SAY
ACTIVITIES ARE TAILORED TO
ADDRESS GENDER ROLES AND THE
TRANSITION AND HOW TODAY TO BE A
HEALTHY YOUNG MAN OR WOMAN.
>> THANKS, STACY.
I WAS STRUCK BY YOUR COMMENT
ABOUT TRYING TO BRING THE
CULTURAL INTERVENTIONS TO OTHER
COMMUNITIES AND I DON'T KNOW IF
YOU'VE READ THE BOOK DREAM LAND
WRITTEN YEARS AGO TALKING ABOUT
THE BEGINNING OF THE OPIOID
CRISIS AND DREAM LAND REFERRED
TO THE SWIMMING POOL IN THE
COMMUNITY CULTURE AND THE
DISILLUSION OF THE COMMUNITY
THAT WAS A FACTOR THAT LED TO
THE OPIOID CRISIS AND WITHOUT
RESTRUCTURING OR BRINGING THE
COMMUNITY BACK TOGETHER, WE WERE
NOT GOING TO MAKE PROGRESS.
I THINK WE'RE STILL SUFFERING
FROM THAT BUT I THINK THE IDEA
OF LEARNING FROM WHAT YOU'RE
DOING AND TRYING TO FIND WAYS TO
TRANSFER IS IMPORTANT.
THANK YOU.
>> WE'VE RECENTLY RESOURCE ED --
RECEIVED FUNDING FROM DOD AND
DOING A TRANSLATION OF THIS
INTERVENTION AND WORKING WITH
OUR ARMY BASE HERE AND IT'S A
CULTURE THAT'S VERY SIMILAR IN A
LOT OF WAYS TO TRIBAL CULTURES
AND NATIONS I'VE HAD IN
DISCUSSIONS WITH OUR ARMY
GENERAL FOR ALASKAN COMMAND AND
HE GETS IT IN TERMS OF WHAT AT
THE SYSTEM LEVEL NEEDS TO HAPPEN
FOR SOLDIERS AND IN ALASKA WE'RE
HAVING CLUSTERING AFTER CLUST
ERS OF SUICIDE AMONG SERVICE
MEMBERS.
I WAS ENCOURAGE THE MILITARY'S
RESPONSE AND BEING ABLE TO SEE
HOW THIS COULD TRANSLATE INTO A
CONTEXT LIKE THAT.
WE'LL BE DOING THAT AND IT
SHOULD BE INTERESTING.
>> WE'RE FINALLY AT THE OPEN
TABLE DISCUSSION AND THIS CAN BE
A CONTINUATION OF ANY
DISCUSSIONS STARTED EARLIER OR
ANYTHING ELSE YOU'D LIKE TO
BRING UP.
ARE THERE ANY -- DOES ANYONE
WANT TO START?
>> I WAS INTRIGUED BY THE
EFFORTS OF INCREASING EQUITY,
DIVERSITY AND INCLUSION IN ABCD
AND THE START PROGRAM.
I'M WONDERING ABOUT DEVELOPING
GUIDELINES FOR HOW IT PLACE DATA
IN CONTEXT AND GATHER CONTEXTUAL
FACTORS IF YOU THINK THE START
PROGRAM COULD A WAY TO DEVELOP
THOSE KINDS OF GUIDELINES FOR
RESEARCHERS EITHER WITHIN OR
WITHOUT OUTSIDE THE STUDY USING
DATA AND THE VARIOUS ASPECTS OF
IT THAT NEED TO ATTEND TO
WHATEVER IT IS, RACE, ETHNICITY,
DIVERSITY AND CONTEXTUAL
FACTORS.
>> THERE WAS A GREAT DISCUSSION
AT THE KICKOFF MEETING AMONG THE
YOUNG SCHOLARS ON THEIR
PERSPECTIVES AND WHAT SHOULD BE
INCLUDE AND ONE OF THE FOLKS ON
THE ABCD GROUP DISCUSSING
RESPONSIBLE DATA USE WAS PART OF
THE COHORT.
WE ARE HAVING THE CONVERSATIONS
AND WE'RE TRYING TO BROADEN THE
CONVERSATIONS AND FIND DIFFERENT
WAYS TO GET THE SCIENTIFIC
COMMUNITY AT LARGE INVOLVED IN
THE DISCUSSIONS.
IT'S SOMETHING WITH A PUSH FOR
OPEN DATA HAS BEEN LAGGING.
AND IF PEOPLE ARE GOING TO
ACCESS THE DATA SET WE NEED TO
BE THINKING OF THIS FROM TO THE
O
OUTSET AND TRYING TO CATCH UP
NOW.
>> MAY BE PART OF THE OPEN USE
FOR DATA.
>> THAT'S SOMETHING WE'VE BEEN
IN DISCUSSIONS ABOUT FOR SOME
TIME.
THERE'S A NEED FOR TRAINING
BEFORE GETTING ACCESS TO DATA IN
HOW TO DO THIS IN A RESPONSIBLE
WAY.
ELIZABETH HAS BEEN TALKING TO
ALL OF US WHO HAS BEEN DOING A
GOOD JOB IN DEVELOPING TRAINING
FOR HOW TO ETHICALLY AND
RESPONSIBLY ANALYZE THESE KINDS
OF LARGE DATA SETS SO WE CAN
INCORPORATE THAT INTO OUR DATA
ACCESS MODEL MOVING FORWARD.
>> IDEALLY IT WOULD BE BROADER
EFFORT AND HOPING TO DEVELOP AND
TAKE THEIR LEAD AND WITH AND WE
HAVE A DATA MANAGEMENT POLICY IN
PLACE TO ACCESS THE DATA PEOPLE
WOULD HAVE TO HAVE SOME
COMPLETION AND THEN KEEPING THAT
UP SO THEY'RE NOT DOING
TRAINING AND ANALYSIS AND NEVER
COMING BACK AND WANT IT BUILT IN
SO PEOPLE ARE AWARE AND EDUCATED
AND HAVE KNOWLEDGE AND REACHING
DATA USERS ACROSS THE SPECTRUM
OF TRAINING.
AND IT'S LIKELY TO POTENTIALLY
USE DATA IN WAYS THAT ARE NOT
NECESSARILY INFORMATIVE OR
CONTEXTUALLY INFORMED.
THIS UNDER SCORES THE IMPORTANCE
OF A TRAINING MODULE.
>> AN WE'LL NEED A SYSTEM FOR
ADJUDICATING FOR CASES WHEN
PEOPLE MISUSE THE DATA AND
SOMETHING ALL OF US IS DOING AND
WE'RE TRYING TO LEARN FROM TERMS
OF THEIR EXPERIENCE IN TO DO
THAT EFFECTIVELY.
>> WITHOUT ANTAGONIZING PEOPLE
YOU WANT TO USE THE DATA AND
BRINGING IN DATA AND DIVERSITY
LIKE WITH START AND THEN HAVE
YOU PEOPLE LIKELY IN THE EARLY
STAGES OF THEIR CAREER AND WHO
YOU REALLY WANT TO BE ABLE TO
ALSO HAVE AT THE TABLE ARE
PEOPLE WHO REPRESENT DIVERSE
BACKGROUNDS AND HAVE THE
EXPERIENCE AND TRACK RECORD AND
MAYBE THIS NEW TO THEM OR CAN BE
THE BIGGEST LEADERS OF CHANGE
AND APPROACH.
>> AM I ON VIDEO OR MUTE?
YOU CAN BE HEARD.
IT'S GREAT TO LEARN ABOUT THE
TRAINING AND HOW SUCCESSFUL IT'S
BEEN BUT IN TERMS OF THE JOB WE
HAVE TO HELP GUIDE WORKING
PRACTS
PRACTSES -- PRACTICES TO GRANTS
AND IT STRIKES ME IN THE WORK
I'VE BEEN DOING WITH THE
NATIONAL ADVISORY GROUP BUT
AALSO APPLIES TO OTHER GROUPS
AND THAT'S THE ROLE OF THE
PROJECT MANAGERS.
YOU KNOW THE PROJECT MANAGERS
HAVE A LOT OF EMPOWERMENT AND IN
THE ONCOLOGY SPACE THEY'LL
PROBABLY HAVE MORE WITH THE MOON
SHOT TWO TO PASS THE SCIENTIFIC
ADVISORS AND EMPOWER MORE AND
MORE THE PROJECT MANAGERS.
I'M WONDERING IF THERE'S OTHERS
IN THIS CALL OR GROUP WHO STILL
SEE THE SAME DYNAMIC AND THE
PROJECT MANAGERS ARE TRAINED IN
THIS AND HOW THEY INTERACT WITH
THE GRANT APPLICANTS AND HOW
THEY TRAIN THEM IN DIFFERENT
VENUES GOING FORWARD.
YOU CALL THEM PROGRAM MANAGERS
IN DIFFERENT INSTITUTES.
>> IT'S HARD TO ANSWER BAYS
THERE'S A VARIETY OF MECHANISMS
BY WHICH WE SUPPORT THINGS AND
IN ONLY DO WE HAVE PROGRAM
MANAGERS OVERSEEING THE PROJECTS
THAT THEY'RE PART OF LIKE FOR
EXAMPLE THE ABCD STUDY BUT I
THINK THE POINT IS IMPORTANT AND
WE HAD A DISCUSSION ABOUT DATA
SHARING AND ACCESS AND THE MORE
WE GET INTO THIS SORT OF THING
AS WELL AS HAVING THESE LARGE
DATABASES THE MORE IMPORTANT IT
BECOMES THAT PEOPLE ARE USING
THEM RESPONSIBLY AND KNOW HOW TO
USE THEM AND KNOW WHAT THE
LIMITATIONS ARE AND WHAT THEY
CAN SAY AND HOW TO CONTEXTUALIZE
THEIR QUESTIONS OR HOW TO BE
THOUGHTFUL ABOUT THE QUESTIONS
AND ABCD BROUGHT TO OUR
ATTENTION PEOPLE CAN MISUSE THE
DATA IN WAYS THAT COULD BE
HARMFUL AND MAKING SURE PEOPLE
ARE KNOWLEDGEABLE AND THOUGHTFUL
AND FINDING WAYS TO ADJUDICATE
WHETHER OR NOT THAT'S REALLY
HAPPENED AND HOW DO WE KEEP
PEOPLE FROM DOING THAT AND WE'RE
OPENING UP A WHOLE OTHER SERIES
OF QUESTIONS WHICH INVOLVES
TRAINING AND IT INVOLVES
TRAINING IN AREAS PEOPLE MAY NOT
HAVE YESTERDAY.
WE'RE TRYING TO LEARN FROM EACH
OTHER AND FIGURE OUT HOW TO DO
AND THAT CREATE REASONABLE
EXPECTATIONS.
>> I THINK THERE'S STRUCTURES IN
PLACE TO ENSURE PROGRAM
DIRECTORS DO NOT GO OUT LOOSEY
GOOSEY IN TERMS OF HOW THEY
INTERACT WITH THE SCIENTIFIC
COMMUNITY.
THERE WOULD NOT BE AN INITIATIVE
WITHIN THE NCI THAT WOULD BYPASS
THE BOARD OF SCIENTIFIC ADVISORS
OR ANY OTHER OF THE OTHER BOARDS
OR COMMITTEES IN PLACE.
I'M SURE THAT'S THE SAME WITH
ANY OF THE I.C.s.
>> SOME OF THE INITIATIVES I
TALKED ABOUT WERE MOONSHOT
INITIATIVES BUT ULTIMATELY WERE
WORKED ON AND DEVELOPED AND
FLUSHED OUT BY OUR PROGRAM
OFFICERS AN WENT THROUGH BSA.
>> HAVE WE ADDRESSED YOUR
CONCERNS?
>> I'M CONFUSED BECAUSE THE
CONVERSATION WITH KEITH FLAHERTY
AND OTHERS IS THE PLANNING FOR
MOONSHOT 2 WILL NOT GO THROUGH
BSA.
>> MOONSHOT 2 WOULD BE A
PRESIDENTIAL INITIATIVE AND KEEP
THIS CORRECT, THEY'VE BEEN
PLANNING FOR THE MOONSHOT
INITIATIVE IT MUST GO THROUGH
THE NATIONAL CANCER ADVISORY
BOARD.
THAT'S THE NCI'S PRESIDENTIAL
APPOINTED BOARD.
>> OKAY, GREAT.
>> YOU'RE GOOD?
>> WITH YOU I ALWAYS LOVE TO BE
GOOD.
YOU MAKE ME BE GOOD.
>> I THINK IT'S A MATTER OF
PROCESS.
IT'S A PRESIDENTIAL INITIATIVE.
THERE WILL BE PRIORITIES
IDENTIFIED AS THERE WERE BY THE
BLUE RIBBON PANEL IN THE FIRST
MOONSHOT BUT ULTIMATELY IT
DRIBBLES DOWN TO THE STAFF AND
THEY END UP BEING THE ONES TO
DEVELOP THE INITIATIVES AND
THERE'S A PROCESS FOR THAT TO
HAVE IT APPROVED BY OUR PROGRAMS
LEADERS GROUP AND THE DIRECTOR
AND THE DIRECTORS OF OUR VARIOUS
DIVISIONS AND ULTIMATELY UP TO
BSA.
>> IF IT'S A CONCEPT INITIATIVE
THEY MUST BE APPROVED BY THE BSA
AND WHEN THE GRANTS COME IN,
SECOND-LEVEL PEER REVIEW OCCURS
WITH THE NCAB HOWEVER, THOUGH
THAT'S A PROCESS WHEN IT'S A
PRESIDENTIAL INITIATIVE, THE
IMMEDIATE DISCUSSION WOULD OCCUR
WITH THE CANCER ADVISORY GROUP.
>> I WANT TO BRING BACK UP THE
CONVERSATION WITH CHANGING THE
WAY WE APPROACH ALL OF THIS SO
EQUITY IS FRONT AND CENTER.
EVERYTHING'S GETTING WORSE IN
TERMS OF INEQUITIES.
THE PANDEMIC ONLY EXACERBATED
IT.
IF WE KEEP DOING SCIENCE THE WAY
WE'VE BEEN DOING IT, WHY WOULD
WE EXPECT A DIFFERENCE IN OUR
OUTCOMES?
I THINK STACY'S PRESENTATION AND
ALL THIS WONDERFUL WORK AROUND
COMMUNITY-DRIVEN,
COMMUNITY-BASED PARTICIPATORY
RESEARCH IS A PARADIGM SHIFT.
PEOPLE DON'T GET IT.
THEY THINK IT'S A QUALITATIVE
METHOD.
IT'S NOT.
IT'S IN APPROACH.
IT RELATES TO THE CONVERSATION
OF MOONSHOT INITIATIVES SORT OF
IN CAN WE CHANGE THE WAY
RESOURCES ARE ALLOCATED SO THAT
RELATIONAL COMMUNITY OUTREACH
AND PERIODS ARE MUCH LONGER SO
THAT AND CHRISTINA, YOU ARE
RUNNING THIS STUDY AND I MARVEL
AT HOW FAST YOU HAVE TO RAMP IT
UP WITHOUT RESOURCES AND CURIOUS
WHAT PEOPLE'S GRAND IDEAS ARE
AND I KNOW THERE'S TASK FORCES
AND ALL SORTS OF THINGS BUT I
WOULD LOVE RADICAL THINKING AND
DEMAND IF TAXPAYER FUNDS ARE
GOING TO THESE MAJOR STUDIES,
THEY SERVE THE PEOPLE WHO ARE
PART.
>> I CAN SPEAK TO THE FACT THAT
WITHIN OUR OWN INSTITUTES WE'RE
WORKING HARD TO ADDRESS THE
ISSUES YOU'VE RAISED.
I THINK BILL MENTIONED THIS WITH
THE CENTERS AT NCI AND IT CAME
UP AT OUR COUNCIL TODAY ABOUT
REQUIRING OUR CENTERS TO HAVE A
DIVERSITY PLAN.
SO WE'RE AT THAT AND THERE ARE
MULTIPLE INITIATIVES THERE'S
INITIATIVES GOING ON AT NIH ON
DISPARITIES AND EQUITY AND SO
FORTH BUT WE'RE ALL COMING UP
WITH INDIVIDUAL PLANS FOR OUR
INSTITUTES AND THOSE ARE BEING
REVIEWED CURRENTLY I UNDERSTAND
YOUR FRUSTRATION AND UNDERSTAND
THE FRUSTRATION WITH WHAT
HAPPENED DURING THE PANDEMIC BUT
THE ONLY BEING THE ETERNAL
OPTIMIST IS THINGS ARE UNDERWAY
AND I THINK THERE'S GOING TO BE
CHANGE.
IT'S GOING ON THE NUMBER ONE
PRIORITY IN OUR STRATEGIC PLAN
WILL BE DIVERSITY AND EQUITY AND
UTILIZING THAT AS AN ENGINE TO
IMPROVE THE INNOVATIVENESS OF
RESEARCH.
I'M STOP THERE AND MAYBE SOMEONE
WANTS TO COMMENT.
I KNOW NORA WOULD IF SHE WERE
HERE.
>> AND STARTING IN 2020 NORA
LAUNCHED OUR RACIAL EQUITY
INITIATIVE DESIGNED TO SOME OF
THE LONG-STANDING SOCIAL
INEQUITIES AS OUR COMPONENT OF
THE WORLD WE HAVE THE MOST
INFLUENCE ON.
WE CERTAINLY SEE THIS AS BEING
WELL BEYOND JUST THE SCIENTIFIC
ENTERPRISE BUT EXTENDING TO MANY
ASPECTS.
THIS HAS THREE MAJOR COMPONENTS.
ONE IS TO FOCUS INTERNALLY
THERE'S AN EQUITY PLAN
DEVELOPMENT FOR EACH INSTITUTE
UNDERWAY NOW TO LOOK INTERNALLY
AT OUR OWN INTERNAL WORKPLACE
ISSUES.
ONLY IF WE GET OUR OWN HOUSE IN
ORDER CAN WE WORK WITH THE
EXTERNAL COMMUNITY ON OTHER
ISSUES.
THE OTHER COMPONENTS ONE IS
FOCUSSING ON WORKFORCE
DIVERSITY.
WE HAVE A DREADFUL SITUATION IN
TERMS OF LACK OF DIVERSE AND
VERY FEW ALASKAN NATIVE ARE
PRINCIPLE INVESTIGATE AND VERY
FEW AFRICAN AMERICAN ARE
INVESTIGATORS AND LEADERS OF OUR
PROJECTS.
THIS IS A COUPLE OF EXAMPLES OF
PLACES WHERE WE ARE PUTTING IN
EXTRA EFFORTS TO ADDRESS
LONG-STANDING DISPARITIES AND I
CAN'T TELL WHETHER YOUR COMMENT
FOCUSES ON THE WORKFORCE OR THE
HEALTH DISPARITIES.
IT'S A LITTLE BIT OF BOTH, I
THINK.
IT'S BY CHANGING THE WORKFORCE
WE MAY HAVE BETTER OPPORTUNITIES
TO ADDRESS HEALTH DISPARITIES.
I WOULD POINT A CONVERSATION WE
HAD YESTERDAY SEVERAL ARE AWARE
OF AT THE NIDA COUNCIL REGARDING
OUR MERIT AWARDS THESE AWARDS
THAT BRING RECOGNITION AND EASE
OF FUNDING.
THAT'S THE MOST PRACTICAL ISSUE
IT GIVES LONGER TERM FUNDING FOR
VERY ESTABLISHED SENIOR
INVESTIGATORS.
BECAUSE OF THE INEQUITIES AND
DISPARITIES IN HOW THEY'RE
AWARDED WE'LL LOOK HARDER AT
THAT AND ONE EXAMPLE WHERE WE'VE
PUT IN EFFORTS JUST IN THE LAST
COUPLE DAYS.
I'LL ALSO POINT OUT SEVERAL HAVE
BEEN HEAVILY INVOLVED IN THE
RAPID DIAGNOSTICS FOR UNDER
SERVED POPULATIONS INITIATIVE
PART OF THE COVID PROGRAM TO
BRING TESTING TO UNDER SERVED
POPULATIONS AND THAT HAS BEEN A
VERY MUCH A COMMUNITY-BASED
PARTICIPATORY RESEARCH PROGRAM
BUT ALSO STRUGGLED WITH DATA
SHARING AND COORDINATION.
I WAS INTERESTED IN THE PREVIOUS
DISCUSSION AROUND HOW DO WE
ASSURE THAT DATA SHARING IS DONE
IN A WAY THAT PAYS ATTENTION TO
THE NUANCES OF THE ORIGINAL DATA
AND DOESN'T MISINTERPRET THEM
BECAUSE THAT HAS A HUGE
IMPLICATION IN FROM MULTIPLE
PLACES.
IT'S A LITTLE BIT OF A RAMBLING
ANSWER BUT YOU HAVE OUR
ATTENTION AND BY BRINGING IT UP
HERE YOU INCREASE THE VISIBILITY
OF THE IMPORTANT ENTRENCHED
ISSUES WE LOVE YOUR IDEAS ON HOW
TO SOLVE THEM.
>>I DON'T HAVE A LOT OF MORE
SPECIFIC TO SAY EXCEPT HOW WE'VE
LOOKED AT THESE DISORDERS AND
ARE WE GOING TO WE'RE NOT GOING
TO BE ADDRESS THESE RIGHT AWAY
BUT I THINK THE MORE THAT WE ARE
THINKING ABOUT IT AND
INCORPORATING THEM INTO
OPPORTUNITIES AND MORE THINGS
WILSON SAID ABOUT INCORPORATING
RESEARCHERS FOCUSSED ON THAT AND
MORE SOCIAL SCIENTISTS OR
BEHAVIORAL SCIENTISTS THAT ARE
COMING FROM DIFFERENT
BACKGROUNDS.
THOSE ARE THINGS WE'RE VERY MUCH
AWARE OF AND VERY MUCH TRYING TO
CHANGE IN THE WAY IN WHICH WE
ARE DOING THINGS BUT PROBABLY
NOT FAST ENOUGH BUT WE ARE
TRYING TO GET THERE.
>> I WOULD ADD DR. VOLKOW HAS
SPECIFICALLY ASKED OUR STAFF AS
THEY'RE MAKING RECOMMENDATIONS
FOR CONSIDERATION TO SUPPORT
LESS-RESOURCED INSTITUTIONS AS
WELL.
THE MINORITY-SERVING
INSTITUTIONS, HISTORICALLY BLACK
COLLEGES AND UNIVERSITIES AND
OTHER NON-RO1 INSTITUTIONS ARE
GETTING A PARTICULARLY CAREFUL
LOOK IN OUR FUNDING AS ANOTHER
WAY TO WE HOPE WILL BEGIN TO
ADDRESS THE STRUCTURAL
INEQUITIES IN DISTRIBUTION OF
FUNDING.
>> SO MANY IMPORTANT
DISCUSSIONS.
I LIKE ALL THE DISCUSSION ABOUT
INCREASING DIVERSITY, EQUITY AND
INCLUSION WITHIN OUR SCIENCE
COMMUNITY AND WHETHER WE
INTEGRATE INTO BIO SKETCHES AND
ASK FOR WHAT THE DIVERSITY OF
THE LAB LOOKS LIKE AND FOR WHAT
PEOPLE ARE DOING WITHIN THEIR
OWN INSTITUTION AND WHAT THEIR
PORTFOLIO LOOKS LIKE.
THE MORE OF THOSE METRICS ARE
INTEGRATED FULLY INTO THE ENTIRE
SCIENCE PROCESS THE MORE
FACILITATES PEOPLE REALLY PAYING
ATTENTION TO IT AND DOING IT.
I THOUGHT YESTERDAY'S DISCUSSION
THE IDEA ALSO OF INCREASING THE
ABILITY FOR PEOPLE WHO ARE
MENTORS AND MENTEES AND JUNIOR
AND SENIOR FACULTY ACROSS
MULTIPLE INSTITUTIONS TO SHARE
THEIR EXPERIENCES WITH OTHERS
FROM MULTIPLE COMMUNITIES AND
BACKGROUNDS AND THIRD I JUST
THOUGHT IT'S A REMARKABLE
PRESENTATION ABOUT WORKING WITH
COMMUNITIES SO THE CAN ADVANCE
THE PRESENTATION SOMETIMES WHAT
WE HAVE IN RESEARCH IS THAT YOU
CAN CULTURALLY ADAPT
INTERVENTIONS.
THAT'S NOT COUNTER TO SCALING
UP.
I THINK YOU CAN SCALE UP BY
TAKING THINGS THAT WORK AND
HAVING COMMUNITIES ADAPT THOSE
OR CONSIDER THEM FOR ADAPTATION
DEPENDING ON WHAT IS OR ISN'T
VIABLE FOR THAT PARTICULAR
COMMUNITY AND IT'S A WAY TO
CONSIDER HOW TO ADVANCE POSSIBLE
RFAs FOR THOSE KINDS OF THINGS
SO THE WORK STACY'S DOING I
THINK SOMEBODY PUT IN THE CHAT
ABOUT A CONSORTIA OF COMMUNITIES
THAT WANT TO ADAPT PARTICULAR
THINGS SAY FROM STACY'S MODEL
AND IT WOULD BE WAY BEYOND
ALASKA.
IT COULD BE IN ALL SORTS OF
COMMUNITIES THAT REALLY ALMOST
TO THIS POINT ARE EXTREMELY HARD
HIT BY ALL THESE THINGS.
JUST IN THE LAST HOUR I'VE
GOTTEN LIKE FOUR TEXTS TRYING TO
GET ADOLESCENTS INTO TREATMENT.
FOUR TEXTS.
THIS GOES ON ALL DAY.
WHAT WE CAN DO TO MOVE THE
AGENDA FORWARD AS FAST AS WE CAN
COULD BE WELCOME OUT HERE
WELCOME IN THE FIELD.
>> I'VE DONE WORK WITH COMPANIES
IN HOW TO MOVE THE NEEDLE AND
WHO IS REVIEWING THE STUDIES.
I CAN TELL YOU -- I'M A BASIC
SCIENTIST BUT AT THE SAME TIME I
DO COMMUNITY ENGAGED RESEARCH
AND I CAN TELL YOU THAT THERE
ARE PEOPLE WHO DON'T UNDERSTAND
HOW IT DO COMMUNITY-ENGAGED
RESEARCH DOING PRESENTATIONS AND
I KNOW PANELS GET TOGETHER BUT
SOMETIMES PEOPLE ARE TRYING BE
INNOVATIVE AND THE OTHER THING
THAT'S IMPORTANT I LOVED WHEN
NCI WAS DOING THE SUPPLEMENT AND
YOU DO IT ROUTINELY FOR THE
CANCER CENTERS AND IT ENABLES
FOR CAPACITY BUILDING.
THAT'S WHAT'S REALLY NEEDED.
I KNOW THERE'S FOCUS ON MINORITY
SERVING INSTITUTIONS BUT I CAN'T
TELL YOU HOW STRUCK BY THE
INEQUITY EXISTS JUST BY THE
STRUCTURAL BARRIERS NO JUST
GETTING RESEARCH DONE SOMETIMES
AT THE MINORITY SERVING
INSTITUTIONS.
IT'S IMPORTANT TO LOOK AT
PARTNERSHIPS AND WAYS TO BUILD
CAPACITY AND THERE'S ONE EXAMPLE
AND HOLDING PEOPLE'S FEET TO THE
FIRE.
WE NOW HOW TO WRITE A GRANT.
IT'S WHAT THE ACTUAL OUTCOMES
AND BEING REAL CLEAR EVEN FROM
THE COMPREHENSIVE CANCER
STANDPOINT AND IF YOU HAVE
COMMUNITIES IN YOUR BACKYARD
BECAUSE YOU HAVEN'T HAD THE TIME
TO BUILD THOSE OPPORTUNITIES
THOSE ARE REAL-WORLD METRICS WE
HOPEFULLY START TO HOLD PEOPLE
ACCOUNTABLE TO.
>> SO WE'VE KIND OF OVER TIME
AND I THOUGHT THE LAST COMMENT
WAS GOOD TO END ON BUT TINA GO
AHEAD.
I NOW HAVE TO TALK ABOUT SEX AS
A PSYCHOLOGICAL VARIABLE AND
TALK ABOUT RIGOR AND
REPRODUCIBILITY AND MAYBE WE
SHOULD REQUIRE GRANT APPLICANTS
TO SAY HOW THEY'LL HANDLE
DISPARITIES AND THINKING OF THIS
RECOVER PROJECT IS FOCUSSED ON
LONG COVID BUT THERE'S PROBABLY
A LOT OF HEALTH DISPARITY
QUESTIONS THAT CAN BE INTEGRATED
INTO THAT PROCESS OF WHO DID AND
DIDN'T GET TESTED AND WHO GOT
VACCINATED AND SO ON.
>> ALL GREAT SUGGESTIONS.
>> WELL, WE ARE OVER TIME.
I WANT TO THANK EVERYONE I THINK
THESE WERE IMPORTANT
DISCUSSIONS.
A LOT TO GO BACK TO NORA WITH TO
LET HER CONSIDER IT AS WELL AND
I REALLY APPRECIATE EVERYBODY'S
CONTRIBUTIONS.
GEORGE.
>> I THINK I'M CHARGED WITH
CLOSING US OUT AND I WANT TO
THANK EVERYONE FOR WOOF WONDERFUL
INTERACTIONS AND NOTES.
WONDERFUL CRAN MEETING AND DON'T
FORGET TO SEND SUGGESTIONS ON
DESEMINATION OF THE HEALTH CARE
PROFESSIONALS CORE RESOURCE.
I'M GETTING IT DOWN.
SEE YOU ALL.