>> 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.