THE NATIONAL INSTITUTE ON
MINORITY HEALTH AND HEATH
DISPARITIES.
WELCOME TO THE 61st MEETING OF
THE ADVISORY -- NATIONAL
ADVISORY COUNCIL ON MINORITY
HEALTH AND HEALTH DISPARITIES.
THIS IS THE OPEN SESSION OF OUR
COUNCIL AND I WILL NOW TURN IT
OVER TO OUR EXECUTIVE SECRETARY
Dr. PAUL COTTON, WHO WILL TAKE
ROLL CALL.
PAUL --
>> Paul: THANK YOU, Dr.
PEREZ-STABLE.
GOOD MORNING AND WELCOME TO THE
61st MEETING OF THE NIMHD
ADVISORY COUNCIL.
TODAY'S SESSION OF THIS MEETING
IS OPEN TO THE PUBLIC AND BEING
BROADCAST ON THE NIH VIDEO
NETWORK.
COUNCIL MEMBERS, PLEASE SPEAK
SLOWLY AND DISTINCTIVELY.
WHEN YOU REQUEST OR ARE CALLED
ON TO SPEAK, THE VIDEO CAST
OBSERVERS, TECHNICAL STAFF AND
NOTE TAKERS WILL BE LISTENING TO
NOTE YOUR COMMENTS.
THERE'S NO NEED TO ASK IF YOU
ARE BEING HEARD.
AFTER YOU ARE RECOGNIZED TO
SPEAK, I WILL PROMPT YOU IF
AUDIO PROBLEMS ARE DETECTED.
IN AN EFFORT TO CONSERVE
INTERNET BANDWIDTH, I WILL LEAD
THE ROLL CALL.
PLEASE TURN ON YOUR CAMERA,
UNMUTE, INTRODUCE YOURSELF,
FIRST NAME, LAST NAME, AND MAKE
A BRIEF STATEMENT.
INSTITUTIONAL ORGANIZATION
AFFILIATION ROLE.
PLEASE MUTE YOURSELF AND TURN
OFF YOUR CAMERA FOLLOWING.
I WILL MOVE ON TO THE NEXT
PERSON AFTER THAT.
SO, I WILL BEGIN.
AGULIA.
>> HI, GOOD MORNING, MY NAME IS
EMMA AND I'M PROFESSOR AT THE
SCHOOL OF PUBLIC POLICY FROM USC
AND I'M AN ECONOMIST BY TRAINING
AND MY RESEARCH IS HOW DIFFERENT
THE SCIENCE OF SOCIAL INSURANCE
PROGRAMS SUCH AS WELFARE
PROGRAMS THAT WILL GUARANTEE
BASIC INCOME PROGRAMS THAT SEEK
TO RAISE STATUS AT DIFFERENCE IN
STAGES OF THE LIFE COURSE,
IMPROVE HEALTH AND WELLBEING OF
THE POPULATION.
I USE EXPERIMENTAL METHODS AND
IT'S A PLEASURE TO BE HERE.
THANK YOU.
>> Paul: BARNES.
>> GOOD MORNING.
MY NAME IS LISA BARNES.
I AM AN ENDOWED PROFESSOR OF
GERIATRIC MEDICINE AT RUSH
UNIVERSITY MEDICAL CENTER IN
CHICAGO AND A COGNITIVE
NEUROPSYCHOLOGIST IN THE RUSH
ALZHEIMER'S DISEASE CENTER.
I'M THE ASSOCIATE DIRECTOR OF
OUR ALZHEIMER'S CENTER.
MY AREA OF EXPERTISE IS IN THE
EPIDEMIOLOGY OF DEMENTIA AND
AGING WITH A FOCUS ON OLDER
AFRICAN AMERICANS.
IT'S A PLEASURE TO BE HERE.
THANK YOU.
>> Paul: CALMAN.
>> GOOD MORNING, EVERYONE.
MY NAME IS NEIL CALMAN I'M A
FAMILY PHYSICIAN AND PRESIDENT
AND C.E.O. OF THE INSTITUTE FOR
FAMILY HEALTH WHICH IS A LARGE
NETWORK OF 30 COMMUNITY HEALTH
CENTERS SITES IN NEW YORK AND I
ALSO CHAIR THE DEPARTMENT OF
FAMILY MEDICINE AND COMMUNITY
HEALTH AT THE MOUNT SINAI SCHOOL
OF MEDICINE.
MY RESEARCH IS LARGELY IN
STRUCTURAL RACISM, HOW IT'S
BUILT INTO THE STRUCTURE OF
INSTITUTIONS AS WELL AS STATE
AND FEDERAL GOVERNMENT.
THANK YOU.
>> Paul: ELLIOTT.
>> GOOD MORNING.
AMY ELLIOTT.
THE CHIEF CLINICAL OFFICER OF
VERA HEALTH WHICH IS A RURAL
INTEGRATED SYSTEM.
I'M A PROFESSOR AND DIVISION
CHIEF AT THE UNIVERSITY OF SOUTH
DAKOTA SCHOOL OF MEDICINE IN THE
DEPARTMENT OF PEDIATRICS.
MY RESEARCH HAS BEEN IN MATERNAL
CHILD HEALTH ON THE EFFECTS OF
PRE-NATAL EXPOSURES ON LATER
HEALTH AND DEVELOPMENT.
I AM PRE-NATAL ALCOHOL, TOBACCO
AND OTHER EXPOSURES --
SUBSTANCES.
SO LOOKING FORWARD TO THE
MEETING TODAY.
THANK YOU.
>> Paul: ESCALA.
>> GOOD MORNING.
I'M AN ATTORNEY BY TRAINING.
AS PRACTITIONER, I GET CASES ON
IMPACT ISSUES RELATING TO HEALTH
ISSUES AND DISCRIMINATION AND
CURRENTLY I SERVE AS THE ADJUNCT
AT A COLLEGE.
THANK YOU.
>> Paul: JOHNSON.
>> GOOD MORNING, EVERYBODY, I'M
KIMBERLEY JOHNSON I'M A
PROFESSOR OF MEDICINE AND
GERIATRICIAN IN PALLIATIVE
MEDICINE HERE AT DUKE UNIVERSITY
SCHOOL OF MEDICINE IN NORTH
CAROLINE A MY RESEARCH FOCUSES
ON IMPROVING SERIOUS ILLNESS
CARE FOR OLDER AFRICAN
AMERICANS.
I ALSO LAID CENTER OF EXCELLENCE
IN MINORITY HEALTH AND HEALTH
DISPARITIES WHICH IS CALLED
REACH EQUITY.
>> Paul: RESINCLAU.
>> GOOD MORNING.
I'M KEN.
I'M A HEALTH PSYCHOLOGIST AND
HEALTH COMMUNICATIONS RESEARCHER
AND PRACTITIONER.
I'M AT THE UNIVERSITY OF
MICHIGAN AND ANN ARBOR AT THE
SCHOOL OF PUBLIC-HEALTH AND THE
SCHOOL OF MEDICINE.
FOR OUR CANCER CENTER, I'M THE
DIRECTOR OF COMMUNITY OUTREACH
ENGAGEMENT IN HEALTH DISPARITIES
RESEARCH AND I HELP LEAD OUR
CENTER FOR HEALTH COMMUNICATIONS
RESEARCH.
MOST OF MY RESEARCH INVOLVES
SOME COMBINATION OF MOTIVATIONAL
INTERVIEWING AND TAILORED
COMMUNICATION MUCH OF THAT WORK
IS FOCUSED ON ETHNIC AND RACIAL
SUB POPULATIONS.
HAPPY TO BE HERE.
>> Paul: SIMS.
>> GOOD MORNING, I'M MARIO SIMS,
PROFESSOR OF SOCIAL MEDICINE,
POPULATION OF PUBLIC-HEALTH
MEDICINE AND I'M SOCIAL
EPIDEMIOLOGIST BY TRAINING AND I
FOCUS ON SOCIAL AND PSYCHOSOCIAL
DETERMINANTS OF CARDIOVASCULAR
DISEASE AND DISPARITIES.
POLICE TO BE HERE.
>> SUTHERLAND.
>> GOOD MORNING.
MY NAME IS BILL SUTHERLAND.
I'M A PROFESSOR OF BIOCHEMISTRY
AT HOWARD UNIVERSITY.
I'M ALSO THE PRINCIPLE
INVESTIGATOR OF HOWARD RESEARCH
CENTERS IN MINORITY INSTITUTIONS
PROGRAM.
AND I AM THE INTERIM DIRECTOR OF
HOWARD CENTER FOR APPLIED DATA
SCIENCE AND ANALYTICS.
MY RESEARCH CENTER HAS TO DO
WITH UTILIZING DATA SCIENCE AS A
TOOL TO BETTER UNDERSTAND THE
CLIENT DISEASE BURDEN IN
MINORITY GROUPS RIGHT NOW.
WE'RE LOOKING AT THE CHRONIC
DISEASE BURDENS AS DISTRIBUTED
AMONG THE WARS OF WASHINGTON DC.
THANK YOU.
>> SHERBOURNE.
>> GOOD MORNING, I AM PROFESSOR
OF POPULATION HEALTH AND
MEDICINE.
I ALSO SERVE AS VICE-CHAIR FOR
RESEARCH AND DIVISION CHIEF OF
HEALTH BEHAVIOR IN THE
DEPARTMENT OF POPULATION HEALTH
AT THE NYU SCHOOL OF MEDICINE.
I'M A SOCIAL EPIDEMIOLOGIST BY
TRAINING AND MY RESEARCH IS
FOCUSED ON UTILIZING SOCIAL
DETERMINANTS FOR HEALTH AND
COMMUNITY HEALTH WORKERS
APPROACHES TO REDUCING HEALTH
DISPARITIES IN NEW YORK CITY.
I CO-LEAD NIMHD FOCUS AMERICAN
COMMUNITIES AND FOCUS ON CANCERS
AGING AND MORE RECENTLY
COVID-RELATED HEALTH
DISPARITIES.
THANK YOU.
>> Paul: LONG.
>> HELLO, MY NAME IS JUDITH LONG
AND I AM A GENERAL INTERNIST AND
I AM ALSO A CORE FACULTY MEMBER
OF THE VA CENTER FOR HEALTH
EQUITY RESEARCH AND PROMOTION
AND VA REPRESENTATIVE ON
COUNCIL.
I AM ALSO THE DIVISION CHIEF OF
GENERAL INTERNAL MEDICINE AT THE
UNIVERSITY OF PENNSYLVANIA AND
MY RESEARCH FOCUSES ON
INTERVENTIONS TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH AND
SUPPORT VULNERABLE POPULATIONS
WITH CHRONIC DISEASES AND I'M
HAPPY TO BE HERE.
THANK YOU.
>> Paul: HUNTER.
>> HI, GOOD MORNING.
I'M CHRISTINE HUNTER I'M A
CLINICAL HEALTH PSYCHOLOGIST AND
I'M CURRENTLY SERVE NORTH TWO
ROLES AT NIH, THE ACTING
DIRECTOR FOR THE OFFICE OF
BEHAVIOR AND SOCIAL SCIENCE
RESEARCH AND THE ASSOCIATE
DIRECTOR FOR THE BEHAVIOR AND
SOCIAL SCIENCE RESEARCH.
THANK YOU FOR HAVING ME.
>> YOU ARE WELCOME TO ALL OF YOU
AND THANK YOU.
WE ALSO HAVE ADDITIONAL
EX-OFFICIO MEMBERS WHO ARE NOT
PRESENT TODAY.
Dr. SHELL, DR. TABAK ARE
EX-OFFICIO MEMBERS AND XAVIER
BARAKARA ARE NOT WITH US TODAY.
I WOULD ALSO LIKE TO HAVE Dr.
WEB HOOPER INTRODUCE HERSELF.
>> HELLO, HI.
I'M MONICA WEB-HOOPER.
DEPUTY DIRECTOR HERE AT NIMHD.
WELCOME.
>> Paul: THANK YOU.
MY SECOND TASK OF THE MORNING
WILL BE THE REVIEW OF THE
MINUTES.
WE WILL NOW GO AHEAD AND GET
STARTED WITH THAT.
I'M GOING TO GIVE YOU THE VOTING
INSTRUCTIONS.
THE CHATBOX WILL BE USED TO
RECORD THE VOTE OF THE ACTIONS.
WHEN ASKED ALL IN FAVOR,
PLEASANT YES OR Y IN THE
CHATBOX.
WHEN ASKED ANY OPPOSED, ENTER NO
OR N IN THE CHATBOX.
THE MINUTES FROM THE MAY 2022
COUNCIL MEETING WERE POSTED IN
THE ELECTRONIC COUNCIL BOOK.
HAVING REVIEWED THE MINUTES, ARE
THERE ANY QUESTIONS, CONCERNS OR
CORRECTIONS FOR THESE MINUTES?
SEEING NONE, MAY I HAVE A MOTION
TO APPROVE THE MINUTES FROM
MAY'S COUNCIL?
>> MOVE TO APPROVE THE MINUTES
FROM THE MAY COUNCIL MEETING.
>> AND I SECOND THE MOTION,
PLEASE.
>> Paul: THANK YOU.
ALL IN FAVOR ENTER "Y" IN THE
CHATBOX.
ANY OPPOSED, ENTER "N" IN THE
CHATBOX.
AFTER HAVING BEEN MOVED AND
PROPERLY SECOND, THE MINUTES
FROM THE MAY 22 ADVISORY COUNCIL
ARE APPROVED.
THANK YOU.
I ALSO WOULD LIKE TO TAKE THIS
TIME TO ANNOUNCE THE FUTURE
MEETING DATES IN THE AGENDA THAT
YOU HAVE.
THE 2023 AND 2024 DATES ARE
LISTED.
THE 2023 FEBRUARY 6th AND
7th.
MAY 22nd, 23, AUGUST 31 TO
ACCEPT FIRST.
2024 DATES -- FEBRUARY 1st AND
2nd.
MAY 30-31.
AND SEPTEMBER 5th THROUGH THE
SIXTH.
PLEASE NOTE IT'S THE NIH'S
POLICY THAT A COUNCILMEMBER MAY
HAVE ONE ABSENCE PER CALENDER
YEAR.
AND INDIVIDUAL CANNOT SERVE ON
ANY PEER REVIEW PANELS WHILE
SERVING AS A COUNCILMEMBER.
I WILL NOW TURN THE MEETING BACK
OVER TO Dr. PEREZ-STABLE FOR
THE NIMHD DIRECTORS' REPORT.
ALMOST GOT THROUGH IT.
>> Dr. Eliseo J. Perez-Stable: .
THANK YOU, EVERYBODY.
I'M GOING TO SO SHARE MY SCREEN
AND PRESENT.
WE'RE AHEAD OF SCHEDULE SO
HOPEFULLY WE'LL HAVE TIME FOR
LITTLE BIT OF CONVERSATION.
IT WILL BE UP TO QUESTIONS THAT
COUNCIL MEMBERS WILL HAVE AND
HOPEFULLY HAVEN'T ANY GLITCHES
WITH THE TRANSMISSION TO THIS
MORNING.
AS WE ALREADY SAID, WELCOME TO
OUR 61st MEETING OF THE
NATIONAL ADVISORY COUNCIL ON
MINORITY HEALTH AND HEALTH
DISPARITIES TO NOT JUST THOSE AT
THE VIRTUAL TABLE AND HERE AT
NIH BUT ALSO ACROSS THE COUNTRY.
SO, THE BIG NEWS EVERYONE
ALREADY HEARD ABOUT WAS THE
ANNOUNCED RETIREMENT FROM
FEDERAL SERVICE OF Dr. TONY
FAUCI AND I THINK THAT IT IS
SOME MOMENTOUS OCCASION.
HE IS GIVING US I GUESS A FULL
FOUR MONTH'S NOTICE WHICH IS
GREAT.
WE'LL ALLOW FOR LOTS OF
OPPORTUNITIES TO HOPEFULLY SEE
HIM AND GIVE HIM -- FAIR HIM
WELL.
I ACTUALLY MET Dr. FAUCI AT
THE -- HE GAVE GRAND ROUNDS AT
UCSF AT SAN FRANCISCO GENERAL
HOSPITAL WHEN I WAS A MEDICAL
RESIDENT MUCH IT WAS ON WAGNER'S
GRANULE MATOSIS WHICH IS HOW HE
MADE HIMSELF KNOWN TO US
PUBLISHING PAPERS IN THE NEW
ENGLAND JOURNAL OF MEDICINE ON
TREATMENT OF THAT PREVIOUSLY
UNTREATABLE CONDITION WITH, I
BELIEVE, IT WAS COURT I CAN OWE
STEROIDS AND ENTERED WHAT WAS A
REMARKABLE ADVANCE FOR A DISEASE
THAT WE UNIFORMLY SAW AS NOT
ABLE TO TREAT IN VERY, VERY
HARSH ON OUR PATIENTS.
SUBSEQUENTLY OF COURSE, HE
BECAME THE LEAD SCIENTIST ON
HIV/AIDS FOR WHICH WE WERE VERY
INVOLVED WITH AT UCSF AND
NAVIGATED THE CHALLENGES OF THE
ADVOCACY GROUPS WHO WERE ANGRY
ABOUT THE LACK OF SCIENTIFIC
PROGRESS, THE LACK OF ATTENTION
FROM GOVERNMENT, REAL OR
PERCEIVED, TO A CONDITION THAT
WAS LEADING TO UNIFORM DEATH IN
OUR PATIENTS.
Dr. FAUCI HAS WRITTEN AND
SPOKEN ABOUT THIS AND ELOQUENTLY
I EXPERIENCED IT MYSELF
INITIALLY AS A FELLOW AND
SUBSEQUENTLY AS FACULTY IN A
PRIMARY CARE DOCTOR.
PATIENTS WHO I TOOK CARE OF.
AND I KNEW BEFORE THEY DEVELOPED
SYMPTOMATIC AIDS, AND HIS
LEADERSHIP IN THAT SITUATION WAS
A HALLMARK OF THE FUTURE.
AND Dr. FAUCI WAS A HERO BACK
THEN.
A HERO TO FORMER PRESIDENT H.W.
BUSH.
HE WAS POTENTIALLY COULD HAVE
BEEN NIH DIRECTOR BUT I
PREFERRED REALLY TO BE -- HE
PREFERRED TO BE LEADING NIMHD
THROUGH THESE INFECTIOUS DISEASE
CRISIS AND HE DID MULTIPLE ONES
AND CAME UP SARS-CoV-2, H1N1,
EBOLA WHICH NEVER EFFECTED THE
UNITED STATES BUT CERTAINLY
CREATED A LOT OF PANIC IN THE
POPULATION AND OF COURSE THE
BIGGEST CHALLENGE THE TWO AND A
HALF YEARS OF COVID-19.
HE IS ALWAYS PROUD TO SAY HE HAS
ADVISE THE SEVEN PRESIDENT OF
EITHER PARTY.
HE IS A CLINICIAN SCIENTIST ANDD
EXEMPLAR, I'VE ASKED HIM
CLINICAL QUESTIONS WHEN I WAS AT
NIH ABOUT TOPICS THAT CAME UP
AND RELATED TO WAGNERS OR OTHER
DISEASE AND HE SAID HE IS
RETIRING FROM FEDERAL SERVICE
AND HIS NIH AND WHITE HOUSE ROLE
BUT NOT FROM WORK AND WE WILL
SEE WHAT HIS NEXT CHAPTER WILL
BRING.
WE'LL ALSO WELCOME Dr. MONICA
BERGOLI AND SELECTED BY THE
PRESIDENT.
SHE WILL COME TO NIH FROM
HARVARD BRIGHAM WHERE SHE IS
PROFESSOR THE SURGERY IN
SURGICAL ONCOLOGY AND SHE TREATS
G.I. CANCERS AND ADVOCATE OF
DIVERSITY AND PATIENTS ENROLLED
IN TRIALS.
WE HOPE SHE WILL JOINS BIT END
OF THE MONTH IN THE LEADERSHIP
RETREAT BUT IT DEPENDS ON
CLEARANCE AND A VARIETY OF OTHER
THINGS.
PEOPLE WHO KNOW HER SPEAK VERY
HIGHLY OF HER NOT ONLY OF HER
SCIENCE BUT HER LEADERSHIP
SKILLS AND WE LOOK FORWARD TO
HAVING HER AT THE TABLE.
AND THANK Dr. LOWY FOR HIS
SERVICE AS ACTING DIRECTOR.
I HAVE NOT MET WITH Dr. RUSS
RUSSELL YET, ALTHOUGH I'VE BEEN
IN MEETINGS AND THERE'S A
PLANNED MEETING WITH HIS TEAM
LATER THIS MONTH.
HE WAS NAMED BY SECRETARY AS THE
ACTING DEPUTY DIRECTOR OF
ARPA-H-FOR HEALTH AND THERE'S
YET TO BE A PERMANENT DIRECTOR
AND THAT WHEN HIS ROLE AS DEPUTY
WILL THEN BE CONSOLIDATED.
HE WAS A CHIEF SCIENTIST AT
UNIVERSITY OF MARYLAND APPLIED
RESEARCH LABORATORY FOR IN TELL
AGAINST AND SECURITY AND HE HAS
EXPERIENCE IN MANAGEMENT IN
THESE AREAS AND EXPERTISE AND
SCIENTIFIC EXPERTISE IN
PHYSIOLOGY AND SOCIAL AN THROW
POLICY AND YOU CAN SEE HE WENT
TO DUKE AND OXFORD AND HE BEGAN
HIS ROLE AT ARPA-H IN JUNE OF
2022.
CURRENTLY ARPA-H IS IN NIH BUT
IT'S AUTONOMOUS ENTITY AND
REMAINS IN THE D.C. AREA
ALTHOUGH THE FINAL WORD COMES TO
CONGRESS.
WE WELCOME KEVIN WILLIAMS FROM
THE OFFICE OF EQUITY AND
DIVERSITY AND INCLUSION.
I'VE HAD THE PLEASURE TO MEET
HIM AND HE IS A GREAT ADDITION
TO AN IMPORTANT OFFICE IN THE
OFFICE OF THE DIRECTOR THAT
OVER'S OUR ACCESSIBILITY ISSUES
AND THERE'S A LOT OF IMPORTANT
BACKGROUND WORK THAT OCCURS
THROUGH THAT OFFICE.
ALSO, NINA SHORE, WHO IS THE
DELIGHTFUL INDIVIDUAL.
WAS RECRUITED TO NIH BY Dr.
PORTIA AS THE DEPUTY DIRECTOR OF
THE NATIONAL INSTITUTE OF
NEUROLOGICAL DISEASES AND
STROKE.
SHE IS NOW BEEN NAMED THE
OFFICIAL ACTING DEPUTY DIRECTOR
OF INTRAMURAL RESEARCH.
DR. TABAK WOULD WANT TO MAKE
SURE NEW ENOUGH NIH DIRECTOR IS
FINE WITH THIS.
SHE REPLACES MICHAEL GOODERMAN
THE DEPUTY DIRECTOR FOR 29 YEARS
AND NINA IS PEDIATRIC
NEUROLOGIST AND OVERSEES THE
LARGEST BIOMEDICAL RESEARCH
PROGRAM IN THE WORLD AND SHE
HELPS COORDINATE AND COLLABORATE
OVER SEEN BY EACH OF THE I.C.s
AND WILL BRING NEW ENERGY AND
IDEAS TO THE PROGRAM.
WE ALSO SAID GOOD-BYE TO JIM
ANDERSON.
WHO HAD COME TO NIH AS THE FIRST
PERMANENT DIRECTOR OF THE
DIVISION OF PROGRAM COORDINATION
PLANNING AND STRATEGIC
INITIATIVES.
THIS IS COMMONLY REFERRED TO
WITH NIH AS THE PACIPSI IT
OVERSEES THE COMMON FUND AND ALL
OF THE OFFICES WITHIN THE OFFICE
OF THE DIRECTOR ARE UNDER THIS
DEPUTY DIRECTOR OF NIH.
AND SO, THEY WILL BE BIG SHOES
TO FILL.
DR. TABAK IS GOING TO LAUNCH THE
SEARCH FOR THE NEW PERMANENT
DIRECTOR.
IN THE MEANTIME, BISINGER WILL
RETURN AS ACTING DIRECTOR WHILE
THE NATIONAL SEARCH IS
INITIATED.
JIM WAS A DELIGHT TO WORK WITH.
JUST A REALLY, VERY TERRIFIC
LEADER, BROAD MINDED, ALWAYS WAS
ABLE TO BE FLEXIBLE AND
RESPONSIVE TO THE NEEDS OF THE
NIH COMMUNITY AND SO WE WILL
MISS HAVING HIM PRESENT.
HE WAS A HEPATOLOGIST BY
BACKGROUND AND IN ADDITION TO
HIS SCIENCE BACKGROUND AS A
PH.D.
SO SOME UPDATES WITHIN OUR
INSTITUTE.
FIRST, LET'S START, WE DON'T
HAVE FINAL BUDGET NUMBERS FOR
2022.
WE'RE BUSY CRUNCHING THOSE NOW.
SHARE SOME GLOBAL ASPECTS OF OUR
BUDGET AND GRANTS.
THIS IS A TRAJECTORY OF NIMHD'S
PRESENCE IN THE SCIENTIFIC
COMMUNITY OF RO1 APPLICATIONS.
SINCE 2016, THIS IS FISCAL YEAR,
WHICH IS THE FIRST FISCAL YEAR I
OFFICIALLY WAS AT NIH.
OUR RO1 APPLICATIONS HAVE
QUADRUPLED ROUGHLY, NOT QUITE
BUT YOU'VELY, THROUGH 2021.
THE NUMBER WE HAVE BEEN ABLE TO
FUND HAS JUST ABOUT DOUBLED WITH
OUR INCREASE IN 2021 BEING
REFLECTED IN THE RO1 AWARDS AND
WE HAD A BIG INCREASE IN
'17 BECAUSE WE TRANSITIONED SOME
OTHER PROGRAMS AND THE GOAL IS
REALLY TO HAVE A STEADY STATE
THAT ISN'T -- THAT ONLY GOES UP
WHEN WE HAVE A INCREASE IN BASE
BUDGETS AND YOU CAN SEE OIR
SUCCESS RATE HAS PLUMMETED AFTER
17 BUT NOW HAS BEEN INCHING UP
AFTER HITTING A IN 2020.
I EXPECT 2022 WILL BE ALSO GOING
UP.
OUR SOURCES HAVE SWITCHED TO
BEING MORE COMING FROM OUR
PROGRAM ANNOUNCEMENTS.
WE BEGAN LAUNCHING THOSE IN 2017
ON THE INITIATIVES AND
ENTHUSIASM OF STAFF PROMPTED IN
PART BY SOME IDEAS I PUT OUT BUT
REALLY MOST OF IT WAS
INITIATIVES LAUNCHED BY STAFF.
THERE ARE A NUMBER THAT COME
FROM RFAs AND SPENDING TO
SPECIFIC ISSUES WHETHER IT WAS
MORBIDITY, MORTALITY, COVID-19,
MISINFORMATION THIS YEAR AND
OTHERS.
PRIOR TO 2017 IT WAS ALMOST
EXCLUSIVELY BY RFA AS YOU CAN
SEE.
IT WAS A RFA FOR RO1 AND WE
JOINED THE PARENT UNDER Dr.
MADDOX AND WE HAVE TRANSITIONED
TO THIS PATTERN AND PROBABLY OUR
BUDGET WILL HOVER AROUND 50% AND
RO1s GIVEN OUR OTHER PROGRAMS
THAT WE ARE REQUIRED OR WANT TO
FUND.
IT MAY BE TIME TO MAKE SURE THAT
WE'RE NOT DEPENDING ONLY ON
PAs OR THE COMMUNITY THINGS
AND OH WE'LL WAIT FOR THE PA AND
GO THERE WE WANT PEOPLE TO COME
UP WITH THEIR OWN IDEAS THAT'S
OFTEN THE MOST RELATIVE GRANTS
OR IMPACTFUL RESULTS THAT WE GET
AND WE'VE ALSO BEEN PROMOTING
DIVERSITY SUPPLEMENTS.
IT VARIES.
MY PHILOSOPHY ON THIS IS THAT WE
NEVER HAVE ENOUGH WHEN WE GET TO
THE POINT WHERE WE'RE NOT
FUNDING 50% OF THEM IT'S A
MATTER -- SOME IS BUDGETARY
PRIORITIES AND QUALITY BUT QUALT
GETTING ENOUGH APPLICATIONS.
I WOULD TELL EVERY PRINCIPLE
INVESTIGATOR WHO IS LISTENING,
THAT IT'S WHEN YOU GET AN RO1 OR
EQUIVALENT IN A U54 OR P50 WOULD
BE MORE THAN EQUIVALENT.
IT'S YOUR RESPONSIBILITY TO FIND
CANDIDATES FOR DIVERSITY
SUPPLEMENTS AND MHD FUNDS
INDIVIDUALS AT THE LATTER END OF
THEIR DEVELOPMENT, CAREER
DEVELOPMENT, SO WE'RE INTERESTED
IN PEOPLE WHO ARE EITHER
POSTDOCS OR EARLY CAREER FACULTY
AND I REALLY WANT TO SEE MORE
COMING THROUGH AND YOU SEE THAT
THE RESULTS.
WE END UP FUNDING, AT LEAST HALF
IN ONE YEAR UP TO OVER THREE
QUARTERS.
WE ALSO MONITOR WITH HELP FROM
OUR OER AND COLLEAGUES AS WELL
AS OUR OWN OFFICE.
WHAT IS OUR AWARD RATE FOR THE
TWO EXTREMES?
THERE'S OF COURSE THE MID CAREER
ONES, I'M NOT SHOWING YOU, I'M
NOT GOING TO SHOW YOU.
EARLY STAGE INVESTIGATORS ARE,
WE GET FEEDBACK ALL THE TIME AS
TO HOW WE DO AND WE'RE A SMALL
CONTRIBUTOR TO THE BIG PICTURE
AT NIH.
WE'RE NOT ABSENT AT THIS TABLE.
SUE CAN SEE WE'VE HAD MORE
APPLICATIONS INCHING UP ON
AWARDS IN BEGINNING MORE CLEARLY
IN 2021 AS WE'VE HAD BETTER
BUDGETARY PERSPECTIVES AND WE'RE
UP TO 18% IN 2021 AND WE'LL SEE
HOW WE DO THIS YEAR WHICH IS
BETTER THAN THE OVER ALL RO1
SUCCESS I SHOWED YOU EARLIER OF
13%.
NOW, WHAT ABOUT ESTABLISH
HAVINGORS?
INVESTIGATORS.
THEY'RE DOING BETTER BY A SLIDE
AMOUNT.
AND CONTINUE TO DO SO IN 2021.
AND EXPERIENCE OR ESTABLISHED
INVESTIGATORS THAT ARE NOT
DEFINED BY AGE, BY THEIR NUMBER
OF RO1s THAT THEY HAVE
SUCCESSFULLY HAD.
SO, LEGISLATIVE UPDATES, WE DO
NOT HAVE A BUDGET AND WE DO NOT
EXPECT TO HAVE A BUDGET
OCTOBER 1.
THAT'S A RARE OCCURRENCE IN THE
LAST TWO DECADES.
IF WE EXPECT CONGRESS TO DO ITS
WORK, HOPEFULLY WE'LL HAVE A
BUDGET BEFORE THE NEW CALENDER
YEAR.
I REMIND THAW WE DIDN'T HAVE ONE
THIS FISCAL YEAR UNTIL MARCH.
SO ESSENTIALLY ALMOST SIX MONTHS
OR HALFWAY THROUGH THE YEAR.
WE WILL ASSUME WE'LL HAVE A
CONTINUE RESOLUTION WORK WITH
THAT AND PROCEED WITH OUR WORK
IN A CONSERVATIVE MANNER AFTER
OCTOBER, AFTER THE BOOKS CLOSE
AND WE START UP AGAIN IN
MID-OCTOBER WITH FUNDING.
WE CONTINUE TO BE RESPONSIVE TO
REQUEST FROM CONGRESSIONAL
STAFF.
Dr. DURAN MET WITH THE STAFF
FROM SENATOR CASSIDY WHO IS
INTERESTED IN ARTIFICIAL
INTELLIGENCE AND MEDICAL
IMAGING.
SENATOR CASSIE IS ONE OF THE
PHYSICIANS IN THE SENATE, HE IS
A GASTRO INTERNOLOGIST AND I'VE
MET WITH HIM IN-PERSON A FEW
YEARS AGO.
WE ALSO MET WITH THE STAFF,
HEALTH STAFFER FOR SENATOR
WARNICK AS WELL AS WITH BUDDY
CARTER FROM GEORGIA AND THE
STAFF FROM REMEMBER SEN TIVE
BARRAGAN AND THEY WERE
INTERESTED IN SEEING WHAT WAS
GOING TO HAPPEN WHEN WE WERE
GOING TO ACTUALLY PUBLISH THE
RFA ON THE ENDOWMENT AND I'LL
COME BACK TO THAT IN A FEW
MINUTES.
WE'RE IN-PERSON WE'D ASK HER TO
STAND UP NOW AND MAYBE, I THINK
YOU ARE AT THE VIRTUAL TABLE.
YOU CAN TURN YOUR CAMERA ON TO
SHOW THE REST OF THE COMMUNITY
AND CAMERA AND WE SELECTED
THERESA FOWLER TO BE THE FINIST
AND BASED IN THE OFFICE OF THE
DIRECTOR AND UNDER MYSELF AND
MONICA.
SHE CAME TO US FROM NATIONAL
INSTITUTE OF CHILD HEALTH AND
HUMAN DEVELOPMENT AND THIS IS A
POSITION THAT EVERY INSTITUTE AT
NIH HAS SOUGHT TO ESTABLISH IN
WITHIN WAY OR ANOTHER.
I BELIEVE MOST OF NOW POINTED
SOMEONE EITHER THEY HAVE SOMEONE
LOCALLY INTERNALLY AND WENT
THROUGH THE SEARCH LIKE WE DID
AND NIMHD IS EXCLUSIVELY FOCUSED
ON ISSUES AROUND DIVERSITY AND
WORK ENVIRONMENT AND MOST OTHER
INSTITUTES ARE ALSO ADDING THE
RESPONSIBILITY OF LOOKING AT
THEIR HEALTH DISPARITIES
RESEARCH.
WE OF COURSE DO THAT FOR
FULL-TIME SO TRIESTA WILL BRING
HER TALENTS AS 20 YEARS AS A
PEDIATRICIAN AND ALSO BEING AT
NIH, IN COMMUNICATION,
INTRAMURAL AS WELL AS HER
KNOWLEDGE OF CHILD HEALTH
ISSUES.
SO WE LOOK FORWARD TO HAVING HER
ON BOARD AND CONTRIBUTING TO
PROGRAM AS WELL.
WE ALSO MOVED Dr. DORTHY
CASTILLE TO BE OUR TRAINING COR
DIN AND MANAGE NOT THE LEAST OF
WHICH IS THE CENTER, THE
COORDINATING CENTER FOR THE
RADX-UP PROGRAM WHICH HAS BEEN
TERRIFIC PART OF OUR PROGRAM.
ALSO, WE WELCOME ANTHONY JOHNSON
TO THE DIVISION OF INTRAMURAL
RESEARCH.
Dr. JOHNSON IS KNOWN, LIKES TO
BE CALLED A.J. AND HE JOINED
Dr. NAPALIS IN DIVISION TO
PROVIDE GUIDANCE AND ASSISTANCE
IN DEVELOPING TRAINING PROGRAMS
AND POLICIES AND BUILD A PROGRAM
AND COORDINATE THE INVESTIGATORS
AND THE INVESTIGATORS AND SENIOR
INVESTIGATOR AS WELL AS WE HAVE
Dr. NAPALAS LAB AND INTRAMURAL
LAB BASED AT NIMHD AND MY LAB
COORDINATES CLOSELY WITH NIMHD.
I BELIEVE THAT IN THE SUMMER
WHEN WE HAVE SUMMER USED THE
PROGRAM IS CLOSE TO 50 TRAINEES
SO IT'S A WONDERFUL COMPONENT OF
NIH'S INTRAMURAL PROGRAM THAT
PROVIDES OPPORTUNITIES AND FOR
TRAINEES GOING FROM COLLEGE
STUDENTS TO WOVE A DIVERSE POOL
OF TRAINEES.
SO, THANK YOU A.J.
WE ALSO SAID GOOD-BYE TO RICK
BURGEON WHO HAD BEEN AT NIMHD
FOR 13 YEARS.
HE WAS HERE WHEN I ARRIVED AND I
REMEMBER HIM VERY FONDLY IN HIS
OWN WAY OF DOING THE WORK
ADAPTED TO THE DIFFERENT STYLES
OF, I THINK THREE OR FOUR
DIFFERENT VISION DIRECTORS.
HE DID RETIRE OFFICIALLY ON JUL.
HE WAS VERY COMMITTED TO
INTERNATIONAL PROGRAMS WHICH OF
COURSE WE HAD VERY LITTLE
INVOLVEMENT IN BUT HE KEPT THAT
FLAME ALIVE.
AND ALSO, HIS VERY MUCH FOCUSED
ON NIH/AIDS AS PART OF HIS
PRIORITIES AND SUBJECT MATTER
EXPERTISE.
AND JUDY ARROYO WHO HAD COME TO
US FROM THE NATIONAL INSTITUTE
ON ALCOHOL ABUSE AND ALCOHOLISM
WILL WELCOME ME TO NIH BACK IN
2015, FEDERAL LATINA, SHE
ENTHUSUPPORTED OUR RADX FOR NOT
POPULATION AND RETIRED IN THE
END OF MAY AFTER OUR LAST
COUNCIL.
SO BACK TO THE JOHN LOUIS NIMHD
RESEARCH ENDOWMENT PROGRAM, THIS
IS A UNIQUE PROGRAM AND MANY OF
YOU AND NOT WELL-KNOWN ACROSS
NIH I WOULD SAY OR EVEN TO THE
MANY IN THE SCIENTIFIC
COMMUNITY.
I CERTAINLY LEARNED ABOUT IT
WHEN I GOT HERE.
WE WERE AUTHORIZED TO DO THIS
WITH OUR ORIGINAL LEGISLATION
AND SINCE 2002, THE RESEARCH
ENDOWMENT PROGRAM HAD AWARDED,
AS YOU CAN SEE, CLOSE TO
$500 MILLION TO 22 INSTITUTIONS.
TO BE ELIGIBLE, THE INSTITUTION
HAS TO HAVE LESS THAN HALF THE
MEDIAN ENDOWMENT.
YOU CAN DO THE BATH.
IT'S ABOUT A 25th PERCENTILE.
IT VARIES A LITTLE BIT AND IT'S
IN THE BALLPARK $250 MILLION OR
SO AND HAVE HAD AT THE
ORIGINALLY, A EITHER A HRSA OR
AN NIMHD CENTER OF EXCELLENCE.
WHICH WAS ALSO NIMHD WAS
AUTHORIZED TO DO THESE WHEN WE
WERE CREATED.
SO, IT WAS LIMIT AND IT WAS SET
BY THE DIRECTOR AND MYSELF AND
WHEN HAPPENS AS THE PROGRAM
TRANSITIONED PARTLY DUE TO MY
OWN DECISIONS AT THE DIRECTION I
WANTED TO TAKE THE INSTITUTE, WE
HAD FEWER NUMBER OF ELIGIBLE
INSTITUTIONS AND SO A TECHNICAL
FIX THROUGH CONGRESS WAS TO
BASICALLY MAKE EVERYONE ELIGIBLE
IF THEY HAD A CURRENT OR FORMER
NIMHD OR HRSA CENTER OF
EXCELLENCE.
KEEP IN MIND SOME OF THESE
CENTERS HAVE ALWAYS GONE TO
HIGH-END INSTITUTIONS AT EITHER
AGENCY AND EITHER NIH OR HRSA SO
THIS WAS NOT AN ISSUE WITH A
SIMPLE RESPONSE AND WE WENT FROM
HAVING THREE OR FOUR ELIGIBLE
INSTITUTIONS NOW TO BACK TO A
LIST OF OVER 40.
SO WE ARE ENTHUSIASTICALLY
ANTICIPATING PUBLISHING THE
FUNDING ANNOUNCEMENT, THE RFA
SOON.
IT WORKS ITS WAY THROUGH THE NIH
PROCESS AND THEN WE WILL HAVE
AWARDS OF DEADLINE FOR
SUBMISSION AND 90 DAYS AFTER
PUBLICATION AND REVIEW AND
CLEARANCE AT MAY 2023 COUNCIL.
RIGHT NOW, WE'RE COMMITTED TO AT
LEAST $12 MILLION IN FISCAL '23.
WE HAVE THE FLEXIBILITY TO
INCREASE THAT DEPENDING ON HOW
OUR BUDGET PROCESS PANS OUT.
SO WE LOOK FORWARD TO RESTARTING
THIS CAPACITY-BUILDING PROGRAM
THAT HAS I THINK DONE A LOT OF
GOOD THINGS FOR THE INSTITUTION
THAT'S HAVE SUCCESSFULLY
COMPETED FOR THEM.
THIS IS ONE OF BENEFITS OF ZOOM,
I GUESS OR A VIRTUAL MEETING
FORMAT AND WONDERFUL PHOTO OF
OUR 2022 HEALTH DISPARITIES
RESEARCH INSTITUTE AND I WOULD
SAY THAT THIS IS ONE OF THE
HIGHLIGHTS OF THE YEAR.
I ACTUALLY WOULD LOVE TO SEE
THIS HAPPEN IN-PERSON AGAIN,
ALTHOUGH DOING IT VIRTUALLY HAS
SPECIAL FEATURES.
THIS IS A PROGRAM WE LAUNCHED IN
2016 SORT OF A FOLLOW-UP TO THE
COURSE THAT HAD HAPPENED AT
NIMHD PRIOR TO MY ARRIVAL.
IT IS SORT OF A WEEK-LONG
PROGRAM TO GIVE THE NETWORKING
SOME SCIENTIST I CAN SKILLS AND
SOME SPECIFIC SKILLS TO SELECT
SCHOLARS.
THE APPLICATION PROCESS USUALLY
BEGINS IN MARCH AND YOU CAN SEE
THAT VIRTUAL FORMAT A LOUSE US
TO BE MOM A MORE.
IT'S TARGETED TO POSTDOC TO BAL
FELLOWS, SENIOR POSTDOC TO BAL
FELLOWS AND EARLY CAREER FACULTY
AND WE REPRESENTED A BROAD
NUMBER OF STATES AND DISTRICT OF
COLOMBIA.
AND REALLY THE MOST BENEFICIAL
TIME OF THE FOUR AND A HALF DAYS
THAT THEY SPEND WITH US, WAS
NETWORKING.
NETWORKING AMONG THEMSELVES WAS
SOMETHING THAT NATURALLY HAPPENS
WHEN YOU BRING PEOPLE TOGETHER
AND ALSO NETWORKING WITH OUR
TERRIFIC STAFF FROM NIMHD AND
NIH, THE REST OF THE INSTITUTE.
SO STAFF WERE MOTIVATED TO MEET
WITH THEM DOING A HALF A DAY
SESSION.
THEY DO GET A GRANT REVIEW
SESSION, A REAL GRANT AS
REVIEWED.
GRANT THAT HAS BEEN SUBMITTED
AND REVIEWED AND THEY GET TO SEE
WHAT IT'S LIKE.
THEY ALSO GET SOME SUPPORT IN
THE PAST FROM AAMC AND A WRITING
SKILLS WORKSHOP.
AS WELL AS SELECTED TALKS BY
INVESTIGATORS.
WE STARTED A RECOGNITION OF AN
EARLY CAREER SIGN TIVE LAST
YEAR.
WE DID IT AGAIN THIS YEAR WHICH
IS SOMEONE WHO USUALLY HAS BEEN
THROUGH AN INITIAL PHASE OF A K
AWARD AND IT'S BEEN SUCCESSFUL
AS A SCIENTIST AND THEIR
INSTITUTION AND THIS IS A
PROFILE AND WE OF COURSE DO NOT
CREATE ANY CRITERIA OF RACE
ETHNICITY TO OR ANY OTHER
IDENTITY FACTOR TO BE ELIGIBLE
FOR OUR PROGRAM.
YOU CAN SEE WOMEN DO FEMALES DO
PREDOMINATE AND PH.D PREDOMINATE
WHICH IS NORMAL FOR NIH BUT WE
GET A FAIR NUMBER OF PHYSICIANS
AS WELL AS OTHER CLINICIANS
WOULD WE'RE PROUD OF THIS
PROGRAM AND WE WILL CONTINUE TO
OFFER IT EVERY YEAR.
SOME LEADERSHIP ACTIVITIES.
Dr. WEB COOPER LED -- THIS IS
A HUMONGOUS EFFORT REALLY TO BE
THE SORT OF THE CHIEF EDITOR,
PRODUCER OF THIS NCI TOBACCO
CONTROL MONOGRAPH.
NO SMALL DEAL ON TREATING
SMOKING AND CANCER PATIENTS AND
MONICA SHARES SOME OF HER OWN
WORK WHEN SHE PRESENTED TO
COUNCIL PREVIOUSLY.
ANNA NAPOLES WAS THE FOCUS OF
HILL AND TELEMUNDO ON LATINA
LEADERS SUM EXIT LARISSA HEALTH
SERVICES GAVE A KEYNOTE TALK ON
THE RCMI AND I'M VERY PROUD OF
ALL OF THE ACHIEVEMENTS OF OUR
STAFF AND OUR LEADERS.
WE NOW ARE -- I THINK THIS IS
YEAR TWO OR THREE OF THIS
PROGRAM AND THE DESIGN WHICH IS
A NATIONAL INSTITUTE OF
BIOMEDICAL IMAGING AND
BIOMEDICAL ENGINEERING
INITIATIVE THAT BRUCE TROMBERG
PERSUADED ME TO DO AND IT'S AREA
THAT WE HAVE NOT DEVELOPED AS
MUCH AND SCIENCE IN THE FOCUS ON
MINORITY HEALTH AND HEALTH
DISPARITIES.
THE EQUINOX PROPOSED BY SOMEONE
FROM JOHNS HOPKINS, WON THE OVER
ALL PRIZE AND I SHOW IT EVEN
THOUGH IT WAS OFFICIALLY THROUGH
NIBIB BECAUSE I THINK REALLY IT
WAS THE SELECTION IS TO REALLY
ADDRESS THE ISSUE OF HOW PULSE
OX SEM TER DATA WE'VE BEEN USING
SO MUCH IN THE COVID ERA AND TO
REALLY TRIAGE INDIVIDUALS TO
WHETHER OR NOT THEY NEED TO HAVE
SUPPLEMENTAL OXYGEN, AND IT'S
EASY ENOUGH TO GET ONE AND DO IT
AT HOME AND USE AN EASY TO
REMEMBER CUT OFF UNDER 90% TO
SAY WELL SOMEONE NEEDS TO SEE
THIS PERSON.
A CLINICIAN NEEDS TO SEE THIS
PERSON.
DARKER-SKIN INDIVIDUALS WERE NOT
GETTING AS ACCURATE MEASURES.
THIS WAS NOT REALLY DETERMINED
UNTIL COVID-19 CAME.
THERE WAS A B A BIAS SO IT WAS
ADJUSTED THROUGH AN ENGINEERING
FIX IN ORDER TO GET MORE
ACCURACY.
AS THIS HAPPY HEART, WHICH IS A
CLEVER APPROACH TO DOING WHAT
YOU CAN DO.
YOU CAN ACTUALLY GO ON-LINE AND
GET THIS GIMMICK, THIS CARD, THE
BASIC ONE AND I THINK IT RUNS
FOR $100 FROM THIS FDA-APPROVED
ONE FOR ADULTS AND GET A SINGLE
LEAD ELECTRO CARDIO GRAM BY
PUTTING YOUR TWO FINGERS ON IT
FOR 30 SECONDS AND THEN YOU CAN
SEE WHETHER SOMEONE MIGHT BE IN
ABNORMAL RHYTHM THAT DOES
REQUIRE ATTENTION IF YOU FEEL
PALPITATIONS WITH YOUR IRREGULAR
HEART RATE FOR OLDER ADULTS THAT
MAY BE A USEFUL ADJUNCT FOR
SELF-MANAGEMENT OF HEALTH.
THIS IS A CLEVER MODIFICATION
FOR CHILDREN.
YOU CAN SEE YOU HOLD IT WITH
YOUR HANDS AND YOU HAVE
ENTERTAINMENT SCREEN THERE
BECAUSE KIDS UNDER A CERTAIN
AGE, I SUPPOSE, I THINK IT WAS
TARGETING UNDERAGE 10 ARE
UNLIKELY TO SIT STILL FOR 30
SECONDS AND SO THIS WAS THE ONE
THAT RECEIVED THE AWARD FROM
NIMHD.
LET ME ALSO CALL YOUR ATTENTION,
THIS IS SOMETHING WE WILL PUSH
OUT THROUGH OUR LIST SERVE IF IT
HASN'T ALREADY HAPPENED.
THE COMMUNITY PARTNERSHIP TOP
ADVANCE SCIENCE FOR SOCIETY OR
COMPASS PROGRAMS.
THIS IS A COMMON FUND PROGRAM.
I'M ONE OF THE CO-CHAIRS.
I HAVE BEEN FOR THE PAST YEAR
BUT THERE'S LITERALLY 100 STAFF
ACROSS NIH WHO HAVE BEEN WORKING
ON THIS PRIMARILY AT THE COMMON
FUND AND ALSO ACROSS DIFFERENT
INSTITUTES.
AND THIS IS ANNOUNCED THAT THESE
ARE RFAs ARE GOING TO BE
PUBLISHED.
SO, I URGE OUR COMMUNITY TO PAY
ATTENTION TO THIS AND I HAVE
BEEN PLEASED TO SEE PROFESSIONAL
SOCIETY I'M CLOSEST TO HAVE
PICKED UP ON THIS AND CIRCULATED
WITHIN THEIR HEALTH DISPARITIES
INTEREST GROUPS.
THERE'S GOING TO BE TWO COMING
OUT FIRST.
ONE TO FUND A COMMUNITY
ORGANIZATION TO ACTUALLY DO AND
DEVELOP THE IMPLEMENT THE
INTERVENTION ON STRUCTURAL
FACTORS TO DECREASE DISPARITIES.
SO THIS IS A TRANSFORMATIVE
PROGRAM, WE THINK, IN THAT IS
ADDRESSING STRUCTURAL FACTORS TO
BE DEFINED TO ADDRESS
DISPARITIES.
IT WAS SUBSTANTIVE FUNDING OVER
THE COURSE OF SEVEN YEARS.
ALSO, THE FUNDING IS GOING TO GO
TO THE COMMUNITY ORGANIZATION.
IT WILL NOT GO TO ACADEMIC
INSTITUTIONS.
WE URGE AND WE WILL WORK WITH
THE COMMUNITY ORGANIZATIONS TO
MAKE SURE THAT THEY PARTNER WITH
RESEARCHERS IN THIS SPACE IN
EVERY WAY POSSIBLE.
WE KNOW THAT THERE'S A TERRIFIC
GROUP OF EXPERIENCED SCIENTISTS
OUT THERE WHO ARE POISE TO DO
THIS.
RATHER THAN GO FROM ACADEMICS TO
THE COMMUNITY, THIS IS GOING
FROM COMMUNITY TO ACADEMICS.
SO IN THAT OTHER WAY, IT'S A
TRANSFORMATIVE PROGRAM.
THERE WILL BE A COORDINATION
CENTER THAT WILL BE A MORE
TYPICAL ACADEMIC HEALTH CENTER,
WE ASSUME, BUT IT'S U-24 A
RESEARCH CENTER AND THAT WILL BE
PUBLISHED THAT RFA WILL BE
PUBLISHED AT THE SAME TIME.
PERIODICALLY, WE DO HOLD GRANTEE
MEETINGS OF PROGRAMS.
I'M ALWAYS SORT OF ANTICIPATING
THESE OR EAGER TO ASK OUR
DIVISION DIRECTORS AND STAFF TO
ORGANIZE THESE SO WE CAN FIND
OUT WHAT HAVE WE LEARNED?
SOCIAL EPIGENOMICS WAS A R01
PROGRAM THAT WAS LAUNCHED NOW
FIVE YEARS AGO AND SO IT'S A
GOOD TIME TO SORT OF REFLECT AND
SEE WHAT HAS BEEN LEARNED.
IT IS STILL A WAYS TO GO ON
GETTING SOME PRODUCTS OUT AND
MAYBE END UP WITH A SERIES OF
ARTICLES.
IT'S A GOOD GROUP OF SCIENTISTS
AND THE PARTS I WAS ABLE TO
LISTEN WERE REALLY OUTSTANDING.
SO, WE ARE PLANNING ONE OF THE
VACCINE UPTAKE GRANTEES RELATED
AROUND COVID-19 LATER THIS YEAR.
LET ME GO TO FINAL PART OF MY
REPORT, AND IT'S JUST TO
HIGHLIGHT SOME SCIENCE ADVANCES.
JUST TO SHARE WITH YOU THE
COLLECTION HERE.
WE ASK STAFF TO NOMINATE
PUBLISHED PAPERS IN THEIR
PORTFOLIO.
THEY ARE VETTED BY THE DIVISION
DIRECTOR AND FILTER UP TO ME AND
I MAKE A SELECTION FROM THAT.
I DO ADD A COUPLE OF THINGS ON
MY OWN AND WE ALSO HAVE SIMILAR
SELECTIONS FROM THE INTRAMURAL
PROGRAM.
SO I'LL START WITH COVID.
THIS IS FROM FOUR HIGHLIGHTS
FROM THE RADX-UP PROGRAM AND
I'LL MENTION THAT WE ARE GOING
TO PUBLISH A SPECIAL ISSUE OF
MARKET JOURNAL PUBLIC-HEALTH OR
SAY THAT THE RADX-UP PROGRAM
LATER THIS MONTH WITH 10 OR 12
PEER-REVIEWED PAPERS FROM THAT
PROGRAM.
THIS WAS A EARLY REPORT THAT
CAME OUT OF BALTIMORE COMMUNITY
SCREENING AND USING COMMUNITY
TESTING EVENTS AND LINKING THEM
TO THE ELECTRONIC HEALTH RECORD
AND FOUND IN TESTING ALMOST 1800
PATIENTS, THAT THE POSITIVITY
RATE AMONG LATINO AND LATINAS
WAS DI DISPROPORTIONATELY HIGH D
AGAIN HIGHLIGHTING THE GREATER
RISK OF EXPOSURE PRIMARILY DUE
TO THE TYPE OF EMPLOYMENT AND
THE LIVING CONDITIONS AND
NEIGHBORHOODS THAT OUR
COMMUNITIES WERE LIVING.
LIVE IN I SHOULD SAY.
IN GENERAL, YOUNGER, MORE
LIMITED ENGLISH PROFICIENCY AND
OF COURSE LARGER HOUSEHOLD SIZE,
COMPARED TO OTHER GROUPS.
I THINK I MISSED ONE.
THIS WAS A FOCUSED PROGRAM AND A
BEFORE AND AFTER DESIGN IN A
SYRINGE EXCHANGE PROGRAM IN
OREGON.
THE TIMING OF THIS ONE WAS EARLY
2021 SO WITH VACCINE ALREADY
BEING ROLLED OUT, PROBABLY STILL
IT WOULD PROBABLY BE IN THE FACE
WHERE WE THOUGHT WE WOULD MAKE
THIS GO AWAY AND IF YOU REMEMBER
THOSE DAYS.
IT WAS LED BY A COMMUNITY
ORGANIZATION AND THEY DID FIVE
WEEKS OF OBSERVATION WITHOUT
CONTINGENCY MANAGEMENT AND WAS
ESSENTIALLY A $10 INCENTIVE
AMONG OTHER THINGS.
AND THEY LOOKED AT RULE AND
URBAN COUNTIES AND DID SEE A
SIGNIFICANT INCREASE IN
ACCEPTANCE OF BEING TESTED AND
AMONG THESE PERSONS WHO INJECT
DRUGS FROM 12% TO 35% OF THE YOE
CLIENTS AND GENERATING
INNOVATIVE WAYS TO PROMOTE
TESTING WAS THE PRIORITY OF THE
RADK-UP PROGRAM AND IN SETTINGS.
-- RADX.
THIS IS ALSO DATED BY THE TIME
THAT THE ANNOUNCEMENT WAS DONE,
WHICH WAS JULY 21 TO DECEMBER.
THIS IS DELTA TIME.
AND IT FOCUSED ON THE ROLE OF
SCHOOL MASKING.
A POLICY THAT'S BEEN ABANDONED
IN FACT MOST MASKING IS
VOLUNTARY.
A FEW PLACES, MOSTLY PERFORMANCE
LOCATING ARE REQUIRING OF PEOPLE
WHO ARE ATTENDING OR INDIVIDUAL
AND THIS IS NINE STATES AND A
MILLION STUDENTS AND 160,000
STAFF AND SCHOOL DISTRICTS AND
AGAIN, IN THE SUMMER, THROUGH
DECEMBER OF 2021 SO RIGHT
BEFORE, RIGHT WHEN OMICRON WAS
BEGINNING TO BE NOTED, AND
LOOKING AT WHERE POLICIES HOW
EFFECTED SECONDARY TRANSMISSION
AND ESSENTIALLY THE BOTTOM LINE
WAS MASKING WORKS, WE KIND OF
KNOW THAT, BUT STILL DIDN'T
PERSUADE PEOPLE TO DO IT ALL THE
TIME.
SO THE DISTRICTS THAT HAD THIS
AS OPTIONAL, SAW AN INCREASE
RISK OF SECONDARY TRANSMISSION
AND YOU CAN SEE THE PREPORTION
FOR EVERY 100 COMMUNITY ACQUIRED
CASES SEVEN PREDICT AND COMPARED
TO 26 AND SO WHEN MASKING WAS
REQUIRED, IN A SCHOOL DIRECTING.
THIS ANALYSIS OBSERVATIONAL AND
LARGE SAMPLE, MULTIPLE STATES,
MULTIPLE DISTRICTS AND I THINK
IT PROVIDES AT LEAST FOR DELTA,
MASKING WAS VERY EFFECTIVE AND
LOW COST AND RELATIVELY.
IN SCHOOLS OR ANYWHERE ELSE FOR
THAT MATTER.
FACTORS THAT WE'VE GONE THROUGH
THE -- HAVING TO SCRAMBLE TO GET
A TEST AND WAITING A WEEK FOR A
TEST.
BEING REQUIRED TO TEST IF YOU
WANT TO TRAVEL ORIENT THE
COUNTRY AND NOW WE HAVE
3 MILLION HOME TESTS DISTRIBUTED
AND USED BY AMERICANS AND SO
POSSIBLE USE INCLUDING BEING
SENT BY THE WHITE HOUSE AND
PROVIDED BY SOME EMPLOYERS,
INCLUDE BEING THE NIH.
PEOPLE ARE LOATHE TO WANT TO BE
MONITORED SO THERE'S NO WAY THAT
REPORTING IS GOING TO BE
FEASIBLE IN THE U.S.
ON A VOLUNTARY BASIS.
IF IT HAS VERY LOW UPTAKE AND
OUR EXPERIENCES WORKING WITH THE
RADX-UP PROGRAM IS YOU GET ONE
OR TWO PERCENT UPTAKE WHEN YOU
DO A POPULATION MASSIVE FLOODING
OF AN AREA WITH ACCESS TO FREE
TESTS AND ENCOURAGING PEOPLE TO
USE THEM.
MOST OF US HAVE A BOX AT HOME
AND THEY'RE USE IT BASED ON
SYMPTOMS AND IT SEEMS TO MAKE
SENSE BEFORE GETTING CLOSE TO
SOMEONE CLOSE TO YOU WHO MAY BE
MORE SUSCEPTIBLE BECAUSE OF
UNDERLYING CONDITIONS.
THIS WHOLE IDEA THAT THIS WOULD
BE DISSEMINATED THIS WAY HASN'T
WORKED SO WHO USES THE TEST,
YES, PEOPLE WITH MORE INCOME AND
MORE EDUCATION AND IN THIS
PARTICULAR STUDY, LATINOS,
LATINAS DID IN LOOKING AT THE
PAPER AT THE TABLE WHERE THE
ONLY GROUP THAT HAS SIGNIFICANT
ASSOCIATIONS WITH INCREASED
LIKELIHOOD TO BE MOTIVATED TO
USE THE TEST AND WE'RE AMONG
RACE ETHNIC GROUPS WAS LATINOS.
SO MORE TO BE DONE BUT I THINK
PART OF OUR EVERYDAY
CONSIDERATIONS NOW IN TOTALLY
CHANGED THIS FIELD OF
DEVELOPMENT OF SELF-TEST AND IT
MAY BE IN THE LONG RUN, WE'LL
LOOK BACK AS REALLY A LANDMARK
MOMENT IN THE DEVELOPMENT OF
THIS APPROACH TO HEALTHCARE.
YES, WE'VE HAD PREGNANCY, HOME
PREGNANCY TESTS, HOME HIV TESTS
AND OTHER SELECTED THINGS THAT
ONE CAN DO.
WELL OBVIOUSLY HOME GLUCOSE IS
AVAILABLE FOR PEOPLE WITH
DIABETES.
LITERALLY, NUMBER OF THESE TESTS
DONE ANNUALLY IN THE U.S.
MEASURING THOUSANDS, MAYBE THE
FEW TENS OF THOUSANDS THESE WERE
3 BILLION COVID-19 TESTS.
SO, IT'S A WHOLE DIFFERENT
DIMENSION.
I LIKE THIS PARTICULAR REPORT
BECAUSE I DON'T THINK I'VE SEEN
A FOCUS GROUP IN INDIGENOUS
LANGUAGES AND JUST FOR THAT,
IT'S WORTH NOTING.
INDIGENOUS PEOPLE FROM LATIN
AMERICA HAVE BEEN COMING MORE TO
THE UNITED STATES FREQUENTLY.
YOU SEE STRATIFICATION IN THE
IMMIGRANTS OF THOSE WHO ARE MORE
LET'S SAY MEXICAN,
SPANISH-SPEAKING, CENTRAL
AMERICANS TO LITERALLY PERSONS
WHO SPANISH IS THEIR SECOND
LANGUAGE IF AT BEST AND I THINK
MANY PEOPLE IN THE U.S. DON'T
APPRECIATE THAT THAT'S A REALITY
OF CERTAIN PARTS OF LATIN
AMERICA IN SOUTHERN MEXICO AND
IN THE HIGHLANDS OF CENTRAL
AMERICA AND IN PARTICULAR IN
GUATEMALA AND ALSO IN THE
HIGHLANDS OF THE ANDES AND
PARTICULARLY IN BOLIVIA.
MISINFORMATION, THEMES, DISTRUST
IN GOVERNMENT THERE AND STEMMING
FROM THE HOME COUNTRY AS WELL AS
THE U.S., MORE THAN THE U.S.
AND THE INSECURITY AND FEAR THAT
THEY LIVE WITH IN THEIR HOME
COUNTRY AND NOW IN THE U.S.
AROUND THE DEPORTATION AND
REGULAR EMPLOYMENT THAT CREATES
BARRIERS FOR NOT ONLY TESTING
BUT ALSO ACCEPTING VACCINATIONS.
SO, SOBERING REPORT THAT CAME
OUT OF THE MMWR EARLIER THIS
YEAR AND ON THE OVERDOSE DEATHS.
THIS IS NOT THE OFFICIAL DEATH
RATES FROM NCHS OR THE CDC BUT
THIS IS A SUBSTANCE USE OVERDOSE
REPORTING SYSTEM IN 25 STATES IN
THE DISTRICT OF COLOMBIA AS
OPPOSED TO THE FINAL NATIONAL
RATES.
IT IS LINKED TO CENSUS BASED
METRICS OF HEALTH INEQUALITY AND
SO YOU CAN SEE THE GRADIENTS SO
THINK OF THIS AS A SOCIOECONOMIC
GRADIENT OF THE COMMUNITY SO WE
HAVE THE HIGHEST RATES OF
INEQUALITY COMPARED TO THE
LOWEST RATES OF INEQUALITY OR
SOCIOECONOMIC INEQUALITY.
I SUPPOSE THAT WE WITH HAVE TO
DIG INTO THE EXACT NATURE OF HOW
THEY CALCULATED THAT BESIDES THE
USUALLY THINGS TO -- THEY DID
FACTOR IN ACCESS TO SUBSTANCE
USE TREATMENT INTERESTS OR
PROVIDERS.
BIG GRADIENT FOR THE AFRICAN
AMERICANS FOR WHITES AND
LATINOS.
NOT SO FOR AMERICAN INDIANS AND
ALASKA NEWS AND SEE FLATNESS
HERE IN THE RISK OF OVERDOSE
DEATHS.
OVERDOSE DEATHS, SIX YEARS AGO,
WAS PRIMARILY A PROBLEM OF
WHITES IN RURAL AREAS, AND ALSO
IN URBAN AREAS BUT IT WAS BY FAR
WHITE AMERICANS HAD THE HIGHEST
RATES.
UNFORTUNATELY, WE HAVE NOW SEEN
THAT CHANGE IT'S NOW AFRICAN
AMERICANS AND LATINOS OR CLOSE
BEHIND WHITES IN OVER ALL RATES
AND THE OVER ALL TOTAL MAY BE
VERY CLOSE.
THIS IS SAD.
THIS IS A FAILURE OF OUR ABILITY
TO STEM THIS EPIDEMIC AND I KNOW
OUR COLLEAGUES AT NIADA SPEND
THEIR TIME WORKING ON THIS.
THE PANDEMIC HAS MADE THIS WORSE
AND THE DATA ARE VERY CLEAR AND
SO KEEPING THE EYE ON THESE
ISSUES IS GOING TO REALLY BE
IMPORTANT FOR NIMHD.
WE'RE NOT GOING TO LEAD THIS BUT
WE'RE GOING TO REALLY WORK ON
MAKING THIS BETTER.
THE INTERESTING OBSERVATION
ABOUT ASIANS, WHETHER OR NOT
PACIFIC ISLANDERS WOULD BE IN
THE SAME LEVEL BUT PROBABLY
BASED ON THESE ARE VERY PLAT AND
VERY LOW IN TERMS OF THEIR RISK
OF OVERDOSE DEATHS AND SOMETHING
THAT MERITS FURTHER RESEARCH BUT
THIS IS QUITE STRIKING.
THIS IS A PAPER BY ONE OF OUR
ESI AWARDEES FROM SEVERAL YEARS
AGO.
IT'S EVALUATING A POLICY
INTERVENTION COMPARING THE STATE
OF OREGON, THE STATE OF SOUTH
CAROLINA AND OREGON HAVING MORE
LIBERAL POLICIES, IF YOU WISH,
OR PROGRESSIVE POLICIES, ON
MEDICAID COVERAGE OF UNINSURED,
MANY UNDOCUMENTED LATINA WOMEN
GIVING BIRTH COMPARED TO THE
STATE OF SOUTH CAROLINA.
IT'S REALLY PART AND PARCEL WITH
THE EMPHASIS IN RECENT, IN THE
LAST THROW YEARS ON MATERNAL
HEALTH.
BECAUSE THIS IS NOT ABOUT
MECHANISMS, THIS IS NOT PRE
CONCEPTUAL HEALTH OR HOSPITALS
DOING THE RIGHT THING OR HAVING
POOR SYSTEMS.
THIS IS ABOUT SIMPLE HEATH CARE
COVERAGE AND THEN USING, IN
THEIR CASE, THEY USE GESTATIONAL
DIABETES AS THE TARGET GROUP TO
EVALUATE BECAUSE THEY'RE
SENSITIVE TO, YOU HAVE A
MEASURABLE OUTCOME THAT CAN SHOW
WORSENING OR IMPROVEMENT.
IF YOU GET -- IF YOU ARE
UNINSURED AND PRESENT TO A
HOSPITAL WITH TERM PREGNANCY FOR
DELIVERY, EVERY STATE IN THE
COUNTRY, EVERY HOSPITAL IS
REQUIRED BY-LAW TO PROVIDE CARE
BUT THE MINIMUM CARE THAT IS
PROVIDED IS OF COURSE THE
DELIVERY AND SIX WEEKS.
AT THE END OF SIX WEEKS, THEY'RE
DONE.
AND IN TERMS OF THE LEGAL
OBLIGATION.
AND ONE OF THE POLICY
INTERVENTIONS HERE WOULD BE TO
SAY WELL, WHEN YOU BECOME
PREGNANT, MEDICAID WOULD KICK IN
AND THAT IS IMPORTANT.
AND AFTER DELIVERY, THE COULD
HAVE WOULD EXTEND FOR A YEAR.
THAT'S THE WINDOW WE NEED TO
TARGET BECAUSE SEVERE MORBIDITY
AND MORTALITY OCCURS AT A THIRD
A THIRD AND A THIRD IN THESE
PHASES NOT JUST DURING THE
IMMEDIATE POSTPARTUM PERIOD OR
DOING THE HOSPITALIZATION.
AND IN THIS STUDY, IT WAS SHOWN
THAT USE OF ANTI-BUY A BET TICKN
PEOPLE WITH DIABETES.
THIS MAY NOT BE A LEADING CAUSE
OR MAJOR CONTRIBUTE TO MATERNAL
MORTALITY BUT IT'S CERTAINLY A
SENSITIVE MEASURE IN THIS STUDY
INTO REALLY SHOW THAT HEALTHCARE
BEGINS WITH COVERAGE AND OF
COURSE HAVING A PLACE AND A
CLINICIAN TO GO TO.
IN OTHER RESEARCH, PUBLISHED BY
OUR GRANTEES IT WAS SEEN
GESTATIONAL DIABETES MANAGEMENT
AMONG 440 PREGNANT WOMEN WITH
DIABETES BLACK AND LATINA AND
WOMEN WITH OTHER RACE ETHNESS
TEE HAD HIGHER LEVELS SO THEY'RE
PRESENTING WITH MORE AND HIGHER
RATES OF GLUCOSE TO LESS WELL
CONTROLLED BEFORE BEING
DIAGNOSED.
THIS IS A REPORT IN JOURNAL OF
PEDIATRICS ON THE COHORT STUDY
THAT WAS IN PART FUNDED BY THE
RCMI IN PUERTO RICO LOOKING AT
PEOPLE WHO HAD ZIKA WHILE
PREGNANT.
REMEMBER ZIKA?
AND THESE CHILDREN HAD BEEN
FOLLOWED OVER TIME, 114
CHILDREN.
NOT NECESSARILY SEVERE BERTH
DEFECTS.
2.6% HAD MICROCEPHALY AT BIRTH
BUT A LOT HAD EYE ABNORMALITIES
AND THE MOST IMPORTANT LONG-TERM
EFFECTS IS RELATED TO
DEVELOPMENTAL DELAY IN AT LEAST
ONE DOMAIN IN A THIRD OF THE
CHILDREN.
SO THESE NEURO DEVELOPMENTAL SEE
QUELL A PRESENT IN CHILDHOOD AND
CREATE VULNERABILITIES IN THE
CHILDREN DEVELOPMENT NOW A
NUMBER OF ABOUT FIVE OR SIX OR
SEVEN YEARS OUT FROM THE ZIKA
SUMMER THAT WE HAD A LOT OF
ZIKA.
THE YEAR WE HAD A LOT OF ZIKA.
SO, NON ALCOHOLIC FATTY LIVER
DISEASE IS A PARTICULARLY
RELEVANT CONDITION.
MAJOR CAUSE OF CHRONIC LIVER
DISEASE.
A MAJOR CONTRIBUTE OR TO LIVER
CASER.
IT EFFECTS MALES OVER FEMALES.
ALL RACE AND ETHNIC GROUPS IN
THE U.S. AND COMPARED TO WHITES.
FOR DIFFERENT REASONS.
AND THIS NON ALCOHOLIC FATTY
LIVER DISEASE PARTICULARLY
RELEVANT IN MEXICAN AMERICANS.
NOT ALL UNDERSTOOD WHY.
EVERYONE SAID IT'S OBESITY.
AFRICAN AMERICANS FOR EXAMPLE
HAVE AS HIGH OR HIGHER RATES OF
OBESITY THAN MEXICAN AMERICANS
YET DO NOT HAVE A HIGHER RATE
FATTY INDUCED INFLAMMATION AND
SO THIS IS NOT A -- YOU HAVE
THIS AND YOU ARE GOING TO GET
THAT.
CERTAINLY OBESITY INCREASES THE
RISK OF DIABETES.
FAT IN THE LIVER, WHICH WE ALL
GET, AFTER EATING CERTAIN FOODS
OR DRINKING CERTAIN THINGS, IS
NOT AUTOMATICALLY GOING TO LEAD
TO INFLAMMATION.
SO IT'S A SUBSET OF INDIVIDUALS
WITH FATTY LIVES WHO DEVELOP
INFLAMMATORY RESPONSE AND
STEATOSIS AND HAVE LIVER DISEASE
SO IT'S IMPORTANT TO APPRECIATE
WE'RE ONLY LOOKING AT A SMALL
PREPORTION THAT GO ON TO DEVELOP
AND YOU HAVE CHRONIC
INFLAMMATION OVER YEARS LEADS TO
CHRONIC LIVER DISEASE AND
CIRRHOSIS AND POTENTIALLY LIVER
CANCER.
NOW THERE MAY BE OTHER REASONS
PEOPLE WILL GET CANCER.
YOU MAY NOT GET AS MUCH
INFLAMMATION BUT HAVE A RISK, A
GENETIC RISK OR OTHER RISK LIKE
TOO MUCH ALCOHOL THAT WILL
ACCELERATE THAT RISK OF
DEVELOPING CANCER AND CIRRHOSIS.
THIS IS A STUDY THAT LOOKED AT
THAT WITH REGARDS TO A
PARTICULAR RISK TO A STUDY IN
SOUTHERN ARIZONA WITH
MEXICAN-AMERICANS BOTH MEN AND
WOMEN.
THE IDEA OF COURSE IS THAT IF WE
USE WEIGHT MANAGEMENT
INTERVENTION OR SOMEHOW IMPACT
BMI IT WILL MAKE IT BETTER.
THAT'S WHAT WE HAVE SO FAR.
SOME SCIENTISTS HAVE TRIED USING
THE STAT ANT DRUGS WITH VARIABLE
EFFECTS AND THIS IS AN ACTIVE
AREA OF RESEARCH ACROSS THE
SCIENTIFIC FIELD AND NIMHD HAS
SMILSTUDIES THIS.
I HAD TO SHOW THIS STUDY BECAUSE
IT FELT LIKE BACK TO THE FUTURE
FOR ME.
BACK IN THE 1990s, THERE WAS A
SCHOLAR, I GUESS EARLY 2000s,
I'M DATING MYSELF.
THAT HAD THE IDEA OF LOOKING AT
WHAT WAS THE PREPORTION OF
PUBLISHED PAPERS IN THE
PSYCHIATRY LITERATURE THAT
REPORTED ON THE RACE ETHNIC
DIVERSITY OF THEIR PARTICIPANTS
IN CLINICAL TRIALS AND ONE OF
THE CO-AUTHORS IN THAT IS FORMER
NIMHD STAFF JENNIFER WORK
WITHING THE SCHOLARS AND SHE WAS
A SCHOLAR IN OUR CENTER FOR
AGING DIVERSE COMMUNITIES.
THIS IS SIMILAR MANY LOOKING AT
125 ARTICLES AND AMERICAN
JOURNAL OF PSYCHIATRY BUT NOT
FROM THE EARLY 2000s MIND YOU
OF SOME 2019-2020 AND HOW DID
THEY REPORT THEIR PREPORTIONS?
THE BIGGEST RESULT IS NOT ONLY
THE UNDER REPRESENTATION BUT THE
LACK OF REPORTING AND NOW WE SEE
SEXUAL IDENTITY OF PARTICIPANTS
NOT BEING REPORTED ARE NOW IT
MAYBE HASN'T CAUGHT UP YET.
WE WOULD THINK THAT THE MENTAL
HEALTH LITERATURE MIGHT BE EARLY
UPTAKE OF STANDARDIZED
COLLECTION OF DATA ON THIS
MANUFACTURE BUT THIS LACK OF
REPRESENTATION I THINK DOES
NOT -- HAS NOT BEEN RESOLVED IN
20 YEARS FOR SURE.
THIS WAS ALSO IMPORTANT IN
ACADEMIC MEDICINE SO THE IMPACT
ON THE DEPRESSION IN MEDICAL
STUDENTS, BLACK MEDICAL STUDENTS
IN THE U.S. WAS A SURVEY DONE
AND NOW IT LISTS 733 BLACK
STUDENTS.
I SHOULD HAVE CHECKED.
I DON'T THINK THERE ARE MANY
MORE THIS IS CLOSE TIE UNIVERSAL
SAMPLE OR IT'S A VOLUNTEER NOT
NECESSARILY A RANDOM SAMPLE
BECAUSE THE STATE OF AFFAIRS OF
MEDICAL STUDENTS IN THE U.S.
WITH AFRICAN AMERICANS, THERE
MAY BE A COUPLE THOUSAND.
AND WHAT DO EVENTS DO?
NOW AUGUST 2020 REMEMBER, IS NOT
LONG AFTER ABOUT TWO OR THREE
MONTHS AFTER GEORGE EMPLOYED WAS
MURDERED.
AND THE BLACK LIVES MATTER
PROTEST AFFECTED IN THAT SUMMER
MANY CITIES IN THE UNITED
STATES.
SO, I THINK THAT THESE EXTERNAL
EVENTS HAPPENED AND IT COULD BE
THIS IN THIS CASE IT COULD BE A
DISASTER IN ANOTHER CONTEXT FOR
AN AREA OR IT COULD BE EVENTS
ACROSS THE PLANET.
THEY HAVE AN IMPACT ON OUR
PROFESSIONALS IN TRAINING IN
THIS CASE.
BUT STUDENTS, BLACK, AFRICAN
AMERICAN STUDENTS FEEL THEY HAVE
TO WORK TWICE AS HARD IN ORDER
TO GET THE SAME EVALUATION OR
TREATMENT AND OVER HALF REPORTED
BEING WATCHED MORE CLOSELY THAN
OTHERS AND IN 21% THAT THEIR
INSTITUTION NEVER OR RARELY
RESPONDS TO SEM INOLE RACE
EVENTS THAT IMPLICATE BLACK
INDIVIDUALS.
HOPEFULLY SOME OF THIS HAS
CHANGED.
I THI -- AROUND RACISM AND I ALO
THINK THAT THERE HAS CERTAINLY
BEEN A MORE RETURN TO USUAL
BEHAVIOR WITH LESS INSTITUTIONAL
CHANGE THAN WE WOULD LIKE TO
HAVE SEEN.
SO, THIS IS JUST A HIGHLIGHT OF
THE IMPORTANCE OF THAT.
THIS STUDY WAS MORE MECHANISTIC,
LOOKING AT ATTACHMENT-STYLE AND
MODERATE RISK FOR AFRICAN
AMERICAN RURAL RELATING POVERTY
AND I KNOW THERE'S A RENEWED
INTEREST IN EVALUATING THE ROLE
OF BASIC SCIENCE IS IN
UNDERSTANDING HEALTH
DISPARITIES.
SO, CAN YOU RECREATE ANIMAL
MOLDS OR CREATE CELLULAR MODELS
AND THE MOST PROMISING LINE OF
RESEARCH IS PROBABLY RELATED TO
SORT OF THE SOCIAL DEPRIVATION
OR IN A CONTEXT TO REPRODUCE
THAT, I DON'T KNOW THAT ANYONE
HAS REPRODUCED ANYTHING RELATED
CLOSELY TO RAINFALL RACISM AND
DISCRIMINATION BUT WE CAN WAIT
AND SEE WHAT WHAT COMES OUT OF
THAT.
IT'S USED WIDELY IN POPULATION
SCIENCE AND IN EVALUATING THE
POTENTIAL MECHANISMS AS A
PHYSICAL OWE LOGIC MEASURE OF
CHRONIC STRESS WITH SOME
PROMISING RESULTS IN THAT WAY AS
WE CONTINUE TO DOWN THIS ROAD OF
EVALUATING AND THIS IS LOOKING
AT ATTACHMENT STYLE WHICH IS
SOMETHING THAT I LEARNED ABOUT
BY LOOKING AT THIS.
LIFE EXPECTANCY IN THE UNITED
STATES IS TOPIC THAT WE WORKED
ON THIS YEAR.
AND THEY HAD THE FIRST OF A
SERIES OF CROWN I CAN THAT WILL
BE COMING OUT AND WORKING VERY
CLOSELY WITH THAT GROUP AND YOU
CAN SEE THE EVENS TO USE THE
THAT CONTRIBUTED.
WE MET AND MEET ON A MONTHLY
BASIS AND WE CONCEIVED THIS IN A
PHONE CALL THINKING ABOUT THIS
AFTER LISTENING TO CHRIS MURRAY
AND OTHERS PRESENT DURING ONE OF
THEIR VISITS AND COUPLE OF
VISITS THEY CAME TO NIH BROUGHT
MOSTLY BY THE FOGERTY
INTERNATIONAL CENTER AND ALMOST
ALL OF THE WORK HAS BEEN IN
GLOBAL AND CREATING A MECHANISM
BY WHICH TO LOOK AT U.S. HEALTH
DISPARITIES AND WE FACTOR IN GEE
OFF RAG FEE WAS I THINK VERY
ILLUMINATEING AND WE'RE IN THE
MIDST OF CONTINUING THIS WORK
AND THIS IS A ONE SNAPSHOT FROM
THE MAP FROM THE PUBLISHED PAPER
AND IN ITS COMPARING LIFE LIFE
EXPECTEN SEE BY COUNTY AND RACE
ETHNICITY TO WHITE SO IF IN IN
THE GROAN AND OVER IN THE PURPLE
OR DARK BLUE WHATEVER SO YOU SEE
HISPANIC LATINOS MOST OF THE
COUNTRY THEY HAVE LONGER LIFE EX
PACT ANTSY THAN WHITES DO AFTER
TWO YEARS OF COVID.
AND THEY VALLEY HERE AND FOUR
CORNERS AREA WHERE LATINO
HISPANICS DO WORSE AND THIS IS
KIND OF THE DATA THAT WOULD NOT
BE SO EVIDENCE WITHOUT THIS KIND
OF ANALYSIS AND ASIANS AND THIS
TRULY DOES REPRESENT MOSTLY
ASIANS MAKE UP 95% OR 90% OF THE
POPULATION ANALYZE HERE AND WORE
GOING TO SEPARATE FROM NATIVE
HAWAIIAN DO BETTER THAN WHITES
AND HAVE THE LONGEST LIFE
EXPECTED ANTSY IN THE UNITED
STATES AND THAT WAS NOT
PUBLISHED BY OUR GROUP HERE BUT
ALSO BY THE CDC EARLIER THIS
YEAR AND THEN AFRICAN AMERICANS
HAVE SHORTER LIFE EXPECT ANTSY
BUT THERE ARE COUN TEASE AREAS
WHERE INCLUDING IN FLORIDA WHERE
AFRICAN AMERICANS DO BETTER THAN
WHITES OR AS GOOD AS WHITES
LET'S PUT IT THAT WAY AND YOU
ALSO SEE AMERICAN INDIAN AND
ALASKA NATIVES PREDOMINANTLY
DOING WORSE BUT NOT UNVERSALLY
AND THERE ARE POCKETS OF
COUNTIES WHERE THE LIFE
EXPECTANCY IS WORSE AND NOW WE
HAVE FOR THE FIRST TIME,
ESTIMATES FOR ASIAN AMERICANS
NOW OFFICIALLY IN THE CDC AS
WELL AS AMERICAN INDIAN AND
ALASKA NATIVE AND THOSE HAVE NOT
BUN TESTIFY BUT NOT WIDELY
DISSEMINATED AND IT GIVES US
PUBLIC-HEALTH MET WISHES TO
FOLLOW AND FOR TRACTOR-TRAILER
SECOND YEAR IN A ROW THE UNITED
STATES LIFE EXPECTANCY DROPPED
IN 2021.
MOST HIGH INCOME COUNTRIES HAVE
RECOVERED AND I THINK ALL OF
THEM HAVE EXCEPT THE UNITED
STATES.
IN THE LINK BETWEEN A DEPRESSION
ON SLEEP.
AND MEXICAN AMERICANS AND SLEEP
IS AN AREA OF ACTIVE RESEARCH
FOR NOT ONLY OUR INVESTIGATORS
BUT ALSO THE COMMUNITY.
WE'VE HAD A SLEEP INITIATIVE
THAT HAS FUNDED A NUMBER OF VERY
GOOD INVESTIGATORS AND THAT HAVE
BEEN PRODUCING RESULTS.
SO LIVING MORE TIME IN THE U.S.
WITH LONGER SLEEP DURATION,
ENGLISH SPEAKING HAD HIGHER RISK
OF SHORT SLEEP DURATION.
SO GOING IN TWO DIRECTIONS A
CULTURATION ISN'T ALWAYS GOOD OR
BAD FOR YOU WE HAVE TO STUDY IT
AND THE OTHERS INCREASE IN THIS
DEPRESSION SCORE THAT PHQ WHICH
IS PRIMARILY USED CLINICALLY BUT
IT'S NOW PART OF IT SO GOOD TO
LOOK AT.
ALSO LOOKING AT THE RESULTS OF
WHAT AFRO CARIBBEAN IMMIGRANTS
LOOK LIKE IN TERMS OF HEALTH
COMPARED TO AFRICAN AMERICAN
PEER AND THE ODDS OF GETTING
DIABETES AND BMI AND THIS IS
IMPORTANT IN MECHANISTICALLY
INTERESTING.
SOME QUESTIONS WHY DO WE THINK
OF OUR RACE OR RACE ETHNICITY IN
THE DEVELOPMENT OF DISEASE.
SOMETIMES WE SEE THE OUTCOME AND
IT'S MORE COMMON IN THAT GROUP
OR THIS GROUP AND WE KNOW IT'S
NOT CAUSAL BUT IT HELPS US
UNDERSTAND HOW PEOPLE MIGHT GET
THERE AND ILLUMINATE POTENTIAL
MECHANISMS.
ONE NA IS COMMONLY THOUGHT WELL
YOUR WEIGHT GOES UP, YOUR BMI
GOES UP, YOUR RISK OF DISEASE
PRIMARILY DIABETES IN THIS CASE,
IS GOING TO GO UP.
AND THOSE DATA DATA ARE GENERAN
ONE POPULATION AND ASSUMED TO BE
IN OTHERS.
YOU FIND THE RISKS DON'T BEHAVE
THE SAME IN ALL POPULATIONS.
WE'VE SEEN NOW WITH LATINOS AND
WE'VE SEEN IT WITH AFRICAN
AMERICANS AND NOW WITHIN THE
AFRICAN AMERICAN OR THE BROADER
GROUP OF BLACKS IN THE U.S. AND
LOOKING AT AFRO CARIBBEAN WE SEE
DIFFERENT RATES OF DIABETES FROM
OBESITY.
THIS IS PARTICULARLY RELEVANT.
KATHY WAS A UNDERGRADUATE
STUDENT WHO WORKED WITH ME AT
UCSF IN KEEPING COMPLETE -- SHE
DID THE GRUNT WORK OF ANALYSIS
OF A STUDY WE HAD DONE AND NEVER
FINISHED WRITING IT UP AND WE
DID GET THAT PUBLISHED.
AND MAYBE I THINK IT WAS LAST --
ONE OF THE LAST IF NOT THE LAST
EMPIRICALLY-BASED STUDIES THAT I
WAS FIRST AUTHOR ON.
SHE WENT ON TO FINISH HER BA AND
WENT TO GRADUATE SCHOOLS AND
TEXAS AND CAME BECOME TO SAN
FRANCISCO STATE AND BECAME A
SCHOLAR UNDER THE AGING RESEARCH
OR CADC AND UNDER ANNAPOLIS'
LEADERSHIP AND DID THIS PILOT
WORK LOOKING AT HAIR CORTISOL.
SHE'S A BASIC SCIENTIST BY
TRAINING WHO BECAME INTRIGUED
AND INTERESTED IN DISPARITIES
RESEARCH AS PART OF MENTORING
FROM HER MENTOR AND ALSO I THINK
WORKING WITH US AND THEN
SUBSEQUENTLY WITH ANNA AT UCSF.
SO HAIR CORTISOL IS USED AS A
STABLE MEASURE OF CHRONIC STRESS
AND NORMALLY, WHEN YOU LOOK AT
THE DATA ON MEASURING OF
PHYSICAL LOGIC MANIFESTATION OF
STRESS AND THREE TIMES A DAY
SALIVARY CORTISOL SEEMS TO TALK
ABOUT PARTICIPANT BURDEN.
YOU HAVE TO BE COMPULSIVE AND
REALLY FOCUSED TO DO THAT.
WELL, AIR CORTISOL IS EASY AND
IT TAKES ABOUT A MONTH, RIGHT,
FOR HAIR TO GROW AND FALLOUT.
SO, OR TO REACH THE POINT WHERE
YOU GET THIS.
SO, IN THIS, LOOKING AT HPA
ACCESS DISREGULATION AND
SPANISH-SPEAKING LATINA HAD
SURVIVED BREAST CANCER HAS BEEN
THE LINE OF THIS WORK THAT OF
YOU MAY HAVE HEARD ANNA PRESENT.
SO LET ME FINISH WITH THIS SORT
OF FUTURE PHOTO.
THESE WERE OUR NIMHD SUMMER
INTERNS.
TIN INCLUDES A COUPLE OF INTERNS
FROM MY LAB THAT IS FORMALLY
BASED IN NHLBI.
THEY HAD VIRTUAL POSTERS
PRESENTED AUGUST 3rd.
OR FOURTH.
THAT THEY PARTICIPATED IN THE
ANNUAL SUMMER INTERN
PRESENTATION.
SO JUST REMIND TO ANYONE
LISTENING OUT THERE OR ANY
MENTORS OUT THERE IF YOU HAVE
POTENTIAL APPLICANTS WHO WANT TO
COME JOIN US, WE ARE IN
PERPETUAL RECRUITMENT MODE AS WE
ALWAYS ARE LOOKING FOR GREAT
PEOPLE TO JOIN OUR TEAM.
IT'S A GREAT GROUP OF STAFF.
WE ALL BELIEVE IN THE MISSION
AND NIH IN GENERAL IS A TERRIFIC
ENVIRONMENT TO WORK IN SO DON'T
HESITATE TO TALK US UP IF YOU
ARE LISTENING AS A SCIENTIST.
SO THANK YOU FOR YOUR ATTENTION
AND LET ME STOP SHAKE, THERE WE
GO.
>> COUNCIL MEMBERS, IF YOU HAVE
A QUESTION OR A COMMENT, YOU CAN
USE THE RAISE HAND OPTION AND
YOU CAN TYPE QUESTION OR
COMMENTS, NOT NECESSARILY THE
ENTIRE QUESTION OR COMMENT BUT
JUST LET US KNOW THAT YOU WANT
TO MAKE A QUESTION OR YOU HAVE A
COMMENT.
WOWE HAVE OUR FIRSTQUESTION.
PLEASE TURN YOUR MIC OR CAMERA
ON.
>> THANK YOU SO MUCH FOR NEXT
LENT REPORT.
I THOUGHT, WELL I JUST WANTED TO
HIGHLIGHT AND ASK YOU A QUESTION
ABOUT THE STUDY ON LIFE
EXPECTANCY.
SO, THAT DATA I THINK IS VERY
RELEVANT, FOR EXAMPLE, I CAN USE
LIKE LIFE EXPECTANCY MANY
STUDIES TO UNDERSTAND YOU KNOW
RETIREMENT SOCIAL SECURITY, IT'S
GOING TO BE AN IMPACT IN MANY OF
US IN OUR RESEARCH SO I WAS
LIKE, REALLY HAPPY TO SEE THAT
KIND OF DATA AVAILABLE AND SO I
WANTED TO ASK WHERE IS THE DATA
GOING TO BE AVAILABLE AND YOU
KNOW, ARE YOU PLANNING TO DO IT
BEFORE THE 2000s OR LIKE JUST
TO KNOW A MORE BIT ABOUT THAT.
>> THANK YOU, EMMA.
THE MODEL WAS THE HARDEST PART.
AND GETTING MORE TIMELY DATA IS
A CHALLENGED.
LET'S LEAVE IT AT THAT.
PERHAPS CONVENE WEREN'TLY OR
INCONVENIENTLY, YOU KNOW, THE
TIME SPAN EXCLUDES COVID AND SO
OBVIOUSLY THERE'S A COVID TIME
NEEDS TO BE LOOKED AT AND THEY
ARE DOING IT, OTHER GROUPS HERE
ARE DOING IT AND WORE PART OF
SOME LOOK AT THAT AND EXCESS
DEATHS FOR 2020 THAT THE
POPULATION SCIENCE GROUP AT NCI,
IT WAS ALREADY PUBLISHED.
I HME, THE INSTITUTE FOR HEALTH
METRIC EVALUATION POLICY IS THAT
THEY BASICALLY PUT ALL THE DATA
AVAILABLE.
SO, ALL THE DATA THAT INFORMED
THIS ARTICLE IS ALREADY
AVAILABLE TO ANYONE.
THE DATA VISUALIZATION TOOLS YOU
CAN GENERATE GRAPHS AND LOOK AT
THE DATA.
THAT IS THEIR POLICY.
THEY DON'T CONTROL OR MONITOR
WHO USES IT FOR WHAT.
SO I THINK WHEN THEY GOT THE
MODEL TO WORK, WHICH WAS NO
SMALL DEAL, NOW WE'RE LOOKING AT
OTHER CAUSES OF DEATH.
I'M REALLY PLEASED THAT WE ARE
GOING TO MAKE PROGRESS ON THIS
SEPARATION OF ASIANS FROM NATIVE
HAWAIIANS AND PACIFIC ISLANDERS
AND THIS IS BEEN MOSTLY A
CONSEQUENCE OF STATES NOT
SIGNING ONTO THE MANDATE FOR
YEARS UNTIL 2017, NOT EVERY
STATE HAD SEPARATED THE GROUP XD
THAT'S WHY CDC HAS BEEN
REPORTING THIS OUTCOME AS API
BUT I THINK WE NOW HAVE AN
AGREEMENT THAT WE'RE GOING TO
CALL THE RATES ASIAN AND PUT AN
EXPLANATION AS TO YES, THE
NATIVE HAWAIIAN PACIFIC
ISLANDERS ARE BURIED IN HERE BUT
NOT PRO TEND IT REFLECTS THE
OTHER GROUP WHICH BY AND LARGE
IS WORSE OUTCOMES ON THE LIMITED
AVAILABLE SEPARATE DATA THAT
WE'VE BEEN ABLE TO SEE FROM
OTHER GROUPS.
I WILL MAKE SURE THAT YOU GET
THE LINK TO IHME.
THEY HAVE WONDERFUL RESOURCE AND
IT'S NOT THE ONLY GROUP THAT
DOES THIS, OBVIOUSLY CDC, THE
WONDER, DATABASES ARE ALSO VERY
HELPFUL.
THERE ARE DIFFERENCES BUT BY AND
LARGE, GETTING IHME TO FOCUS ON
THE UNITED STATES AND TO FOCUS
ON GEOGRAPHY IN THE UNITED
STATES IS REALLY IMPORTANT.
SEVERAL YEARS AGO, IN CONSUMING
OUR UNDERSTANDING THE WORK OF
RAJ CHETY AND LOOKING AT A
DIFFERENT RACE OF MORTALITY BY
INCOME, IT'S INTRIGUE TAG SOME
COMMUNITIES REALLY DO A PRETTY
GOOD JOB OF CARING FOR THEIR
MOST UNDER PRIVILEGED AND OTHERS
DO NOT AS GOOD OF A JOB MANY OF
THIS IS SORT OF A WAY TO TRY TO
CREATE A TOOL TO EVALUATE THAT
MORE CLOSELY.
AND LARGE AREAS BUT I THINK THAT
THERE'S THE ABILITY TO LOOK AT
SMALLER AREAS MORE CLOSELY.
SO --
>> Paul: OK.
THANK YOU, VERY MUCH.
WHY SI DON'T SEEANYTHING ELSE I.
SO, I'M GOING TO CLOSE THAT AND
WE WILL ACCEPT ADDITIONAL
QUESTIONS.
AT SOME POINT LATER.
AT THIS POINT, WHAT I WANT TO DO
IS I WANT TO BRING PRISCILLA
GRANT TO PROVIDE THE STATEMENT
OF UNDERSTANDING.
>> HI, I'M THE NIMHD CHIEF
GRANTS MANAGEMENT OFFICER.
I'M GOING TO BRIEFLY OUTLINE THE
STATEMENT OF UNDERSTANDING
BETWEEN NIMHD AND COUNCIL AND
HIGHLIGHT PARTS OF IT.
THE STATEMENT IS IN YOUR
ELECTRONIC FOLDER AND IT
SUMMARIZES OUR UNDERSTANDING
WITH YOU ABOUT HOW OUR
INTERACTIONS WILL PROCEED OVER
THE NEXT YEAR.
I'LL GO THROUGH IT IN THE ORDER
THAT THE SECTIONS APPEAR IN THE
DOCUMENT WHICH IS WHY I WILL
MENTION SOME SECTION THAT'S
DIDN'T APPLY THIS ROUND.
IF YOU HAVE QUESTIONS, PLEASE
FEEL FREE TO CONTACT ME ABOUT
THEM.
MY CONTACT INFORMATION IS ON THE
LAST SLIDE.
TO HELP ACHIEVE THE GOALS OF THE
INSTITUTE, THIS COUNCIL'S
RESPONSIBLE FOR ADVISING,
CONSULTING WITH AND MAKING
RECOMMENDATIONS TO THE DIRECTOR
OF NIMHD ON MATTERS RELATING TO
RESEARCH ACTIVITIES AND
FUNCTIONS OF THE NIMHD.
COUNCIL MEMBERS SERVE AS A
NATIONAL RESOURCE IN DEVELOPING,
RECOMMENDING AND SETTING THE
INSTITUTES POLICY AND RESEARCH
PRIORITIES.
ON OCCASION, SPECIAL WORKING
GROUPS MAY BE FORMED BY OR AT
THE REQUEST OF COUNCIL, TO
EXAMINE IT AND ADDRESS CRITICAL
SCIENTIFIC OR POLICY ISSUES OF
IMPORTANCE TO THE INSTITUTE AND
ITS CONSTITUENCY.
THEY WILL INFORM COUNCIL OF
CURRENT SCIENTIFIC BUDGETARY
LEGISLATIVE OR OTHER ISSUES THAT
MAY HAVE AN IMPACT ON THE NIMHD
AND THE CONSTITUENCY.
THERE ARE TWO COUNCIL SESSIONS
ONE IS OPEN TO THE PUBLIC AND
THE OTHER IS CLOSED TO THE
PUBLIC.
IN THE OPEN SESSION, THERE'S
DISCUSSION OF SCIENTIFIC AND
POLICY ISSUES AND CONCEPT
CLEARANCE OF SPECIAL
INITIATIVES.
CONCEPT CLEARANCE IS DESCRIBED
IN MORE DETAIL IN THE STATEMENT.
IN THE CLOSED SESSION, THERE'S
SECONDARY REVIEW OF GRANT
APPLICATIONS.
THE STATEMENT PROVIDES MORE
DETAILS ON THIS.
CERTAIN ACTIONS MUST BE
CONSIDERED INDIVIDUALLY BY
COUNCIL AND WE BRING TO YOUR
ATTENTION ANY THAT APPLY TO THE
GRANTS BEING REVIEWED.
SO, TWO OF YOUR MOST IMPORTANT
FUNCTIONS ARE CLEARANCE OF NEW
INITIATIVES IN THE OPEN SESSION,
AND SECONDARY REVIEW OF GRANT
APPLICATIONS IN THE CLOSED
SESSION.
ACTIONS CONSIDERED INDIVIDUALLY
ENCLOUD PLANS FOR FUNDING UNDER
RFAs, APPLICATIONS OF HIGH OR
LOW PROGRAM PRIORITIES,
APPLICATIONS FROM FORUM
INSTITUTIONS WITHIN A FUNDABLE
RANGE, SUMMARY STATEMENTS OF
SPECIAL INTEREST OR NEEDING
DISCUSSION OR ACTION FOR EXAMPLE
SOME ASPECT OF THE RRG'S
RECOMMENDATION HAS BEEN
QUESTIONED.
CO FUNDING APPLICATIONS FOR
WHICH OTHER ICUs HAVE PRIMARY
RESPONSIBILITY IF THE NIMHD DID
NOT HAVE PRIMARY OR DUEL
ASSIGNMENT ON THE COMPETING
APPLICATION.
AND SOME INVESTOR APPLICATION OF
PIs RECEIVING $2 MILLION TOTAL
COST FROM YEAR FROM RESEARCH
PROJECT GRANT AWARDS.
THERE IS A SECTION ON REVIEW AND
REVOLUTION OF APPEALS.
THEY DON'T ALLOW APPEALS OF PEER
REVIEW IF WE HAVE ANY APPEALS OF
THE REVIEW OF UNSOLICITED
APPLICATIONS, WE WILL INFORM
YOU.
THE STATEMENT HAS A SECTION THAT
LISTS ADMINISTRATIVE DECISION
AND ACTION THAT'S DON'T REQUIRE
COUNCIL RECOMMENDATION.
THE ITEMS LISTED ON THIS SLIDE
ARE EXAMPLES OF ACTIONS THAT
WOULD NOT BE BROUGHT BEFORE THE
COUNCIL SUCH AS CHANGE OF P.I.,
CHANGE OF DOMESTIC INSTITUTIONS,
OR ADMINISTRATIVE SUPPLEMENTS
FOR INCREASED COST WITHIN THE
PEER-REVIEWED SCOPE OF A FUNDED
GRANT.
A SECTION DESCRIBES OPTIONS
AVAILABLE TO COUNCIL WHEN
REVIEWING GRANT APPLICATIONS
DURING THE CLOSED SESSION.
THE COUNCIL MAY NOT CHANGE THE
SCORES ASSIGNED BY THE
SCIENTIFIC REVIEW GROUP, HERE
ARE THE OPTIONS AVAILABLE.
CONCURRENCE WITH THE SRD
RECOMMENDATION, NON CONCURRENCE
WITH THE SRG RECOMMENDATION
BASED ON SCIENTIFIC OR TECHNICAL
MERIT OR POLICY RECOMMENDATIONS.
RECOMMENDATION OF HIGH OR LOW
PROGRAM PRIORITY OR DEFERRAL TO
OBTAIN ADDITIONAL INFORMATION
FOR CONSIDERATION AT ANOTHER
MEETING.
A REPORT OF THE OBLAC AND
SUMMARY STATEMENTS NOT REQUIRING
INDIVIDUAL DISCUSSIONS ARE
TREATED AN INDIVIDUAL SUMMARY
STATEMENT BE DISCUSSED
INDIVIDUALLY BY THE COUNCIL.
THE EXPEDITED REVIEW PROCESS IS
NOT MENTIONED IN THESE SLIDES
BECAUSE IT DESCRIBES AN OPTIONAL
PROCESS THAT DIDN'T APPLY TO
THIS ROUNDS APPLICATIONS IF WE
WERE TO FOLLOW THIS PROCESS IN
THE FUTURE FOR CERTAIN
APPLICATIONS YOU WOULD BE
PROVIDED WITH DETAILS IN
ADVANCE.
A SECTION DESCRIBED OPTIONS
AVAILABLE TO YOU COUNCIL WHEN
REVIEWING NEW CONCEPTS FOR
CLEARANCE DURING THE OPEN
SESSION.
APPROVAL, DISAPPROVAL, DEFERRAL,
OR APPROVAL WITH RECOMMENDATIONS
FOR SPECIFIC MODIFICATIONS.
TO SUMMARIZE, THE STATEMENT OF
UNDERSTAND WAS WRITTEN TO BE
COMPREHENSIVE NOT ALL SECTIONS
WERE APPLICABLE TO THE
PARTICULAR GRANTS AND ITEMS
DISCUSSED AT THIS COUNCIL ROUND.
HOWEVER, WE BRING TO YOUR
ATTENTION ANY GRANTS OR OTHER
MATTERS REQUIRING YOUR
CONSIDERATION OR THAT MAY HAVE
AN IMPACT ON THE NIMHD AND ITS
CONSTITUENCY.
IN CASE YOU HAVE ANY QUESTIONS
OR CONCERNS, HERE IS MY CONTACT
INFORMATION.
THANK YOU.
>> Paul: DOES ANY COUNCILMEMBER
HAVE A QUESTION OR COMMENT FOR
PRISCILLA?
RAISE YOUR HAND OR PUT QUESTION
OR COMMENT IN THE CHATBOX.
OK.
THANK YOU, VERY MUCH, PRISCILLA.
AND WITH THAT, I AM GOING TO GO
INTO A BREAK.
PLEASE BE BACK PROMPTLY BY 1:00
P.M.
YOU DON'T HAVE TO LEAVE.
YOU CAN JUST TURN YOUR CAMERA
OFF AND MUTE YOUR MICROPHONE AND
ENJOY YOURSELF.
WE HAVE A EXTERNAL SPEAKER
COMING IN THAT WILL BE STARTING
PROMPTLY AT 1:00 P.M. SO PLEASE
GET BACK TO HEAR THIS
PRESENTATION.
THANK YOU.
WE'RE NOW AT BREAK.
WE'RE HERE FOR THE AFTERNOON AND
HOPEFULLY EVERYBODY TOOK A BREAK
AND WE HAVE TWO SPEAKERS TODAY
AND THE FIRST IS MY COLLEAGUE,
Dr. NONI BYRNES WHO IS THE
DIRECTOR OF THE CENTER FOR
SCIENTIFIC REVIEW AT THE NIH.
I THINK EVERYONE'S AWARE THAT
THE CSR DOES THE MAJORITY OF NIH
PEER REVIEWS OF YOUR GRANTS THAT
COME IN.
SHE LEADS THE CENTER THAT IS A
STAFF OF 600 SCIENTIFIC AND
SUPPORT AND CONTRACT PERSONNEL
AND OVER THE COURSE OF ALMOST
NOW FIVE YEARS, FOUR AND A HALF
YEARS THAT NONI HAS BEEN JUST A
TERRIFIC COLLEAGUE IN REALLY
IMPLEMENTING NEW WAYS OF DOING
THINGS AT CSR.
SHE HAS A BACKGROUND IN
CHEMISTRY AND ALSO ANALYTICAL
CHEMISTRY FROM EMERY AND WORKED
IN THE INDUSTRY BEFORE COMING TO
THE NIH IN THE BEGINNING OF THE
21st SCENERY AND SHE WORKED
HER WAY THROUGH A VARIETY OF
CONTACTS AT CSR STARTING AS A
REVIEW OFFICER.
NOW, SUPERVISING THIS ENTITY
THAT IS 170 STUDY SECTIONS AND
SHE'S BEEN VERY COMMITTED TO
MANY OF THE ISSUES THAT WE CARE
ABOUT INCLUDING FINDING AND
MANAGING BIAS IN PEER REVIEW AND
DIVERSITY IN THE WORKFORCE AND
DIVERSITY IN REVIEWERS AND USING
BOTH KWAN INDI QUALITATIVE IN TY
OF REVIEW IN A SPECTRUM OF
SCIENCE THAT IS SO BROAD IT'S
HARD TO FATHOM.
IT'S BEEN REALLY A PRIVILEGE TO
WORK WITH HER AND SIT WITH HER
ON COMMITTEES AND SO NONI, THE
FLOOR IS YOURS.
>> THANK YOU, VERY MUCH, AND
THANK YOU TO AND MONICA AND PAUL
FOR THE INVITATION AND
OPPORTUNITY TO SHARE WITH YOU
SOME OF CSR'S INITIATIVES.
LET'S ME ASK IF YOU CAN SEE THE
SLIDES.
PERFECT.
EXCELLENT.
THIS IS EXCITING.
MORE THAN ANY OTHER INSTITUTE OR
CENTER, THIS INSTITUTE I THINK
WILL HAVE THE MOST INTEREST WE
COVER APPLICATIONS FROM ALL
INSTITUTES BUT THIS SUBJECT
MATTER IS ESPECIALLY RELEVANT
FOR NIMHD.
THANK YOU FOR THE INVITATION,
I'M HAPPY TO BE HERE.
I WANT TO LAY THE BACKGROUND
WHERE PEER REVIEW FITS INTO THE
NIH ENTERPRISE AND WHAT SCOPES
CSR HAS IN THIS DOMAIN.
NIH HAS A TWO-STAGE PEER REVIEW
SYSTEM.
OF YOU KNOW THIS ALREADY BUT
IT'S GOOD TO REITERATE THAT.
THE FIRST LEVEL OF REVIEW IS THE
EVALUATION OF SCIENTIFIC MERIT
AND ABOUT THREE QUARTERS OF THAT
IS DONE AT CSR AND THE REMAINING
QUARTER WITHIN THE FUNDING
INSTITUTES AND CENTER AND WHAT
IS US USUALLY DONE IS THINGS
SPECIFIC TO THAT INSTITUTES
PRIORITIES AND THE SECOND LEVEL
OF REVIEW IS INSTITUTE CENTERS
ADVISORY COUNCIL THAT TAKES INTO
QUESTION THE SCIENTIFIC MERIT
AND PROGRAM PRIORITIES AND
CONSIDERATIONS AND MAKES THE
RECOMMENDATION TO THE INSTITUTE
DIRECTOR FOR FUNDING.
SO, JUST TO GIVE YOU AN IDEA OF
CSR SCOPE THAT WILL END AT THE
END THIS MONTH, FISCAL YEAR '22,
NIH RECEIVED OVER 80,000 GRANT
APPLICATIONS AND CSR REVIEWED
61,000 OF THEM THAT'S AROUND 76
AND THE RANGE IS SCIENCE AND
BASIC AND CLINICAL HEALTH.
WE DO A VAST MAJORITY OF THE RO1
OF THE SMALL BUSINESS AND
PORTFOLIO AS WELL AS THE NRSA
FELLOWSHIP APPLICATIONS.
IN ADDITION TO THAT, WE DO THESE
IN STANDING OR RECURRING PANELS
AND WE HAVE OVER 200 STANDING
AND RECURRING PANELS THAT MEET
THREE TIMES A YEAR, AND WE OF
COURSE DON'T DO THIS IN
ISOLATION WE INTERACT WITH
19,000 REVIEWERS WHO HELP US AS
VOLUNTEERS AND CARRY OUT OUR
MISSION AND OVER 1200 MEETINGS.
INTERESTINGLY, A MAJORITY OF
THESE -- IT'S ABOUT 600 OR SO
MEETINGS ARE THOSE OF STANDING
PANELS AND THE REMAINING ARE
MEETINGS THAT ARE SPECIAL
EMPHASIS PANELS.
I'LL TALK A BIT ABOUT THAT.
IN ADDITION TO OUR CHARTER
STANDING STUDY SECTIONS, WE
HANDLE A LARGE NUMBER OF
INITIATIVES IN SPECIAL PANELS
MOSTLY THINGS THAT ARE TRANS NIH
OR HIGH-PROFILE AND INVOLVE MORE
THAN ONE INSTITUTE SO THIS IS
JUST A RANDOM SAMPLING OF SOME
OF THE SPECIAL INITIATIVES WE'VE
HANDLED OVER THE LAST FISCAL
YEAR.
SO, I THOUGHT WHAT I WOULD DO
BEFORE I TALK ABOUT CSR'S
INITIATIVE IS WALK US THROUGH
THE LITERATURE JUST BRIEFLY WALK
THROUGH THE LITERATURE ON BIAS
AND PEER REVIEW SO THERE'S A
KIND OF A RICH HISTORY OF
LITERATURE, SOME OF IT IS VERY
GOOD AND VERY WELL POWERED,
RIGOROUS STUDIES AND OTHERS ARE
NOT SO MUCH.
LET ME WALK YOU THROUGH STARTING
WITH GINTHER.
THIS WAS A STRONG PAPER, WELL
POWERED, 83,000RO1s OVER A
PERIOD OF SIX YEARS AND OF
COURSE, THIS ONE WAS THE ONE
WHERE THE FUNDING GAP BETWEEN
BLACK AFRICAN AMERICANS P.I.s
AND WHITE P.I.s WAS FIRST
INDICATED AT 13 PERCENTAGE
POINTS WHICH WAS VERY
DISTURBING.
FOLLOWING -- SO THIS PAPER GOT,
I'M SURE YOU'VE HEARD OF IT AND
TALKED ABOUT IT.
FOLLOWING THIS PAPER, BEGIN THEY
ARE HAD A NUMBER OF OTHER
PAPERS.
SHE FOUND BLACK P.I.s WERE
LESS LIKELY TO BE FUNDED BUT THE
GAP BETWEEN BLACKS AND WHITES AT
MEDICINE SCHOOLS WAS NARROWER
THAN THAT OF NON MED SCHOOLS.
IN 2016, SHE EXTENDED HER
ANALYSIS TO LOOK AT GENDER AND
FOUND THAT BLACK FEMALE PH.DES
WERE MORE SUCCESSFUL THAN
BLACKMAIL PH.DES.
BUT BLACK FEMALE MDs WERE LESS
SUCCESSFUL THAN BLACK MALE
MDs.
THIS IS A ONE-SENTENCE RECAP OF
THE MAIN FINDING OF THE PAPER
BUT THERE'S A LOT MORE IN THERE.
IN 2018, SHE LOOKED AT BIO
SKETCHES AND BIB LEO METRICS AND
FOUND THAT THEY WOULD EXPLAIN
ABOUT HALF OF THIS BLACK AND
WHITE FUNDING.
SHE WAS MUCH MORE CIRCUMSPECT.
SHE ACKNOWLEDGES THAT REVIEWERS
DON'T HAVE ACCESS TO SEE THE
APPLICANT'S RACE AND THERE
HASN'T BEEN A DIRECT EVIDENCE OF
IMPLICIT BIAS IN PEER REVIEW
BASED ON RACE AND IT HASN'T BEEN
DODOCUMENTED.
IF YOU WANT TO READ MORE ABOUT
IT, SHE HAS A NICE PERSPECTIVE
IN MOLECULAR BIOLOGY OF THE CELL
THAT WAS PUBLISHED IN THE END OF
2021 CALLED REFLECTIONS ON RACE
ETHNICITY AND NIH RESEARCH
AWARDS WHERE SHE WALKS US
THROUGH HER PAPERS AS WELL AS
OTHER RELEVANT PAPERS IN THE
FIELD.
COUPLE OTHER RECENT PAPERS THAT
GETS CITED BUT YOU KNOW, THERE
WERE QUESTIONS RELATED TO ITS
DESIGN AND SUCH AND ALSO THE
FINDINGS, SO THE 2019 YOU MAY
REMEMBER THIS STUDY, THIS ONLY
HAD 48 NIH ROO1s THAT CREATED
FOUR INVESTIGATIONS AND THEY
CHANGED NAMES.
IT WASN'T VERY WELL DESIGNED.
THE BOTTOM LINE WAS THEY
CONDUCTED FOUR VERSIONS OF THE
REVIEW, SIMULATED NIH REVIEW AND
DIDN'T FIND EVIDENCE OF WHAT
MALE ADVANTAGE.
AGAIN, NOT A STRONG PAPER.
THERE'S EROSHEVA.
SO FIRST OF ALL, THE THING THAT
GETS CITED FROM EROSHEVA IS THE
FUNDING GAP EXISTS, THE ONE
THERE IN 2011 IS STILL THERE IN
2014.
THAT'S WHAT GETS CITED.
THE PRIMARY QUESTION IN THE
PAPER WAS WHETHER THERE WAS
COMMENCE RACE BIAS.
HOW DO THE FORCE COME TOGETHER
TO FORM OVER ALL IMPACTS SCORES
IF THERE'S ANY DIFFERENCE BASED
ON THE RACE OF THE P.I.
SO THE ANSWER THERE TO THAT
PRIMARY QUESTION WAS NO.
WITHIN NIH, YOU HAVE SEEN THIS,
ESPECIALLY IN THIS INSTITUTE
WHERE THERE WAS THE PAPER HIGHLY
CITED PAPER BY HOFF, AN INTERNAL
NIH ANALYSIS IT'S BASED ON THE
CONTRIBUTION OF TOPIC CHOICE TO
THE FUNDING GAPS AT NIH.
AND BASICALLY THEY SAID THAT YOU
KNOW, THEY SAID THAT ALL THREE
OF THE FACTORS THAT UNDER LIE
THE FUNDING GAP THAT GO INTO
THOSE FACTORS REVOLVE AROUND
DECISIONS MADE BY REVIEWERS SO
IT'S REALLY INDICATING A
REVIEWER BIAS BASED ON TOPICS.
WE LOOKED AT THIS CAREFULLY.
FIRST OF ALL, THEY HAD ABOUT 100
PLUS, 150 PLUS CLUSTERS BY
TOPIC.
AND THE AWARD RATES WERE IN DEED
DIFFERENT FOUR FOLD ACROSS TOPIC
CLUSTERS.
SO AN EXAMPLE HERE IS, YOU KNOW,
WE LOOKED AT ONE OF THE REALLY
LOW AWARD RATE CLUSTERS AND IT
HAD THESE KINDS OF TOPICS.
CHILDHOOD OBESITY, WEIGHT LOSS,
HEALTH DISPARITIES AND OTHER
AREAS.
ANOTHER ONE THAT WAS VERY HIGH
AWARD RATE, INCLUDED TOPICS SUCH
AS CORNEAL WOUND HEALING, CAT A
RACK DEVELOPMENT AND MORE OCULAR
TOPICS AND SOME ARE VERY BASIC
SCIENCE TOPICS.
WHAT WAS PUZZLING TO US WAS THE
SCIENCE THAT WAS IN THE LOW
AWARD GRADE AND THE HIGH AWARD
GRADE CLUSTERS, WAS QUITE
DISPARENT AND IT WASN'T REVIEWED
BY CLOSELY RELATED TO THE SAME
STUDY SECTIONS.
IT WAS PUZZLING IT WAS
ATTRIBUTED TO REVIEWER BIAS, THE
DIFFERENTIAL AWARD RATES.
THEY HAD A LOT OF OTHER
VARIABLES AS WELL.
AND IN 2021 THE OFFICE OF EXTRA
MEASURE ALL AND UNDERTOOK
REANALYSIS AND AND ADDED IN A
PRETTY SIGNIFICANT VARIABLE
WHICH IS THE INDIVIDUAL NIH/I.C.
AWARD RATE NOT IN THE HOFF
PAPER.
AND YOU KNOW, WHEN YOU THINK OF
NIH IT'S NOT A MONOLITH OR A
SINGLE AWARD RATE, IT'S 24
DIFFERENT FUNDING INSTITUTES
THAT HAVE THEIR OWN LEVEL OF A
APPROPRIATION, THEIR PRIORITIES
AND IT'S DIFFERENT IN EVERY
INSTITUTE.
AND THEY DID THEIR ANALYSIS A
LITTLE BIT DIFFERENTLY BUT WHAT
THEY ALSO DID WAS PUT CLUSTERS
TOGETHER AND LOOKED AT SORT OF
THE PREPORTIONS OF APPLICATIONS
THAT WERE ON TOPICS THAT MORE
AFRICAN AMERICANS APPLIED TO,
RIGHT.
THEY CALLED THOSE AFRICAN
AMERICAN PREFERRED TOPICS AND
THEY DID AN ANALYSIS BY I.C.
AWARD RATE AND SO INTERESTINGLY,
YOU KNOW, THE INSTITUTE THAT HAD
ONE OF THE HIGHEST AWARD RATES
WAS THE EYE INSTITUTE, DO YOU
REMEMBER THE OCULAR, THE HIGH
CLUSTER INCLUDED A LOT OF OCULAR
SIGNS.
THAT ALSO HAPPENS TO BE THE
INSTITUTE WITH THE LOWEST
PREPORTION, ONE OF THE LOWEST
PREPORTION OF APPLICATIONS FROM
AFRICAN AMERICAN SCIENTISTS.
ALTERNATIVELY HERE IS NIMHD,
WHICH HAS ONE OF THE LOWEST
AWARD RATES AND THE HIGHEST
PREPORTION OF APPLICATIONS, FROM
AFRICAN AMERICANS, ON TOPICS
PREFERRED BY AFRICAN AMERICANS,
AND I WOULD READ THAT PAPER AND
SINCE THAT WAS THE CONTENTION OF
THE FIRST PAPER.
IF YOU LOOK AT ICs THAT HAVE
HIGHER AFRICAN AMERICAN TOPICS
VERSUS OTHER ICs, THE DISCUSS
RATE IN REVIEW IS VERY SIMILAR.
WHERE THE DISPARITY COMES IN IS
IN FUNDING WHICH SPEAKS TO THE
INDIVIDUAL IC AWARD RATES.
SO THIS CONCLUSION OF THIS PAPER
WITH LOWER AWARD RATES AND NOT
TO PEER REVIEW PREFERENCES AND
IT'S PUBLISHED LAST YEAR.
CSR HAS HAD AN ON GOING A NON
HIGHIZATION STUDY STARTED IN
2014 AND 2015 BUT JUST PUBLISHED
LAST YEAR AND THE DESIGN WAS
THAT WE HAD 1200 APPLICATION AND
400 FROM BLACK BLACK PIs AND
400 FROM WHITE PIs WITH THE
BLACK AND 400 FROM RANDOMLY
SELECTED WHITE P.I.s.
THESE APPLICATIONS WERE REDACTED
WITH IDENTIFIERS SO THE NAMES
AND ANYTHING THAT IDENTIFIED THE
P.I. OR THE INSTITUTION WAS
REDACTED.
IT UNDERWENT SIMULATED PEER
REVIEW AND DONE BY AN EXTERNAL
CONTRACTOR.
THE MAIN PEER, THE SINGLE
VARIABLE AGAINST BLACKS OR
AFRICAN AMERICANS THAT IT WOULD
IMPROVE THE SCORES OF BLACK
P.I.s AND THE RESULTS DIDN'T
SHOW THAT.
THE REDACTION DID NOT EFFECT THE
SCORES OF BLACK P.I.s AND IT
MADE THE SCORES OF WHITE P.I.s
SO TAKING AWAY THE IDENTIFIERS
WORSE END THE SCORES OF WHITE
P.I.s.
IT'S SMALL BUT SIGNIFICANT.
AND AROUND 20 PLUS PER OF THE
TIME, THE REVIEWERS AND
ACCURATELY AND IT SPEAKS TO THE
DIFFICULTY OF DEIDENTIFY SCIENCE
AND THESE ARE NETWORKS AND
PEOPLE KNOW EXACTLY WHO IS
WORKING ON WHAT PROJECTS SO IT'S
HARD TO REMOVE IDENTIFIERS
SUCCESSFULLY.
SO DOES THIS MEAN WELL THERE'S
NO BIAS WE SHOULD MOVE ON AND
NOT AT ALL.
YOU CAN'T ISOLATE RACE AS A
SINGLE VARIABLE AND ONE OF THE
THINGS WE NOTICED WITH THE WHITE
P.I.s, BENEFITING FROM BEING
IDENTIFIED IN ESSENCE, REALLY
SPEAKS TO THE DIFFICULTY IN
DISSEN HANGELLING RACE FROM
OTHER SECONDARY LINKED VARIABLES
FROM SUCH AS WHO HAS ACCESS TO
NETWORKS RACIAL DISPARITIES AND
ACCESS AND THE REPUTATIONAL
BIAS, POSITIVE REPUTATIONAL BIAS
THAT COMES UP OR NEGATIVE
INSTITUTIONAL PRESTIGE,
INVESTIGATIVE PEDIGREE, WHO
TRAINED WHO AND THE REDACTION
MAY HAVE REMOVED THESE HALO
EFFECTS OR THESE REDUCES THESE
HALO EFFECTS AND WORSEN THE
SCORES OF WHITE P.I.s SO IT'S
A BENEFIT MORE FOR WHITE
P.I.s.
THE FINDINGS SUPPORT THAT WE
SHOULD LOOK AT APPROACHES THAT
DIMINISH THE ROLE OF P.I. I DEN
TEE WITH THE INVESTIGATOR AS
WELL AS THE INSTITUTION.
AND SO WE'VE BEEN LOOKING AT
BLINDED REVIEW PROCESSES.
THE MAIN ONE THAT IS ON GOING IS
NOT AN EXPERIMENT BUT AN ACTUAL
REVIEW THAT IS OCCURRING WHICH
IS IN COLLABORATION WITH THE
COMMON FUND, HIGH-RISK AND HIGH
REWARD PROGRAM AND THE
TRANSFORMATIVE RESEARCH ROW
AWARD REVIEWS ARE ON GOING AND
IF THIS IS ALREADY A MULTI-STAGE
REVIEW, EVEN WHEN IT WAS FULLY
OPENED, NOW WE HAVE TAKEN THIS
AND REMOVED IDENTIFIERS FOR TWO
AND A HALF UP TO THREE STAGES.
SO THE EDITORIAL BOARD GETS TO
SELECT THE TOP SUBSET OF
APPLICATIONS BASED ONLY ON THEIR
TRANSFORMATIVE NATURE AND ONLY
ON THE SCIENCE AND IT HAS BEEN
REDACTED AND THEN THE SUBJECT
MATTER EXPERTS GET THE TECHNICAL
REVIEWS AND STAGE 2 AND COMES
BACK TO EDITORIAL BOARD THAT
LOOKS AT THESE REVIEWS AND GIVES
PRELIMINARY SCORES AND SETS THE
DISCUSSION ORDER AT WHICH POINT
WE PROVIDE THE IDENTIFIERS AND
THE REASON WE NEED TO DO THAT AT
ALL IS BECAUSE NIH REGULATION
PEER REVIEW REGULATIONS REQUIRE
THAT ALL FIVE REVIEW CRITERIA
ARE CONSIDERED BUT WE HOLD THAT
UNTIL THE THIRD STAGE.
AND THEN THERE'S A STUDY SECTION
MEETING.
THIS IS ON GOING.
WE'VE DONE THE FIRST SET OF
REVIEWS LAST YEAR AND THERE'S
GOING TO BE A REVIEW DONE THIS
YEAR AND THERE'S A MULTI CYCLE
EVALUATION THAT THE COMMON FUND
IS DOING WITH AN EXTERNAL
CONTRACTOR.
BUT THE EARLY RESULTS ARE
PROMISING IN THAT ABOUT A
QUARTER OF THE RESPONDENTS SAID
THAT THEY APPLIED FOR
TRANSFORMATIVE RO1 BECAUSE THEY
KNEW IT WAS ANONYMIZED PROCESS
AND THEY THOUGHT IT WOULD HAVE
LESS BIAS ASSOCIATED WITH THE
PROCESS.
ALONG THE SAME LINES, ALTHOUGH
NOT BINDED REVIEW PROCESSES, BUT
DIMINISHING THE ROLE OF, CSR
ADVISORY COUNCIL HAD TWO WORKING
GROUPS THAT WERE LOOKING TO
SIMPLIFY REVIEW CRITERIA FOR NON
CLINICAL TRIALS AND CLINICAL
TRIALS AND THEIR MAJOR
RECOMMENDATIONS WAS TO TAKE THE
CURRENT FIVE SCORED REVIEW
CRITERIA AND RESTRUCTURE THEM
INTO THREE FACTORS.
PROPERTIANCE OF THE RESEARCH,
FEASIBILITY AND RIG OR AND IT
TOOK INVESTIGATORS AND
ENVIRONMENT AND SUGGESTED ADDING
THOSE TO A THIRD REVIEW FACTOR.
IT ALLOWS US TO HAVE -- EXPLORE
A MULTI-STAGE TRANSFORMATIVE
RO1-TYPE PROCESS JUST FOR
REGULAR RO1s AND THE OTHER
THING IS THIS ENTIRE PARADIGM
HAS BEEN FURTHER DEVELOPED BY
NIH LEADERSHIP AND THERE WILL BE
RESTRUCTURED CRITERIA BEING
ANNOUNCED BIT END OF THE YEAR
AND HOPEFULLY MAYBE EARLY NEXT
YEAR SO STAY TUNED FOR THAT.
THE MENTION OF BIAS AWARENESS
TRAINING IN PEER REVIEW FOR PEER
REVIEWERS AND FOR CHAIRS, SO WE
HAVE, AS I MENTIONED, WE HAVE
AROUND 200 CHARTERED STUDY
SECTIONS WITH CHAIRS OR
APPOINTED FOR TWO YEARS.
EVERY YEAR, WE HAVE ABOUT HALF
THOSE CHAIRS THAT CYCLE OFF AND
NEW CHAIRS COME IN AND WE HOLD A
SUMMER ORIENTATION SESSIONS
EIGHT TO NINE AND NINE TO 10
SESSION THIS IS SMALL GROUPS FOR
CHAIRS.
AND IT'S A TWO-HOUR SESSION THAT
FACILITATED WITH LOTS OF
DISCUSSION.
WE HAVE VERY CAREFULLY
INCORPORATED BIAS AWARENESS
TRAINING IN THIS.
AND ESPECIALLY TALK TO THE
CHAIRS ABOUT RECOGNIZING THEIR
INFLUENCE AND THEIR ROLE TO
FOSTER AN INCLUSIVE STUDY
SECTION CULTURE SO YOU CAN LEARN
MORE ABOUT THIS ON OUR WEBSITE
AS WELL.
THERE'S A SAMPLE CHAIR
ORIENTATION THAT'S BEEN POSTED.
AND THEN, CSR LAUNCHED A NEW
TRAINING MODULE FOR REVIEWERS ON
BIAS AWARENESS AND THE PEER
REVIEW PROCESS.
SO, THE MOST IMPORTANT THING TO
KNOW ABOUT THIS IS THIS IS NOT
IMPLICIT BIAS TRAINING.
IMPLICIT BIAS TRAINING, WE
RECEIVED THAT AT NIH AND NIH
OFFERS THAT OR HAS THAT REQUIRED
FOR ALL OF THE EMPLOYEES AND I'M
ASSUMING THAT MOST INSTITUTIONS
AND UNIVERSITIES AT THIS POINT
ARE DOING THE SAME THING.
REVIEWERS ARE NOT OUR EMPLOYEES.
THEY COME IN AND WE SEE THEM FOR
A BRIEF PERIOD OF TIME AND WE
NEED TO CAPTURE THEM AND FOCUS
ON THE MOST COMMON BIASES THAT
EFFECT THE PEER REVIEW PROCESS.
SO THIS ONE, THIS TRAINING, IS
FOCUSED TOWARDS THOSE THAT
INCLUDES A TESTIMONIAL AND
INTERACTIVE EXERCISES AND A
NARRATED MOCK STUDY SESSION THAT
TELLS YOU WHAT TO DO AND HOW IT
COULD HAVE BEEN BETTER.
IT'S A 30-MINUTE TRAINING
DELIVERED TO REVIEWERS PRIOR TO
WHEN IT WAS DELIVERED PRIOR TO
THE FALL BUT ALSO PRIOR TO THE
SPRING AND THIS IS AN OLD NUMBER
BUT WE HAVE MORE THAN 15,000
REVIEWERS THAT HAS TAKEN THIS
TRAINER.
IT'S BEEN WELL RECEIVED.
I THINK OUR NARRATED MOCK STUDY
SECTION WAS FAMILIAR TO PEOPLE.
THAT WAS IMPORTANT FOR US IN
DEVELOPING THIS TRAINING TO HAVE
SCENARIOS THAT PEOPLE COULD
RECOGNIZE AND RELATE TO.
SO THE EARLY SURVEY RESULTS HAVE
INDICATED IT HAS INCREASED THE
ABILITY OF REVIEWERS TO SERVE AS
BYSTANDERS TO IDENTIFY BIAS AND
INCREASE THEIR COMFORT IN
INTERVENING.
YOU CAN SEE A LOT MORE ABOUT
THIS ON OUR WEBSITE AND I'LL
HAVE A LINK LATER ON.
SOME OF THE QUALITATIVE STUDIES
WE GOT FROM THE TRAINING AND
WE'RE HAPPY AND SATISFIED WITH
THE VALUE OF THE TRAINING.
THEY FELT EMPOWERED AND THEY'RE
LIKELY TO SERVE AS BYSTANDERS,
NOT JUST IN THE MEETING BUT IN
PRIOR TO THE MEETING AND READING
CRITIQUES.
THEY ASKED US THEY THOUGHT IT
WOULD BE IMPORTANT TO HAVE
EXAMPLES SPECIFIC LANGUAGE
REVIEWERS CAN USE WHEN QUESTION
OTHER REVIEWERS, THIS IS A
CULTURE CHANGE.
IT DOESN'T HAPPEN.
PEOPLE ARE VERY COLLEGIAL AND SO
IT WOULD BE GOOD TO KNOW, NOT
JUST HOW THEY CAN INTERVENE BUT
HOW THEY THEMSELVES CAN WRITE
NON BIAS REVIEWS AND WE WILL
HAVE A SECOND VERSION OF THIS
COMING OUT, PROBABLY NEXT YEAR
OR THE YEAR IN 2024.
AND THEN THEY TALKED ABOUT POWER
DYNAMICS AND THE CHALLENGES WITH
INTERVENTION.
AND YOU KNOW, HOW DIFFICULT IT
IS FOR PEOPLE WHO ARE JUNIOR OR
UNDER REPRESENTED GROUPS TO
SPEAK OUT AND WE ADDRESSED THAT
WITH OUR CHAIRS AS BECAUSE
CHAIRS HAVE A IMPORTANT ROLE TO
PLAY AS WELL AS WITH OUR SROs
IN TRAINING.
YOU CAN FIND THE FULL SURVEY
RESULT AND COUNCIL AND I THEY
TOLD US THE TIME, 30 MINUTES AND
AND ANYMORE THAN THAT LOOSE
THEIR INTEREST AND THERE ARE
PEOPLE THAT HAVE EXPERTISE IN
DEVELOPING THESE TYPES OF
TRAININGS AND SO I'M VERY
GRATEFUL TO THEM MANY .
TALK ABOUT BIAS REPORTING.
WHEN BIAS DOES OCCUR IN A STUDY
SECTION MEETING OR IN THE ACTUAL
REVIEW AGAINST THE APPLICANT, WE
WANTED TO HAVE A DIRECT AVENUE
FOR APPLICANTS OR REVIEWERS TO
REPORT BIAS TO US.
GABRIEL IS THE DIRECTOR OF
DIVERSITY AND WORKFORCE
DEVELOPMENT AT CSR, HE REPORTS
DIRECTLY TO ME.
WE HAVE HIM AVAILABLE AND HIS
DIRECT E-MAILS THAT PEOPLE CAN,
HE HAS A MALE BOX AND WE HAVE
PUT THIS LANGUAGE IN ALL OF OUR
OUTGOING E-MAILS BECAUSE WE WANT
TO MAKE SURE THAT THE BROADER
COMMUNITY HAS IT ACCESSIBLE AND
SO ANY TIME YOU HAVE AN SRO OR
ANYONE FROM CSR THEY'LL HAVE HAD
AT THE BOTTOM OF THEIR E-MAIL,
WE'VE PUT IT ON OUR WEB PAGE AND
THE NUMBERS OF HITS WE GET ON
OUR WEBSITE IS ON THE STUDY
SECTION DESCRIPTION PAGES AND SO
WE PUT IT ON THERE AS WELL.
WHEN WE GET THESE COMPLAINTS,
SOMETIMES IT'S ABOUT THE
APPLICATION AND SOME BIAS
COMMENTS BEING MADE IN THE
CRITIQUES, SOMETIMES IT'S
INTERACTIONS DURING THE STUDY
SECTION.
WE HAD LISTENING SESSIONS A
COUPLE OF YEARS AGO WITH THE
BROADER COMMUNITY AND I HEARD
ABOUT THE SORT OF THE HIGHER BAR
THAT WOMEN OR MINORITIES FACE
COMING TO THE REVIEW TABLE TO
PROVE EXPERTISE WHICH IS BOTH
DISTURBING AND UNACCEPTABLE.
THOSE ARE THE THINGS WE'RE
ENCOURAGING PEOPLE TO JUST
REPORT SO WE HAVE AN IDEA OF
WHERE IT'S HAPPENING AND WE CAN
ADDRESS IT.
SO, WHAT ARE WE DOING WHEN WE
GET A REPORT OF A BUY AS?
WELL, EVERY SINGLE REPORT IS
LOOKED AT BY GABRIEL AND CSR
MANAGEMENT, THE DIVISION
DIRECTOR OVERSEEING AND THOSE
REVIEWS AND THEY MAKE SORT OF AN
OBJECTIVE ASSESSMENT WAS AND IT
WAS A BUY AS.
IF WE AGREE, THAT THIS WAS
BIASED REVIEW, WE WOULD REREVIEW
THE APPLICATION IN THE SAME
COUNCIL ROUND WITHOUT GOING
THROUGH THE APPEALS PROCESS
BECAUSE WE MESSED UP, WE'LL FIX
IT AND DO IT IN THE SAME COUNCIL
ROUND SO IT DOES NOT EFFECT
FUNDING FOR THE APPLICANT.
IF WE DON'T AGREE, THEN WE TAKE
THEM, WE REFER THEM TO THE
PROGRAM OFFICER FOR THE NORMAL
COUNCIL APPEAL PROCESS WHICH IS
STILL OPEN TO THEM AND THEY CAN
DO THAT.
THE PART THAT I THINK IS
IMPORTANT IS WE LOOP BACK TO THE
REVIEWER, IF THE REVIEWER MADE A
BUY AS COMMENT IN A CRITIQUE, WE
CAUGHT IT AND WE REREVIEWED IT,
THEY WILL MAKE A PHONE CALL TO
THE REVIEWER AND TELL HIM OR HER
THIS CAUSED A REVIEW AND IT'S
INAPPROPRIATE AND WE'RE DOING
THAT TO MAKE SURE THAT THERE'S
CULTURE CHANGE IN THE COMMUNITY
AND THERE'S MORE REEDUCATION OF
THE REVIEWERS AND VAST MAJORITY
OF CASES REVIEWERS ARE VERY OPEN
TO ACKNOWLEDGE IT, APOLOGIZE AND
SAY NO I SHOULD BE MUCH MORE
CAREFUL AND HE WILL PAY IT
TENSION TO THIS AND THEY ARGUE
WITH US AND WE TAKE ACTIONS AS
NECESSARY.
REGARDING THEIR SERVICE.
AND FINALLY, I WANT TO TALK
ABOUT BROADENING THE REVIEWER
POOL AND OUR EFFORTS TO
DIVERSIFY REVIEW COMMITTEES.
SO, THE FIRST CATER IS JUST
EARLY CAREER REVIEWER PROGRAM.
WHICH HAS BEEN VERY POPULAR.
IT ALLOWS YOUNG INVESTIGATORS,
JUNIOR INVESTIGATORS A CHANCE TO
SEE THE STUDY SECTION PROCESS BY
ATTENDING A MEETING AND BEING
ASSIGNED TO A FIELD
APPLICATIONS.
IT'S BEEN VERY VALUABLE.
WE HAVE THE PROGRAM ON GOING BUT
THE DATABASE WAS SORT OF NOT --
IT DIDN'T ALLOW US TO TRACK AND
THE DATA WAS NOT CAPTURED WELL
AND THE VETTING OF WHO GOT TO
SERVE AND WHO DIDN'T GET TO
SERVE WAS AT THAT POINT LEFT UP
TO THE INDIVIDUAL SROs WHO HAD
THEIR OWN INDIVIDUAL CRITERIA
THAT WERE BEING APPLIED AND THE
300 PEOPLE, 300SROs THAT IS
NOT CONSISTENT.
SO, BASED ON ADVICE THAT LOOKED
AT THE ECR PROGRAM WE HAVE A
SINGLE VETTING COMMITTEE AND WE
DOUBLED THE NUMBER OF ECRs.
WE HAVE TWO INSTEAD OF ONE.
AS YOU KNOW THE ECR POOL IS MORE
DIVERSE AND MORE URMs VERSUS
ALL OTHER CSR REVIEWERS AND ALSO
MORE WOMEN.
IN ADDITION, WE'VE BEEN BUILDING
TOOLS.
SO THIS TOOL WAS LAUNCHED IN
LATE 2020 IN AUGUST.
IT'S CALLED A REVIEWER FINDER
TOOL.
SO NIH HAS A LOT OF REALLY NICE
DATABASEs BUT THEY'RE MOSTLY
POPULATED WITH PEOPLE NIH
INTERACTS WITH, RIGHT.
THE APPLICANTS AND FUNDED FOLKS.
WE WANTED TO MAKE SURE THAT WE
ADDED OTHER SOURCES, OTHER
AGENCY FUNDING, RECOMMENDATIONS
THAT COME IN FROM SOCIETY.
WE'VE REACHED OUT TO SCIENTIFIC
SOCIETIES AND WE'VE HAD THEM
SUBMIT AND ASKED THEM TO SUBMIT
NAMES OF BROADER RANGE OF PEOPLE
WHO ARE DIVERSITY AND WE ALSO
HAVE A GROUP OF PIs WHO ARE
FUNDED BY NIH BUT NOT USED THAT
MUCH.
I DON'T KNOW WHY.
WE ADDED THEM TO IT AND WE HAVE
IC PROGRAM OFFICER
RECOMMENDATIONS THAT GO INTO
THIS DATABASE AND CAREER
REVIEWERS AND WE'VE ADDED THE
APPLICANT POOL BECAUSE IT REALLY
BROADENS THE POOL OF EXPERTISE.
AND SO IT'S A VERY SORT ABLE,
EASY, ONE-STOP-SHOP DATABASE FOR
SROs THAT HELPS WITH A BROADER
RANGE OF REVIEWERS.
WE CAN TALK ABOUT TOOLS AND WE
CAN TALK ABOUT THE EARLY CAREER
REVIEWER PROGRAM AND ALL OF THAT
AND ULTIMATELY THIS COMES DOWN
TO CULTURE CHANGE AND CSR, LIKE
NIH, LIKE ALL OF NIH AND LIKE
ALL OF THE BIOMEDICAL COMMUNITY
IS JUST PART OF THE BROADER
BIOMEDICAL ENTERPRISE AND THERE
ARE STRUCTURES IN PLACE AND
THERE'S -- IT'S IMPORTANT TO
CHANGE THE CULTURE INSIDE AS
WELL.
SO SOME OF THE STRATEGIES WE'VE
USED IS INSTEAD OF TALKING ABOUT
DIVERSITY, AS DIVERSITY, THAT WE
NEED TO HAVE THIS MANY UNDER
REPRESENTED MINORITIES OR THIS
MANY WOMEN, WE'RE REALLY
EMPHASIZING THROUGH MANAGEMENT,
THROUGH TRAINING AND FEEDBACK
THE REALLY IMPORTANT AND
CRITICAL NEEDS FOR THE NIH TO
HEAR DIVERSE PERSPECTIVES
BECAUSE OTHERWISE, WE'RE NOT
GOING TO BE IDENTIFIED THE MOST
DISRUPTIVE AND THE MOST NOVEL
SCIENCE.
SO, CHANGING THAT CONVERSATION
INTERNALLY HAS BEEN IMPORTANT
FOR US.
THE OTHER THING IS TO LINK AND
MAKE IT REALLY CLEAR TO STAFF
THAT ONE MEASURE OF A
HIGH-QUALITY REVIEW COMMITTEE IS
THAT IT MUST BE BROADLY DIVERSE
AND MULTIPLE DIMENSIONS.
SCIENTIFIC BACKGROUNDS IN
PERSPECTIVE.
NOT PEOPLE COMING FROM THE SAME
SCHOOL OF THOUGHT IN A FIELD.
TOWARDS DEMOGRAPHIC AND
GEOGRAPHIC ADDS A RICHNESS AND
DIVERSITY OF PERSPECTIVE.
CAREER STAGE, WE DON'T WANT ALL
SENIOR, IT'S NICE TO HAVE SOME
SENIOR FOLKS AND IT'S GOOD TO
HAVE MID CAREER AND JUNIOR FOLKS
ADVISING US AND PEER REVIEW
EXPERIENCE.
WE NEED TO BRING NEW VOICES TO
THE TABLE AND NOT HAVE PEOPLE
SERVING OVER AND OVER.
IN THE END, WE'RE LOOKING FOR
BREATH IN PEER REVIEW AND NOT
SORT OF AN INSULAR PERSPECTIVE
COMING THROUGH.
THE STANDING STUDY SECTION
MEMBERSHIP PROCESS IS PERIL.
THOSE WHO HAVE BEEN THROUGH IT
KNOW.
IT'S APPROVAL AND WE LOOK AT
DIVERSITY AND BREADTH AND ALL OF
THAT CAREFULLY.
I SIGN OFF ON EVERY MEMBER FOR
EVERY SLATE AND IT GOES INFORM
THE NIH DIRECTOR.
SO, THE ISSUE WE FOUND WAS
DIVERSITY ON SPECIAL EMPHASIS
PANELS.
THESE ARE ASSEMBLED AD HOC AND
SO THERE'S A CURRY.
THEY COME IN AND THEY HAVE TO
ASSEMBLE A PANEL AND WHEN YOU
HAVE CREDIT WHEN YOU ARE IN A
CRUSH THE PEOPLE AND THE TRIED
AND TRUE AND THE TOOLS LIKE
REVIEWER FINDER COME INTO PLACE.
AND THEY HAVE HELPED US.
WE'VE ALSO RAISED COLLECTIVE
AWARENESS OF STAFF AND TO LET
STAFF KNOW HOW THINGS ARE GOING
IN DIFFERENT PLACE AND WE'RE NOT
COMING DOWN HARD, WE'RE JUST,
WE'RE JUST RAISING AWARENESS AND
IT'S MADE A DIFFERENCE.
AND OF COURSE THE TOOLS SUCH AS
REVIEWER FINDER, PREVENTS PEOPLE
RELYING ON THEIR MENTAL ROLODEX
TO MUCH.
WE REALLY BEEFED UP SR
O-TRAINING.
SRO SHARING.
WE HAVE A LOT OF REALLY
COMMITTED, STRONG STAFF WHO
WOULD DO A FANTASTIC JOB IN
BROAD RECRUITMENT AND WE WANT TO
MAKE SURE THAT WE SHARE THOSE
BEST PRACTICES.
AND IT'S BEEN HAVING AN IMPACT.
SO THIS IS THE OF WOMEN.
THE GRAY LINE IS THE PERCENTAGE
OF WOMEN IN THE APPLICANT POOLS
IN CSR.
THE LIGHT, THIS LINE ON TOP, 43%
AND THE LAST, THIS IS NINE
ROUNDS OF DATA.
43% SO 33% IS WOMEN APPLICANTS
AND 43% IS WOMEN ON OUR STUDY
SECTION AS MEMBERS AND THE MOST
IMPORTANT CHANGE WAS THE SUMMER
OF 2020 WHEN WE TALKED TO STAFF
AND RAISED AWARENESS WHERE THE
NUMBER OF WOMEN ON SEX, ON
SPECIAL EMPHASIS PANELS WENT UP.
AND WE'RE GOING TO KEEP PUSHING
ON THAT AND I THINK OUR STAFF
ARE VERY COMMITTED TO DOING
THIS.
SIMILARLY, ACTUALLY A LITTLE BIT
MORE STARK WITH UNDER
REPRESENTED MINORITIES, THIS
GRAY LINE UNDER REPRESENTED
MINORITIES AMONG APPLICANTS IS
JUST UNDER 9% AND AT THIS POINT
AND WE HAVE ALWAYS EMPHASIZED
THE INCLUSION OF UNDER
REPRESENTED MINORITIES AS
MEMBERS AND THAT HAS BEEN
STEADILY GOING UP OVER THE LAST
COUPLE OF YEARS.
AGAIN, FOR SPECIAL EMPHASIZE
PANELS THERE'S A DEFINITE, THEY
WERE FALLING LOWER THAN THE BASE
OF APPLICANTS AND SO I THINK
THANKS TO THE PUSH MANY OF OUR
STAFF AND CONTINUED EFFORTS THAT
IS START TO GO GO UP AND WE
STILL HAVE A WAYS TO GO BUT,
IT'S TRENDING IN THE RIGHT
DIRECTION.
AND I WANT TO THANK OUR ADVISORY
COUNCIL WORKING GROUP THAT'S
CURRENTLY UNDERWAY LOOKING AT
FELLOWSHIP REVIEWS BECAUSE WE
ARE ALSO LOOKING TO RESTRUCTURE
AND MAKE MORE EQUITABLE NRSA
FELLOWSHIP CRITERIA.
YOU CAN WATCH THE
RECOMMENDATIONS THAT WILL BE
PRESENTED AT THE CSR ADVISORY
COUNCIL MEETING LATER THIS MONTH
ON THE 19th.
FINALLY, YOU CAN FIND MORE
DETAILED INFORMATION ON OUR
WEBSITE AND MERE IS THE ADDRESS
AND I'M HAPPY TO TAKE QUESTIONS
NOW OR YOU CAN REACH ME DIRECTLY
THANK YOU.
>> Paul: WE WILL USE THE SAME
PROCESS.
IF ANY COUNCILMEMBER WANTS TO
ASK A QUESTION, JUST USE THE
HAND APP ON THE SCREEN OR TYPE
QUESTIONS AND WE ARE POPULATING
ALL HERE SO LET'S GO WITH KEN,
TURN YOUR CAMERA AND MICROPHONE
ON.
>> THANK YOU FOR THAT WONDERFUL
PRESENTATION.
I HAVE I HAVE A QUESTION THAT
YOU INDIRECTLY TOUCHED ON.
IN ANY WORLD OF BEHAVIORAL
INTERVENTIONIST, THERE'S SOME
CONVENTIONAL WISDOM WE EAT OUR
YOUNG AND THAT BEHAVIORAL
INTERVENTIONS DO WORSE THAN
BASIC SCIENCE.
YOU TOUCHED ON IT INDIRECTLY
THAT DISPARITIES BASED RESEARCH
TENDS TO SCORE WORSE AND DO YOU
HAVE ANY EVIDENCE THAT IN FACT
BEHAVIORAL SCIENTISTS ARE WORSE
TO EACH OTHER, THE SCORES ARE
LOWER IN EFFECT THAN OUR BASIC
SCIENCE COUNTERPARTS.
>> SO, I WANT TO MAKE SURE THAT
I CORRECT THE IMPRESSION.
I DON'T THINK I EVER SAID THAT
THE BEHAVIOR ALL SCIENCE SCORE
WORKS.
WE DIDN'T SEE ANY DIFFERENCES
THERE.
NOW IN TERMS OF HOW WELL NEW OR
EARLY STAGE INVESTIGATORS DO IN
DIFFERENT FIELDS, WE'RE LOOKING
AT THAT VERY CAREFULLY, STUDY
SECTION BY STUDY SECTION,
THROUGH OUR INQUIRE PROCESS
WHICH IS LOOKING AT STUDY
SECTION RESTRUCTURING AND ONE OF
THE THINGS WE LOOKED AT IS THE
RATE OF APPLICATION AND RATE OF
SUCCESS.
SO AS WE RE STRUCTURE THOSE
STUDY SECTIONS SOME OF THOSE
THAT WERE VERY FEW GETTING
THROUGH IN BEHAVIORAL SCIENCE
HAVE BEEN BLOWN UP.
>> THIS IS ALL AN DECK OAT AND
CERTAIN COMMUNITIES THAT WE ALL
FEEL AND SCORE MUCH MORE HARSH
AND WORSE SCORES AND AND THE
SCORE EVERYONE WORSE INCLUDING,
IT WILL BE A WASH WHEN YOU
CALCULATE IT.
THE PROBLEM IS WHEN THEY SCORE
ESR IS WORSE AND THAT'S WHAT
WE'RE LOOKING AT.
>> Paul: Dr. BARNES.
>> THANK YOU FOR THE
PRESENTATION.
I LEARNED SO MUCH.
I HAVE TWO QUESTIONS.
I REALLY APPRECIATE RAYS RAISING
AWARENESS WITH THE SRO TO GET
MORE DIVERSE PEOPLE INTO THE
POOL.
SO MY QUESTION WAS, IT SEEMED
LIKE A LOT HAPPENED AROUND 2020
AND SO DO YOU HAVE A SENSE OF
WHETHER SOME OF THE STUDY
SECTIONS THAT ARE NOW DOING MORE
REMOTE, DID THAT HAVE ANYTHING
TO DO WITH THE GETTING MORE
DIVERSITY IN THE POOL AND THE
SECOND QUESTION S. THIS MIGHT BE
HARDER TO ANSWER, SOMETIMES
THERE'S STRUCTURAL BARRIERS THAT
MAKE IT MORE CHALLENGING FOR
MORE DIVERSE PEOPLE TO SERVE ON
STUDY SECTIONS BECAUSE THEY HAVE
MORE SERVICE REQUIREMENTS, THEY
MIGHT COME FROM LESS RESOURCE
INSTITUTIONS.
IS ANY WORK BEING DONE TO
ADDRESS THOSE TYPES OF
STRUCTURAL BARRIERS?
>> LET ME ANSWER YOUR FIRST
QUESTION FIRST.
THAT'S A REALLY GOOD QUESTION.
SOME OF THE TIMES WHEN I GET
ASKED ABOUT, HOW ARE YOU GOING
TO MEASURE THE IMPACT OF ALL OF
THESE THINGS THAT YOU ARE DOING?
WELL, THESE AREN'T THE ONLY
THING WE'RE DOING.
NIH ITSELF IS COMMITTED TO
TACKLING THIS ISSUE IN A LOT OF
THINGS ARE GOING ON.
AS A RESULT, IT MAKES IT HARD.
PLUS ADD TO THAT THE PANDEMIC
AND YOU CAN NO LONGER FIGURE OUT
WHAT IS A RESULT OF THAT, WE ARE
TURNING AWAY NOMINATION SLATES
AND THERE'S A LOT OF
CONVERSATION INTERNALLY IN THE
CENTER GOING ON.
RELATED TO DIVERSE FEE AND WE
DIDN'T SEE DIVERSE FEE WHERE
WE'RE SEEING IT.
IT'S A REAL EFFORT MADE BY THE
STAFF.
TO COME IN-PERSON.
SO, WE'LL SEE THAT.
THE MINORITY TAX.
THERE'S A LOT OF AWARENESS OF
THAT AND WE DO THE BEST -- I
THINK THERE'S ALWAYS A STRUGGLE
BETWEEN WE WANT TO HAVE
MINORITIES PARTICIPATE IN PEER
REVIEW BECAUSE IT'S STRONGER AND
WE DON'T WANT TO BURDEN THEM.
BUT PART OF THOSE DECISIONS HAVE
TO BE MADE AT THE INSTITUTIONAL
LEVEL, AS TO HOW TO RELIEF AND I
THINK IT'S INSTITUTIONAL
STRUCTURAL CHANGE THAT OTHER
PARTS OF NIH THROUGH UNITED, ARE
UNDERTAKING.
>> THANK YOU.
>> Paul: WE HAVE Dr.
SUTHERLAND AND Dr. LONG.
>> GOOD AFTERNOON, HOW ARE YOU
DOING.
>> I'M DOING WELL.
>> I WANT TO APPLAUD YOU ON THE
WORK YOU ARE DOING.
IT'S IMPRESSIVE AND NEEDED.
I WANT TO THANK YOU FOR THAT.
ME QUESTION IS THAT I WORK AT A
HBCU AS YOU KNOW, WHEN WE WRITE
GRANTS, FROM HBCU, WHEN YOU LOOK
AT THOSE FIVE CRITERIA, THE ONE
THAT INHERENTLY CAUSES DREAD IS
THE ENVIRONMENT.
AND THAT IS SOMETHING THAT AS AN
INDIVIDUAL INVESTIGATOR, IT'S
REALLY HARD FOR US TO IMPACT
VERY MUCH WHAT WE HAVE TO LIVE
WITH IT AND SO EVEN THOUGH IN
SOME INSTANCES ENVIRONMENT AND
SOME HBCUs MAY BE COMPARABLE
OF OTHER PLACES BUT IT'S THE
MIND SET IN THE REVIEWERS WHO
INHERENTLY BELIEVE, WELL, IF YOU
ARE AT HOWARD, YOUR ENVIRONMENT
CAN'T BE AS GOOD AS HOPKINS.
COME ON, IT JUST CAN'T BE.
I WOULD LIKE YOU TO COMMENT ON
THAT AND ANOTHER THING IS THAT,
IT'S RELATED, IN TERMS OF RACE
BIAS.
HOW SIGNIFICANT IS INSTITUTIONAL
BIAS IF YOU REMOVE THE RACE
IDENTIFIERS, HOW BIG OF A FACTOR
IS THAT IT'S SOMETHING THAT WE
STRUGGLE WITH OFTEN.
SO I JUST LIKE TO HAVE YOUR
COMMENTS AND THOUGHTS ON THOSE
TWO ISSUES.
I DON'T THINK THAT STUDY HAS
BEEN DONE.
THE OPPOSITE HAS FOR EXAMPLE HOW
DO MINORITIES DO AT THE TIER ONE
INSTITUTIONS VERSUS -- THAT'S
BEEN DONE AND THERE'S STILL A
GRAPH.
EVEN GINTHER LOOKED AT THAT.
CLEARLY, I THINK YOUR FIRST
POINT IS IT RESINATES WITH ME.
TWO THINGS THAT I WANT YOU TO
KNOW, ONE IS THE REVIEWERS BIAS
AWARENESS TRAINING AND I DON'T
KNOW IF YOU HAD IT BUT IT'S
AVAILABLE TO COUNCIL AND WE CAN
SEND THE LINK, IT TAKES 30
MINUTES.
I THINK YOU WILL ENJOY IT.
IT ACTUALLY STARTS WITH A
PERSONAL TESTIMONIAL TALKING
ABOUT THE EXACT ISSUE THAT YOU
ARE SAYING AND THE SCENARIO
COVERS INSTITUTIONAL BIAS VERY
EXPLICITLY, RIGHT.
SO I THINK WE'RE MAKING CHANGES
IN REVIEWER TRAINING.
THAT ASIDE, WHEN YOU HEAR ABOUT
THE RESTRUCTURED REVIEW CRITERIA
COMING AT THE END OF THE YEAR,
HOPEFULLY, YOU WILL SEE A
SIGNIFICANT CHANGE IN THE AMOUNT
OF EMPHASIS THAT IS BEING GIVEN
TO INVESTIGATOR AND ENVIRONMENT.
STAY TUNED, YOU WILL LIKE WHAT
IS COMING.
>> THANK YOU SO MUCH.
>> Paul: Dr. LONG.
>> THIS IS AMAZING WORK AND SO
IMPORTANT.
AS A DIVISION CHIEF WITH LOTS OF
PEOPLE ON COMMITTEES, I WANT TO
PUSH BACK ON YOUR COMMENT ABOUT
THE MINORITY TAX OR EVEN WHAT
WOULD BE A WOMAN'S TAX.
IS IT SO MANY COMMITTEES GET
FILLED UP BY MINORITIES AND
WOMEN THAT -- AND I DO THINK
SERVING ON A GRANT REVIEW
COMMITTEE IS INCREDIBLY GOOD FOR
PEOPLE'S CAREERS AND IT MAKES
THEM LEARN.
LIKE LEARNED MORE ABOUT WRITING
A GOOD GRANT BY SERVE BEING ON A
COMMITTEE THAN ANYTHING ELSE.
IT'S GOOD FOR YOUR NATIONAL
REPUTATION.
THERE'S SOME ONUS ON NIH TO WORK
WITH THE INSTITUTIONS TO HELP
NAVIGATE THIS ISSUE.
I WORRY IT WILL BE FILLED WITH
WOMEN AND MINORITIES WHO ARE NOT
GETTING THEIR OWN RESEARCH DONE.
I DON'T THINK IT WILL HAPPEN BUT
I THINK IT'S IMPORTANT TO SERVE.
IT TAKES A LOT OF WORK AND TIME
IF YOU DO IT WELL, AT LEAST IT
TAKES ME A LOT OF WORK AND TIME
TO DO IT WELL.
I THINK THERE NEEDS TO BE SOME
MORE BACK AND FOURTH WITH THE
INSTITUTIONS TO REALLY HELP PAVE
THIS WAY BECAUSE I THINK OF THE
KINDS OF COMMITTEES A SCIENTIST
CAN DO THIS IS PROBABLY ONE OF
THE OONESUSEFULLY IN THEIR SCIES
WELL AS THEIR ABILITY TO GET
PROMOTED AND RISE IN THEIR
INSTITUTIONS.
SO, I JUST THINK THAT WE NEED TO
THINK CAREFULLY ABOUT HOW NIH
CAN HELP MAKE IT POSSIBLE AND
NOT SAY IT'S JUST UP TO THE
INSTITUTIONS TO FIGURE OUT.
>> SO, THANK YOU FOR THAT.
I AGREE.
I THINK THERE'S NIH AND THEN
THERE'S CSR THAT IS PART OF NIH.
SOME OF WHAT WE HEARD WHEN WE
WERE TRYING TO MAKE THE CHANGE
WITHIN CSR BUT INVITE MORE
JUNIOR FACULTY, IS THE SORT OF
CULTURE AMONG SOME OF OUR STAFF
SAYING, WELL, WE'RE PROTECTING
THEIR TIME.
I THINK WE HAVE TO ALLOW
INVESTIGATORS WHO IS GONE
THROUGH GOOD TRAINING AND ON
FACULTY TO MAKE THOSE NOT
DECISIONS SO I HESITATE TO TELL
OUR STAFF, TRY TO PROTECT AND BE
CAREFUL ABOUT WHO YOU INVITE IN
CASE YOU OVER TAX THEM.
WE NEED TO ALLOW INVESTIGATORS
TO MAKE THOSE CALLS THEMSELVES
AND I THINK THEY SHOULD PICK
COMING TO STUDY SESSIONS OVER
WHATEVER INSTITUTIONAL
COMMITTEE.
>> I GUESS I WONDER IF YOU CAN
WORK WITH INSTITUTION TO HELP IT
EASIER FOR THEM FOR JUNIOR
INVESTIGATORS OR WOMEN FOR
MINORITY INVESTIGATORS TO SERVE
AND SORT OF MAKE THAT PATH
EASIER AND SO I GUESS I'M NOT
SAYING DON'T DO IT, I'M JUST
SAYING I THINK THERE'S A WAY
THAT THERE COULD BE A BIT MORE
BACK AND FOURTH.
>> YEAH, AND I THINK THAT UNITE
IS -- I DON'T KNOW, IF YOU ARE
ON UNITE E OR AWARE WHAT IS
HAPPENING WITH UNITE BUT UNITE
EXTRAMURAL IS LOOKING AT
STRUCTURAL BARRIERS FOR UNDER
REPRESENTED MINORITIES AND WOMEN
AT INSTITUTIONS AND TRYING TO
CHANGE INSTITUTIONAL CULTURE SO
I THINK NIH IS VERY ACTIVE IN
THAT REALM.
IT'S NOT THE CSR PART OF IT SO I
DIDN'T MEAN TO IMPLY THERE ISN'T
WORK GOING ON ACTIVELY RIGHT
NOW.
>> THANK YOU, VERY MUCH.
THIS HAS BEEN A VERY GOOD
SESSION.
WE'RE GOING TO TURN IT BACK OVER
TO Dr. PEREZ-STABLE TO
INTRODUCE OUR NEXT SPEAKER.
>> Dr. Eliseo J. Perez-Stable: I
WANT TO THANK NONI FOR A
WONDERFUL -- I DIDN'T REMEMBER
YOU WOULD FOCUS ON BIAS.
I HAD MENTIONED SOME OF THE
STUFF ON BIAS THAT YOU HAD BEEN
DOING AND I GATHER THIS IS NOW
IMPLEMENTED THROUGHOUT ALL THE
CSR COMMITTEES.
IT PROBABLY OUGHT TO BE
REPLICATED IN THE COMMITTEES
THAT WE RUN AS INSTITUTES.
SYSTEMATICALLY SO I WANT TO
THANK YOU.
I REALLY GREATLY APPRECIATE YOUR
LEADERSHIP IN REALLY RAISING THE
BAR AND EXPECTATIONS THAT WE
SHOULD HAVE ABOUT CSR AND NOT
JUST LET PEOPLE EXPLAIN COMPLAE
TIME.
I ALSO THINK THIS CONVERSATION
CAN WILL GUN FOR A WHILE BECAUSE
I HAPPEN N. THIS CASE, DISAGREE
WITH THE PERSPECTIVE THAT THE
INSTITUTION SHOULD LOOK FOR NIH
TO MAKE THINGS HAPPEN.
I THINK IT'S BOTH.
I THINK MOST OF THE TIME WHAT
I'VE SEEN THE LAST SEVEN YEARS,
NIH DOES MORE THAN THE REST OF
THE INSTITUTIONS.
WITH SOME EXCEPTIONS.
I DO THINK THAT PROTECTING, AS A
DIVISION CHIEF, I WOULDN'T LET A
JUNIOR PERSON BE ON A REVIEW
COMMITTEE OF ANY KIND BECAUSE I
SAID, YOU HAVE TO GET YOUR WORK
DONE.
THEN CAN YOU SERVE ON COMMITTEES
AND THAT WAS ONE OF MY MANTRAS
AND THAT'S WHAT MY DIVISION
CHIEF DID WHEN I WAS ASKED TO DO
SERVICE AS A MID ASSISTANT
BEFORE I HAD GOTTEN MORE
PROMOTED AT UC SAN FRANCISCO.
SO, LOTS TO BE DONE BUT IF WE
DIDN'T START TALKING ABOUT IT,
NOTHING WOULD HAPPEN.
SO I'M REALLY DELIGHT THAT WE'RE
ABLE TO HAVE THESE CONVERSATIONS
MORE OPENLY.
WE HAVE TO HIRE MORE PEOPLE.
[LAUGHTER]
THAT WAY THE POOL WILL BE MORE
DIVERSE TO BEGIN WITH.
SO, THANK YOU AGAIN, NONI.
>> THANK YOU, VERY MUCH.
BYE-BYE.
WE HAVE A SECOND PRESENTATION
BEFORE WE GET TO THE REST OF OUR
WORK TODAY AND IT'S ONE OF OUR
OWN MEMBERS, KEN RESNICOW THE
IRWIN ROSENSTOCK PROFESSOR OF
HEALTH BEHAVIOR AND HEALTH
EDUCATION AT THE UNIVERSITY OF
MICHIGAN SCHOOL OF PUBLIC-HEALTH
AND THE TITLE OF PROFESSOR
PEDIATRICS IN SCHOOL OF
MEDICINE.
REN IS A WORLD-RENOWNED
BEHAVIORAL SCIENTIST AND HE IS
BEEN OVER THE PAST 35 YEARS
INVOLVED IN OVER 80 NIH AND
OTHER EXTERNALLY FUNDED PROJECT.
WHEN I FIRST HEARD OF KEN, HE
WAS AT EMERY WORKING WITH A
MENTEE OF MINE BUT I THINK HE
HAS REMAINED AT MICHIGAN SINCE
AND HE IS REALLY SORT OF HAS SET
DEFINED THE FIELD IN MANY WAYS
AND IT'S TOPICS AND HIS WORK AND
SMOKING CESSATION AND
SELF-DESCRIBES HIM AND ALSO WENT
ON TO ISSUES AROUND PHYSICAL AND
NUTRITION AND CANCER SCREENING
AND USING COMMUNITY ENGAGEMENT
AND INCLUDING FAITH-BASED
ORGANIZATIONS AND TO FOCUS ON
AFRICAN AMERICANS AND HE HAS
DONE WORK WITH MIDDLE EASTERN,
NORTH AFRICAN COMMUNITIES IN
MICHIGAN AND HE HAS WORKED IN 25
DIFFERENT COUNTRIES AND MORE
RECENTLY, HE HAS REALLY GOTTEN
INVOLVED IN USING E HEALTH TO
ENHANCE THE MESSAGES AND WE'RE
ALL VERY SENSITIVE IN A WAY IN
THE CHALLENGES COMMUNICATION AND
BUILDING TRUST AND SCIENCE AND
THE EXPERIENCE OF COVID HAS BEEN
SOBERING TO SAY THE LEAST SO
KEN, THE FLOOR IS YOURS.
>> I THINK THE SCREEN SHARE
WORKED.
THANK YOU FOR THE KIND WORDS
ALTHOUGH IT WAS A LITTLE
DAUNTING TO HEAR IT'S BEEN 35
YEARS THAT I'VE BEEN DOING THIS.
AT SOME POINT, IT'S BEEN A
PLEASURE TO SERVE ON COUNCIL FOR
THE PAST THREE AREA MORE YEARS.
I HAVE THREE MORE MEETINGS TO GO
AND I'M LOOKING FORWARD TO MY
CHANCE TO PRESENT ALTHOUGH IT
WAS DIFFICULT TO DECIDE WHAT TO
FOCUS ON AND I HOPE I'VE CHOSEN
THE RIGHT APPROACH.
WHAT I WANT TO TALK ABOUT TODAY
IS HOW A HEALTH COMMUNICATIONS
ARE BEHAVIORAL INTERVENTIONISTS
VIEWS DISPARITIES.
AND WHAT DO WE DO WITH SOME OF
THE SAME INFORMATION THAT WE
HEAR SO MUCH ABOUT.
FIRST OF ALL, THEY'RE SORT OF
WHAT WE CALL THE EPIDEMIOLOGIC
LENS ON DISPARITIES AND THIS IS
RIGHT FROM OUR OWN NIMHD WEBSITE
IT'S ABOUT PREVALENCE AND BURDEN
OF DISEASE.
HOWEVER, FROM OUR PERSPECTIVE,
DATA ON LIFE EXPECTANCY, DISEASE
BURDEN AND HEALTH SERVICES
REALLY INFORMS THE ALLOCATION OF
RESOURCES AND WHO SHOULD GET
INTERVENTION BUT IT TELLS US
GENERALLY VERY LITTLE ABOUT HOW
TO INTERVENE, WHAT SHOULD BE THE
DIFFERENCE IN INTERVENTION
FORMAT, CONTENT AND TIMING AND
INFORMING DIFFERENT SUB
POPULATIONS THAT THEIR GROUP IS
AT GREATER RISK IN SOME STUDIES
ACTUALLY DEMOTE RATE ISING SO
DISPARITY DATA ALONE IS NOT THAT
HELPFUL FOR BEHAVIORAL
INTERVENTIONISTS.
AND IN FACT, IF WE WANT TO
EXTEND THAT FURTHER, THERE ARE
DISEASES AND RISK FACTORS, FOR
WHICH THERE IS NO DISPARITY OR
IN FACT THE RACIAL ETHNIC
SUBGROUP MAY BE DOING BETTER BUT
FROM OUR PERSPECTIVE, SPEAKING
ON BEHALF OF MY GUILD, THERE ARE
UNIQUE DETERMINANTS THAT SHOULD
BE INCORPORATED INTO THOSE
TAILORED INTERVENTIONS.
IN OUR VIEW, FOR SOMEONE THIS
MIGHT BE QUEASY, THE NEED FOR
TAILORED INTERVENTIONS NOT THAT
LINKED TO THE PREVALENCE OF
BURDEN DATA OR THE HEALTH
SERVICES DATA.
LET ME JUST REMOVE THIS LITTLE
BAR IF I CAN.
SO FROM A HEALTH COMMUNICATIONS
PERSPECTIVE, WHAT WE'RE LOOKING
FOR ARE OPPORTUNITIES TO TAILOR.
WE'RE LOOKING FOR YES, THERE'S
AN DISPARITY HERE BUT DOES IT
CHANGE OUR MESSAGE?
A VERY GOOD EXAMPLE IS, AS WE
KNOW, FOR MOST HEALTH CONDITIONS
BEING OF LOWER SES STATUS INCOME
EDUCATION AND BEING EXPOSED TO
STRUCTURAL RACISM AND
DISCRIMINATION, OUR VERY
POWERFUL DETERMINANTS OF THE
EPIDEMIOLOGIC OBSERVATION, THOSE
OBSERVATIONS THOUGH ARE VERY
WEAK IN TERMS OF INTERVENTION
STRUCTURE AND CONTENT SO THE
INDIVIDUAL MESSAGES WE PROVIDE
FOR LOW AND MIDDLE AND HIGH
INCOME INDIVIDUALS ARE NOT THAT
DIFFERENT.
OF COURSE THERE ARE SUBTLE
DIFFERENCES BUT WHAT I WANT TO
ARGUE WITH YOU TODAY IS THERE'S
A WHOLE REALM OF DATA WE NEED TO
DIG INTO IN ORDER TO TAILOR OR
INTERVENTIONS.
I'M GOING TO GIVE TWO EXAMPLES
TODAY.
I'M GOING TO TALK ABOUT OBESITY,
PHYSICAL ACTIVITY AND DIET AND
SCREEN TIME AND THEN I'M GOING
TO TALK ABOUT SMOKING CESSATION
WHICH IS A LITTLE DAUNTING FOR
ME BECAUSE THEY'LL SAY THEY'RE
WORLD EXPERTS ON THAT BUT I'M
GOING TO TOUCH ON SOME OF THEIR
WORK TO MAKE MY BROADER POINT.
SO LET'S LOOK AT THE DISEASE
BURDEN OR PREVALENCE DATA.
SO, IF WE START WITH THE MOST
RECENT DATA WE HAVE IN ADULTS WE
SEE THAT THE PREVALENCE OF
OBESITY, LET'S JUST FOCUS RIGHT
NOW ON BLACK VERSUS WHITE.
THAT IF YOU LOOK AT THE MALE
DATA, THERE'S REALLY NOT A
POSITIVE THERE'S A REVERSE
DISPARITY WITH BLACK MEN
SLIGHTLY LOWER AND IF WHICH RELY
ON THAT TO DRIVE OUR DISPARITY
AGENDA, THERE'S NO NEED TO DO
ANY TAILORED INTERVENTION HERE
BECAUSE THE PREVALENCE IS LOWER.
FOR BLACK WOMEN PREVALENCE IS
MUCH HIGHER SO IT TELLS US WE
MAY WANT TO ALLOCATE RESOURCE
AND ALLOCATE MORE INTERVENTIONS
BUT IN ITS SELF IT DOESN'T TELL
US HOW WE SHOULD TAYLOR THAT
INTERVENTION SO I'M GOING TO
START WITH AN INTERESTING SORT
OF HEALTH SERVICES OBSERVATION.
THIS PAPER LOOKED AT SEVEN MAJOR
MULTI SITE TRIALS FOR WHICH
OBESITY WAS A PRIMARY SECONDARY
OUTCOME.
THESE WERE ALL FUNDED BY NAH.
YOU CAN SEE IT'S QUITE STRIKING.
WHEN YOU LOOK AT WITH THE
STUDIES THE DPP FOR EXAMPLE, THE
FIRST THREE REPORTED BY GENDER.
YOU SEE THAT IN THIS CASE BLACK
MEN LOST MUCH WEIGHT, MUCH LESS
WEIGHT IN THE SAME TRIAL.
THRTHE SAME FOR BLACK VERSUS WHE
WOMEN.
THE SAME IN PREMIERE AND GOING
ON WITH THE STUDIES DID NOT
REPORT SEPARATELY BY SEX AT
BIRTH.
YOU STILL SEE THAT IN EVERY CASE
OF THE MAIN TRIALS, BLACK
PARTICIPANTS LOST LESS WEIGHT
THAN WHITE PARTICIPANTS.
WHY IS THAT?
SO I WANT TO DRILL DOWN INTO
THAT AND CONCLUDE WITH DEEP
TAILORING.
THIS IS THE CONCLUSION.
AFRICAN AMERICANS LOST LESS
WEIGHT IN THE SAME STUDY THAN
WHITES.
THOSE BLACK-WHITE DIFFERENCES
ARE ACTUALLY ALSO OBSERVED IN
BARIATRIC SURGERY.
WHEN YOU LOOK AT THE OUTCOME OF
BARIATRIC PATIENTS, ON AVERAGE,
AFRICAN AMERICANS PATIENTS LOSE
CONSIDERABLY LESS WEIGHT AFTER
BARIATRIC SURGERY THAN THEIR
WHITE COUNTERPARTS.
SO WHY ARE THERE THESE
DIFFERENTIAL OUTCOMES?
MANY FACTORS, PSYCHE OH SOCIAL
AND BIOLOGICAL.
I WILL GIVE EXAMPLES OF EACH.
AS WE PROGRESS INTO THE TALK I'M
GOING TO ASK WHAT IS THE TAIL
ORGANIZE IMPLICATIONS THIS
FINDING.
I'LL START WITH A POWERFUL
INTERACTION.
THIS IS A LITTLE BIT
COMPLICATED.
WE'RE LOOKING AT HOUSEHOLD
INCOME FROM LOWER TO HIRE.
WE'RE LOOKING AT THE RATE OF
OBESITY AMONGST FEMALES IN THOSE
HOUSEHOLDS.
WHAT WE SEE CLEARLY IS IN WHITE
HOUSE HOLDS AS INCOME GOES UP
THE PREVALENCE OF OBESITY AMONG
THE FEMALES IN THE HOUSEHOLDS
GOES DOWN SO IN OTHER WORDS,
VERY CLEARLY, INCOME RISING IS
PROTECTIVE FOR WHITE PEOPLE.
YOU CAN NEVER BE TOO RICH OR TOO
THIN.
HOWEVER, THIS IS A REALLY
CLASSIC INCOMPECLASSINTERACTION.
HERE IS A GOOD ONE.
AS INCOME GOES UP, FOR BLACK
FAMILIES OBESITY GOES UP SO THE
SAME VARIABLE OF SOCIOECONOMICS
STATUS IS ASSOCIATED WITH THE
OPPOSITE EFFECT IN WHITE AND
BLACK FOLKS.
NOW WE'RE GOING TO TALK ABOUT
THE INTERVENTION IMPLICATIONS OF
THAT, HOLD ON.
IF YOU ARE INTERESTED IN MORE
RECENT DATA AND ADULT DATA WE
SEE IT AS WELL IN ADULTS.
THIS IS A VERY COMPLICATED SLIDE
AND I'M GOING TO WALK YOU
THROUGH A TINY PIECE OF IT.
WHEN YOU LOOK AT FOCUSING ON MEN
FOR NOW, WHEN YOU LOOK AT WHITE
MEN, YOU SEE THAT COLLEGE
GRADUATES, WHICH IS THE DARK
BLUE BAR, IS ASSOCIATED WITH
LOWER OBESITY PREVALENCE.
28 VERSUS 34.
IT'S PROTECTIVE.
HOWEVER FOR BLACK MEN, HIGHER
EDUCATION, COLLEGE GRADUATE IS A
RISK FACTOR, IT'S THE SAME
PATTERN IN THE SLIDES BEFORE
EXCEPT IT WAS A LESS THAN
PREVALENCE BY HOUSEHOLD INCOME
AND THIS IS BY ADULT EDUCATION.
THE SAME IS IT TRUE FOR FEMALES.
IN ITS SELF, THIS IS NOT
EFFECTING OUR MESSAGES.
YES, SOME MESSAGES WE CAN
CONSTRUCT BUT WE HAVE TO DRILL
DOWN INTO THIS IN ORDER TO COME
UP WITH TAILORING MANIFESTATIONS
OF THESE DIFFERENCES.
THE MAJOR THING THIS LEADS TO IS
A DISCUSSION OF GENERATIONAL TEE
OF WEALTH.
IT'S A HIGHLY UNDER RESEARCHED
AREA BUT VERY IMPORTANT ONE.
WHEN YOU LOOK AT SOME OF THE
WORK THAT DAVID WILLIAMS
FORMALLY OF MICHIGAN NOW AT
HARVARD HAS DONE AND OTHERS YOU
SEE THE FIRST-GENERATION WEALTH
WHICH IS COMMON IN AFRICAN
AMERICANS HAS SOME UNIQUE
STRESSORS ASSOCIATED WITH IT AND
IT'S LESS STABLE AND LESS SECURE
AND THAT SAYING LET'S CALL IT
$100,000, THAT SAME $100,000 FOR
FIRST-GENERATION BLACK FAMILY IS
LESS STABLE THAN $100,000 IN A
WHITE FINANCIALLY.
ALSO, FOR FIRST-GENERATION BOTH
EDUCATIONAL AND FINANCIAL
SUCCESS, THERE ARE OTHER THINGS
LIKE JOHN HENRY AND SUPER WOMEN
SYNDROME THAT MIGHT EXPLAIN WHY
HIGHER EDUCATION AND HIGHER
INCOME IS PARADOX I CANNILY
ASSOCIATED WITH HIGHER RATES OF
OVERWEIGHT AND OBESITY.
I'M HIGHLIGHTING ON THE BOTTOM,
HE SHOWED WITH DATA AND STUDIES
THAT FOR AFRICAN AMERICANS, OVER
EATING IS A RESPONSE TO CHRONIC
ENVIRONMENTAL AND STRESS
INCLUDING THE
FIRST-GENERATIONALITY OF WEALTH.
ANOTHER REASON WHY PERHAPS
AFRICAN AMERICANSS HAVE LOST
LESS WEIGHT AND AS WE'LL GET TO
IN A FEW MINUTES, HAVE LOWER
WEIGHT LOSS INTENTIONS IT HAS TO
DO WITH THE IDEAL BODY IMAGE.
THE DATA OF THIS IS SOMETIMES
EXAGGERATED AND THERE'S A
DIFFERENCE IN IDEAL BODY TYPES.
BUT IT'S MODEST SO WHEN YOU LOOK
AT CLASSIC NINE-PERSON
CONTINUUM, OVER ALL ACROSS
STUDIES INCLUDING OUR OWN,
AFRICAN AMERICANS AND WHITES ARE
ONE TO ONE AND A HALF POINTS OFF
SO THE RED BOX IS THE IDEAL PREF
PRESENCE.
THREE TO FOUR WHITE FOLKS, MEN
AND WOMEN CHOSE AND AFRICAN
AMERICANS FOLKS CHOSE IMAGE ONE
TO ONE AND A HALF FIGURES TO THE
RIGHT.
BUT THIS NONE THE LESS DOES
IMPACT MOTIVATION TO LOSE
WEIGHT.
ANOTHER WAY TO SAY IT, IF YOU
LOOK AT THE DIFFERENCE BETWEEN
BLACKS AND WHITES AS BMI GOES
UP, YOU SEE THAT FOR WHITE
ADULTS SELF-ESTEEM OR PHYSICAL
SELF-ESTEEM GOES DOWN.
FOR BLACK ADULTS THERE'S LITTLE
IMPACT ON LOW TO HIRE BMI ON
PHYSICAL SELF-ESTEEM.
YOU MAY SAY WHAT ARE THE
INTERVENTION IMPLICATIONS AND
WE'LL GET INTO IT BUT THIS
SUGGESTS THAT THINNESS AND
APPEARANCE WOULD BE
DE-EMPHASIZED IN AN AFRICAN
AMERICAN CULTURALLY TAILORED
WEIGHT LOSS INTERVENTION.
ANOTHER WAY TO LOOK AT THE DATA,
OVERWEIGHT BLACK MEN AND WOMEN.
IT FOUND IS AFRICAN AMERICAN
WOMEN WERE SIGNIFICANTLY LESS
LIKELY TO FEEL GUILTY AFTER
EATING THREE TIMES MORE LIKELY
TO STILL FEEL ATTRACTIVE
ADJUSTING FOR WEIGHT AND
EDUCATION AND THEY WERE THREE
TIMES MORE LIKELY TO SAY THEY
WERE STILL ATTRACTIVE.
MOTIVATION IS AN INTERESTING
VARIABLE FOR US.
SO IT TURNS OUT WHEN YOU LOOK AT
MOST NATIONAL STUDIES INCLUDING
THIS ONE AMONGST THE LARGEST,
AFRICAN AMERICANS ADJUSTING FOR
EDUCATION AND ADJUSTING FOR AGE
ARE SIGNIFICANTLY LESS LIKELY TO
SAY THEY WANT TO LOSE WEIGHT
THAN WHITES AND THIS MAY BE
BECAUSE WE EMPHASIZE
ATTRACTIVENESS, THINNESS AND
OTHER THINGS IN OUR WEIGHT LOSS
PROGRAMS THIS MAY BE LESS OF
ANNA TRACTION TO AFRICAN
AMERICANS.
SO IT MAY NOT BE AN INHERENT
LOWER DRIVE, IT MAY BE THAT THE
REASONS FOR WEIGHT LOSS ARE
DIFFERENT.
A REALLY NICE STUDY THAT STARTS
AGAIN TO I THINK VERY PRACTICAL
IMPLICATIONS WAS DALIA SMITH'S
ANALYSIS OF THE LOOK AHEAD
TRIAL.
NOW, A LOT OF FOLKS SAY THAT
LOWER INCOME, LOWER
SOCIOECONOMIC PARTICIPANTS HAVE
HIGHER DROP OUT RATES AND LOWER
ENGAGEMENT RATES.
THAT WAS NOT TRUE IN LOOK AHEAD.
SO IF YOU LOOK AT THE NUMBER OF
SESSIONS A ENDED, LET'S START
WITH MEN FIRST.
THE EXPECTED NUMBER OF SESSIONS
WAS 42, WELL IT WAS 38 FOR WHITE
MEN AND 37 FOR BLACK MEN NO
DIFFERENCE.
AND FOR WOMEN, THE EXACT SAME.
37, 37, AND THAT IS TRUE AS YOU
WENT ON TO YEARS TWO THROUGH
YEAR EIGHT THAT THERE WAS REALLY
NO DIFFERENCE IN ATTENDANCE SO
ENGAGEMENT CANNOT BE OFFERED BY
RACE.
HOWEVER, THE BEHAVIORAL
STRATEGIES USED WERE QUITE
DIFFERENT.
SO ONE OF THE PRIMARY BEHAVIORAL
STRATEGIES IN THESE WEIGHT LOSS
TRIALS IS SELF-MONITORING AND
SELF-MANAGING WHICH IS DAILY
WEIGHING.
BOTH AT BASELINE 13 AND 8, BUT
MORE IMPORTANT AS THE STUDY WENT
ON, 39 AND 36.
AFRICAN AMERICAN WOMEN WERE FAR
LESS LIKELY TO DO DAILY
WEIGHING.
MAYBE BECAUSE THEY'RE LOSING
LESS WEIGHT AND BECAUSE YOU ARE
LOSING LESS WEIGHT THE SCALE IS
LESS REINFORCING
PSYCHOLOGICALLY, IT'S COMING NOT
INDICATED BUT THEY WERE LESS
LIKELY TO USE THIS
EVIDENCE-BASED STRATEGY AND THE
SAME DIFFERENCE IS TO LOOK AT
MAN 42 VERSE 30, STRONG
DIFFERENCES IN ONE KEY
BEHAVIORAL STRATEGY.
HOW DO WE DEAL WITH THIS?
SHOULD WE DISCOURAGE USE OF
WEIGHTING OR COME UP WITH WEIGHS
TO USE IT.
IT'S THE CLASSIC DILEMMA WE FACE
AS BEHAVIORAL RESEARCHERS WHEN
WE IDENTIFY THESE DIFFERENCES.
NOW THERE'S SOME BIOLOGICAL
DIFFERENCE THAT'S ARE IMPORTANT
MEDICALLY BUT DON'T GIVE US A
LOT BEHAVIORALLY SO THERE'S
SEVERAL STUDIES THAT SHOW THAT
AFRICAN AMERICANS HAVE LOWER
RESTING METABOLIC RATE.
THIS IS NOT ALTER OUR BEHAVIORAL
MESSAGES VERY MUCH AND IT COULD
BE DISCOURAGING AND SOMETHING WE
WANT TO DE-EMPHASIZE.
ON THE OTHER HAND, ANOTHER
BEHAVIORAL OBSERVATION HAS
TREMENDOUS IMPLICATIONS AND
THERE'S SOME DATA, ALTHOUGH THE
BEST WAY TO TEST IT IS WITH
NEONATAL TASTING STUDIES.
THERE'S A SIGNAL THAT AFRICAN
AMERICAN ADULTS PREFER SWEETER
FOODS.
IF THAT IS TRUE, THERE'S
TREMENDOUS INTERVENTIONS
IMPLICATIONS.
EVEN WITHIN THE BIOLOGIC
DIFFERENCES, SOME OF THE
BIOLOGIC OBSERVATIONS LEND
THEMSELVES TO TAYLOR MESSAGING
AND DON'T.
DOES TAILORING ON THESE
INTERVENTIONS TARGETS MATTER?
WELL THE GENERAL ANSWER IS YES.
WHEN YOU LOOK AT CULTURALLY
TAILORS INTERVENTIONS IN GENERAL
THEY'VE DONE BETTER THAN
INTERVENTIONS THAT DON'T TAKE
THESE DIFFERENCES INTO ACCOUNT.
I WILL GIVE YOU A BETTER EXAMPLE
FROM MONICA WEB HOOPER THAT
REALLY SHOWS THAT CULTURAL
TAILORING MATTERS.
SO THESE ARE SOME OF THE
CULTURALLY TAILORED IMPLICATIONS
OF WHAT THESE BEHAVIORAL
OBSERVATIONS LEAD TO.
WE WANT TO USE STRESS COPING AS
THE CORE OF WEIGHT CONTROL.
A FEW PEOPLE LOOKED AT THAT.
WE WANT TO EMPHASIZE A FEW
PEOPLE BUT NOT ENOUGH HAVE
WORKED AT THAT.
LINKING THE MOTIVATION MORE TO
HEALTH AND FITNESS OR BEING
TIGHT OR THICK VERSUS THIN.
A LITTLE BIT OF WORK HAS BEEN
DONE ON THAT BUT NOT ENOUGH.
AND AS WE SAW EARLIER, WE HAVE
TO MAYBE DESIGNING UNIQUE
INTERVENTIONS FOR MIDDLE AND
UPPER MIDDLE INCOME AFRICAN
AMERICANS THAT ADDRESS
GENERATIONAL TEE OF WEALTH.
NOW, I WANT TO MOVE ONTO THE
SECOND EXAMPLE AND THAT IS
SMOKING.
THIS IS, I THINK, A VERY
EXCELLENT EX 'EM PAR FOR THE
BEHAVIORAL LENS IS VERY
DIFFERENT HERE THAN THE 'EM DEEM
EPIDEMIOLOGIC ONE.
AFRICAN AMERICANS ARE A POINT
AHEAD OF WHITE AND IF WE SAY
PREVALENCE SHOULD DRIVER OUR
DISPARITY AGENDA WE WOULD SAY
THERE'S NOT A HUGE DISPARITY
HERE.
OF COURSE YOU CAN SAY THERE'S
ONE HERE BUT I'M FOCUSING ON
BLACK AND WHITE DIFFERENCES.
SIMILARLY, LUNG CANCER DEATH
RATES IN THE U.S. ARE THE SAME
BLACK AND WHITE.
IF YOU LOOK AT SMOKING
PREVALENCE OR LUNG CANCER
MORTALITY, THERE'S NOT A BIG
DISPARITY IF WE LET THE
EPIDEMIOLOGIC DATA DRIVE OUR
AGENDA.
THERE ARE SOME DIFFERENCES IN
LUNG CANCER DEATHS THAT ARE
IMPORTANT BUT AGAIN FROM A
MESSAGING PERSPECTIVE THEY DON'T
HELP US VERY MUCH.
AT LIGHTER LEVELS OF SMOKING AT
10 CIGARETTES A DAY AFRICAN
AMERICANS HAVE HIGHER RATES OF
LUNG CANCER THAN WHITES.
NOW IN ITS SELF, THAT'S NOT A
SALIENT MESSAGE IN OUR
EXPERIENCE ALTHOUGH IT'S
INTERESTING AND CAN EFFECT HOW
WE ALLOCATE RESOURCES.
FROM A PURELY EPI FEMALE LOGIC
SURVIVAL DISEASE BURDEN THERE'S
NOT A LOT OF DISPARITY HERE.
HOWEVER, THERE ARE, FROM A
HEALTH COMP PERSPECTIVE, MASSIVE
DIFFERENCES IN HOW SMOKING
DEVELOPS IN AFRICAN AMERICANS,
HOW THE TRAJECTORY OF SMOKING
AND HOW AFRICAN AMERICANS QUIT.
I'LL GO THROUGH A FEW OF THOSE
AND IN EVERY CASE, THESE HAVE
MAJOR IMPLICATIONS FOR
INTERVENTIONS SO THE FIRST ONE
IS AFRICAN AMERICANS ARE THREE
TO EIGHT TIMES MORE LIKELY TO
SMOKE MENTHOL CIGARETTES AND
IT'S BEEN KNOWN FOR 25 YEARS.
YOU MAY SAY WHO CARES, ISN'T
THAT JUST A DIFFERENCE OF
WHETHER OR NOT YOU LIKE VANILLA
OR CHOCOLATE ICE CREAM.
NO.
THE WAY THAT MENTHOL IS MARKETED
IS DIFFERENT AND IMPACTS
INTERVENTION RECEPTIVITY AND
WHAT DO WE MEAN?
THIS IS HOUR OUT NUMBER ONE NON
MENTHOL CIGARETTE IS SMOKED.
IS THERE ANYTHING THAT MAY NOT
BE THAT APPEALING TO AFRICAN
AMERICANS?
I CAN'T SEE YOUR FACES I'M
GUESSING YOUR CHUCKLING.
SO INSTEAD THEY MARKET MENTHOL
DIFFERENTLY.
THIS IS A WONDERFUL STUDY LOOKED
AT HOW MENTHOL IS MARKETED.
IT'S A CELEBRATORY CULTURALLY
ACTIVE EVENT.
YOU ARE AROUND MUSIC, SPORTS,
FRIENDS IT'S NOT THE LOAN COWBOY
IN MONTANA IT'S ALSO MARKETED
INDIRECTLY AS LESS HARMFUL
ALTHOUGH THEY DON'T DIRECTLY SAY
IT AND THEY IMPLY IT BY HAVING
THEM DO SPORTS.
SO THIS IS A ACCURATE WAY TO
MARKET MENTHOL CIGARETTES TO
AFRICAN AMERICANS.
NOW, BRAND IN ITS SELF IS
PROBABLY NOT THE KEY OBSERVATION
THAT CHANGES OUR MESSAGING BUT
LET'S GET INTO SOME OF THE MORE
DEEP BEHAVIORAL TOPOGRAPHY OF
SMOKING.
FIRST OF ALL WHEN YOU ASK WHITE
AND BLACK ADULTS TO SMOKE
MENTHOL AND NON MENTHOL
CIGARETTES OVER ALL, WHEN
PARTICIPANTS SMOKE MEN THAT WILL
THEY TAKE BIGGER AND LONGER
PUFFS AND IT MAY RESULT IN
INHALING MORE CARCINOMA OWE CAR.
MENTHOL SMOKERS WHAT WAIT LESS
TIME FOR CIGARETTES.
THEY MAY BE MORE ADDICTED.
I'M NOT GOING TO GET INTO THE
WORK BUT THERE'S PRETTY GOOD
DATA FROM HIS STUDY THAT MOST
MEDICATIONS, BE IT ZIBAN AND
CHANTEXT ARE LESS EFFECTIVE WITH
MAN TMENTHOL SMOKERS.
OVER ALL IT SEEMS TO BE PROBABLY
A MENTHOL EFFECT.
AS WE SAID, IT'S NOT A HARMLESS
THING THAT BECAUSE PERHAPS OF
THE NUMBING SECESSION OR THE
PERCEPTION THAT MENTHOL
CIGARETTES ARE LESS HARMFUL THAT
AFRICAN AMERICAN SMOKERS INHALE
MORE CARCINOGENS PER PUFF.
IF YOU LOOK AT THE MARKETING
IT'S DIFFERENT BY PLACE.
AFRICAN AMERICAN RESPONDENTS
HERE, ALTHOUGH THIS IS A SMALL
SAMPLE OF WHITE MENTHOL SMOKERS,
THEY REALLY FEEL THAT MENTHOL
CIGARETTES ARE MORE INHALE-ABLE.
PARTICULARLY IF YOU SEE AFRICAN
AMERICANS VERSUS WHITE
RESPONDENTS.
THIS MAY BE DRIVING OR
INTERACTING WITH THE NUMBING
SENSATION TO MAKE THEM HARMFUL
AND PERHAPS LESS EASY TO REFRAIN
FROM.
AFRICAN AMERICANS WE HAVE KNOWN
FOR A LONG TIME HAVE BEEN
SMOKING FEWER CIGARETTES AND
THEY'RE MUCH MORE LIKELY TO BE
LIGHT AND INTERMITTENT SMOKERS
AND THERE'S SEVERAL WAY IT'S
BEEN QUANTIFIED AND THEY LOOK AT
LITS AND 70% OF BLACK MALE AND
79% OF BLACK FEMALES ARE LIGHT
OR OCCASIONAL SMOKERS VERSUS
HEAVY SMOKERS OR REGULAR SMOKERS
56% OF WHITE AND 46% OF WHITE
FEMALES.
NOW WHAT ARE THE IMPLICATIONS OF
THAT?
WELL THERE'S ONE SORT OF 'EM
DEEM LOGIC INDICATION IT WAS
HARD TO RECRUIT AFRICAN
AMERICANS INTO DRUG TRIALS WHICH
REQUIRED MORE THAN HALF A PACK A
DAY.
BUT IN TERMS OF INTERVENTION,
THIS IS IN ITS SELF NOT
NECESSARILY TAILOR ABLE
OBSERVATION BUT WE'LL GET TO IT
AS WE DRILL DOWN FURTHER HOW
THIS AFFECTS INTERVENTION
RESPONSE.
AND IN TERMS OF CIGARETTES A DAY
IT'S 15 FOR WHITES AND 10 FOR
BLACKS WHICH IS ANOTHER WAY TO
ROTATE THAT DATA.
THIS STUDY THAT SHOWED THAT 24%
OF BLACK SMOKERS ARE A PACK OR
MORE A DAY VERSUS 48% OF WHITE
SMOKERS.
ALSO AFRICAN AMERICAN START
LATER.
WHEN YOU LOOK AT EARLY ONSET IN
AGE OF FIRST CIGARETTE, AFRICAN
AMERICANS SMOKERS START SMOKING
ABOUT A YEAR AND A HALF LATER.
THEY WERE REGULAR SMOKERS ALMOST
THREE YEARS LATER.
THIS HAS MAJOR IMPLICATIONS AND
ONE OF THEM IS FOR PREVENTION.
IF YOU KNOW THAT AFRICAN
AMERICAN START A YEAR PLUS
LATER, IF WE DO SMOKING
PREVENTION IN ABOUT SEVENTH
GRADE FOR WHITE STUDENTS, ONE
COULD ARGUE THAT WE SHOULD
PERHAPS DO IT A YEAR OR SO LATER
FOR BLACK STUDENTS.
I DON'T KNOW ANY SCHOOL DISTRICT
THAT TAILERS IT BASED ON THIS
OBSERVATION.
IT'S VERY INTERESTING THAT
AFRICAN AMERICAN KIDS, IT'S BEEN
KNOWN FOR A LONG TIME, EVEN
BEFORE 2011, I'M JUST SHOWING
YOU THE TREND, SMOKE IN HIGH
SCHOOL ABOUT HALF THAT RATE AS
WHITES.
NOW, HOW DOES THAT LEAD TO EQUAL
ADULT RATES?
WELL THERE'S A COUPLE OF REASONS
THAT CAN BE THE CASE.
LATER ONSET.
SO MANY MORE AFRICAN AMERICAN
SMOKERS START AFTER HIGH SCHOOL
BUT ALSO LOWER CESSATION RATES.
THOSE AND OTHER FACTORS
CONTRIBUTE TO THIS PA PARADOX 5%
ARE IN HIGH SCHOOL AND SIMILAR
PREVALENCE IN ADULTHOOD.
NOW, I'VE DECIDE NOT TO GO INTO
THIS JUST BECAUSE OF TIME BUT
I'M GOING TO SUMMARIZE ABOUT 100
DIFFERENT STUDIES THAT IN
GENERAL BLACK SMOKERS ARE EQUAL
OR GREATER MOTIVATION TO QUIT.
SO IT'S NOT A MOTIVATIONAL
ISSUE, HOWEVER, THEY ARE HIGHER
QUIT RATES THAN BLACK NON
MENTHOL.
HOWEVER, IN GENERAL, THEY HAVE
LOWER SUCCESS.
NOW WHY THAT IS THE CASE IS
COMPLICATE AND IT MAY BE BECAUSE
OF INTERACTION WITH MEDICATION
AND IT MAY BE BECAUSE MENTHOL IS
MORE ADDICTIVE AND IT MAY BE
BECAUSE OF EFFICACY.
THESE IN ITS SELF DON'T CHANGE
OUR INTERVENTION STRUCTURE SO I
WILL MOVE ON TO THINGS THAT DO
SO FIRST OF ALL, AFRICAN
AMERICAN KIDS GROW UP IN A VERY
DIFFERENT TOBACCO SOCIALIZATION
ENVIRONMENT.
WHEN YOU LOOK AT BLACK AND WHITE
PARENTS, THAT'S WHAT THIS IS
HERE, THEY WERE ASKED ABOUT
THEIR RULES IN THE HOUSE OR
THEIR BELIEFS ABOUT PREVENTING
SMOKING AND WHAT YOU SEE IS VERY
DIFFERENT BELIEFS.
PUNISHING KIDS IS NOT GOING TO
WORK.
72% OF WHITE PARENTS BELIEVE
THAT ONLY 22% OF BLACK PARENTS
BELIEVE THAT.
50% OF WHITE PARENTS BELIEVE
THAT AND ONLY 12% OF BLACK
PARENTS AND IT'S THE SCHOOL'S
JOB NOT MINE AND 32% OF WHITE
AND 9% OF BLACK.
THIS IS A GOOD CASE TO INDICATE
WE SHOULD ENCOURAGE
CONVERSATIONS AND ASKING WHITE
PARENTS TO TALK TO A BLACK
PARENT.
WHAT ARE YOU DOING SO WELL IT'S
REFLECT INSIDE HIGH SCHOOL WITH
50% LOWER UPTAKE.
NOW I WANT TO GET INTO DATA THAT
CHANGES HOW WE TAILOR OR
INTERVENTION.
SO WE SURVEYED A COUPLE OF
THOUSAND PEOPLE A COUPLE YEARS
BACK AND ASKED THEM TO DAVID
WILLIAMS EFFORT DISCRIMINATION
SCALE AND ACHIEVE WHY THAT
HAPPENED AND IT'S PART OF HIS
MEASURE AND AND WHAT WE FOUND
FIRST OF ALL, I TOOK THE SLIDE
OUT.
HERE IT IS.
WE ALSO MEASURED ON FAIRNESS.
I LOVED THIS IDEA AND I
ENCOURAGE YOU TO USE IT AND IT
CAPTURES A LOT OF OUR
DISPARITIES RESEARCH SO I'M
GOING TO SHOW YOU THE EFFECTS OF
UNFAIRNESS AND EVERYDAY
DISCRIMINATION SO FIRST OF ALL,
WHEN YOU LOOK AT BLACK VERSUS
WHITE WE DID WITH DIE NATOSSI WE
SAW AFRICAN AMERICAN REPORTING
HIGHER RATES OF INFAIRNESS AND
DISCRIMINATION AND IT'S NOT
SURPRISING.
I WANT TO PUT IN OUR WORK THE
LAST 10 YEARS, WE KEEP FINDING
THIS THAT MULTI RACIAL TENDS TO
BE AS BAD OR WORSE THAN PEOPLE
IDENTIFIED AS BLACK AND THERE'S
SOMETHING ABOUT THE MULTI RACIAL
BY RACIAL GROUP UNDER
RESEARCHED.
BRINGING US BACK TO THIS GROUP
HERE.
WHAT YOU SEE HERE IS THE
ASSOCIATION OF HIGH LEVELS OF
FAIRNESS AND DISCRIMINATION ON
SMOKING RATES.
IN EVERY ETHNIC GROUP WE
MEASURED, THE HIGHER YOUR
PERCEIVED UNFAIRNESS HIGH VERSUS
LOW OR THE HIGHER THE EVERYDAY
WILLIAMS DISCRIMINATION SCORE,
THE HIGHER YOUR ODDS OF SMOKING.
HOWEVER, WHAT YOU SEE IS AN
INTERACTION.
THE AFFECT OF DISCRIMINATION AND
UNFAIRNESS IS GREATER
SIGNIFICANTLY SO IN BLACKS.
SO UNFAIRNESS IN DISCRIMINATION
IS A GREATER DETERMINANT OF
SMOKING IN BLACK FOLKS.
THE REASONS PEOPLE ATTRIBUTE THE
DISCRIMINATION IS MUCH
DIFFERENT.
FOR AFRICAN AMERICANS NOT
SURPRISING 87 ATTRIBUTE TODAY
RACE WHERE FOR MENA37% WERE
RELIGION.
IT HAS BEEN KNOWN FOR MANY
YEARS, BOTH IN STUDIES IN THE
U.K. AND IN THE U.S., THAT
PEOPLE WHO REPORT QUITTING.
THEY WOKE UP AND SAID I'M
BREAKING UP WITH YOU TOBACCO.
THEY HAVE BETTER QUIT RATES OR
LONGER PERIODS OF ABSTINENCE
BEFORE THEY RELAPSE AND IT'S
CALLED SPONTANEOUS QUITTING,
EPIPHANY QUITTING AND
CATASTROPHIC QUITTING, HOWEVER,
NONE OF THOSE STUDIES HAD
SUFFICIENT AFRICAN AMERICANS TO
SEE WHETHER OR NOT THERE WAS A
HEALTH BEHAVIOR DIFFERENCE HERE
BY RACE SO WE OVER SURVEYED
AFRICAN AMERICANS WITH
COLLEAGUES AT THE TIME IN
MINNESOTA AND KANSAS.
WE FOUND WAS STRIKING.
WE DID NOT EXPECT THIS.
WHEN YOU LOOK AT THE DIFFERENCE
BETWEEN PLANNED AND UNPLANNED
QUITTING YOU SEE FOR WHITES IT'S
EXACTLY THE SAME AS OTHER
STUDIES.
ON AVERAGE, THE UNPLANNED
QUITTERS LASTED 103 DAYS FOR
WHITES VERSUS 58% FOR PLANS.
SO PLANNED QUITTING HAD WORSE
OUTCOMES THAN UNPLANNED QUITTING
SO SUDDEN EPIPHANY QUITTING WAS
ASSOCIATED WITH BETTER OUTCOMES
FOR WHITES HOWEVER FOR BLACKS
THE PATTERN WAS THE OPPOSITE.
FOR BLACK SMOKERS, PLANNED
QUITTERS HAD BETTER QUIT RATES
OR LONGER SUSTAINED ABSTINENCE
THAN UNPLANNED.
THIS IS BEEN A ACTUALLY REPORTED
IN OTHER PAPERS AND IT'S NOT THE
PRIMARY FINDING AS OTHER PAPERS
FIND THIS SEPTEMBER 11th I
WANT TO MOVE ON TO SAY THAT EVEN
IN THIS STUDY OF NATIONAL
SMOKING PATTERNS YOU SEE THE
AFRICAN AMERICANS COMPARED TO
WHITES ARE SLIGHTLY MOST LIKELY
TO QUIT ALL AT ONCE.
WE KNOW THEY'RE LESS SUCCESSFUL
WHEN THEY DO.
I WANT TO GET INTO ONE LAST
TOPIC.
I THINK IT'S A LITTLE
CONTROVERSIAL WHEN WE PUBLISH
THIS LAST YEAR AND WRITTEN TWO
COMMENTARY ON IT WE GOT BUSH
PUSH BACK ON REVIEWERS.
WE DID A TRIAL WITH 204 SMOKERS
AND THEY WERE RANDOMIZED TO GET
HEATH EDUCATION AND WE ASSUMED
HEALTH ED WOULD DO WORSE AND
THIS WAS THE GOAL STANDARD AND
THE CONTROL CONDITION AND BOTH
ARMS AND FOUR SESSIONS AND THE
MAIN OUTCOME FOR THIS PAPER WAS
QUIT ATTEMPTED AS YOU MAY KNOW
IT'S A WAY OF TALK TO GO PEOPLE
THAT LITTLE IS ITS MOTIVATION
CONTRACT LESS DIRECTIVE THAN
HEALTH ED AND IT'S IN THIS CASE
AND CONSIDERED MORE DIRECTIVE.
WE HAD A VERY UNANTICIPATED
FINDING AND FOR AFRICAN
AMERICANS, SMOKERS IN THIS
STUDY, WITH THE OUTCOME BEING
QUIT ATTEMPTS WE DIDN'T HAVE
ENOUGH QUITTERS TO VERIFY
CESSATION, AFRICAN AMERICANS DID
BETTER WITH HEALTH EDUCATION.
THE NON BLACK WHICH IS WHITE AND
A FEW ASIAN PARTICIPANTS THAT WE
AGO AGREE GATED THEY DID BETTER
WITH AI AND THIS IS A
SIGNIFICANT FINDING THAT AFRICAN
AMERICANS IN THIS STUDY DID
BETTER WITH THE DIRECTIVE
APPROACH THAN MI AND WE WERE
ABLE TO IN A PAPER UNDERSTAND
STATISTICALLY WHAT DROVE THIS
AND WHAT DROVE THIS WAS A
PREFERENCE FOR DIRECTIVENESS.
AFRICAN AMERICANS WERE MORE
LIKELY TO AGREE WITH THIS ITEM.
SO THEY HAD HIGHER RATES OF
AGREEING WITH THIS ITEM.
THIS IS AN OUR WORLD, A
PREFERENCE FOR DIRECTIVENESS AND
WHEN WE ADJUSTED FOR THE
PREFERENCE FOR DIRECTIVENESS,
THE RACIAL EFFECT OF MI VERSUS
HEALTH ED DISAPPEARED.
THE REASON MI DID WORSE OR
HEALTH ED DID BETTER IN AFRICAN
AMERICANS MODERATED FULLY BY THE
FACT THAT AFRICAN AMERICANS
SAID, NOT ALL, JUST TELL ME WHAT
TO DO.
THIS IS CONSISTENT WHEN WE GO
INTO THE LITERATURE WITH OTHER
STUD SKIS THISTUDY.THIS INTERVEI
INTERVENTION SO AFRICAN
AMERICANS UNADJUSTED HAD LOWER
SATISFACTION WITH THE MI
INTERVENTION.
THERE ARE TWO QUALITATIVE
STUDIES THAT SHOWED AFRICAN
AMERICANS MI TRAINING TAPES AND
THEY DIDN'T LIKE THE MI SESSION
THAT THEY VIEWED ON TAPE AND
THEY LIKED THE CONTROL
CONDITIONS BETTER.
IT'S CONSISTENT WITH SURVEY
RESEARCH THAT WE'VE WRITTEN
ABOUT WHERE THEY'VE ASKED IF YOU
WANT TO BE INVOLVING IN DECISION
MAKE ORGANIZE DO YOU WANT YOUR
PHYSICIAN TO DIRECT YOUR
DECISION MAKING AND IT TURNS OUT
AFRICAN AMERICANS AND HISPANICS
ARE MUCH MORE LIKELY TO SAY I
PREFER TO RELY ON MY DOCTOR
KNOWLEDGE JUST TELL ME WHAT TO
DO.
SO IN THAT STUDY THERE WAS A
GREATER PREF PRESENCE FOR
AFRICAN AMERICANS TO DELEGATE
THEIR AUTONOMY BACK TO THIS
POSITION.
NOW THERE'S MAJOR IMPLICATIONS
FOR THESE INTERVENTION TARGETS.
THE BEST STUDY THAT'S TESTED IT
IS A BEAUTIFUL STUDY BECAUSE SHE
USED REALLY THE CORRECT CONTROL
GROUP.
HERE SHE COMPARED CBT AND
EVIDENCE-BASED VERY STRONG COM
PAR TO BE TO A SIMILAR DOSE OF
TAILORED CBT SO MERE IS THE
CULTURALLY TAILORED TOPIC THAT
WAS INJECTED OR INTER WOVEN INTO
EACH OF THE ACTB SESSIONS SO A
RIGOROUS DESIGN AND THESE ARE
SOME OF THE EXACT TOPICS THAT
WE'VE TALKED ABOUT TODAY DURING
OUR BEHAVIOR ALANAL SIS AND WHAT
SHE SHOWS IS END OF TREATMENT
AND THREE MONTHS POST.
THERE WAS A SIGNIFICANT BENEFIT
IN THE CULTURALLY TAILORED ARM.
THE LAST THING I WANT TO TALK
ABOUT, TAKE ME ABOUT TWO OR
THREE MINUTES, THIS IS THE IDEA
OF INDIVIDUAL TAILORING.
IN THE LAST FIVE OR 10 MINUTES
OF THE TALK AND AFRICAN
AMERICANS ARE MORE LIKELY TO SAY
TELL ME WHAT TO DO AND SAY MY
PHYSICIAN AND THEY DID BETTER
WITH MORE DIRECTIVE
INTERVENTIONS AND I WANT TO SHOW
YOU HOW CAREFULLY WE HAVE TO BE
WITH INTERESTING DATA.
SO HERE IS AN EXAMPLE OF WHAT WE
MEAN BY INDIVIDUALLY TAIL
ORGANIZE INTERVENTIONS.
THIS IS ONE WE CREATED FOR
SMOKING CESSATION FOR HIV
POSITIVE, GAY AND TRANS MEN IN
DETROIT.
YOU SEE HERE, THAT WE'RE
TAILORING BASED ON INDIVIDUAL
IDENTITY SO HERE BLACK IDENTITY
IS LOW.
THEIR INTERNALIZATION IS LOW SO
THIS IS THE MESSAGE TO THEM IN
THIS APP WE CREATED.
HOWEVER, IF YOUR BLACK IDENTITY
HIGH AND YOUR HIV STIGMA IS HIGH
YOU NOTICE HOW THE MESSAGE
CHANGES.
AND SIMILARLY IF YOU HAVE HIGH
BLACK IDENTITY, HIGH SEXUAL
IDENTITY AND DISCRIMINATION YOU
CAN SEE HOW THE MESSAGE IS
DIFFERENT THAN LOW
DISCRIMINATION, LOW IDENTITY.
IT'S VERY SUBTLE AND YOU WILL
SAY WILL THIS CREATE AN
INTERVENTION EFFECT.
THIS IS ONE OF SEVERAL HUNDRED
MESSAGES SO OVER THE COURSE OF
THE INTERVENTION, THERE'S A
PRETTY BIG DIFFERENCE IN HOW THE
TAILOR MESSAGING MANIFESTED
DEPENDING ON YOUR ANSWER TO
BASELINE ITEMS.
SO, WE ALSO HAVE TAILORED FOR
AFRICAN AMERICANS SEVERAL
DIFFERENT INTERVENTION.
ONE FRUIT AND VEGETABLE AND ONE
ON COLORECTAL SCREENING.
THIS IS BASED ON ETHNIC IDENTITY
AND WE HAVE FOUR TYPES AND THIS
IS THE MESSAGE IF YOU SCORED
HIGH ON AFROCENTRIC.
HERE IS THE MESSAGE IF YOU SCORE
HIGH ON BLACK AMERICAN.
TAKE A LOOK.
HIGH IF YOU SCORE LOW CENTRALITY
OR WHAT IS CALLED ASSIMILATED
AND HERE IS THE MULTI CULTURAL.
THIS IS THE MESSAGE WITH HIGH
MISTRUST.
IF THE PERSON SCORED HIGH ON
SOCIAL, CULTURAL MISTRUST, THEY
GOT REFERENCED TO IF YOU DID NOT
SCORE HIGH ON MISTRUST IS YOU
DID HEAR ABOUT -- LET ME DRIVE
THOME THIS LAST POINT.
IF YOU TAKE THIS PAPER THAT WE
TALKED ABOUT, YOU MIGHT SAY OK,
SO ALL OUR INTERVENTION SHOULD
GIVE AFRICAN AMERICANS DIRECTIVE
MESSAGING AND WE'LL FIX
DISPARITIES.
HERE IS THE CAUTIONARY TALE --
WE DID A TAILORED FRUIT AND
VEGETABLE INTERVENTION FOR
AFRICAN AMERICANS AND WE LOOKED
AT THEIR FRUIT AND VEGETABLE
INTAKE THREE MONTHS LATER.
THERE WERE TWO ARMS.
THE CONTROL ARM GOT BASIC
TAILORING AND THE INTERVENTION
ARM WE FURTHER TAILORED ON
SELF-DETERMINATION OR AUTONOMY
SUPPORT OR IN EFFECT THE
VARIABLE.
HERE IS SOME WAYS THAT THE TWO
INTERVENTIONS DIFFER.
THIS IS THE LANGUAGE OF PUSH AND
THIS IS THE CONTROL LANGUAGE.
YOU HAVE TO BE BETTER IT'S
IMPORTANT AND THE YOUR DIRECTIVE
HEALTH ED AND THE MI
SELF-DETERMINATION TONE THAT IS
UP TO YOU AND IT'S YOUR CHOICE
AND HELP YOU SOLVE THE PROBLEM.
AND THEY GOT TAILORED NEWS
LETTERS THAT WE PRINTED.
EVERYONE'S IS DIFFERENT.
THIS PART IS TAILOR AND THIS
PART IS TAILORED AND THIS
HAPPENS TO BE THE NEWSLETTER FOR
FEMALE AND THE CONTROL CONTINUE
WHO HAD HIGH IMPORTANCE AND
CONFIDENCE AND THEN OF COURSE WE
ASKED THE BASELINE DO YOU WANT
TO BE TOLD WHAT TO DO?
THIS IS HAULED HIGH AUTONOMY
BELOW SIX AND THIS IS HIGH TELL
ME.
WHAT WE FOUND WAS STRIKING.
IT'S A LITTLE BIT OF A
COMPLICATED INTERACTION TERM AND
LET ME WALK YOU THROUGH IT.
FOR INDIVIDUALS, AND EVERYONE IN
THE STUDY WAS AFRICAN AMERICANS.
THEY WERE ALL ADULT.
MEMBERS OF KAISER OR HENRY FORD
HEALTH SYSTEM.
AND IF THEY SAID, DON'T TELL ME
WHAT TO DO, WHICH WAS BASICALLY
DISAGREEING WITH THIS ITEM, THEY
DID VERY WELL.
THIS IS THE EFFECT.
THEIR CHANGE OF FRUIT AND
VEGETABLE TAKE 1.1 SERVING.
IF YOU WANTED THE A TONY MESSAGE
IT CAUSED HARM.
THEY DID THE WORST.
SO WHAT THIS SHOWS YES, AFRICAN
AMERICANS ON AVERAGE MAY BE MORE
LIKELY TO SAY TELL ME WHAT TO DO
BUT THERE'S HUGE WITHIN GROUP
VARIABILITY AND IF YOU DON'T
ACCOUNT FOR THAT AND TAILOR ON
IT YOU COULD CAUSE HARM.
SO IN THIS CASE, WE IN EFFECT
CAUSE HARM BY AND THIS WAS JUST
THE EXPERIMENTAL MANIPULATION
USED BUT BY GIVING PEOPLE WHO
WERE AT BASELINE, SAYING OH
DON'T TELL ME WHAT INFORM DO I
NEED AUTONOMY.
ASSIGNING THEM TO THE
CONTROL-PUSH MESSAGES THEY DID
WORSE.
SO THIS IS WHAT WE CALL THE
SMALL DIFFERENCE TRAP.
WE'RE SO HAPPY, WE FOUND A GROUP
DIFFERENCE AND IT'S TAILOR ABLE.
BUT IT DOESN'T ACCOUNT FOR
WITHIN GROUP VARIABILITY.
WE HAVE FIVE OR SIX OTHER
STUDIES WHERE WE HAVE THE SAME
FINDINGS.
THAT THE JUST MAKING THE
DECISION TO DIFFERENT AFRICAN
AMERICANS A PUSH DONOR DIRECTIVE
MESSAGES OR HAVE THEM ALL VERSUS
AND WE FOCUS MORE OR
DETERMINANTS AND
-- INDIVIDUAL CHALLENGE IS VERY
IMPORTANT BECAUSE IT ACCOUNTS
FOR VARIABILITY AND AVOIDS THE
SMALL GROUP DIFFERENCE TRAP AND
ULTIMATELY WHAT WE'RE ASKING,
NIMHD AND OTHERS IS TO THINK
MORE BROADLY IN OUR DISPARITY
FRAMEWORK ABOUT TARGET
AUDIENCES, TAILORING AND NOT
JUST LOOK AT MORTALITY BECAUSE
THAT MISSES WHAT WE REALLY NEED
TO DO WHICH IS DEEP CULTURAL
TAILORING.
THANK YOU FOR MY RERVERY RUSHEDD
VERY DENSE PRESENTATION.
I'D LOVE TO TAKE SOME QUESTIONS.
>> THANK YOU VERY MUCH.
WE WILL USE THE SAME FORMAT,
RAISE YOUR HAND OR PUT A
QUESTION IN THE QUESTION BOX AND
I'LL ACKNOWLEDGE YOU AND LET YOU
PROCEED.
OKAY.
FIRST QUESTION, DR. CALVIN.
>> YEP.
SO THIS IS REALLY GREAT.
I MEAN, THIS FOLLOWS SO MUCH OF
WHAT WE'RE DOING ALL THROUGH
PRIMARY CARE NOW WHICH IS TO
REALLY NOT MAKE ASSUMPTIONS
ABOUT PEOPLE.
BASICALLY, NOT MAKE ASSUMPTIONS
BASED ON ANY CHARACTERISTIC.
WE TRY TO GROUP PEOPLE IN
DIFFERENT CATEGORIES BUT
HONESTLY, IT'S REALLY ABOUT
LISTENING.
IT REALLY IS ABOUT PEOPLE
STATING THEIR PREFERENCES SO
ISN'T THAT MORE CONSISTENT WITH
THE INTERVIEWING MODEL AND ARE
YOU SAYING M.I. YOU, START BY
TRYING TO UNDERSTAND PEOPLE
BETTER BEFORE YOU MAKE
RECOMMENDATIONS.
AND ALSO, NOT ONLY UNDERSTAND
WHERE THEY'RE COMING FROM BUT
UNDERSTAND HOW THEY WANT TO
RECEIVE INFORMATION.
THAT'S MY FIRST QUESTION.
ARE THERE TOOLS YOU RECOMMEND
FOR THAT?
>> GREAT QUESTION.
SO IN GENERAL, YOU'RE RIGHT,
WHEN YOU DO M.I. WELL BY
DEFINITION YOU'RE INDIVIDUALLY
TAILORING YOUR INTERVENTION
SESSION, HOWEVER, THERE ARE
THINGS WE NEED TO KNOW BEFORE I
START THAT SESSION.
I HAD TO SKIP A FEW OF THE
SLIDES.
WE KNOW PREFERENCE FOR A
RACE-MATCHED COUNSELOR IS
DEPENDING ON YOUR ETHNIC
IDENTITY.
IF YOU HAVE A TRIAL AND SCORE
HIGH YOU WANT MAY WANT A BLACK
PRACTITIONER BUT YOU SCORE HIGH
IN ASSIMILATION YOU WOULD WANT A
DIFFERENT DOCTOR AND WE CAN
ALWAYS SWITCH AND WE'VE ASKED
SEVERAL HEALTH CARE SYSTEMS TO
INTEGRATE IF THEY'RE QUEASY.
THE OTHER IS DO YOU WANT
DISPARITY INFORMATION BECAUSE
SOME DATA SHOWS FOR SOME DATA
IT'S DISCOURAGE AND TIRED OF BAD
NEWS WE ASK DO YOU WANT THE
DISPARITY INFORMATION.
WE FIND WHEN IT'S MATCHED TO
THEIR PREFERENCE YOU GET BETTER
ABSORPTION.
YOU MAY NEED OUTSIDE AN SESSION
OR IN THE MIDDLE BUT MAY AUTHOR
HOW YOU DELIVER THE INFORMATION
AND WHO THEIR PROVIDER IS BUT
YOUR OBSERVATION IS GREAT, GOOD
M.I. PATIENT-CENTERED AND HONORS
THEIR ATTRIBUTES IS SOME OF WHAT
THEY CALL THE ETHNIC LOSS TRACK.
>> THIS IS GREAT, KEN.
REALLY APPRECIATE IT.
>> WE HAVE A QUESTION FROM
DR. ADULA.
>> THANK YOU FOR THE
PRESENTATION.
THANK YOU VERY MUCH.
I WAS WONDERING, SO THE
VARIABILITY THANK YOU MENTIONED
IN THE END WOULDN'T BE RELATED
TO INCOME OR PERHAPS CULTURAL
DIFFERENCES.
LIKE OLDER ADULT HISPANICS MAY
THINK MEDICAL DOCTORS, THEY ARE
SUPER SPECIALIZED.
THEY SHOULD TELL YOU WHAT TO DO
OR THE YOUNGER COHORTS LIKE I
WANT TO MAKE MY OWN DECISIONS OR
WANT TO IF YOU ANALYZED THAT.
>> OLDER HISPANICS EXPECT A
DOCTOR TO BE AN EXPERT AND LIKE
THE ELDER AFRICAN AMERICAN IN
THE SOUTH WHEN DOCTORS ELICIT
THEIR OPINION THEY FEEL THEY'RE
NOT VERY GOOD.
THERE'S AN IMMIGRANT-AGE COHORT
EFFECT THAT IS IMPORTANT AS IS
WE ALSO FIND IDENTIFY AND
CULTURATION ARE IMPORTANT AND
RELATED TO GENERATIONALITY.
THANK YOU.
>> DR. CHEVRON.
>> WOW, WHAT AN INTERESTING
PRESENTATION.
I KNOW YOU TOUCHED A LITTLE BIT
ABOUT THE ROLE OF I GUESS RACIAL
PROCESSES OR EVEN THE ROLE OF
TRUSTED MESSENGERS.
AND I WAS JUST THINKING ABOUT
THE WORK THAT NEIL AND I HAVE
BEEN INVOLVED IN IN NEW YORK
CITY OR EFFORTS TO INCREASE
COVID VACCINE UPTAKE AND WE SAW
THAT WORKING WITH THE COMMUNITY
HEALTH WORKERS AND COMMUNITY
ORGANIZATIONS WERE ESSENTIAL IN
ESTABLISHING TRUST GIVEN THE
NEWNESS OF INFORMATION AND GIVEN
THE NEWNESS OF WHAT COVID WAS
AND ALSO THE INFORMATION AND
WHAT WAS REALLY KEY WAS THE AND
OR HERE'S THE COMMUNITY HEALTH
WORKER DELIVERING THE MESSAGES.
IT WAS GOING BACK ONE, TWO,
THREE, FOUR, FIVE TIMES TO
REALLY HONE IN THAT MESSAGE WE
WANTED TO IMPART AND SO IT'S
TRICKIER TO ALMOST TEST OR
EVALUATE IN AN INTERVENTION
STRATEGY IN REAL-LIFE SETTINGS.
JUST CURIOUS ABOUT YOUR THOUGHTS
AROUND THAT ALSO THE NOTION OF
NOW, THE WHOLE GROWING SHIFT OF
INCREASING MISTRUST IN SCIENCE
AND HOW DO WE TACKLE THAT WITH
THE FRAMEWORKS YOU'VE BEEN
INVOLVED WITH AND HELPED TO
STRENGTHEN.
AND THEN THE LAST PIECE, THE
LAST QUESTION, THE QUESTION
AROUND SOCIAL DETERMINATES OF
HEALTH.
WITH TOBACCO CESSATION, ONE OF
MY COLLEAGUES HAVE NOTED THAT IN
WORKING WITH SOME COMMUNITIES,
FINANCIAL EMPOWERMENT OR
FINANCIAL LITERACY STRATEGIES IN
COMBINATION WITH EDUCATION WAS
MUCH MORE EFFECTIVE IN TERMS OF
INCREASING TOBACCO CONTROL
OUTCOMES.
SO CURIOUS ABOUT YOUR THOUGHTS
IN ADDITION TO THE COMMUNICATION
MESSAGES.
HOW DO WE BETTER INTEGRATE
SOCIAL DETERMINATES OF HEALTH TO
BE MORE COMPREHENSIVE AND FAR
REACHING.
>> I NEED ABOUT 45 MINUTES TO
ADDRESS THAT SERIES OF
QUESTIONS.
THOSE ARE GREAT.
I DIDN'T HAVE A CHANCE TO GO
INTO THE NIMHD STUDIED AND 30%
OF MINORITY COMMUNITIES ARE NOT
VACCINATED AND WE HAVE A FREE
OPEN VERSION AS LONG AS YOU'RE
NOT IF THE FOUR CITIES TARGETED
WE'LL SHARE IT EVERYTHING AND IT
SHOWS HOW TO USE MOTIVATIONAL
INTERVENTION TO LOWER RESISTANCE
AND FIND FRAGMENTS OF CHANGE
TALK AND IT'S ALL AUTOMATED AND
ON THE PLATFORM CALLED
ARTICULATE.
HAVING SAID THAT, WE ARE PUTTING
OUT A PAPER IN A COUPLE KNOWS
WHICH ARE THE HARD NOS SAYING
THE GROUP THEY'RE NEVER GETTING
IT THEY'RE VACCINE HESITANCE IS
DRIVEN BY PERSONALITY FACTORS.
THEY'RE HIGH IN TRAIT REACTANTS
AND CONSPIRACY THEORIES AND A
DOGMA TO THEM AND IN ROLLING
WITH THE RESISTANCE, WE TRY TO
GIVE THEM AN OFFERING TO SAY,
YOU'RE RIGHT, YOU DON'T NEED IT
BUT GRANDMA LIVING IN YOUR HOUSE
MIGHT SO WE'VE COME UP WITH A
COUPLE STRATEGIES THAT ALLOW
THEM TO PRESERVE THIS AUTONOMOUS
REBELLION AND STILL PRESERVE
THAT WHILE STILL SAYING I CAN
GET VACCINATED TO PROTECT
GRANDMA.
I LOVE THAT EXAMPLE YOU GAVE
THAT FINANCIAL ASSISTANCE MIGHT
BE CRITICAL.
YES, THE MULTIPLE LEVEL
INTERVENTIONS MORE OF THOSE NEED
TO BE TESTED WHERE YOU TRIED TO
CHANGE SLIGHTLY FINANCIAL
INSECURITY.
I WORK A LOT WITH THE GRETCHEN
SLAWSEN FOOD PROGRAM WHICH TAKES
SNAP AND WIC AND ADDS IN $3, $5,
$10, $20.
THEY LOWER FOOD INSECURITY AND
INCREASE SELF-PERCEIVED HEALTH
SO THOSE STRUCTURAL, BOOSTS
SHOULD BE USED AND I DON'T KNOW
THE PRICE POINT IS BUT WHEN YOU
RAISE TAX IN CALIFORNIA AND I
FORGOT WHAT PROP IT WAS, GOING
UP OVER A DOLLAR LOWERED
SMOKING.
THOSE ARE BOOSTS OF INCREASING
THAT.
>> THANK YOU.
>> OKAY.
THANK YOU, VERY MUCH.
DR. PEREZ-STABLE --
>> I THINK KIMBERLY JOHNSON MAY
HAVE HAD ONE FINAL QUESTION.
>> OKAY.
I MISSED THE QUESTION.
KIMBERLY.
>> IF THERE'S TIME, JUST A QUICK
QUESTION.
THANK YOU, KEN, OUTSTANDING
THINGS TO THINK ABOUT.
THIS IS A MORE PRACTICAL
QUESTION AND EXCITING.
IF YOU THINK ABOUT AND STARTED
SAYING IF THE HEALTH SYSTEM
WANTED TO ROLL OUT A PROGRAM
TARGETING WHATEVER, SMOKING
CESSATION OR IN INCREASING
FRUITS AND VEGETABLES AND
OBESITY AND HOW DO THEY
RACIALIZE PREFERENCES FOR
AUTONOMY AND DECISION MAKING?
>> SO THERE'S TWO ANSWERS TO
THAT.
THERE'S -- AND WE WORKED WITH
SOME AND A FEW ARE OPEN ASKING
FOR DIRECT PREFERENCES.
WE VERY THE OPPORTUNITY AT
KAISER TO MATCH SOME PROVIDERS
WITH PEOPLE'S PREFERENCES.
WOULD I LIKE TO ANSWER THAT
PREFERENCE QUESTION.
YOU DO NOT HAVE TO ANSWER IT.
SAME WITH DO YOU WANT THE
DISPARITIES PAMPHLET.
THE OTHER APPROACH IS TO MEASURE
SOME ATTRIBUTES LIKE CULTURAL
IDENTITY AND MAKE YOUR MATCHING
DECISION MADE ON THE INHERENT
TRAIT.
MOST THE FOLKS YOU WORKED WITH
ARE OPEN TO THE DIRECT
PREFERENCE APPROACH RATHER THAN
THE INFERENCE AND I GUESS YOU
CAN GUESS IN THIS CURRENT
ENVIRONMENT SO MANY HEALTH CARE
SYSTEMS WANT TO STEER CLEAR OF
THIS THOUGH THEY'RE INTENTIONS
AND HEART'S IF THE RIGHT PLACE,
THEY'RE SCARED GENERALLY IT WILL
BE TWISTED INTO SOMETHING
NEFARIOUS WHICH IS A BUMMER
BECAUSE I THINK PEOPLE
APPRECIATE THE CHANCE TO RECEIVE
DISPARITY INFORMATION OR HAVE A
CULTURALLY MATCHED PRACTITIONER.
>> OUR FINAL QUESTION FROM
DR. SUTHERLAND.
>> KEN, VERY GOOD PRESENTATION.
I LIKED IT A LOT.
MY QUESTION IS DO YOU HAVE
INSIGHT OF THE ROOT CAUSES OF
THE DIFFERENCES YOU SHOWED EARLY
ON IN THE PERCEPTION BETWEEN
BLACKS AND WHITES AND THE LEVEL
OF HOW THEY FEEL ABOUT
THEMSELVES BASED ON THEIR WEIGHT
OR SIZE OR LEVEL OF OBESITY.
WHAT'S THE -- WHERE DOES THAT
PERCEPTION COME FROM?
I CAN GIVE YOU AN EXAMPLE I HAVE
PERSONALLY EXPERIENCED.
FOR EXAMPLE, SOME YEARS AGO I
WEIGHED A LOT MORE THAN I WEIGH
RIGHT NOW AND BEFORE I LOST
WEIGHT, SOME DEAR FRIENDS OF
MINE THOUGHT I WAS SICK.
SO WHERE DID THAT PERCEPTION
COME FROM?
CAN YOU TALK ABOUT THAT A LITTLE
BIT?
>> IT'S NOT BEEN FULLY
ARTICULATED.
THERE'S THE TRADITIONAL
CONVENTIONAL WISDOM SAYING BACK
IN THE CONTINENT BIGGER WAS
STRONGER AND THIN WAS UNHEALTHY.
WHITE FOLKS HAVE AN EXTREME
ABNORMAL DRIVE FOR THINNESS AND
WHAT YOU SEE FROM AFRICAN
AMERICANS IS NOT THAT THEY HAVE
AN ABNORMAL DRIVE FOR BEING BIG
BUT YOU SEE THE ABSENCE OF THE
DRIVE FOR THINNESS.
IF YOU TOOK AWAY THE EATING
DISORDER GENE FOR WHITE PEOPLE
YOU'D PROBABLY SEE THEIR BODY
IMAGE SIMILAR TO BLACK PEOPLE.
I DO THINK THE IDEA THAT THIN IS
A SIGN OF ILLNESS AND HIV DIDN'T
HELP THAT, BUT IN OUR RESEARCH
WE HAVEN'T FOUND THAT TO BE THE
PRIMARY DRIVE.
IT'S IN PART DRIVEN BY IF I CAN
PUT IT IN QUOTES, A THOUGHT IN
THE WHITE COMMUNITY OF NOT
NECESSARILY WORRIED ABOUT
THINNESS OPPOSED TO AFRICAN
AMERICANS HAVING AN ABNORMAL
DRIVE FOR BIGNESS OR THICKNESS,
THEIRS IS THE NORMAL AND SHOULD
NOT BE PATHOLOGIZED AND IT'S
STILL UNKNOWN AND WORTH
RESEARCHING.
THANK YOU FOR THAT.
>> THANK YOU.
>> THANK YOU, KEN.
PAUL, ARE WE GOING TO TAKE A
BREAK OR PLOW ON WITH THE
CONCEPTS?
>> WOULD YOU LIKE TO PLOW
THROUGH WITH THE CONCEPTS?
>> UP TO THE GROUP.
I'M OKAY.
>> PLOW THROUGH.
>> ALL RIGHTY.
I WANT TO THANK KEN.
MANY THEMES YOU TALKED ABOUT
BEFORE AND HAPPY TO SEE HOW THEY
DEVELOPED AND THINK IT RESONATES
WITH MY OWN PRACTICAL
EXPERIENCES AS A CLINICIAN.
MUCH OF WHAT YOU SAID FOCUSSING
ON AFRICAN AMERICANS IS ALSO
TRUE WITH LATINO HISPANICS BUT
THE LANGUAGE FACTOR WAS SO
IMPORTANT IT WAS EASIER TO SAY
LINGUISTIC TAILORING WAS SO
OBVIOUSLY NEEDED IT WAS HARD TO
DIFFERENCE.
THE ISSUE OF WEIGHT IS
INTERESTING BECAUSE I THINK IT'S
SOCIO ECONOMICALLY AND
STRUCTURALLY DRIVEN AS WELL.
ACCESS TO CHEAP, CALORICALLY
DENSE FOOD NOW IN THE UNITED
STATES AND UNFORTUNATELY OTHER
COUNTRIES DRIVES SOME OF THAT.
I HAVE NOT BEEN TO SUB-SAHARAN
AFRICA BUT YOU HAVE AND I'M THE
RESULT IS NOT THE SAME AND IN MY
NATIVE COUNTRY, IN CUBA, THE
LEVEL OF OBESE IS LESS
INFLUENCED BY RACE THAN BY
ANYTHING ELSE AND ACCESS TO
CALORIES.
FASCINATING TOPIC AND ABSOLUTELY
ALWAYS LEARN A LOT WHEN I LISTEN
TO YOU SO, PAUL, BACK TO YOU.
>> THANK YOU VERY MUCH.
WHAT WE'LL DO NOW IS MOVE ON TO
THE CONCEPTS.
THERE ARE TWO CONCEPTS FOR
APPROVAL THIS AFTERNOON.
TWO COUNSEL REVIEWERS ARE
ASSIGNED TO EACH PROJECT.
TO MAKE THE BEST USE OF TIME
OTHER MEMBERS ARE ASKED TO SHARE
ANY COMMENTS WITH AN ASSIGNED
REVIEWER AND ASSIGNED REVIEWERS
WILL BE ASKED FOR THEIR COMMENTS
AND THERE'LL BE AN OPEN
DISCUSSION PERIOD FOR ADDITIONAL
COMMENTS FROM ANOTHER MEMBER AND
THEN A MOTION TO APPROVE OR
DISAPPROVE IN A VOTE BY ALL
COUNCIL MEMBERS.
WE'LL START WITH CONCEPT NUMBER
1 BY DR. AVILES SANTA.
CONCEPT ENTITLED LATIN AMERICA
SYNERGIZING HEALTH RESEARCH
ACROSS THE HEMISPHERE.
>> MY COLLEAGUES AT NIMHD AND
NIH AND THE VIDEOCAST.
I'M PROUD TO PRESENT THE CONCEPT
ON THIS CONCEPT.
SPECIAL THANKS TO RENA AND
MICHELLE AND JARROD, NANCY AND
OTHERS FOR THEIR CONTRIBUTIONS
TO THIS CONCEPT.
WITH THIS INITIATIVE -- SORRY.
WITH THE INITIATIVE WE AIM TO
SUPPORT MULTI-DISCIPLINARY AND
COLLABORATIVE RESEARCH THAT
ADDRESSES HEALTH AND HEALTH CARE
DISPARITIES RELATED TO
NON-COMMUNICABLE DISEASES AND
ESPECIALLY THOSE ASSOCIATED WITH
THE HIGHEST BURDEN OF DISEASE
AND MORTALITY IN LATIN AMERICA
AND AMONG U.S. HISPANIC LATINOS.
AND COVERS INFORMATION OF
HISPANIC LATINO HEALTH AND
TRANSLATE TO OPTIMAL HEALTH
OUTCOMES ACROSS THE HEMISPHERE.
SO WHY IN RESEARCH INITIATIVE IN
LATIN AMERICA AND IN 2020, $62
MILLION PERSONS LIVING IN THE
CONSTITUTIONAL
U.S. SELF-IDENTIFIED AS LATINO
REPRESENTING 18.9% OF THE
U.S. POPULATION.
AMONG HISPANIC LATINOS IN THE
U.S., THE PREVALENCE OF NCDs
CONTINUES TO INCREASE AND
TREATMENT AND CONTROL FOR THE
CONDITIONS REMAIN UNACCEPTABLY
SUB OPTIMAL.
IN PARALLEL, NCDs ARE
INCREASEDLY RECOGNIZED AND
STUDIED IN LATIN AMERICA.
IT'S IMPORTANT TO NOTE THAT
U.S. HISPANIC LATINOS IN ALL THE
COMMUNITIES AND POPULATIONS
SHARE MANY COMMONALITIES IN
HISTORY, LANGUAGE AND CULTURE
THAT ARE ROOTED IN THE HISTORY
AND CULTURES IN LATIN AMERICA.
HOWEVER, DIFFERENCES IN
PREVALENCE AND MORTALITIES
RELATED TO NCDs HAVE BEEN
DOCUMENTED AMONG HISTORIC
LATINOS FROM DIFFERENT HERITAGE
GROUPS AND AMONG LATIN AMERICA
COUNTRIES.
IN TERMS OF ALL COSTS,
CARDIOVASCULAR AND CANCER
MORTALITY, DIFFERENCES BETWEEN
U.S. HISPANIC LATINOS AS ONE
GROUP AND OTHER DEMOGRAPHIC
GROUPS IN THE U.S. AND BETWEEN
LATIN AMERICA COUNTRIES AND THE
U.S. HAVE ALSO BEEN DOCUMENTED.
VIOLENCE IS A LEADING CAUSE OF
DEATH AMONG YOUNG U.S. HISPANIC
LATINOS AND A PUBLIC CONCERN
ACROSS LATIN AMERICA.
ON THE OTHER HAND, THERE'S
RESEARCH DEVELOPMENTS SHEDDING
PERSPECTIVES IN UNDERSTANDING
NCDs AND A BETTER WAY TO TREAT
THEM IN LATIN AMERICA AND SOME
SAMPLES INCLUDE, STUDIES THAT
HAVE IDENTIFIED DIFFERENT
CLINICAL FAIL TIMES FOR DEMENTIA
IN DIFFERENT COUNTRIES.
ADVANCES IN PHARMACO GENOMICS
AND DIGITAL TECHNOLOGIES IN
HEALTH CARE AND INNOVATIVE
HEALTH CARE MODELS.
AS YOU CAN SEE ON THE SLIDE, THE
INCREASING PREVALENCE OF NCDs
AMONG U.S. HISPANIC LATINOS
UNDER LINES THE NEED FOR
EFFECTIVE INTERVENTIONS DESIGNED
TO PREVENT AND TREAT THESE
CONDITIONS IN THIS HETEROGENEOUS
POPULATION EVIDENT IN LATIN
AMERICA.
BOTH THE COMMONALITIES AND THE
DIFFERENCES IN THE PREVALENCE OF
NCDs AMONG THESE COMMUNITIES AND
THEIR COUNTRIES OF ORIGIN COULD
BE INFORMING US OF CRUCIAL
FACTORS THAT WOULD SHED LIGHT ON
DIGITAL SOLUTIONS.
THEREFORE, THROUGH THIS
INITIATIVE WE HAVE A UNIQUE
OPPORTUNITY TO IDENTIFY THOSE
SOLUTIONS THROUGH UNDERSTANDING
THE THEOLOGY OR MEDE IATORS AND
LOOKING AT CLINICAL
MANIFESTATIONS OF NCDs,
EXPLORING SOCIAL, CLINICAL CARE
AND HEALTH CARE CONTEXT AND
LOOKING AT MINORITY HEALTH AND
HEALTH DISPARITIES THROUGH
BETTER UNDERSTANDING OF HISPANIC
LATINO HEALTH THAT CANNOT BE
ACCOMPLISHED SOLELY IN THE
U.S. AND PROMOTING OPTIMAL
HEALTH OUTCOMES ACROSS THE
HEMISPHERE.
AS PREVIOUSLY DESCRIBED, WE AIM
AT PROMOTING AND SUPPORTING
MULTI-DISCIPLINARY RESEARCH THAT
IS FOCUSSED ON ADDRESSING THE
HEALTH AND HEALTH CARE
DISPARITIES RELATED TO NCDs WITH
THE HIGHEST BURDEN AS SHOWN ON
THE TABLE.
AND THOSE INCLUDE CHRONIC
INFECTIOUS DISEASES THAT TURN
INTO CHRONIC DISEASES AND THE
IMPACT OF VIOLENCE ON HEALTH.
MORE THAN ONE CONDITION WOULD
IDEALLY BE ADDRESSED AND WOULD
BE ENCOURAGED.
IN TERMS OF THE COLLABORATIVE
RESEARCH TEAMS THAT ARE
ENVISIONS, THEY WILL CONSISTENT
OF INVESTIGATORS BASED IN THE
U.S. INSTITUTIONS AND
COLLABORATE WITH INVESTIGATORS
IN INSTITUTIONS AND FUNDING
WOULD BE CHANNELLED THROUGH THE
U.S.-BASED INSTITUTIONS AND
EXPECT SUB AWARDS WITH LATIN
AMERICA INSTITUTION.
THE PROPORTION OF THE FUNDING
WOULD BE ALLOCATED IN A WAY TO
SUPPORT THE MAJORITY OF THE WORK
WHICH WILL BE PERFORMED IN LATIN
AMERICA.
WE ALSO WANT TO HIGHLIGHT THAT
WE CAN TALK ABOUT ACADEMIC
INSTITUTIONS AS WELL AS OTHER
PARTNERSHIPS.
COLLABORATIONS WITH COUNTRIES
HIGHLY REPRESENTED IN THE
U.S. HISPANIC POPULATION ARE
EXPECTED INCLUDING PUERTO RICO
AND WHERE HE CAN ALSO EXPLORE
OTHER PARTNERSHIPS AND TRAINING
AND CAPACITY BUILDING COULD BE
EMBEDDED WITHIN THE CON TEXT OF
THE PROPOSED RESEARCH.
STUDIES THAT IDENTIFY CLINICAL
DISEASE PHENOTYPES AND CLINICAL
MANIFESTATIONS OF NCDs,
INTERVENTION OPTIMIZE PREVENTION
AND PREVENTIBLE COMPLICATIONS
THAT CAN BE REDUCED AND LOOKING
AT PERSONAL VIOLENCE ON HEALTH
AND THE RELATIONSHIP BETWEEN
COVID-19 AND DIABETES AND
CARDIOVASCULAR DISEASE.
UNDER THE DOMAIN OR FIELD OF
HEALTH CARE SERVICES RESEARCH,
EXAMPLES INCLUDE INNOVATIVE
HEALTH CARE MODELS WHERE
MULTIPLE CHRONIC CONDITIONS
ESPECIALLY WITHIN THE CONTEMPT
OF LOW-RESOURCED SETTINGS
INCLUDING FEASIBILITY AND
SUSTAINABILITY ANALYSIS AND
LOOKING AT UNDER SERVED
POPULATIONS.
EXAMPLES ARE INDIGENOUS
COMMUNICATIONS AND COMMUNITIES
OF AFRO DESCENT AND OTHER
POPULATIONS.
THE IMPACT OF HEALTH CARE AND
NON-HEALTH CARE POLICIES
IMPLEMENTATION ON THE
INTERVENTIONS AND LOOKING AT
DISASTERS AND OTHER HUMANITARIAN
CRISES.
UNDER THE DOMAIN OF
COMMUNITY-ENGAGED RESEARCH THE
CONCEPTUALIZATION OF COMMUNITY
AND SOCIAL DETERMINATES OF
HEALTH AND HOW THEY CAN BE BEST
INTEGRATED INTO RESEARCH.
HOW A COMMUNITY-BASED STRATEGIES
THAT OPTIMIZE HEALTH PROMOTION.
THE EFFECTIVE INTEGRATION OF
SOCIAL AN HEALTH SERVICES.
THE IMPACT OF INTERPERSONAL
VIOLENCE ON COLLECTIVE HEALTH
AND COMMUNITY WELL BEING WITH
DISASTERS AND MECHANISMS OF
DISEASE AND RESILIENCE, THE
CONCEPTUALIZATION OF RACE AND
ETHNICITY AND HOW IT RELATES TO
RACISM AND DISCRIMINATION.
SOCIAL DETERMINATES OF HEALTH
AND HEALTH OUTCOMES AND
MECHANISMS OF RESILIENCE AND
PROTECTIVE FACTORS ESPECIALLY
RELATED TO LONGEVITY OR
MORTALITY.
THANK YOU FOR LISTENING AND I'M
GLAD TO ANSWER QUESTIONS.
>> THANK YOU VERY MUCH FOR THE
PRESENTATION.
DR. AVILES DO YOU HAVE COMMENTS
ON THE CONCEPT.
>> THE GOAL OF THE CONCEPT NOTE
AS JUST PRESENTED IS TO SUPPORT
RESEARCH THAT ADDRESSES HEALTH
AND HEALTH CARE DISPARITIES
RELATED TO NON-COMMUNICABLE
TODAYS WITH THE HIGHEST BURDEN
AND MORTALITY IN LATIN AMERICA
REPRESENTING AMONG U.S. HISPANIC
LATINOS AND THERE'S
HETEROGENEITY IN
NON-COMMUNITYICABLE DEPENDING ON
COUNTRY OF HERITAGE.
AND THERE IS A NEED TO ANALYZE
HISPANICS BY THEIR COUNTRY OF
HERITAGE.
THE SECOND GOAL IS SUPPORTING
THIS RESEARCH WILL HELP UNCOVER
UNDERSTANDING OF HISPANIC LATINO
HEALTH THAT CANNOT BE SOLELY
ACCOMPLISHED IN THE U.S.
I CONSIDER THIS GOAL
PARTICULARLY RELEVANT TO
HIGHLIGHT.
STUDIES CONDUCTED IN LATIN
AMERICA CAN PROVIDE A LARGER
SAMPLE SIZE OF THE TARGETED
POPULATION SO BETTER POSITION OF
THE ESTIMATES.
THEY COULD POTENTIALLY BE EASIER
TO IMPLEMENT AS WELL AS AT A
LOWER COST THAN IN THE U.S.
THERE HAS BEEN PREVIOUS EXAMPLES
OF VERY SUCCESSFUL INITIATIVES
IN LATIN AMERICA THAT HAVE
PRODUCED RESEARCH BREAKTHROUGHS
AS MENTIONED.
JUST TO GIVE AN EXAMPLE, THE
STUDY OF EARLIER ONSET OF
ALZHEIMER'S AT AGE 40 IN
COLOMBIA.
THERE'S EVIDENCE THE PROTEIN TAU
ACCUMULATES RAPIDLY IN THE
BRAINS OF PEOPLE WITH THE
DISEASE AS SYMPTOMS BEGIN TO
EMERGE.
OTHER RESEARCH HAS FOCUSSED ON
THE AMYLOID PROTEIN BUT SOME OF
THE CLINICAL TRIALS TESTING
DRUGS TO REDUCE AMYLOID PROTEIN
LEVELS HAVE FAILED TO RELIEF THE
SYMPTOMS OF THE DISEASE.
THIS HAS BEEN PARTICULARLY
SUCCESSFUL BECAUSE OF THE LARGER
SAMPLES OF PERSONS WITH EARLY
ONSET ALZHEIMER'S WITH THE SAME
GENETIC MUTATION.
MOREOVER, IT'S IMPORTANT TO
HIGHLIGHT RESEARCH IN LATIN
AMERICA CAN ALSO ALLOW FOR
CROSS-COUNTRY COMPARISONS
PROVIDING RELEVANT INFORMATION
TO BETTER UNDERSTAND
NON-COMMUNICABLE DISEASES AMONG
HISPANICS.
TO GIVE AN EXAMPLE, THE HISPANIC
HEALTH PARADOX THAT HAS
DOCUMENTED THAT HISPANIC
AMERICANS TEND TO HAVE SIMILAR
OR BETTER HEALTH OUTCOMES TO
THEIR U.S. NON-HISPANIC WHITE
COUNTERPARTS THOUGH HISPANICS
HAVE LOWER AVERAGED INCOME AND
EDUCATION.
TO GIVE A SPECIFIC EXAMPLE OF
THE STUDIES, THERE'S LITERATURE
THAT HAS COMPARED MEXICAN
IMMIGRANTS IN THE U.S. TO
MEXICANS IN MEXICO ANALYZE THE
HISPANIC HEALTH PARADOX WITH
RESPECT TO MORTALITY AND OTHER
HEALTH OUTCOMES.
ANALYZING MEXICAN IMMIGRANT IN
THE U.S. AND RETURN MY GRANTS
AND NON-MIGRANTS HELPS BETTER
UNDERSTAND HEALTH SELECTION
COULD BE POSITIVE OR NEGATIVE OF
THE GROUPS OF POPULATION AND
THIS IS POSSIBLE BECAUSE OF
ACCESS OF DATA OF THESE
COMPARISONS TO THESE GROUPS IN
LATIN AMERICA.
A THIRD GOAL IS THE RESEARCH
WILL TRANSLATE INTO BETTER
HEALTH OUTCOMES FOR
U.S. HISPANICS AND OTHER
VULNERABLE GROUPS.
I CONSIDER THIS INITIATIVE AN
EFFECTIVE WAY TO ADVANCE
RESEARCH ON NON-COMMUNICABLE
DISEASES AND NEW RESEARCH
DISCOVERIES WILL BENEFIT THE
POPULATION IN GENERAL.
A PROGRAM LIKE THIS CAN SERVE AS
A MODEL FOR OTHER IMMIGRANT
COMMUNITIES IN THE U.S.
IN TERMS OF THE EXAMPLE OF
RESEARCH PRIORITIES I WOULD ALSO
SUGGEST CONSIDERING CLIMATE
CHANGE, POLLUTION AND VARIETAL
EXPOSURES AND NON-COMMUNICABLE
DISEASES.
AND LOOKING AT ECONOMIC
DISADVANTAGES, CLIMATE AND
ENVIRONMENTAL EXPOSURES CAN
AFFECT THE ONSET OF
NON-COMMUNICABLE DISEASE.
THERE'S AN ASSOCIATION BETWEEN
EXTREME WEATHER AND POLLUTION ON
COGNITIVE DECLINE.
ENVIRONMENTAL EXPOSURES MAY
CAUSE EPIGENOMIC CHANGES AND
LOOKING AT THE RISK OF ADRD AND
THERE'S LITTLE ON HOW CLIMATE OR
ENVIRONMENTAL EXPOSURES CAN
AFFECT ECONOMICALLY
DISADVANTAGED POPULATION OR
VULNERABLE POPULATION AND
POTENTIAL INTERVENTIONS.
CONGRATULATIONS TO DR. AVILES
SANTA FOR THE EXCELLENT CONCEPT
NOTE.
>> THANK YOU.
>> DR. CALVIN, DO YOU HAVE
COMMENTS.
>> YES, THANK YOU.
I STRONGLY SUPPORT THE CONCEPT.
IT'S WELL WRITTEN AND THE
EXAMPLES ARE VERY WORTHWHILE.
THE ABILITY TO LOOK AT
PREVALENCE, DIAGNOSIS, TREATMENT
AND PROGNOSIS BETWEEN FOLKS
LIVING IN THEIR NATIVE OR
ANCESTRAL COUNTRIES TO THOSE WHO
IMMIGRATED TO THE U.S. IS A
GREAT WE TO LOOK AT HOW
STRUCTURAL RACISM AND STRESS
AFFECTS THE DISEASES OF
INTEREST.
IT ALSO OPENS THE DOOR TO MANY
EPIGENETSIC STUDIES.
I HAVE A FEW MINOR SUGGESTIONS
FOR YOUR CONSIDERATION ON THE
IMPLEMENTATION OF THE CONCEPT
BUT NOT ON THE CONCEPT ITSELF.
FIRST, I SUSPECT THERE'S A
RELATIONSHIPS BETWEEN CURRENT
RESEARCH CENTERS AND THOSE IN
LATIN AMERICA COUNTRIES.
BUILDING ON THE WILL BE
IMPORTANT TO THE SUCCESS OF THIS
INITIATIVE.
AT THE SAME TIME, IMPORTANT WORK
MAY NEED TO BE DONE WHERE SUCH
RELATIONSHIPS DON'T CURRENTLY
EXIST AND SOME DEVELOPMENT YEAR
FUNDING MAY NEED TO BE AVAILABLE
TO ENGAGE IN THE WORK OF
BUILDING THOSE RESEARCH
RELATIONSHIPS WHERE THEY DON'T
CURRENTLY EXIST.
AND WE LOOK TO BE IN PLACE
WHERE'S ACADEMIC PARTNERSHIPS
MAY NOT BE AVAILABLE AT ALL.
LOOKING AT THE POSSIBILITY OF
PARTNERING WITH OTHER ENTITIES
AND OTHER COMMUNITY-BASED
PARTNERS IN RESEARCH MAY HELP
YOUR OTHER OBJECTIVE OF BUILDING
CAPACITY WHERE THERE'S LIMITED
CAPACITY NOW FOR RESEARCH.
AND WE LOOK AT THE IMPORTANT
WORK BEING DONE IN LATIN AMERICA
AS WE JUST HEARD WITH
ALZHEIMER'S.
WORK FOCUSSED ON ONE VERY
IMPORTANT CONDITION.
FINALLY, I'D SUGGEST LOOKING AT
THE REQUIREMENT FOR THE SPLIT OF
THE U.S. AND LATIN AMERICA
PARTNER.
BEING PRESCRIPTIVE HELPS TO
ESTABLISH THE INITIATIVE EXPECTS
THE MAJOR PORTION OF FUNDING TO
GO TO THE LATIN AMERICAN PARTNER
WHICH IS PARTNER BUT SETTING A
MINIMUM PERCENTAGE TO BE
ALLOCATED TO THE PARTNER OR
RANGE MAY PROVIDE MORE FLEXIBLE
TO ENABLE THE PARTNERS TO BETTER
ALLOCATE RESOURCES TO BE WHERE
THEY'LL BE MOST EFFECTIVE.
OVER ALL, IT'S A WELL-THOUGHT
OUT CONCEPT AND SUPPORT THE
ADOPTION FROM THE BOARD AND
THANK YOU FOR YOUR TEAM AND THE
HARD WORK IN PUTTING THIS
TOGETHER.
>> THANK YOU, FOR YOUR COMMENTS
AND THANK YOU, WE WILL
INCORPORATE THEM AFTERWARDS.
>> THANK YOU VERY MUCH.
ARE THERE ANY OTHER COMMENTS
FROM COUNCIL MEMBERS AT THIS
TIME?
ANY QUESTION OR COMMENT OR RAISE
YOUR HAND?
GOING TWICE, OKAY.
SEEING NONE WE'LL NOW ACCEPT A
MOTION TO MOVE THE CONCEPT
FORWARD FOR FOA DEVELOPMENT.
>> I MOVE TO SUPPORT THE NOTE
FOR CONCEPT DEVELOPMENT.
>> ALL IN FAVOR.
ALL IN FAVOR WHY IN THE CHAT BOX
AND OPPOSED, ENTER "N".
AFTER MOVED AND PROPERLY
SECONDED IT WILL MOVE FORWARD TO
FUNDING OPPORTUNITY.
THE MOTION CARRIES.
>> THANK YOU AGAIN TO THE
COUNCIL AND THE COMMENTS.
I LOOK FORWARD TO SEEING THIS
CONCEPT DEVELOPED INTO AN FOA.
>> THANK YOU VERY MUCH.
>> WE'LL MOVE TO OUR SECOND
CONCEPT.
DR. WONNUM WILL PRESENT THE
SECOND CONCEPT ENTITLED HEALTH
DISPARITIES EXPERIENCED AMONG
PERSONS LIVING WITH
DISABILITIES.
>> GOOD AFTERNOON TO THE ENTIRE
COUNCIL.
THANK YOU FOR THE OPPORTUNITY TO
REPRESENT OUR MULTI-DISCIPLINARY
GROUP OF SCHOLARS ACROSS NIMHD
ON THE TOPIC AND I WOULD
ESPECIALLY LIKE TO ACKNOWLEDGE
WITH GRATITUDE THE COUNCIL
REVIEWERS WHO REVIEWED THE
CONCEPT, YOUR TIME AND CRITICAL
FEEDBACK WHICH WILL INFORM THE
SHAPING OF THIS CONCEPT GOING
FORWARD.
THE OBJECTIVE IS TO SUPPORT
NOVEL RESEARCH WHICH APPLIES AN
INTERSECTIONAL LENS TO EXAMINING
AND ADDRESSING HEALTH CARE AND
HEALTH DISPARITIES EXPERIENCED
AMONG PERSONS LIVING WITH
DISABILITIES.
THIS REVIEW OF UNIQUE SOCIAL
DETERMINATES AND HEALTH
DISPARITIES AMONG PERSONS LIVING
WITH DISABILITIES EXPANDS GAPS
AND THE DOMAIN OF INFLUENCE IS
VAST WHICH UNDER SCORES THE
ARGUMENT FOR FURTHER RESEARCH
ENDEAVORS.
MOREOVER, IT'S IMPORTANT THAT
OUR INTENT OF THE WORK GROUP IS
NOT ONLY TO BRING DISABILITY
GROUPS TO THE FOREFRONT BUT TO
FOCUS ON FUTURE RESEARCH
ENDEAVORS THAT ARE
INTERSECTIONAL.
PAIRING OR COMBINING STUDY
POPULATIONS NOT ONLY WITH
DISABILITIES PART OF OUR ALREADY
DEFINED MINE MINORITY GROUPS.
WE KNOW THE POPULATION OF
PERSONS WITH DISABILITIES IS
HETEROGENEOUS WITH DIFFERENT
BACKGROUNDS, LIFE CIRCUMSTANCES,
DISABLING CONDITIONS AND THUS
HEALTH CARE DISPARITIES.
WHERE HE ACKNOWLEDGE IT MAY BE
PRESENT AT BIRTH OR DUE TO
INJURY OR DEVELOP WITHIN THE
LIFE SPAN.
WE ACKNOWLEDGE THE DYNAMIC
NATURE AND SEVERITY AND IMPACT
ON A PERSON'S LIFE AND
FUNCTIONING MAY ALSO CHANGE OVER
TIME AND FURTHERMORE THERE'S
IMPACTS LIKE ENVIRONMENT AND
CONDITIONS AND RESOURCES.
OUR FOCUS IS ON MANY CURRENT
STABILITIES RATHER THAN ANY
TEMPORARY DISABLING CONDITION OR
DISEASES OF CENTRAL FOCUS OF
OTHER STUDIES.
20% OF THE ADULT POPULATION
LIVING WITH A DISABILITY AND
COGNITION IS MOST COMMON AMONG
ADULTS AND CHILDREN 5 AND OLDER.
EXAMPLES OF HEALTH DISPARITIES
AMONG ADULTS WITH DISABILITIES
COMPARED TO THE OVER ALL
POPULATION ARE OBESITY, NICOTINE
DEPENDENCE, MORE THAN TWICE THE
GENERAL POPULATION, DIABETES
MORE THAN TWICE THE GENERAL
POPULATION AND HEART DISEASE
WHICH AMOUNTS TO MORE THAN
THREE-FOLD THAT OF THE GENERAL
POPULATION.
FURTHERMORE, ADULTS LIVING WITH
THE DISABILITY OF SERIOUS
ILLNESS AND ASSOCIATED
FUNCTIONAL IMPAIRMENT ACCOUNT
FOR 5. 6% AND IT'S CORRELATED
WITH DIABETES, OBESITY AND
HYPERTENSION AND THREE TIME
HIGHER MORTALITY RATE THAN THE
GENERAL POPULATION.
SOME PORP HEALTH DISPARITIES ARE
HIGHER RATES OF STROKE, HIGHER
RATES OF DEPRESSION, COVID
INFECTION AND DEATH AND POORER
QUALITY OF LIFE, FUNCTIONING,
SHORTER LIFE EXPECTANCY,
NUTRITION INSECURITY IMPACTING
HEALTH AND ADVERSE PRE AND POST
NATAL OUTCOMES PARTICULARLY
AMONG INDIVIDUALS WITH SOME
DISORDERS.
WITH FUNCTIONAL IMPAIRMENT AND
THERE'S MANY FACTORS THE
EXPERIENCE OF THOSE LIVING WITH
DISABILITIES CAN BE COMPLICATED
ACROSS THE LIFE SPAN AND STILL
EXISTING INTERVENTIONS ARE
LARGELY FOCUSSED ON OLDER ADULTS
NOT NECESSARILY CROSS
MINORITIZED POPULATIONS AND
THERE'S CHARACTERISTICS
ASSOCIATED WITH HEALTH
DISPARITIES.
AND THERE'S INTEGRATED SOCIAL
CARE INCLUSIVE OF NON-MEDICAL
SERVICE TO ADDRESS HOUSING,
FOOD, TRANSPORTATION, FINANCIAL
AND OTHER NEEDS IMPACTING AN
INDIVIDUAL'S HEALTH OR
COMMUNITY-INTERVENTIONS INTO
HEALTH CARE DELIVERY MODELS OR
ADAPTING CLINICAL CARE
GUIDELINES TO UNIQUE NEEDS OF
THOSE LIVING WITH EXACTS WHO
EXPERIENCE OTHER HEALTH
DISPARITIES.
AND THERE'S UNMET MEDICAL AND
DENTAL NEEDS CONTRIBUTING TO
HIGHER RATES OF HEALTH RISK AND
OUTCOMES.
RESEARCH TENDS TO HAVE LIMITED
SAMPLE SIZE AND SCOPE OR BE
REPRESENTED OF RACIAL AND ETHNIC
DIVERSITY, LIFE CIRCUMSTANCES OF
POPULATIONS LIVING WITH
DISABILITIES.
THERE'S BARRIERS TO OPTIMAL
HEALTH CARE SUCH AS HEALTH CARE
DISCRIMINATION AND ABLISM OR
MISPERCEPTIONS ABOUT HEALTH,
BEHAVIOR AND QUALITY OF LIFE AND
PROGNOSIS.
LIMITED COMMUNICATION MECHANISMS
THAT SUPPORT VISUAL AND AUDITORY
AND COGNITIVE DISABILITIES AND
INACCESSIBILITY OF EQUIPMENT AND
BARRIERS TO OPT HEALTH CARE.
AND THERE MAY BE LESS ACCESS TO
FULL SCOPE BEHAVIORAL HEALTH AND
SURGICAL INTERVENTIONS WHEN
NEEDED OR MORE LIKELY TO HAVE
THEM ATTRIBUTED ERRONEOUSLY TO
THE DISABILITY RATHER THAN ANY
NEW OR CO-OCCURRING CONDITIONS.
THERE'S ALSO UNDER
PRIORITIZATION OF DISEASE
PREVENTION AND HEALTH PROMOTION
WORK.
THERE'S LIMITED STUDY IN
INTERVENTIONS FOCUSSING ON
BETWEEN AND WITHIN GROUP
DIFFERENCES IN MULTIPLE
MINORITIZED GROUPS AND AFFECTING
COGNITIVE FUNCTIONING.
STUDY OF OLDER ADULTS, RACIAL
AND ETHNIC MINORITIES INCLUDING
INDIGENOUS POPULATIONS AND
SEXUAL-GENDER MINORITIES AND
PREGNANT PERSONS.
IN STUDIYSS -- IN STUDIES LOOKIG
AT PATIENTS SUBJECTED TO
DIFFERENT CARE IF NEEDED.
BASED UPON THE REVIEWS AND RICH
DISCOURSE WE RECOMMEND THE
FOLLOWING EXAMPLES NOT FULLY
INCLUSIVE OF RESEARCH PRIORITIES
WITH THE ALIGNMENT OF THE NIMHD
FRAMEWORK.
STUDY OF SOCIAL CARE SERVICES
AND SUPPORTS WHICH IMPROVE
OUTCOMES.
CLINICAL OR COMMUNITY ENGAGED
PREVENTION AND INTERVENTIONS TO
IMPROVE INSTRUMENTAL ACTIVITY
LIKE COMMUNICATION,
TRANSPORTATION AND FINANCES,
HOUSING, FOOD, EMPLOYMENT,
ETCETERA.
INNOVATION TO IMPROVE QUALITY OF
LIFE ACROSS DOMAINS OF INFLUENCE
AND HEALTH SYSTEMS AND SERVICE
DELIVERIES INFLUENCING OUTCOMES
LIKE FACTORS AND MECHANISMS
INFLUENCING QUALITY CARE ACCESS,
UTILIZATION SCREENING, TREATMENT
AND REFERRALS AND CLINICAL
PRACTICE GUIDELINES AND
ADDRESSING BIASES AND
COMPOUNDING SOCIAL AND HEALTH
CONSIDERATIONS.
FACILITATORS TO IMPLEMENTING AND
SUSTAINING EQUITABLE ACCESS TO
COMPREHENSIVE AND CARE DELIVERY
MODELS.
OF NOTE, THE INTERVENTIONS NEED
TO THE COME FROM A PERSPECTIVE.
THE PLASTICITY OF THOSE LIVING
WITH DISABILITIES ARE
INTERESTING AND COPING BEHAVIORS
TO BE UNDERSTAND AND ENHANCED
AND CAPITALIZED UPON AND FURTHER
ADAPTED FOR OTHERS.
FURTHERMORE, WE RECOMMEND STUDY
OF DISABILITY CONDITIONS WITH
CO-OCCURRING DISEASES OR
COMORBIDITIES WHICH ADDRESS
BETWEEN AND WITHIN GROUP
DIFFERENCES AND INTERSECTIONAL
CHARACTERISTICS OF POPULATIONS
AND MITIGATING FACTORS OF
CONDITIONS DISEASE PROGRESSION
OR TREATMENT.
IMPLEMENTATION OR CLINICAL
PRACTICE GUIDELINES FOR
DIAGNOSIS AND CARE AND
MANAGEMENT OF CONDITIONS.
POPULATION HEALTH MODELS TO
REDUCE COMPLICATING HEALTH RISK
FACTORS ACROSS DOMAINS OF
INFLUENCE.
FINALLY, EXPLORATION,
DEVELOPMENT AND IMPLEMENTATION
OF DISEASE PROMOTION STRATEGIES
WHICH ADDRESS TAILORED HEALTH
EDUCATION AND BEHAVIOR CHANGE,
SCREENING AND EARLY DETECTION
INTERVENTIONS EFFECTS,
NUMERATORS AN MODERATORS OF
HEALTH RISKS AND LEADING TO
DISABILITY CONDITIONS.
COMMUNITY ENGAGED OR
COLLABORATIVE DISASTER OR
EMERGENCY PREPAREDNESS OR
RESPONSE INTERVENTIONS ACROSS
SECTORS AND DOMAINS.
THIS IS A DEVELOPING AREA WITH
ROOM TO LOOK UPON INCOMING DATA.
THE EMPHASIS TO SUPPORT NOVEL
RESEARCH APPLYING AN
INTERSECTIONAL LENS TO EXAMINING
AND ADDRESSING HEALTH CARE AND
HEALTH DISPARITIES AMONG PEOPLE
LIVING WITH DISABILITIES
PARTICULARLY THOSE IN MULTIPLE
AND MINORITIZED POPULATION.
IT'S THE HOPE INITIATIVES RESULT
FROM THIS CONCEPT WILL SUPPORT
RESEARCH THAT ADVANCES OUR
UNDERSTANDING OF AND EFFORTS TO
MITIGATE THE IMPACT OF
UNDERLYING CAUSES AND CAUSAL
PATHWAYS OF HEALTH DISPARITIES
EXPERIENCED AMONG ADULTS AND
CHILDREN LIVING WITH
DISABILITIES.
THANK YOU.
I WELCOME YOUR QUESTIONS AND
YOUR FEEDBACK.
>> THANK YOU VERY MUCH FOR THAT
PRESENTATION.
DR. BARNES.
>> YES.
>> I UNDERSTAND YOU WILL BE
PRESENTING COMMENTS FOR YOURSELF
AND DR. JOHNSON.
>> YES.
PROCEED, PLEASE.
>> THANK YOU FOR THE OPPORTUNITY
TO COMMENT ON THE CONCEPT AND
THANK YOU DR. WONNUM FOR
PRESENTING A VERY CLEAR WAY
FORWARD.
THIS IS A TIMELY CONCEPT AND ONE
OF CRITICAL IMPORTANCE.
THE PURPOSE IS TO BETTER
UNDERSTAND THE RANGE OF FACTORS
INTERACTIONS AND CAUSAL PATHWAYS
THAT INFLUENCE HEALTH
DISPARITIES EXPERIENCED AMONG
PERSONS LIVING WITH DISABILITIES
AND TO DEVELOP ACTIONABLE
STRATEGY TO MITIGATE THEIR
IMPACT ON HEALTH OUTCOMES AND
QUALITY OF LIFE.
ACCORDING TO THE EXISTING
LITERATURE AND WHAT YOU
PRESENTED, THIS IS A POPULATION
THAT RECEIVED LITTLE PUBLIC
HEALTH ATTENTION AND THERE'S A
DEARTH OF RESEARCH THAT EXAMINES
THIS.
THIS WAS HIGHLIGHTED IN THE
WORKSHOP SPONSORED BY THE
NATIONAL ACADEMIES IN 2016 ON
THE INTERSECTIONS BETWEEN HEALTH
DISPARITIES, DISABILITIES,
HEALTH EQUITY AND HEALTH
LITERACY.
THE REPORT FROM THAT WORKSHOP,
THE BURGEONING BODY OF
LITERATURE ON DISABILITY AND
HEALTH AS WELL AS INFORMATION
AND RESOURCES COMING OUT OF THE
ADMINISTRATION FOR COMMUNITY
LIVING ALL UNDER SCORE THE NEED
FOR FOCUSSED EXAMINE OF THE
MULTI-LEVEL FACTORS THAT
INFLUENCE THOSE LIVING WITH
DISABILITIES.
THE CONCEPT AND YOUR
PRESENTATION INCLUDED A NUMBER
OF IMPORTANT POINTS THAT WERE
HELPFUL IN UNDERSTANDING THE
SIGNIFICANCE OF THE PROBLEM FOR
BOTH CHILDREN AND ADULTS
INCLUDING THE EXAMPLES YOU GAVE
OF THE CLAIR -- THE GLARING
GAPS.
AND THE MAJORITY OF EXISTING
RESEARCH HAS FOCUSSED ON ISSUES
OF ACCESS OR LACK OF ACCESS.
A KEY STRENGTH OF THE CONCEPT IS
IT AIMS TO BROADEN THE SCOPE OF
AVAILABLE RESEARCH BY CALLING
FOR A BETTER UNDERSTANDING OF
MITIGATING FACTORS AND CAUSAL
PATHWAYS THAT MAY INFLUENCE
DISPARITIES IN THE POPULATION.
A FEW COMMENTS OR QUESTIONS THAT
YOU MIGHT CONSIDER AS YOU
FURTHER DEVELOP THE CONCEPT
INCLUDING THE FOLLOWING AND
AGAIN THIS IS AN INCORPORATION
OF DR. JOHNSON'S THOUGHTS AS
WELL AS MY OWN.
FIRST, SUPPORTING RESEARCH THAT
WILL APPLY AN INTERSECTIONAL
LENS BUT IT'S NOT ENTIRELY CLEAR
HOW INTERSECTIONALITY IS BEING
OPERATIONALIZED AND ONE IS TO
FOCUS ON PERSONS WITH
DISABILITIES WHO HAVE ANOTHER
MARGINALIZED OR MINORITIZED
PRIORITY AS A HEALTH DISPARITY
POPULATION.
AS NIMHD HAS FREQUENTLY FOR
OTHER HEALTH CONDITIONS.
WHILE IT WAS DESCRIBED IN THE
CONCEPT, IT INCLUDES OTHER AREAS
OF FOCUS WHICH MAY ALSO BE
CONSIDERED INTERSECTIONAL SUCH
AS PEOPLE WITH DISABILITIES WHO
ARE CO-OCCURRING MEDICAL
CONDITIONS.
IT'S IMPORTANT TO CLEARLY DEFINE
INTERSECTIONALITY TO ENSURE
RESPONSIVE PROPOSALS IN
ALIGNMENT WITH THE MISSION OF
NIMHD.
A SECOND POINT EXPLAINS TO THE
BROADNESS OF THE DEFINITION OF
DISABILITIES AND THE A.D.A.s
BROAD DEFINITION WAS MENTIONED
IN THE BACKGROUND AND WE KNOW
THERE ARE DIFFERENT WAYS PEOPLE
EXPERIENCE DISABILITIES.
SOME PEOPLE EXPERIENCE
DISABILITIES DURING EARLY LIFE.
AND SOME DEVELOP AND IT'S
PLAUSIBLE SOCIAL AND SOCIAL
DETERMINATES CAN IMPACT
DIFFERENT GROUPS.
DO WE WANT A MORE ON THE
CONCEPT?
THIRD, THE RESEARCH PRIORITIES
TO A LARGE DEGREE FOCUS ON
HEALTH CARE DELIVERY WHICH IS
IMPORTANT GIVEN A BROADER RANGE
OF TOPIC IN THE NIMHD HEALTH
DISPARITIES FRAMEWORK AND MAY
ALSO BE IMPORTANT TO CONSIDER A
LIFE COURSE PERSPECTIVE THAT
ALLOWS FOR AN EXPECTATION IN THE
WAY HEALTH CARE NEEDS CHANGE AS
PEOPLE WITH DISABILITIES
TRANSITION FROM PEDIATRIC CARE
TO ADULT SYSTEMS OR HOW TO
UNDERSTAND HOW NEEDS OR BARRIERS
CHANGE AS PEOPLE AGE.
FOURTH, THERE'S ATTENTION
THROUGHOUT THE CONCEPT ON
INTERSECTION OF DISABILITY WITH
RACE AND ETHNICITY AND SOCIO
ECONOMIC DISADVANTAGE AND A GAP
IN OUR KNOWLEDGE THAT BEARS
CALLING OUT IS THE DEARTH OF
INFORMATION ON PEOPLE WITH
DISABILITIES IN RURAL
COMMUNITIES AND TRIBAL NATIONS
SPECIFICALLY WHO OFTEN HAVE LESS
ACCESS TO HEALTH CARE AND
TREATMENT.
HOW DOES THAT AMPLIFY HEALTH
DISPARITIES FOR THIS POPULATION?
I REALLY LIKE THAT YOU MENTIONED
LOOKING AT PROTECTIVE MEASURES
AND RESILIENCE FACTORS.
I THINK THAT IS REALLY SOMETHING
POSITIVE TO STRESS IN THIS
CONCEPT AND I ENCOURAGE
FURTHER -- A DEEPER DIVE ON THAT
PARTICULAR ASPECT.
IN CLOSING, BOTH DR. JOHNSON AND
MYSELF WERE VERY SUPPORTIVE OF
THIS CONCEPT AND WE APPLAUD THE
EFFORTS OF YOUR ENTIRE TEAM.
THANK YOU FOR THE OPPORTUNITY TO
COMMENT.
>> THANK YOU VERY MUCH.
>> THANK YOU, DR. BARNES.
ARE THERE ADDITIONAL COMMENTS
FROM OTHER COUNCIL MEMBERS?
>> SEEING NO HANDS RAISED OR
COMMENTS OR COMMENTS IN THE CHAT
BOX, I WILL ASK FOR A MOTION TO
MOVE THE CONCEPT FORWARD
>> I MOVE TO ACCEPT THE CONCEPT
TO MOVE FORWARD FOR FUNDING
OPPORTUNITIES.
>> CAN I GET ANOTHER COUNCIL
MEMBER TO SECOND THAT?
>> I SECOND.
>> THANK YOU.
ALL IN FAVOR, ENTER "Y" IN THE
CHAT BOX, ANY OPPOSED, ENTER "N"
IN THE CHAT BOX.
AFTER HAVING BEEN MOVED AND
PROPERLY SECONDED THE CONCEPT
WILL MOVE FORWARD TO FUNDING
OPPORTUNITY ANNOUNCEMENT
DEVELOPMENT.
THANK YOU.
OKAY.
WE'RE GOING TO MOVE ON TO MY
VERY QUICK AND BRIEF REQUEST TO
THE COUNCIL.
THIS IS A REQUIRED STEP TO
APPROVE A WORKING GROUP.
BEFORE THAT GROUP IS FORMED, THE
COUNCIL MUST APPROVE A
FUNCTIONAL STATEMENT.
SO WIN THE APPROVAL OF THE
COUNCIL, OF THE FUNCTIONAL
STATEMENT, WOULD WILL CONVENE A
WORKING GROUP TO PROVIDE GENERAL
GUIDANCE AND STRATEGIC DIRECTION
TO NIMHD REGARDING OPPORTUNITIES
TO ADVANCE HEALTH DISPARITIES
AMONG PEOPLE LIVING WITH
DISABILITIES.
THE WORKING GROUP IS CHARGED
WITH REVIEWING THE STATE OF THE
SCIENCE AND PROVIDING GAPS AND
RESEARCH NEEDS AND STRATEGIC
OPPORTUNITIES FOR DISPARITIES
RESEARCH WITH A LENS ON THOSE
LIVING WITH DISABILITIES AND
WOULD LIBERATE AND ADVISE ON THE
BENEFITS AND RISK OF EXPANDING
THE NATIONAL INSTITUTES OF
HEALTH DESIGNATED HEALTH
DISPARITIES POPULATION TO
INCLUDE PERSONS LIVING WITH
DISABILITY.
THIS WILL INCLUDE FOCUSSING ON
THE MISSION PART, PROCESS AND
SCIENTIFIC ACTIVITIES OF NIMHD.
WORKING GROUP MEMBERSHIP WILL
INCLUDE SELECTIVE COUNCIL
MEMBERS AS WELL AS INDIVIDUALS
WITH APPROPRIATE EXPERTISE AND
THE WORKING GROUP WILL ADVISE
THE COUNCIL AND THE DIRECTOR OF
NIMHD.
MAY I HAVE A MOTION TO APPROVE
THE FUNCTIONAL STATEMENT TO
CONVENE A WORKING GROUP ON
PERSONS WITH DISABILITIES AND
LIVING WITH HEALTH DISPARITIES.
>> SO MOVED.
>> MAY I HAVE A SECOND.
>> SECOND.
>> ALL IN FAVOR, "Y" IN THE CHAT
BOX AND ANY OPPOSED MAY ENTER AN
"N" IN THE CHAT BOX AS WELL.
>> THE MOTION PASSES AND THE
FUNCTIONAL STATEMENT APPROVED
FOR THE FORMATION OF THE WORKING
GROUP.
I'LL PASS IT BACK TO
DR. PEREZ-STABLE FOR HIS REMARKS
AND ADJOURNMENT.
>> CAN WE STOP SCREEN SHARING
AND MAYBE SEE EVERYBODY AGAIN I
THINK I'VE SPOKEN ENOUGH TODAY
AND WANT TO THANK YOU FOR YOUR
SERVICE AND FOR TAKING TIME TO
BE WITH US MOST THE LAST TWO
DAYS.
I KNOW THAT THOSE -- ALL OF YOU
HAVE BEEN DOING THIS A LITTLE
BIT AND UNDERSTANDING THE
IMPORTANCE AND VALUE AND THE
ADVICE WE AS NIMHD STAFF AND
LEADERS GET FROM YOU.
WE'RE NO LONGER IN THE SAME
CRISIS MENTALITY WE WERE IN 2020
AND 2021 AS WE HAVE ADAPTED TO A
CHRONIC STATE WHICH IS MY
COMFORT ZONE AS A CHRONIC
INTERNIST DEALING WITH CHRONIC
DISEASE AND THE INTENSITY AND
IMPORTANCE OF OUR WORK ISN'T
DIMINISHED AT ALL.
I THINK THE NATIONAL INSTITUTES
OF HEALTH IS IN A VERY DIFFERENT
SPACE TODAY THAN THREE YEARS
AGO.
I THINK THE PANDEMIC HAS BEEN
THE TRIGGER BUT OTHER SOCIAL
FORCE HAVE LED TO CHANGE IN THE
WORLD OF SCIENCE.
MANY ARE OCCURRING AT THE SAME
TIME AND THE ISSUES RELATED TO
SOCIAL JUSTICE AND PROMOTING THE
IMPROVEMENT THOSE MOST
DISADVANTAGED AND DIMINISHING
THE WELL DESCRIBED DISPARITIES
AS WELL AS INTERVENTION WORK FOR
ALL SEGMENTS OF THE POPULATION
IN COMMUNICATION STRATEGIES HAS
NOT DIMINISHED AT ALL, IF
ANYTHING HAS BEEN HEIGHTENED
WITH WHAT'S HAPPENED THE LAST
THREE YEARS.
WITH THAT SAID, I AGAIN WANT TO
THANK THE PRESENTERS,
PARTICULARLY DR. BYRNES AND KEN
FOR HIS MAGNIFICENT PROFESSORIAL
TIME AND THOSE AT NIMHD WHO MAKE
THIS POSSIBLE.
I OFFICIALLY ADJOURN THE MEETING
OF THE COUNCIL OF MINORITY
HEALTH AND HEALTH DISPARITIES.
THANK YOU.