||National Center For Research Resources:
Strategic Plan to Reduce Health Disparities
The National Center for Research Resources (NCRR) serves as a
catalyst for discovery for investigations throughout the Nation supported by the National
Institutes of Health (NIH). NCRR creates, develops, and provides access to a
comprehensive range of human, animal, and technological resources and other research
tools that enable biomedical research. NCRR promotes collaborations within and across
scientific disciplines, providing quick, flexible approaches to address new and emerging
NCRR has a trans-NIH mandate--to develop and maintain
the research infrastructure that enables all lines of biomedical inquiry. This effort
transcends both clinical and basic research. NCRR supports the development of
technologies to enable sophisticated research, and it also creates and supports a broad
range of sophisticated, multidisciplinary research facilities for basic, clinical, and animal
research. NCRR programs support biorepositories with companion, Web-based
databases for a wide range of organisms, both mammalian and nonmammalian. NCRR
programs also support institutional development for minority-serving institutions that
award doctoral degrees in health-related sciences, as well as competitive support for
infrastructure and faculty development for academic institutions in states with historically
low levels of NIH funding. NCRR's support of research resources and research
infrastructure complements the missions of the NIH categorical institutes and facilitates
discoveries in many areas of health research.
NCRR intends to mobilize those research resources and other infrastructure components
to strengthen and complement initiatives of other NIH Institutes and Centers (ICs) to
reduce Health Disparities (HDs) among ethnic minority populations. NCRR programs
will be enhanced to provide career development and training opportunities to increase the
number of minority investigators in biomedical research. In FY 1999, NCRR provided
$51.6 million to support research on the several diseases and other health-related
concerns that relate to minority populations.
III. Ongoing NCRR Research and Research Resource Efforts:
research to discern the cause of disease and develop effective treatment, that in turn,
reduces health disparities among racial and ethnic populations. NCRR supported
investigators have made numerous scientific contributions in several HD-related areas,
including AIDS, cancer, cardiovascular disease, cerebrovascular research, diabetes, and
infant mortality. For example, scientists at the University of Hawaii and the Ponce
School of Medicine in Puerto Rico have collaborated to analyze DNA samples from
individuals in search of a specific mutation believed to confer relative protection against
HIV infection and result in a slower progression to AIDS. The protective mutation in the
CCR5 cytokine receptor gene was most prevalent among the Caucasians tested, and was
less prevalent, or completely absent, among subsets of minorities.
Researchers at the University of Hawaii determined that smokers who carried a particular
variant of a carcinogen-activating enzyme had more than a two-fold increased risk of
squamous cell carcinoma, a common type of lung cancer that occurs centrally on the
main bronchi or air pipe. The study suggests that polymorphisms in carcinogen-metabolizing
ezymes may influence the type of lung cancer that develops in smokers.
Although blood transfusions are known to prevent recurrent strokes in children with
sickle cell anemia, it was unclear if transfusions also could prevent a first stroke. This
has now been established so convincingly that the investigators terminated a clinical trial
early in order to protect all participating children from this devastating complication of
sickle cell anemia.
To gain more information about stroke incidence, investigators identified all first stroke
victims in a study, during a 3-year period. The surveillance showed that African
Americans had a 2.4-fold and Hispanics a 2.1-fold higher stroke incidence than did
Investigators at the University of Hawaii have estimated the prevalence of impaired
glucose tolerance and type II diabetes mellitus in Native Hawaiians 30 to 64 years old.
Age-adjusted type II diabetes was four times higher than among the U.S. National Health
and Nutrition Examination Survey II population. Prevalence of glucose intolerance was
significantly higher among women than among men, and it was associated with body
mass index, waist circumference, and waist-to-hip ratio.
A large percentage of all births in the United States end in premature delivery because of
rupture of defective fetal membranes, an elastic sack containing the developing fetus.
Researchers in Hawaii have now identified the protein elastin as the elastic component
that enables membranes to withstand the fetus' forceful movements. A better
understanding of elastin's molecular and structural properties may eventually provide
opportunities for addressing this major health problem.
A study investigated whether previously demonstrated differences among black and white
adolescents in insulin secretion and insulin sensitivity are present in the prepubertal
period or are characteristic of the pubertal period. The researchers concluded that
previously reported differences in insulin secretion and sensitivity between black and
white adolescents may originate in early childhood, when they are manifested as
- Area of Focus:
Expand and encourage clinical and basic research on
HDs for racial and ethnic minorities through enhanced clinical research among
institutions within Institutional Development Award (IDeA)-eligible states.
Although there are a number of medical schools within the 24
IDeA-eligible states (23 states and Puerto Rico), there is a limited number of NIH-supported
research activities focused on diseases that disproportionately affect minorities.
The IDeA-eligible states include minorities -- Alaskan Natives, Native Hawaiians,
Hispanic Americans and African Americans -- with health disparities for several diseases.
The presence of these populations makes the IDeA states a promising location for
investigations to reduce HDs. Clearly, enhanced research efforts among this subset of
states, and specifically among those states with medical schools, will also pay off with
development of research expertise among junior faculty and enhance their
competitiveness for NIH research funding.
Use the Centers of Biomedical Research Excellence (COBRE)
program as a model to support investigators from the IDeA-eligible states to conduct HD
research in academic medical centers and other comparable sites. This approach will
contribute to the reduction of health disparities among ethnic and racial minority
populations in these states.
B. Research Infrastructure
1. Support Research Training and Career Development
- Area of Focus:
Ensure state-of-the-art research training and career
development of more minority investigators in basic and clinical research, focusing on those
diseases that disproportionately affect racial/ethnic minorities.
NCRR gives high priority to strengthening the Nation's human
resources in science. If we are to adequately address reducing Health Disparities among
minority populations, we must provide programs for more minority investigators to
receive training in basic and clinical research. In the past, NCRR has provided support to
minority physicians through the Minority Clinical Associate Physician (MCAP) Program.
The MCAP was designed to provide career development for patient-oriented research,
mentored by an investigator established at a General Clinical Research Center (GCRC).
From 1991 through 1999, NCRR supported approximately 130 MCAP awards. In 1999,
the MCAP program was consolidated with the Clinical Associate Physician (CAP)
award. This effort constitutes one of the largest NIH efforts to enhance the number of
minority physician investigators trained to conduct independent patient oriented research.
NCRR is further exploring more effective approaches to encourage young minorities to
pursue careers in the biomedical sciences.
NCRR has also addressed career development through its Research Centers in Minority
Institutions (RCMI) Program, which has recently initiated a Clinical Research Faculty
Development award mechanism. These faculty development awards are patterned after
the CAP awards, and allow for the training and career development of clinical research
faculty within the RCMI-Clinical Research Center (CRC) or a collaborating GCRC. The
expansion of this mechanism will enable the six minority medical schools that are
supported via the RCMI Program to develop more investigators that pursue both basic
and clinical research questions that are germane to HDs.
NCRR supports research in development and application of state-of-the-art biomedical
technology (BT) centers involving multidisciplinary teams that collaborate with
investigators located at other institutions and research organizations regionally or
nationally. These centers are located in major urban centers throughout the U.S., such as
Boston, New York, Pittsburgh, Philadelphia, Baltimore, Durham, Cleveland, Chicago,
Houston and Los Angeles. There are currently 14 centers associated with imaging
technologies (MRI, functional MRI, ultrasound, and x-ray) that specialize in cancer,
cardiovascular disease, or cerebrovascular imaging. Modern imaging technologies will
be critical to the treatment and diagnosis of diseases prominent in African Americans and
other minority populations. An important feature of the BT centers is their role in
training and dissemination of biomedical technologies. The centers organize regular
workshops and schools to train individuals in the use and application of the technologies.
The availability of these advanced technologies is strongly dependent on the capabilities
of the users; trained individuals know when use of a technology is appropriate, and they
will also know how to use it.
NCRR also supports career development in animal-based science through pre- and
post-doctoral fellowships, and entry level and mid-career awards. National and regional
resources for animal-based biomedical research also provide ideal situations for career
development in these state-of-the-art resources. Many of these resources are at the leading
edge of their respective research fields and are ideal settings for career development of
promising young minority investigators. The Regional Primate Research Centers
(RPRCs) are large, complex resources with a broad range of experimental studies and
opportunities. The RPRCs provide a unique venue for the career development of
promising students and young investigators, including minorities.
Increase exposure to clinical research for minority medical
students and junior faculty clinical investigators through the Mentored Medical Student
and Clinical Research Scholars (CRS) Programs. Expand the use of these model
programs to RCMI institutions with affiliated medical schools.
Aggressively expand, through supplements to existing
Biomedical Technology (BT) Centers, the number of minority researchers (graduate and
post-doctoral fellows) associated with these centers, particularly for those imaging
centers located in urban areas. Modern imaging technologies are critical for research,
diagnosis and treatment of diseases that are prominent among minority populations.
Target training and dissemination of biomedical
technologies to minority-serving graduate and medical schools to provide hands-on
opportunities for researchers and educators.
Work with minority-serving graduate and medical schools to
assure that their researchers have access to Internet II and advanced bioinformatics tools
to facilitate their research. Through the Biomedical Research Technology Resource
Centers for bioinformatics, provide hands-on instruction for investigators from minority
Provide training, career development and research
opportunities in comparative medicine through the use of supplements to minority
veterinarians, physicians and other investigators at RPRCs, as well as other appropriate
Comparative Medicine resource centers.
Develop a supplement program within the GCRCs to encourage
sabbaticals of minority clinical researchers from minority medical schools to pursue HD
research at institutions with GCRCs, and reciprocally, GCRC investigators to pursue
sabbaticals at RCMI-CRCs.
2. Provide Support for Institutional Resources (Extramural)
- Area of Focus:
Provide incentives to investigators to enhance their
research efforts to reduce HDs through GCRCs and RCMI-CRCs in specific, targeted areas such
as diabetes, obesity, lupus, HIV/AIDS that are prevalent in minority and other lower
socioeconomic status populations.
In FY 1999, the NCRR provided clinical research infrastructure
support to host more than $9.0 million in AIDS clinical trials aimed at minorities.
Similarly, $6.4 million was expended on diabetes research involving minorities, and
$11.5 million on cardiovascular research focused on minorities. With the disparately
high prevalence of these diseases among minorities along with the high economic and
personal costs associated with these diseases, a concerted effort to prevent or significantly
reduce the prevalence of these diseases among minority populations is essential.
Increased research support in these areas would help to improve the health of minority
In concert with other NIH components and private sector
disease related organizations, provide incentives to institutions to stimulate their research
to reduce health disparities through the use of GCRCs and the RCMI-CRCs to host and
facilitate HD research.
Area of Focus:
Expand collaborative efforts between GCRCs and RCMI CRCs.
Several RCMI CRCs are geographically close to GCRC sites. The
RCMI institutions include many young aspiring minority clinical investigators. This
geographical relationship can be developed for collaborative efforts between RCMI
investigators and those at nearby GCRCs to develop research partnerships, and also
provide minority investigators ready access to the more robust clinical research
infrastructure available through the GCRCs.
Increase collaborative efforts, particularly for facilitating
HD clinical trials and other related studies, through existing GCRCs with co-located
RCMI Clinical Research Centers.
Develop Comprehensive Centers for studies on Health
Disparities through collaborations among RCMI CRCs, GCRCs and other NIH
components (e.g., National Center for Complementary and Alternative Medicine).
Develop approaches to encourage community-based minority participation in clinical
research studies that focus on diseases that differentially impact ethnic minorities and
constitute health disparities.
Area of Focus:
Increase minority recruitment for clinical trials for HD-related
Although NIH requires the inclusion of minorities in clinical
research and clinical trials, at times it has proven difficult for investigators to recruit
adequate numbers of representative minority patients for their studies, either because of
their geographic location or due to a lack of trust within the community. Inclusion of
minority investigators from the RCMI-CRCs will provide a certain level of trust among
patients within the minority communities. This will enhance enrollment of minority
participants in clinical research studies, and will result in statistically meaningful research
that will provide important information to health care providers of minority patients.
Enhanced efforts to enroll minorities in clinical research studies is a necessary step to
Increase minorities in study populations in all categories of
clinical research ranging from epidemiological studies to studies of basic disease
mechanisms and clinical trials to address HDs.
Facilitate collaborative involvement among NIH IC-supported
disease specific centers, RCMI-supported minority medical schools, and community
Area of Focus:
Assist minority institutions with developing the research
infrastructure necessary to provide stable, well maintained, state-of-the-art research
environments that will make them more competitive in biomedical research.
Only one minority graduate institution, Howard University, has an
animal research program accredited by the Association for the Assessment and
Accreditation of Laboratory Animal Care (AAALAC). Other minority-serving graduate
schools conduct animal-based biomedical research within guidelines of the Public Health
Service. To further strengthen biomedical research programs that include the capacity for
more sophisticated animal-based research at these institutions, it is essential to upgrade
their animal research facilities and staff support to AAALAC standards.
In concert with the annual meetings of the Association of
Minority Health Professional Schools (AMHPS) and the RCMI program directors'
meeting, NCRR staff will arrange meetings between senior institutional officials from
the participating minority institutions and AAALAC staff to apprise institutional officials
of the process and requirements for animal research facilities to become eligible for
accreditation by AAALAC. NCRR staff will also facilitate AAALAC pre-accreditation
evaluation site visits so that specific facility needs can be identified for each participating
To further enable this initiative, NCRR will develop a special initiative within NCRR's
Animal Facility Improvement (AFI) Program for minority-serving institutions to compete
for funds for upgrading their animal research facilities to become AAALAC accredited.
Since minority graduate schools lack adequate institutional funds, NCRR will waive the
match for successful minority institution applicants to this AFI Program initiative.
C. Public Information/Outreach/Education
- Area of Focus:
Determine strategies for assessment, intervention and
prevention of diseases that disproportionately affect minorities.
Currently, there is no national database that catalogs minority
participation in clinical trials and other clinical research studies which relates to HDs. A
central database, perhaps a subset of the clinical trials database established in the National
Library of Medicine, could include information on the outcomes of different interventions
in HD-related diseases. This could provide both investigators and physicians providing
health care a valuable resource to better understand the reasons why these diseases tend to
disproportionately affect minorities and help identify effective interventions to prevent or
reduce the impact of the several diseases with HDs.
In concert with other NIH and components of the Department of
Health and Human Services, either develop a new, or modify an existing, database to
systematically capture the research information on the outcomes of clinical trials and
other comparable studies on efficacy of various therapies in the prevention and/or
treatment of HDs in minority populations.
Support Science for the Lay-Public Forums that focus on HDs
in conjunction with GCRCs and RCMI-CRCs. These forums may be held at churches,
community health centers, and within school systems that have high concentrations of
ethnic minorities. Also, in concert with other NIH ICs and university-based minority
recruitment offices, include research on the best methods to recruit minority participants.
Encourage GCRC-based investigators and administrative leadership to work with their
local communities to enhance recruitment efforts for minorities in clinical research
Via the Internet or telemedicine broadcasts, such as at Charles
R. Drew University, provide health information directed at increasing science/health
literacy of the racial/ethnic minority communities and populations, and enhance their
awareness of opportunities to participate in clinical trials.
Provide access to GCRC-based, clinical research-related
workshops, courses, and symposia to students and investigators at nearby minority
Expose K-12 students and the racial and ethnic minority public
to biomedical research and enhance their awareness of HD prevention and treatment
strategies available so minorities can make healthier lifestyle choices. Provide
administrative supplements to science museum exhibits that relate to health disparities so
that the exhibits can be displayed in geographic areas with higher concentrations of
minorities. This initiative can be carried out through the Science Education Partnership
Award Program for HD-related science museum and other comparable exhibits.
Vidyya. Home |
Ex Libris |
Subscription Information |
About Vidyya |
Vidyya Archives |
Editor: Susan K. Boyer, RN
© Vidyya. All rights reserved.