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Back To Vidyya National Center For Research Resources:

Strategic Plan to Reduce Health Disparities

I. Introduction:

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 research queries.

II. Background:

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:

NCRR supports 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 whites.

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 hyperinsulinemia.

IV. Goals:

A. Research

Area of Focus:
Expand and encourage clinical and basic research on diseases with HDs for racial and ethnic minorities through enhanced clinical research among institutions within Institutional Development Award (IDeA)-eligible states.

Background:
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.

New Initiative:
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.

Background:
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.

Expanded Initiative:
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.

Expanded Initiative:
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.

Expanded Initiative:
Target training and dissemination of biomedical technologies to minority-serving graduate and medical schools to provide hands-on opportunities for researchers and educators.

New Initiative:
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 serving institutions.

Expanded Initiative:
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.

New Initiative:
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.

Background:
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 populations.

New Initiative:
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.

Background:
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.

Ongoing Initiative:
Increase collaborative efforts, particularly for facilitating HD clinical trials and other related studies, through existing GCRCs with co-located RCMI Clinical Research Centers.

New Initiative:
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 diseases.

Background:
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 reduce HDs.

New Initiative:
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.

New Initiative:
Facilitate collaborative involvement among NIH IC-supported disease specific centers, RCMI-supported minority medical schools, and community health centers.

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.

Background:
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.

New Initiative:
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 minority institution.

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.

Background:
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.

New Initiative:
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.

New Initiative:
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 studies.

New Initiative:
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.

New Initiative:
Provide access to GCRC-based, clinical research-related workshops, courses, and symposia to students and investigators at nearby minority medical schools.

New Initiative:
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.


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Editor: Susan K. Boyer, RN
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