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NIAAA's Strategic Plan to Address Health Disparities

NIAAA-supported research reveals that about one-third of Americans do not drink at all and the majority of people who drink do so without adverse consequences. The NIAAA is committed to increasing and strengthening efforts to address health disparities in the context of our primary mission of conducting and supporting research. A broad range of epidemiological, psychosocial and biomedical research suggests that some minority groups suffer greater adverse effects from alcohol than do other populations. Groups of particular concern include African Americans, Hispanics/Latinos, American Indians/ Alaska Natives, Asian Americans, and Native Hawaiians and other Pacific Islanders. In addition, we recognize significant variability between subgroups within populations and we are committed to promoting research designed to explore the causes and consequences of these differences.

The NIAAA reaffirms a long-term commitment to addressing health disparities consistent with the three broad NIH goals: (a) support research; (b) expand community outreach; and (c) expand research capacity. The NIAAA investment in programs targeted to minority populations in these three broad categories has increased almost five-fold since 1989. Our progress is due in part to an ongoing partnership with NIH’s, National Center for Minority Health and Health Disparities (NCMHD) In addition to co-funding initiatives aimed at reducing health disparities, NCMHD actively supports high-risk, high-impact projects designed to increase alcohol research in minority-serving institutions.

A. Support Research on Health Disparities

This strategy requires actively encouraging established alcohol researchers to incorporate issues related to minority populations in their work. Alcohol research programs, which span a wide range of disciplines from molecular biology to the social sciences, all include health disparities issues. See box on following page for a brief description of the common mechanisms to support research.

Aims of the NIAAA Health Disparities Plan are:

  • To strengthen the infrastructure of Minority Serving Institutions to conduct alcohol research,
  • To bring important new resources and ideas from minority communities to the alcohol research community,
  • To build multi-disciplinary, multi-ethnic collaborating teams to address specific research questions, and
  • To facilitate the transfer of research knowledge to practice, and experiential and clinical knowledge to research.

Image of an African American has Fagan Test of Infant Intelligence.

An African American infant from Detroit is assessed on the Fagan Test of Infant Intelligence, which evaluates visual recognition memory and processing speed, important components of information processing, which are predictive of cognitive functioning later in childhood. This test was administered as part of the Prenatal Alcohol Exposure and Infant Cognition study, which was conducted by Drs. Sandra W. Jacobson and Joseph L. Jacobson and sponsored by the National Institute on Alcohol Abuse and Alcoholism.

Epidemiology of alcohol-related health disparities. Detailed epidemiologic information about patterns of alcohol use and alcohol-related problems among various racial and ethnic minorities is fundamental to effective efforts to address alcohol-related health disparities. Epidemiological research increases understanding of the nature and scope of these disparities and generates hypotheses for subsequent research.

Biomedical risk factors contributing to disparities in the effects of alcohol. Population differences in responses to alcohol as well as alcoholic liver disease and other biomedical outcomes result from many factors yet to be well understood. Some of these differences may be related to alcohol metabolism and other gene-environment interactions; other differences appear to be related to diet or differential rates of vulnerability to viral hepatitis or type 2 diabetes. Genetic research has helped to establish the biological basis of alcoholism and provided the basis—and impetus—for much of the progress in enetics, neuroscience, and neurobehavioral research. Recent progress in neuroscience research has yielded information critical to characterizing some of the cellular and molecular processes involved in alcohol use and has helped associate these processes with the behavioral and physiologic manifestations of alcohol use and abuse.

Genetics and neuroscience research has set the stage for the development of medications to treat a variety of alcohol use problems. Neuroscience researchers are investigating new medications that target the mechanisms of the addiction itself. While it is unlikely that one medication will be effective for everyone or that there will be the proverbial“silver bullet” of pharmacotherapy for alcoholism, this research will likely yield a range of medications, which when coupled with verbal therapies will enhance clinicians’ ability to treat alcohol related problems.

Research Grants

R01 Research Project: To support a discreet, specified, circumscribed project to be performed by the named investigator(s) in an area representing specific interest and competencies.

R03 Small Research Grants: To provide research support specifically limited in time and amount for studies in categorical program areas. Small grants provide flexibility for initiating studies which are generally for preliminary short-term projects and are non-renewable.

R21 Exploratory/Developmental Grants: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.)

Alcohol Pharmacogenetics in Mexican Americans

Led by Yu-Jui Y Wan, Ph.D. at Harbor-UCLA Medical Center in Los Angeles, this genetic study of Mexican-American is yielding valuable data on the occurrence of specific genes such as the CYP2E1, ADH2, ADH3, and ALDH2 genes implicated in alcoholism and alcoholic liver disease. This research project has also yielded data on alcohol drinking behaviors and associated problems in binge versus non-binge drinker Mexican American alcoholic men. Dr.Wan has mentored 11 minority undergraduate and graduate students in her lab in order to help train the next generation of minority researchers.

image of researchers at UCLA with children who have prenatal alcohol exposure to develop peer friendships

Reseachers at UCLA work with children who have prenatal alcohol exposure to develop peer friendships.

Adverse pregnancy and infant health outcomes related to alcohol use. Fetal Alcohol Syndrome (FAS) is the leading cause of preventable birth defects in the United States. Since prevalence and problems of affected children are significantly higher in some minority groups, it is critical that health care providers, scientists, clinicians, educators and psychologists from these communities be involved in the development of new knowledge and the study of promising interventions. The NIAAA has developed multidisciplinary, multi-ethnic collaborative teams working on fetal alcohol syndrome in South Africa and the U. S. Since this model has proven successful, it will be used in a number of health disparities research and training initiatives.

Prevention and intervention research. Alcohol prevention research is aimed at reducing the causes and consequences of alcohol abuse and alcoholism. Given the disparities in the adverse alcohol outcomes among minority groups it is important to develop science-based prevention approaches which are optimally effective for these populations. We need information on whether and how key components of prevention strategies (such as community and family involvement techniques) and critical precursors of behavioral change (such as alcohol expectancies and beliefs about drinking) vary across racial/ethnic groups. While some standard approaches have been shown to be effective among minority populations it is unclear whether interventions specifically designed for particular minority groups might be even more beneficial. Research on resiliency within cultural groups factors offers a promising approach to prevention of alcohol-related problems. Prevention research has also developed effective environmental strategies that are now being evaluated in minority urban neighborhoods. Community-based interventions have sought to alter zoning laws as a means of reducing alcohol-outlet densities and attendant problems in poor ethnic minority communities. Prevention research is also examining the role that advertising within minority communities plays in alcohol use and abuse.

Alcoholism treatment and health services research. The main goal of alcoholism treatment is to help alcoholics maintain sobriety. Some of the most compelling health disparities treatment questions have to do with factors influencing the effectiveness of alcohol treatment services across different populations. Some studies have shown significant reductions in drinking among ethnic minorities after treatment behavioral therapies. Other strategies, involving brief interventions in primary care settings, have proved to be effective in reducing alcohol consumption in persons at risk for negative health consequences. NIAAA will continue to support research on the efficacy and effectiveness of standard and innovative treatments for alcohol use disorders among ethnic minorities. Majority and minority population differences with respect to access to effective treatment may contribute to health disparities. In addition, the absence of insurance coverage for alcoholism treatment may be an important barrier to treatment access. Available data indicate that Hispanics/ Latinos and African Americans are less likely than the general population to have health insurance that would support access to treatment. Lack of culturally and linguistically appropriate care may similarly impede the effective delivery of treatment to minority patients.

People Awakening Project:
Pathways to Alaska Native Sobriety

Led by Dr. Gerald Mohatt, this is a three-year study on Alaska Native pathways to sobriety. Most past research on alcohol and Alaska Natives has focused on problems and abuse. As a result, there has been little research attention on the many Alaska Native people who are sober, who are not problem drinkers, and who have succeeded in recovery from alcoholism.The People Awakening Project focuses on strengths and the potential for all Alaska Native people to live healthy lives.The project is funded by a NIAAA research grant awarded to University of Alaska Fairbanks.

Image of Amanda Russell

Amanda Russell, an American Indian (Cherokee), conducts a telephone survey as a summer research trainee with the American Indian Research Group of Oklahoma. Russell is a University of Oklahoma Health Sciences Center medical student.

B. Expand Community Outreach

NIAAA is expanding its community outreach efforts by increasing access to information, information dissemination, creation of appropriate alcohol and health materials, education for health professionals, and soliciting and incorporating community input regarding alcohol research.

Increase at-risk and minority access to alcohol-related health messages. In order to increase an awareness of the consequences of alcohol abuse and dependence among minority populations, the NIAAA is committed to developing culturally relevant health messages on a variety of alcohol-related issues such as FAS, drinking and driving, alcoholic liver disease, and HIV/AIDS. Many of NIAAA pamphlets and brochures are translated into Spanish; translation of pamphlets and brochures into other languages is underway. Another approach currently being implemented is to develop materials targeted to ethnic and racial populations, which integrate group specific researchbased information. A variety of new programs will reach out to minority (and minority-serving) health care professionals to promotecommunications and thereby improve the quality of health messages and the efficiency of information dissemination.

Training of health care professionals. Efforts are under way to facilitate the application of research results to practice through the development of curricula for pediatricians and prenatal care professionals on the identification of children affected by prenatal exposure to alcohol and on screening women of childbearing age for at-risk drinking. A companion booklet in English and Spanish has also been developed to assist women in cooperating with their health care providers to reduce at-risk drinking.

Science education and health professionals education initiative. NIAAA seeks to make research-based education regarding alcohol use disorders, interventions and treatment a priority in the training of health professionals serving minority populations. We seek to increase the number of faculty role models knowledgeable in the handling of alcohol use disorders and intervention as well as to improve the patient physician interaction around the topic of alcohol use, abuse and alcoholism.

Bring resources to the alcohol research community. Minority educators, health care professionals, clinicians and investigators are integral to promoting health disparities research. Minority populations, study cohorts and minority intensive settings are also essential resources. The NIAAA is working to assure the availability of these resources to those who conduct research in response to the health disparities initiative.

Transfer research knowledge to practice and experiential/clinical knowledge to research. The NIAAA recognizes the need to assure that minority serving organizations receive the results of alcohol research. We are developing and promoting means whereby the experience and clinical knowledge of minority serving health care professionals and community members are transferred to those conducting health disparities research.

C. Expand Research Capacity

Minority serving institutions and minority clinicians and scientists have much to add to our understanding of alcohol-related health disparities. Expanding research capacity includes support for building the research infrastructure at minority institutions, recruitment and career development for minority investigators. NIAAA has identified three general areas where new and enhanced activities could meet these objectives: increased support of capacity development in minority serving institutions, expansion of efforts to attract minority investigators to alcohol research, and enhanced career development opportunities for minority investigators.

Strengthening the capacity in minority serving institutions (MSIs) to contribute to and conduct to alcohol research. NIAAA currently has three mechanisms to support development of alcohol research expertise and infrastructure development at MSIs to conduct research to identify, characterize, and reduce alcohol-related health disparities in American ethnic and cultural populations and their subpopulations.

Development grants for minority collaborative projects (PAR-00-085). These grants support pilot projects developed collaboratively between scientists in minority institutions and established alcohol researchers. The purpose is to support the transition from mentored collaborative research development to larger, independent investigator-initiated research projects. Developmental awards are intended to enhance and extend the alcohol research activities of minority scientists.

Cooperative agreement for exploratory /developmental grants for minority institutions alcohol research planning (U01). Collaborative minority serving institution alcohol research (CMSIAR) (U56). Both of these mechanisms take the form of cooperative agreements that require long-term committed partnership between the MSI participants, senior alcohol-researchers who serve as mentors to the MSI participants, and collaborators from one or more established collaborating alcohol research programs. These cooperative agreements support a variety of exploratory research projects each building upon existing expertise at minority serving institution, strong collaborations from established alcohol research scientists, and significant input from Institute staff.

Expansion of efforts to attract minority investigators to alcohol research. NIAAA supports individuals to come to the campus of the National Institute of Health (NIH) in Bethesda, Maryland to work with senior researchers to enhance their research capability. Students and scientists interested in working at the National Institutes ofHealth (NIH) during breaks, summer, or for a more extended period may want to apply to one of the following three programs that support research experiences in NIH laboratories. These programs offer applicants an opportunity to conduct independent research projects while working closely with leading investigators in biomedical science. NIAAA also seeks to attract minority investigators who plan on working within their home academic or research institution and supports their efforts to develop expertise in alcohol-related research.

Howard University Collaborative Alcohol Research Center (HUCARC)

Center Director: Robert E.Taylor, M.D., Ph.D., Chairman, Howard University College of Medicine Department of Pharmacology.

Founded in 1997 to address alcohol related issues that contribute to the biological and psychological deterioration of African American communities, the Howard University Collaborative Alcohol Research Center (HUCARC) serves as a teaching, education, and clinical research site at Howard University in Washington, DC.The faculty within the University’s undergraduate, graduate and professional schools, together with community partners is engaged in basic and clinical research focused on reducing the negative consequences of alcoholism and alcohol abuse.The Center’s theme is “Ethnic factors in alcohol abuse among African Americans”. The goal of the HUCARC is to stimulate, strengthen, and facilitate multi-disciplinary research and collaborations, which will lead to the reduction of alcohol morbidity and mortality among minority populations with emphasis on African Americans. This will be accomplished through a comprehensive program of education, research, service, and community outreach.

Subsequent NIAAA awards to HUCARC investigators include:

Taylor, Robert E. Novel Phenotypes for the Genetics of Alcoholism (R01)
Taylor, Robert E. Malt Liquor Pharmacokinetics in African-Americans (R21)
Akala, Emmanuel O. Controlled Delivery System for Naltrexone (R21)
Akinshola, Babatunde E. Effects/Ethanol/ Specific sites/AMPA glutamate receptors (R21)

 

image of Howard Univ. Collaborative Alcohol Research staff demonstrate how an EEG cap is applied

Howard University Collaborative Alcohol Research Center Gloria Cain, Clinical Program Manager and Natosha Smith, Research Assistant demonstrating how an EEG cap is applied.

Images of Dr. Robert Taylor, DR. Walter Bland, and Natosha Smith

Howard University Collaborative Alcohol Research Center Dr. Robert Taylor, Center Director; Dr.Walter Bland, Co-Investigator, Natosha Smith, Research Assistant in Neuropharmacology Laboratory.


NIH Summer Research Fellowship Program.
This program is for 1st through 3rd year medical or dental students who have a strong interest in pursuing biomedical or behavioral research. Students train for eight weeks or more in research procedures and independent investigation in a laboratory at the NIAAA during the summer. There is a stipend that varies by education level. Apply to the NIH Office of Education by March 1st each year.

NIH Summer Internship Program in Biomedical Research. Open to students from high school through the graduate level, this program provides research training at NIAAA laboratories for eight weeks or more during the summer. Students must demonstrate a strong interest in biomedical or behavioral research through coursework in biology, chemistry, physical science, psychology, computer science, biostatistics, mathematics, and/or biomedical engineering. There is a stipend that variby education level. Apply to the NIH Office of Education by March 1st each year.

Clinical Research Training Program. This program provides one to two years of mentored clinical research on the NIH campus for medical and dental students who have completed or are in process of completing one year of clinical rotations (normally 3rd year students). Candidates for the M.D./PhD. are also eligible. Trainees receive a stipend plus some expenses. Apply to the NIH Office of Education by January 15th.

Alcohol Research Mentoring System (ARMS). ARMS is a pilot program that recruits new, minority investigators and non-minority faculty at historically black colleges and universities interested in alcohol-focused social or behavioral science research projects and matches them with senior, NIAAA–funded research mentors. The new investigator, under the guidance of the mentor, will produce a grant application or improve an earlier grant submission. For more information, visit www.niaaa-arms.org.

Technical Assistance Workshops. NIAAA has been conducting a series of workshops to attract faculty, postdoctoral and graduate students in minorityserving institutions to alcohol research. Technical assistance initiatives have included convening project development and grantsmanship workshops, face-toface mentoring in prevention research, discussions on the conduct of clinical alcohol research, and sessions to stimulate collaborative projects.

Minority Supplements. NIAAA provides funding through the Underrepresented Minority Supplement Program. Under this program the Institute supplements existing grants to assist developing scientists from a racial or ethnic group underrepresented in the biomedical or behavioral sciences to obtain research experience and develop individual projects under the mentorship of NIAAA supported alcohol researchers. Such projects have the potential for expansion into larger studies.

Enhanced career development opportunities for minority investigators. NIAAA sponsors a wide range of opportunities and mechanisms for minority investigators to develop skills in alcohol-related research (see box on next page for selected examples). There are even mechanisms in place to pay off students loans (see box on next page)!

For more information on these or any of the other programs at NIAAA, contact: