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NIDA Council Meeting Bethesda, Maryland February 12, 2004 Funded by NIDA Contract N01DA-1-1200 PowerPoint Presentation
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NIDA Council Meeting Bethesda, Maryland February 12, 2004 Funded by NIDA Contract N01DA-1-1200. Mission Statement. The National Hispanic Science Network on Drug Abuse is dedicated to improving the health of Hispanics by:.

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slide1

NIDA Council Meeting

Bethesda, Maryland

February 12, 2004

Funded by NIDA Contract N01DA-1-1200

mission statement
Mission Statement

The National Hispanic Science Network on Drug Abuse is dedicated to improving the health of Hispanics by:

  • Increasing the amount and quality of interdisciplinary translational research on Hispanic drug abuse; and
  • Fostering the development of Hispanic scientists in drug abuse
major activities
Major Activities
  • National Network of Hispanic scientists, students & NIH federal advisors
  • National scientific conference
  • Summer Research Training Institute for graduate students & post-doctoral fellows
  • On-line Measures Archive
  • Website (www.HispanicScience.org)
a national strategic plan for hispanic drug abuse research
A National Strategic Plan for Hispanic Drug Abuse Research

Funded by Robert Wood Johnson Foundation

slide5

Cultural

Social

Psychological

Biological

slide6
Goal
  • To identify gaps in research and scientific opportunities – that can quicken the rate of discovery with regard to Hispanic drug abuse
slide7
Why?
  • To improve the health of Hispanics
  • To capitalize on ethnic variability to enhance our scientific understanding of universal principles
national strategic plan hortensia amaro ph d chair
National Strategic PlanHortensia Amaro, Ph.D. Chair
  • Epidemiology
  • Human Genome & Neurobiology
  • Prevention
  • Treatment
  • Health Services
  • Blending Research to Practice
  • HIV/AIDS
  • Training & Mentoring
development process
Development Process
  • More than 60 researchers participated in the formulation of the Strategic Plan
  • Each chapter was externally reviewed by a minimum of 2 outside experts in the field of drug abuse research
  • NHSN Steering Committee provided a second level of review
common themes
Common Themes
  • No or low samples of Hispanics in most drug abuse research studies
  • Few studies provide analyses of data by race/ethnicity including Hispanics
  • NIH Guidelines for inclusion of racial/ethnic minorities and valid analyses
common themes1
Common Themes
  • Few studies of prevention and treatment interventions with Hispanics
  • Few validated instruments in Spanish
  • Need for a better understanding of the role of culture, cultural adaptation and acculturation in drug use/abuse
common themes2
Common Themes
  • Few Hispanic researchers across all areas, but particularly severe in behavioral prevention and treatment intervention research
hispanics are 13 of the us populations
Hispanics are 13% of the US populations
  • 4 genetic studies
  • 4 adolescent behavioral treatment trials from one lab
  • 3 pharmacotherapy trials
  • No behavioral treatment trials of Latinas
slide15
The Latino population is growing at a rate of 4.7%, as compared to 0.3% for whites and 1.5% for African Americans
  • Rates for illicit drug abuse and dependence are highest for Hispanics (7.8%), followed by Whites (7.5%) and Blacks (6.2%) (SAMHSA, 2002).”
slide16
“Hispanic adolescents are more likely to abuse drugs, especially crack cocaine, heroin, and ‘ice,’ than are adolescents from other ethnic groups (Johnston, O’Malley & Bachman, 2003).
  • Inhalants- epidemic
  • Latino youth are more likely to report having been approached by someone selling drugs
slide17
Latinos experience more serious consequences of drug use (e.g., school drop out, prison, HIV)
  • Such consequences may be a function of lower access to drug abuse treatment services.
  • Hispanics report as much need for services as Whites, but are more likely to report not receiving services and to be less satisfied with the services they receive.
epidemiology nativity
EpidemiologyNativity
  • US born Latinos in all sub-groups report higher rates of use, abuse and dependence than immigrants
  • Many studies show that higher acculturation leads to more drug use, but this does explain drug use for all Latino groups
risk and protective factors for drug use social context effects
Risk and Protective Factors for Drug UseSocial Context Effects
  • Familism (family as referent, value family) is uniquely important in the Latino culture and is seen as protective against drug use; and should be studied as a protective factor
  • Factors that diminish the positive influence of the family should be investigated.
future research
Future Research
  • Empirically validated measures for acculturation (cultural change) need further evaluation.
  • What are the mechanisms by which acculturation influence drug use?
slide21

In First Generation Hispanic immigrant families,

YOUTHS

ACCULTURATION

INTER-GENERATIONAL/

ACCULTURATIONAL DIFFERENCES

PARENTS

TIME

(Szapocznik, Scopetta, Aranalde & Kurtines, 1978)

slide22

In second generation adolescents,

Mother’s Familism Values

.13

.15

Mother’s Behavioral Hispanicism

Adolescent

Deviancy

.48**

.23**

-.68**

Parenting

** = p<.01

(Santisteban, et al., 2000)

global recommendation hispanic populations
Global Recommendation: Hispanic Populations
  • Hispanics are biologically heterogeneous
    • Human studies on candidate genes as well as on neurobiology should consider biologically homogeneous subpopulations of Hispanics
biological differences related to health
Biological Differences Related to Health
  • Hispanic subpopulations show biological differences in comparison with other populations
    • genes, proteins and risk for disease
recommendations genes
Recommendations: Genes
  • Target Hispanic populations for research on candidate genes related to addiction
  • Genetic vulnerability-environment interactions, for example, may account for the very high rates of drug use among Puerto Ricans
slide28

Hybrid Interventions

  • Developing “Hybrid Prevention Interventions,” that build-in cultural adaptation as a formal design feature of the prevention program
adolescents what we know
Adolescents: What we know
  • Group therapy has iatrogenic effects on delinquent and drug abusing adolescents – also true for Hispanics
  • One family therapy treatment has been found to be efficacious with Hispanic drug using adolescents
treatment research with hispanic women
Treatment Research with Hispanic Women:
  • There are no published randomized clinical trials of a behavioral treatment with Hispanic women.
hispanic women recommendations
Hispanic Women: Recommendations
  • Test Motivation Enhancement Therapy, Contingency Management and Engagement Moms interventions - to improve engagement, retention and treatment outcomes.
  • Test trauma treatments because exposure to trauma is high among drug using Hispanic women
pharmacotherapy research
PHARMACOTHERAPY RESEARCH
  • Differences in response to pharmacotherapy for depression and schizophrenia in Hispanic populations vs. others
  • Only three published studies have explored pharmacotherapy for drug abuse in Hispanic populations
      • Methadone treatment for heroin addicts
      • Nicotine patch for smokers
      • Naltrexone for alcoholism
recommendations pharmacotherapy
Recommendations: Pharmacotherapy
  • Test the hypothesis that Naltrexone may be more acceptable to Hispanics when family involvement is a component of treatment
training
Training

Establish a National Training Center on Interdisciplinary, Translational Hispanic Drug Abuse Research

slide40

The workgroup selected a strategic research focus on:

.
  • Issues impacting the training of Hispanic services providers in innovative treatments
  • The characteristics of organizations/providers that facilitate or hinder adoption of innovative treatments for Hispanics (e.g., Hispanic agencies are more likely to be small, and small agencies are less likely to innovate).
  •  The nature of multilevel dissemination in the Hispanic community
recommendations for training research
Recommendations for Training Research:
  • Research can be most productive by focusing on:

1) The impact of different types of training on competence and adherence for Hispanics serving counselors.

2) The impact on adoption of a Hispanic-serving provider’s philosophy of change and problem conceptualization; and

3) Perceptions regarding the usefulness and limitations of manualized treatment. The impact on adoption of having Latinos counselors and manual developers collaborate on adaptations.

organizational barriers facilitators to adoption of innovative interventions
Organizationalbarriers/facilitators to adoption of innovative interventions
  • Organizational variables including size of organization, functional differentiation, number of years of operation, and level of training of the administrator appear to be positively related to adoption.
  • Also appearing in some literature: having patients covered by HMOs, PPOs, or other managed care arrangements, client clinical characteristics, and having higher percentage of relapsers treated by the center.
  • Hodge, Cardenas, & Montoya (2001) – Staff reported that financial problems did not allow for rewarding of innovation. Financial weaknesses did not allow agency to invest in a promising ATOD pilot programs.
implications for hispanic latino serving organizations
Implications for Hispanic/Latino Serving Organizations
  • The potential impact on adoption rate of agency size and level of training and education of administrators may be particularly important given that many Hispanic serving agencies may be smaller size.
  • The finding that individuals enrolled in HMOs and managed care programs were more likely to receive innovations, is also problematic given that Latinos/ Hispanics are over-represented among the uninsured and thus, may be less likely to receive innovative treatment intervention.
recommendations for research on organizational factors
Recommendations for Research on Organizational factors
  • Research specifically focused on:
  • 1) The makeup and characteristics of Hispanic- serving agencies and key organizational characteristics related to adoption.

2) Testing the generalizability of previous findings with Hispanic serving agencies.

  • 3) How the unique clinical characteristics of Hispanics impact variables related to adoption, such as clinical characteristics of caseload and high relapse rates.
the nature of multilevel dissemination in the hispanic community
The Nature of Multilevel Dissemination in the Hispanic Community

Social marketing - a consumer-oriented approach to dissemination – would help bridge the gap.

Aguilar-Gaxiola et al. (2002), working with Mexican Americans in California, report on evidence-based processes to educate the community, mobilize action, translate research for multiple stakeholders, and to effect regional policy changes that directly impact services.

recommendations for research on multi level dissemination
Recommendations for Research on Multi-level Dissemination.

Research must be conducted on the unique needs of Hispanic-serving substance abuse prevention and treatment providers, and study the effectiveness of matching innovations to those needs.

Research on marketing strategies that reach multiple stakeholders (e.g., community agencies, state and county-level funders) relevant to Hispanics.

Research must also focus on effective strategies for mobilizing public and political pressures to facilitate the adoption of innovation in the Hispanic community.

sexual risk within the context of drug abuse
Sexual Risk within the Context of Drug Abuse
  • Hispanics have more negative attitudes towards safe sex practices and a corresponding tendency towards risky sexual behaviors such as not using condoms.
  • “with those less acculturated reporting the most negative attitudes” towards safe sex practices.
initiation of injection risk in latino youth young adults
Initiation of Injection Risk in Latino Youth & Young Adults.
  • Pedagogy of technical skills necessary to prepare and inject illicit drugs.
  • Prospective studies of Latino IDUs
      • Evolution of social, behavioral, & environmental processes.
      • Situate within context of key life-course changes.
sexual risk within the context of drug abuse1
Sexual Risk within the Context of Drug Abuse
  • Latinosacross all sexual orientations report more negative attitudes toward safer sex practice.Correlates with level of acculturation.
  • High-risk heterosexual activities are the main predictor for HIV seroconversion among Latinas.
    • Latinas have low overall sexual assertiveness.
    • Significant proportion believe they never have the right to make decisions about condom use.
sexual risk within the context of drug abuse2
Sexual Risk within the Context of Drug Abuse
  • Enrich our understanding of personal &situational factors that will enable the development of targeted interventions.
  • Ways that normative beliefs brought from sending cultures filter through sexual decision-making contexts to increase risk behavior.
  • Ways in which drugs are imbedded in sexual partnering processes.
  • Prospective intervention studies with Latina youth that parallel developmental life-course changes and build sexual communication & negotiation capacity over time.
slide56

There are indications that the overall NIH training endeavor, especially those directed at minority individuals, is also making very slow progress overall. The number of NIH R01 grants received by underrepresented minorities rose slowly from 154 (2.8% of the total) in 1997 to 344 (5% of the total) in 2001.

slide57

NIDA Will Establish, or Collaborate or Support:

  • A Career Development Award (K01) for minority faculty
  • A Minority Clinical Research Scholars Fellowship as part of NIDA’s CTN program.
  • Establish Training Centers in the basic neurosciences, behavioral sciences, clinical neurosciences and intervention science at minority-serving Research I universities.
slide58

Recommendation 1. Develop a comprehensive progress report for existing NIDA training programs that target underrepresented minorities, with a focus on Hispanics.

Recommendation 2. Establish a NIDA National Drug Abuse and Addiction Health Research mentorship program devoted to training future Hispanic researchers.

Recommendation 3. Encourage NIDA staff to share information about successful Hispanic program initiatives with other NIH Institutes.

Recommendation 4. Encourage and strengthen new and existing networks and partnerships to enhance science-training goals that exceed NIDA’s training resources.

slide59

Recommendation 5. Develop Diversity T32’s.

  • Recommendation 6. Comprehensive training grants that:
  • support infrastructure and faculty mentor time as well as providing resources for trainees, and
  • support all levels of training across the early career pipeline (graduate students, post-docs, junior faculty).
  • Recommendation 7. Create interdisciplinary, translational thinkers and research teams.
  • Recommendation 8. Attend to the most critical training need: Behavioral prevention and treatment intervention science.