Research CoreNearly half of all preventable deaths in the U.S. are related to high-risk behaviors. Community healthcampaigns aimed at reducing those risks have been successful primarily among those with higher incomes.Evidenced-based behavioral health promotion strategies need to be adapted, tested, and disseminated withinlow-income and minority communities to eliminate health disparities. The Research Core includes two fullresearch projects covering: (1) diabetes and depression and (2) HIV/AIDS. Since Drew opted to include theoptional Research Training and Pilot Core, Drew placed the 'active mentorship of the pilot projects and pilotinvestigators' within that core. The Research Training and Pilot Core will fund innovative health disparities pilot projects for junior and established faculty members at Drew University and UCLA in an enriched trainingenvironment. An important goal of the Research Core is to develop infrastructure that will support thedevelopment of research capacity at Drew, as well as minority junior faculty interested in disparities research.This core will provide methodological and infrastructure support and monitoring for the research and pilot projects, and will develop new methods to address health disparity problems such as the use of improvedsurvey instruments and statistical methods and modeling.The two research projects, briefly described below, will provide the active environment for training in the setting of improving health outcomes for key health disparity areas. These are challenging studies, but they seek tohave an impact on important areas of health disparities. The Center proposes to devote substantial resources to these research efforts. The two studies take different, but complementary approaches to building research capacity. The diabetes and depressive symptoms study brings together accomplished senior investigators inthese substantive areas. They will merge interventions in an effort to improve care for both conditions. Junior investigators will participate in the study with the goal of moving them toward career development awardfunding. The HIV prevention study is being led by two relatively junior investigators, one of whom is a Project EXPORT product (having previously had pilot project funding). They will be mentored and supported by several senior investigators who have extensive experience in addressing the issues upon which the study is focused.Both approaches should serve the goal of making important contributions to disparities research, whileadvancing the career development of investigators in the field.Diabetes and Depression Study The complications from diabetes are particularly severe among older Latinos, a rapidly growing population witha high prevalence of the disease. Recently, Dr. Mangione (project co-leader) demonstrated that a self-care intervention improves diabetes outcomes for older Latinos. However, 30 percent of these older Latinos were depressed, and the intervention did not result in improved diabetes outcomes for this subset of depresseddiabetics. This finding is not surprising given that depression results in lack of motivation, negative attitudes towards change, and lack of assertiveness necessary to garner support for good diabetes self care. Dr.Miranda (project co-leader) has demonstrated that Cognitive Behavioral Therapy is highly effective for treating depression in low-income Latinos and has recently modified this depression intervention so that it can be given by non-mental health professionals. In this project, Drew examines the impact of a mood treatment enhanceddiabetes self-care intervention for depressed, low-income Latino diabetics. Drew hypothesizes that the moodtreatment enhancement will lead to significant improvement in both diabetes and depression outcomes ascompared with the self-care intervention alone.
The specific aims of this project are:1. To improve diabetes and depression outcomes for older Latinos through development of a self-carediabetes intervention combined with a depression treatment intervention.2. To support dissemination of positive findings from our intervention to the community through ourongoing participation in the Community Core with the 'Witness for Wellness and Building Bridges toOptimum Health - Diabetes Throughout the Lifespan' community dissemination projects.Diana Echeverry, MPH, MD, (Hispanic endocrinologist and assistant professor, Drew) and Kenrik Duru, MD,MSHS (African American internist and assistant professor, UCLA) will serve as emerging junior researchfaculty for the diabetes and depression study. The study will be led by accomplished senior investigators in theareas of depression care (Jeanne Miranda), diabetes self-care (Carol Mangione), clinical investigation indiabetes (Mayer Davidson), and quality improvement for the treatment of diabetes and other chronic diseasesin indigent care settings (Michael Rodriguez and Mohsen Bazargan).HIV Prevention StudyHIV directly or indirectly related to men having sex with men is the single largest contributor to HIV infectionamong Blacks.55 In states with long-term HIV reporting, cases attributed to sex between men account for anestimated 49 percent of US HIV/AIDS cases diagnosed among Black men and a substantial but unknownpercentage of cases diagnosed among Black women between 2001 and 2004.56 No other single risk factoraccounts for a larger proportion of cases. Drew proposes to test the efficacy of the Men of African AmericanLegacy Empowering Self (MAALES) Project, a newly developed, novel, and culturally congruent interventiondesigned to reduce HIV risk-related behaviors and improve psychosocial outcomes. The MAALES interventionwas developed through an extensive formative research process and involves six two-hour group sessionsheld over three weeks with six men and lead by two ethnically matched co-facilitators. This project will beamong the first to develop and test a HIV risk-reduction intervention designed specifically for African AmericanMSMW. The Primary Aims include:1) Determine the impact of the MAALES intervention on: (a) HIV-related sexual risk behaviors and (b) sexunder the influence of drugs and alcohol among African American MSMW, and2) Determine the impact of the MAALES intervention condition on psychosocial outcomes, includingreducing HIV stigma and increasing racial/cultural pride among African American MSMW.The Exploratory Aims are to:1) Examine whether reductions in internalized homophobia and gender role conflicts act as mediators ofthe sex under the influence of drugs.2) Examine whether psychological distress (i.e., depression and anxiety) predicts for risky sexualbehaviors and moderates the MAALES intervention condition's efficacy.Nina T. Harawa, MPH, PhD, (African American epidemiologist and newly appointed as an assistant professor,Department of Research, Drew) will serve as the PI for the HIV prevention study. Dr. Harawa was initiallyinvolved with Drew/UCLA as a pilot project investigator. She has since become a full-time faculty member atDrew, and due to the potential for innovative advances in health disparities in HIV/AIDS among AfricanAmericans, her pilot project has evolved into a full project for the Drew/UCLA EXPORT Center. The Co-Pi onthe project is John Williams, MD, an African American psychiatrist, and an assistant professor, Department ofPsychiatry and Biobehavioral Sciences, UCLA. The mentors include senior faculty with expertise in HIVprevention Drs. Thomas Coates and Hector Myers, and other senior faculty with research studies of HIVbehaviors and health care by Drs. Martin Shapiro and William Cunningham (primary project mentor).The products of these two research projects will include new evidenced-based strategies to improve outcomesfor (1) patients with diabetes and depression and (2) populations at high risk for HIV/AIDS. Additionaloutcomes will include scientific papers and transferable experience working with the community in designinginterventions that are evidence-based, acceptable to the community and have the potential of decreasingadditional health disparities in the population.
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