Research Core Nearly half of all preventable deaths in the U.S. are related to high-risk behaviors. Community health campaigns 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 within low-income and minority communities to eliminate health disparities. The Research Core includes two full research projects covering: (1) diabetes and depression and (2) HIV/AIDS. Since Drew opted to include the optional Research Training and Pilot Core, Drew placed the """"""""active mentorship of the pilot projects and pilot investigators"""""""" 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 training environment. An important goal of the Research Core is to develop infrastructure that will support the development 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 improved survey 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 to have 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 in these 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 award funding. 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, while advancing 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 with a 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 depressed diabetics. 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 enhanced diabetes self-care intervention for depressed, low-income Latino diabetics. Drew hypothesizes that the mood treatment enhancement will lead to significant improvement in both diabetes and depression outcomes as compared 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-care diabetes intervention combined with a depression treatment intervention. 2. To support dissemination of positive findings from our intervention to the community through our ongoing participation in the Community Core with the """"""""Witness for Wellness and Building Bridges to Optimum 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 research faculty for the diabetes and depression study. The study will be led by accomplished senior investigators in the areas of depression care (Jeanne Miranda), diabetes self-care (Carol Mangione), clinical investigation in diabetes (Mayer Davidson), and quality improvement for the treatment of diabetes and other chronic diseases in indigent care settings (Michael Rodriguez and Mohsen Bazargan). HIV Prevention Study HIV directly or indirectly related to men having sex with men is the single largest contributor to HIV infection among Blacks.55 In states with long-term HIV reporting, cases attributed to sex between men account for an estimated 49 percent of US HIV/AIDS cases diagnosed among Black men and a substantial but unknown percentage of cases diagnosed among Black women between 2001 and 2004.56 No other single risk factor accounts for a larger proportion of cases. Drew proposes to test the efficacy of the Men of African American Legacy Empowering Self (MAALES) Project, a newly developed, novel, and culturally congruent intervention designed to reduce HIV risk-related behaviors and improve psychosocial outcomes. The MAALES intervention was developed through an extensive formative research process and involves six two-hour group sessions held over three weeks with six men and lead by two ethnically matched co-facilitators. This project will be among the first to develop and test a HIV risk-reduction intervention designed specifically for African American MSMW. The Primary Aims include: 1) Determine the impact of the MAALES intervention on: (a) HIV-related sexual risk behaviors and (b) sex under the influence of drugs and alcohol among African American MSMW, and 2) Determine the impact of the MAALES intervention condition on psychosocial outcomes, including reducing 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 of the sex under the influence of drugs. 2) Examine whether psychological distress (i.e., depression and anxiety) predicts for risky sexual behaviors 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 initially involved with Drew/UCLA as a pilot project investigator. She has since become a full-time faculty member at Drew, and due to the potential for innovative advances in health disparities in HIV/AIDS among African Americans, her pilot project has evolved into a full project for the Drew/UCLA EXPORT Center. The Co-Pi on the project is John Williams, MD, an African American psychiatrist, and an assistant professor, Department of Psychiatry and Biobehavioral Sciences, UCLA. The mentors include senior faculty with expertise in HIV prevention Drs. Thomas Coates and Hector Myers, and other senior faculty with research studies of HIV behaviors 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 outcomes for (1) patients with diabetes and depression and (2) populations at high risk for HIV/AIDS. Additional outcomes will include scientific papers and transferable experience working with the community in designing interventions that are evidence-based, acceptable to the community and have the potential of decreasing additional health disparities in the population.
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