1
|
Ogletree AM, Percy-Laurry A, Assenov A, Dinwiddie GY, Jones NL, Marshall VJ, Motley ER, Williams-Parry K, Farhat T. Social Determinants of Health Research at NIMHD: An Analysis of Studies Funded During 2019-2023. Am J Prev Med 2024; 67:713-721. [PMID: 38971453 PMCID: PMC11499023 DOI: 10.1016/j.amepre.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Social determinants of health (SDOH) contribute to differences in health outcomes and exacerbate health disparities. This study characterizes the National Institute on Minority Health and Health Disparities' (NIMHD) portfolio of funded grants in SDOH research, identifies gaps, and provides suggestions for future research. METHODS Using the National Institutes of Health's SDOH Research, Condition, and Disease Categorization, research projects funded from 2019 to 2023 were identified and linked with NIMHD's internal coding system to extract in-depth study characteristics, including sociodemographics of study participants, disease and condition focus, and alignment with strategic priorities. Natural Language Processing methods were used to categorize projects into five Healthy People 2030 SDOH domains. RESULTS The resulting sample included 675 unique research projects. Most projects included racial and ethnic minority groups (89%), followed by people with lower socioeconomic status (33%), underserved rural communities (16%), and sexual and gender minority groups (13%). Most projects focused on the Etiology of health disparities (61%), followed by Interventions (54%), and Methods and Measurement (39%). Of the Healthy People 2030 domains, Social and Community Context had the greatest representation (61%) whereas Education Access and Quality had the least (6%). Variation in research project characteristics across SDOH domains is also presented. CONCLUSIONS This study documents characteristics of SDOH research funded by NIMHD and explores how they differ across Healthy People 2030 SDOH domains. Findings highlight how study characteristics and foci align with strategic priorities and suggest opportunities for future research.
Collapse
Affiliation(s)
- Aaron M Ogletree
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
| | - Antoinette Percy-Laurry
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Assen Assenov
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Gniesha Y Dinwiddie
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Nancy L Jones
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Vanessa J Marshall
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Essence R Motley
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Kester Williams-Parry
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Tilda Farhat
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
2
|
Biglan A, Prinz RJ, Fishbein D. Prevention Science and Health Equity: A Comprehensive Framework for Preventing Health Inequities and Disparities Associated with Race, Ethnicity, and Social Class. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:602-612. [PMID: 36757658 DOI: 10.1007/s11121-022-01482-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/10/2023]
Abstract
The ultimate goal of our public health system is to reduce the incidence of disability and premature death. Evidence suggests that, by this standard, the USA falls behind most other developed countries largely as a function of disparities in health outcomes among significant portions of the US population. We present a framework for addressing these disparities that attributes them, not simply to differences in the behavioral and physical risk factors, but to social, environmental, and structural inequities such as poverty, discrimination, toxic physical setting, and the marketing of harmful products. These inequities result from de facto and instituted public policies. An analysis of the NIH research portfolio indicates a relative lack of investment in experimental evaluations of preventive interventions-especially studies targeting disadvantaged populations. Moreover, experimental research on reducing social inequities is almost entirely lacking. A line of research focusing on the drivers of inequities and their dissolution must include experimental evaluation of strategies for getting policies adopted that will reduce inequities. In conclusion, a summary is provided of the types of research that are needed and the challenges involved in conducting the experimental research that is essential for reducing inequities and disparities and, in turn, prolonging life.
Collapse
Affiliation(s)
- Anthony Biglan
- Oregon Research Institute, 2324 West 28th Avenue, Eugene, Eugene, OR, 97405, USA. .,National Prevention Science Coalition to Improve Lives, Pennsylvania, USA.
| | - Ronald J Prinz
- University of South Carolina, Columbia, USA.,National Prevention Science Coalition to Improve Lives, Pennsylvania, USA
| | - Diana Fishbein
- University of North Carolina, Chapel Hill, USA.,The Pennsylvania State University, Pennsylvania, USA.,National Prevention Science Coalition to Improve Lives, Pennsylvania, USA
| |
Collapse
|
3
|
Ganoza LF, Villani J, Klabunde CN. Investment in Prevention Health Care Delivery Research by the National Institutes of Health. Med Care 2023; 61:75-80. [PMID: 36630558 PMCID: PMC9846585 DOI: 10.1097/mlr.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Research assessing the delivery of preventive health care has considerable potential for improving health outcomes and reducing health care costs for the United States population. OBJECTIVE To characterize the prevention health care delivery research grant portfolio supported by the National Institutes of Health (NIH). MATERIALS AND METHODS A random sample of 14,523 NIH research projects funded during 2012-2019 was selected and coded for various study topics using a structured taxonomy. We analyzed the subset of prevention research projects, for which health care delivery was identified as an independent or dependent variable, including study characteristics and funding trends. RESULTS Overall, 11.2% of NIH-funded prevention research projects were relevant to health care delivery. Of these projects, 68.6% assessed access to care, 53.4% examined quality, and 27.1% assessed costs. Over the study period, the percentage of funded prevention research projects involving health care delivery increased from 10.9%-15.1%. Over half of the projects assessed research related to the prevention of a new health condition, identification of risk factors, or health promotion (55.5%), whereas < half addressed prevention of disease progression/recurrence (40.4%), screening for early disease (20.2%), or screening for risk factors (1.4%). human immunodeficiency virus/acquired immune deficiency syndrome, cancer, and substance use were the most prevalent health topics studied, whereas other topics-such as lung diseases and Alzheimer disease-were less frequently studied. CONCLUSIONS Health care delivery research comprises a modest portion of the NIH prevention research portfolio and is mostly focused on access and quality of care; cost-related analyses are less prevalent.human immunodeficiency virus/acquired immune deficiency syndrome, cancer, and substance use are frequently studied health topics in this portfolio.
Collapse
Affiliation(s)
- Luis F. Ganoza
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, 6705 Rockledge Drive, Room 733, MSC 7990, Bethesda, MD 20892
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Three White Flint North, 11601 Landsdown St, North Bethesda, MD 20852
| | - Carrie N. Klabunde
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, 6705 Rockledge Drive, Room 733, MSC 7990, Bethesda, MD 20892
| |
Collapse
|
4
|
Ganoza LF, Alvidrez J, Liggins CA. Assessing National Institutes of Health Prevention Research on Leading Causes of Death Focused on Racial or Ethnic Minority Populations, Fiscal Years 2016-2020. Ethn Dis 2023; 33:44-50. [PMID: 38846263 PMCID: PMC11152156 DOI: 10.18865/1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Objective To characterize the National Institutes of Health (NIH) prevention research portfolio on leading causes of death focused on racial or ethnic minority populations. Research Design Longitudinal analysis of NIH-funded prevention research projects from FY2016-FY2020. Measures Project characteristics including type of prevention, study design, budget, minority health focus, and causes of death addressed. Results Minority health projects comprised 27.0% of prevention projects and 33.1% of funding across all leading causes of death. Homicide (42.9%), diabetes (36.3%), and stroke (35.5%) had the highest proportion of minority health projects and suicide (20.2%), Alzheimer disease (18.8%), and pneumonia or influenza (8.3%) the lowest. Most minority health projects focused on identifying risk factors or on primary prevention efforts (80.3%). Most projects had an observational design (80.0%), and this predominance was observed for each cause of death. There was a significant correlation between the proportion of minority health projects for cause of death and the ratio of minorities versus non-minorities mortality rate. Conclusions Only about one-fourth of NIH-funded prevention research on leading causes of death focused on racial or ethnic minorities, who currently comprise about 40% of the US population. Only a small fraction of minority health prevention projects included an intervention design, suggesting a limited contribution to the evidence base on effective interventions to address racial or ethnic mortality disparities. Also, we identified that the number of projects increase where mortality rate disparities are higher. This portfolio analysis provides a useful baseline to assess future progress in building the minority health prevention research portfolio, a critical component to promoting health equity in population health.
Collapse
Affiliation(s)
- Luis F. Ganoza
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, MD
| | - Jennifer Alvidrez
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, MD
| | - Charlene A. Liggins
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, MD
| |
Collapse
|
5
|
Alvidrez JL, Barksdale CL. Perspectives From the National Institutes of Health on Multidimensional Mental Health Disparities Research: A Framework for Advancing the Field. Am J Psychiatry 2022; 179:417-421. [PMID: 35599536 DOI: 10.1176/appi.ajp.21100969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Racial, ethnic, and other mental health disparities have been documented for several decades. However, progress in reducing or eliminating these disparities has been slow. In this review, the authors argue that understanding and addressing mental health disparities requires using a multidimensional lens that encompasses a wide array of social determinants of health at individual, interpersonal, organizational, community, and societal levels. However, much of the current research on mental health disparities, including research funded by the National Institutes of Health, is characterized by a narrower focus on a small number of determinants. The authors offer a research framework, adapted from the National Institute on Minority Health and Health Disparities Research Framework, that provides examples of determinants that may cause or sustain mental health disparities and that can serve as intervention targets to reduce those disparities. They also discuss different types of mental health disparities research to highlight the need for more research testing and implementing interventions that directly modify social determinants of health and promote mental health equity.
Collapse
Affiliation(s)
- Jennifer L Alvidrez
- Office of Disease Prevention, NIH, Bethesda, Md. (Alvidrez); Office for Disparities Research and Workforce Diversity, NIMH, Bethesda, Md. (Barksdale); National Institute on Minority Health and Health Disparities, NIH, Bethesda, Md. (Barksdale)
| | - Crystal L Barksdale
- Office of Disease Prevention, NIH, Bethesda, Md. (Alvidrez); Office for Disparities Research and Workforce Diversity, NIMH, Bethesda, Md. (Barksdale); National Institute on Minority Health and Health Disparities, NIH, Bethesda, Md. (Barksdale)
| |
Collapse
|
6
|
Lieu TA, Wojtowicz A, Stratton K. Closing Evidence Gaps in Clinical Prevention: A Report From the National Academies of Sciences, Engineering, and Medicine. JAMA 2022; 327:815-816. [PMID: 35085389 DOI: 10.1001/jama.2022.0849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Alexis Wojtowicz
- Board on Population Health, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Kathleen Stratton
- Board on Population Health, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC
| |
Collapse
|
7
|
Oyedele NK, Ganoza LF, Schully SD, Liggins CA, Murray DM. NIH Primary and Secondary Prevention Research in Humans: a Portfolio Analysis of Study Designs Used in 2012-2019. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:477-487. [PMID: 35064895 DOI: 10.1007/s11121-022-01337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
We can learn a great deal about the research questions being addressed in a field by examining the study designs used in that field. This manuscript examines the research questions being addressed in prevention research by characterizing the distribution and trends of study designs included in primary and secondary prevention research supported by the National Institutes of Health through grants and cooperative agreements, together with the types of prevention research, populations, rationales, exposures, and outcomes associated with each type of design. The Office of Disease Prevention developed a taxonomy to classify new extramural NIH-funded research projects and created a database with a representative sample of 14,523 research projects for fiscal years 2012-2019. The data were weighted to represent the entirety of the extramural research portfolio. Leveraging this dataset, the Office of Disease Prevention characterized the study designs proposed in NIH-funded primary and secondary prevention research applications. The most common study designs proposed in new NIH-supported prevention research applications during FY12-19 were observational designs (63.3%, 95% CI 61.5%-65.0%), analysis of existing data (44.5%, 95% CI: 42.7-46.3), methods research (23.9%, 95% CI: 22.3-25.6), and randomized interventions (17.2%, 95% CI: 16.1%-18.4%). Observational study designs dominated primary prevention research, while intervention designs were more common in secondary prevention research. Observational designs were more common for exposures that would be difficult to manipulate (e.g., genetics, chemical toxin, and infectious disease (not pneumonia/influenza or HIV/AIDS)), while intervention designs were more common for exposures that would be easier to manipulate (e.g., education/counseling, medication/device, diet/nutrition, and healthcare delivery). Intervention designs were not common for outcomes that are rare or have a long latency (e.g., cancer, neurological disease, Alzheimer's disease) and more common for outcomes that are more common or where effects would be expected earlier (e.g., healthcare delivery, health related quality of life, substance use, and medication/device). Observational designs and analyses of existing data dominated, suggesting that much of the prevention research funded by NIH continues to focus on questions of association and on questions of identification of risk and protective factors. Randomized and non-randomized intervention designs were included far less often, suggesting that a much smaller fraction of the NIH prevention research portfolio is focused on questions of whether interventions can be used to modify risk or protective factors or to change some other health-related biomedical or behavioral outcome. The much heavier focus on observational studies is surprising given how much we know already about the leading risk factors for death and disability in the USA, because those risk factors account for 74% of the county-level mortality in the USA, and because they play such a vital role in the development of clinical and public health guidelines, whose developers often weigh results from randomized trials much more heavily than results from observational studies. Improvements in death and disability nationwide are more likely to derive from guidelines based on intervention research to address the leading risk factors than from additional observational studies.
Collapse
Affiliation(s)
- Natasha K Oyedele
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD, USA.
| | - Luis F Ganoza
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD, USA
| | - Sheri D Schully
- All of Us Research Program, Office of the Director, NIH, Bethesda, MD, USA
| | - Charlene A Liggins
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD, USA
| | - David M Murray
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, MD, USA
| |
Collapse
|