Strategic Goal: Goal 2: Reduce Human Disease

How do we address health disparities especially in our most vulnerable populations?

How do we address health disparities especially in our most vulnerable populations, including children?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Research Advocacy Committee, American Thoracic Society

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Strategic Goal: Goal 3: Advance Translational Research

Health Behavior Change in Vulnerable Individuals

What knowledge about health behavior change can be leveraged to design innovative and effective strategies for behavior change among the most vulnerable individuals?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Significant health disparities exist in part because primary and secondary prevention strategies are not optimal for particularly vulnerable populations, who often grapple with multiple co-morbidities and low resources. Improving health promotion efforts by targeting health behaviors could help to close the disparity gap.

Feasibility and challenges of addressing this CQ or CC :

Many health damaging behaviors, such as smoking, are much more prevalent in certain groups than in the population at large. Multi-level efforts to promote health behavior change have not been optimally effective in these vulnerable groups. We need to build on what we know, understand the gaps, and develop new, culturally sensitive behavior change intervention strategies that will be effective for all groups.

Multi-level strategies to change health-damaging behaviors are effective for some behaviors, but tend to be least effective for the most vulnerable populations. For example, the percentage of people who smoke has decreased dramatically in the last 60 years, but significantly less so for racial and ethnic minorities, those with mental health issues, low income groups, and other vulnerable individuals. These differences contribute to health disparities among these groups, and are in part due to the need for multiple risk reduction and for strategies that are culturally informed.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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Strategic Goal: Goal 1: Promote Human Health

Health Disparities and Sleep

What is the role of health disparities in sleep and circadian health development?

Submitted by (@jcs500)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

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Strategic Goal: Goal 3: Advance Translational Research

Improving heart, lung, blood, sleep Health Outcomes for Minority and Underserved Men

What are the best strategies to improve implementation of evidence-based practices (EBP) to enhance effective health risk communication strategies among racial and ethnic minority males and underserved men? Examples of several issues that need to be addressed are: • Need for better definition of the role of families/communities in EBP (as co-therapists). • Requires less system fragmentation • Need for improved measurement, ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Our improved ability to develop, implement and disseminate EBPs tailored specifically for men in health disparity populations may help us move beyond current obstacles in addressing health inequities and improve health outcomes.

Some current challenges:

• High blood pressure affects more than 40 percent of African Americans.

• The odds for stroke, the third leading cause of death in the United States, are especially high for African American men at 70%.

• African Americans are about 50% more likely to experience stroke than Caucasians.

• Sleep apnea is seen more frequent among men than among women, particularly among African-American and Hispanic men.

• Life expectancy for African American men is 4.7 years less than for white men (2010).

• Native American men have an average life expectancy of 71 years old compared to white men who have an average life expectancy of 76.5 year.

Feasibility and challenges of addressing this CQ or CC :

• Shifting demographics of race as well as ageing of the population in this country will have a major impact on the utilization, organization and delivery of health care.

• Country acknowledges significant economic burden of health inequities in the U.S. in the near future.

• Hospitals and health systems are working hard to align quality improvement goals with disparities solutions. Opportunity to leverage these efforts for the development and implementation of targeted health disparities initiatives is timely.

• HL has a number of large population-based studies (such as JHS, Strong Heart, Hispanic Community Health) that could be leveraged to specifically identify EBP for wider implementation and dissemination to underserved areas.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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Strategic Goal: Goal 3: Advance Translational Research

Addressing Health Inequities through Nontraditional Partnerships

What non-traditional partnerships can be leveraged to address health inequities?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

- Broaden reach to underserved populations

- Increase ability to generate evidence based solutions to address health inequities

- Bring expertise and resources to core partner (NIH)

- Enhance ability to identify unanticipated problems and strengthen efforts across all phases of the implementation research agenda

Feasibility and challenges of addressing this CQ or CC :

Feasibility:

- Increased emphasis on health and health inequities by non-profit and particularly, for-profit organizations

- Affordable Care Act (ACA) includes both general and explicit provisions that could narrow the health disparities gaps through implementation research.

- Can leverage and build upon current research partnerships that exist between government agencies and health care delivery systems to address questions of major public health importance

- Opportune time to employ implementation research addressing health inequities through non-traditional research partnership with sectors such as education, state and local government, transportation (built environment), penal and re-entry systems (health risks and disparities), ministries of health, and for-profits, foundations, and non-profits with health care focus.

 

 

Challenges:

 

 

- Risk of disagreements and friction among partners and management with different priorities

 

- Synchronization of timing for decision making

 

- Achieving partners’ concurrence on decisions that provide the most cost effective solutions

 

- Time needed to establish trust among partners that do not routinely partner to address health inequities

 

- There are limited resources dedicated to fostering Public Private Partnerships

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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Strategic Goal: Goal 2: Reduce Human Disease

Reducing Disparities

Given the dearth of information on cardiovascular, lung, and hematologic outcomes in minorities, NHLBI should develop strategic aims that promote evaluation of these outcomes and potential interactions with kidney disease that disproportionately affect minorities.

Submitted by (@golan0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

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Strategic Goal: Goal 2: Reduce Human Disease

HEALTH CARE DISPARITIES IN DIAGNOSIS AND TREATMENT OF COMMON SLEEP AND CIRCADIAN DISORDERS

There is evidence of a higher prevalence of sleep and circadian disorders in different ethnic groups. This is true for both adult and pediatric subjects. There is also evidence that minority populations in lower socioeconomic groups do not seek evaluation for sleep disorders as frequently as other segments of our population. There is also evidence that they are less adherent to treatments such as nasal CPAP for obstructive ...more »

Submitted by (@jnoel0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Sleep disorders are more common in minority populations. Moreover, these populations have higher rates of the known consequences of these disorders such as stroke, myocardial infarction, hypertension, resistant hypertension. Despite this, current population studies such as the Sleep Heart Health Study have included only a very small percentage of African Americans. The impact of this would be the following:

 

a. Elucidating the basis of barriers to case identification in these group

b. Designing specific intervention to overcome these barriers.

c. Developing methods to improve adherence to therapy in this group.

d. Removing sleep and circadian disorders as a risk factor for consequences such as stroke, cardiovascular disease and resistant hypertension in minority populations

Feasibility and challenges of addressing this CQ or CC :

There is a developing interest in this area in the field of circadian and sleep research. There is a developing knowledge base about health disparities in sleep and circadian disorders. Minority institutions such as Morehouse have developing programs in this area. We also have mobile technology that facilitates study of sleep and circadian disorders in minority populations.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

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Strategic Goal: Goal 1: Promote Human Health

ROLE OF HEALTH DISPARITIES IN SLEEP AND CIRCADIAN HEALTH—ENVIRONMENT

Self-report data indicate that insufficient sleep is more common in minority populations. This seems to be related to socioeconomic status. There is a need to move this beyond self-report and obtain objective measures in the relevant populations. Moreover, the basis of this difference needs to be established. What aspect of the environment leads to these differences, e.g., noise, stress related to sense of vulnerability, ...more »

Submitted by (@jnoel0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Self-report indicates that sleep duration is lower in minority populations. This seems to be related to socioeconomic groups. To address this issue requires understanding the basis of this and developing appropriate interventions.

 

The impact of this is as follows:

 

a. Implementing new technology based on mobile approaches to assess sleep duration in subjects in different socioeconomic groups.

b. Developing a comprehensive approach to understanding and evaluating environmental influences in sleep and circadian rhythm.

c. Designing and testing intervention to increase sleep duration in disadvantaged populations.

d. Improving the sleep health of minority populations.

Feasibility and challenges of addressing this CQ or CC :

There is rapidly developing new mobile technology to assess sleep duration and other phenotypes in individuals living in their normal lives. There are a number of studies currently being conducted that could be leveraged to address this question. There are also developing approaches to assess environmental influences on sleep and circadian rhythm such as noise, light exposure, etc. Thus, this question could be addressed in the near future.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

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Strategic Goal: Goal 2: Reduce Human Disease

Asthma Disparities in Low income children

What are the most effective methods to reduce asthma disparities in low income children?

Submitted by (@lwright8)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Despite advances in care, asthma inequities are persistent among low income children. What are the most effective measures to close the gap?

Feasibility and challenges of addressing this CQ or CC :

There are multiple strategies but what are the most effective treatment options in low income children who have higher morbidity and mortality?

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Strategic Goal: Goal 3: Advance Translational Research

Disparities in cardiac arrest care

How do we eliminate disparities in cardiac arrest care?

Submitted by (@rebecca.lehotzky)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : AHA Staff & Volunteers

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Strategic Goal: Goal 3: Advance Translational Research

Addressing Health Care Disparities Requires Pragmatic Research

Jumpstarting progress in eliminating health care disparities requires comparative effectiveness and implementation research (T3 and T4) regarding optimal strategies for ensuring health care equity in the real world. Ensuring minority and other socially disadvantaged groups receive and benefit from evidence-based interventions at the same rate as others requires pragmatic research that identifies and addresses barriers ...more »

Submitted by (@kevinfiscella)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Meeting this challenge offers promise for elimination of disparities in morbidity and mortality among minority and other socially disadvantaged groups. Many major health care organizations are hungry for science-based interventions and implementation strategies for ensuring equitable care relevant to heart, lung, blood and sleep conditions. Pragmatic scientific evidence in these areas is urgently needed.

Feasibility and challenges of addressing this CQ or CC :

There are several feasibility challenges. The first is the broader challenge surrounding pragmatic, comparative effectiveness and implementation research including its integration within health care systems. Too little of this type research is conducted by funded institutions within their own health care systems. This failure reduces the likelihood that research findings, including best strategies for improving equity in health care delivery, will be adopted by health care systems. Ultimately, those responsible for implementation along with those receiving care must be active research partners in conducting pragmatic research in order to ensure that the research addresses real world priorities and feasibility issues.This represents a major shift in research paradigms but is critical to the success of health care disparities research.

 

The second challenge is that research funding streams narrow along the translational continuum. This poses a challenge to pragmatic research that focuses on equity in care. There is no doubt that research along the entire research continuum is needed to address health and health care disparities. However, research focusing on ensuring provision of evidenced-based interventions for groups least likely to receive them will have the most immediate impact.

Name of idea submitter and other team members who worked on this idea : Kevin Fiscella, MD, MPH

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Strategic Goal: Goal 4: Develop Workforce and Resources

Research training to support population-focused obesity research in ethnic minority populations

NIH is already facing a challenge in increasing the number and viability of researchers of color. Obesity research in black (or other high risk minority) populations can be used to explore how research training programs that focus on specific issues of importance to populations of color might contribute to the recruitment and success of ethnic minority researchers in the NIH system.

Submitted by (@skumanyi)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

To say the least, not all researchers of color study disparities related issues and not all disparities research is done by researchers of color. That is the way it should be. However, I suspect that research focusing on populations of color would attract a greater than average proportion of researchers of color (NIMHD might have data on this but NIMHD funding alone would be grossly insufficient as the only relevant funding stream. It would also be inappropriate and ineffective to silo the entire burden as an NIMHD responsibility).

Feasibility and challenges of addressing this CQ or CC :

The infrastructure for such training might not exist. Isolated minority researchers attached to various centers and programs would not necessarily work; some sort of networking would have to be done based on an infrastructure devoted to population-oriented obesity research and with a critical mass of obesity researchers focusing on the black (or other) population..

Name of idea submitter and other team members who worked on this idea : Shiriki Kumanyika, Melicia Whitt-Glover, Debra Haire-Joshu

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