NIDA Council MeetingNIDA Council Meeting

Bethesda, MarylandBethesda, Maryland

February 12, 2004February 12, 2004

Funded by NIDA Contract N01DA-1-1200Funded by NIDA Contract N01DA-1-1200

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

1)1) Increasing the amount and Increasing the amount and quality of interdisciplinary quality of interdisciplinary translational research on translational research on Hispanic drug abuse; andHispanic drug abuse; and

2)2) Fostering the development of Fostering the development of Hispanic scientists in drug Hispanic scientists in drug abuseabuse

Major ActivitiesMajor Activities

National Network of Hispanic scientists, National Network of Hispanic scientists, students & NIH federal advisorsstudents & NIH federal advisors

National scientific conferenceNational scientific conference Summer Research Training Institute for Summer Research Training Institute for

graduate students & post-doctoral graduate students & post-doctoral fellowsfellows

On-line Measures ArchiveOn-line Measures Archive Website (www.HispanicScience.org)Website (www.HispanicScience.org)

A National Strategic Plan for A National Strategic Plan for Hispanic Drug Abuse Hispanic Drug Abuse

ResearchResearch

Funded by Robert Wood Johnson Foundation

Social Cultural

Psychological Biological

GoalGoal

To identify gaps in To identify gaps in research and scientific research and scientific opportunities – that can opportunities – that can quicken the rate of quicken the rate of discovery with regard to discovery with regard to Hispanic drug abuseHispanic drug abuse

Why?Why?

To improve the health of To improve the health of HispanicsHispanics

To capitalize on ethnic To capitalize on ethnic variability to enhance our variability to enhance our scientific understanding scientific understanding of universal principlesof universal principles

National Strategic PlanNational Strategic PlanHortensia Amaro, Ph.D. Hortensia Amaro, Ph.D.

ChairChair Epidemiology Epidemiology Human Genome & NeurobiologyHuman Genome & Neurobiology PreventionPrevention TreatmentTreatment Health ServicesHealth Services Blending Research to PracticeBlending Research to Practice HIV/AIDSHIV/AIDS Training & MentoringTraining & Mentoring

Development ProcessDevelopment Process

More than 60 researchers participated More than 60 researchers participated in the formulation of the Strategic Planin the formulation of the Strategic Plan

Each chapter was externally reviewed Each chapter was externally reviewed by a minimum of 2 outside experts in by a minimum of 2 outside experts in the field of drug abuse research the field of drug abuse research

NHSN Steering Committee provided a NHSN Steering Committee provided a second level of reviewsecond level of review

Common ThemesCommon Themes No or low samples of Hispanics in No or low samples of Hispanics in

most drug abuse research studiesmost drug abuse research studies

Few studies provide analyses of Few studies provide analyses of data by race/ethnicity including data by race/ethnicity including HispanicsHispanics

NIH Guidelines for inclusion of NIH Guidelines for inclusion of racial/ethnic minorities and racial/ethnic minorities and valid valid analysesanalyses

Common ThemesCommon Themes

Few studies of prevention and Few studies of prevention and treatment interventions with treatment interventions with HispanicsHispanics

Few validated instruments in Few validated instruments in Spanish Spanish

Need for a better understanding of Need for a better understanding of the role of culture, cultural the role of culture, cultural adaptation and acculturation in adaptation and acculturation in drug use/abuse drug use/abuse

Common ThemesCommon Themes

Few Hispanic researchers Few Hispanic researchers across all areas, but particularly across all areas, but particularly severe in behavioral prevention severe in behavioral prevention and treatment intervention and treatment intervention researchresearch

Hispanics are 13%Hispanics are 13% of the US populations of the US populations

4 genetic studies4 genetic studies 4 adolescent behavioral 4 adolescent behavioral

treatment trials from one labtreatment trials from one lab 3 pharmacotherapy trials3 pharmacotherapy trials No behavioral treatment trials No behavioral treatment trials

of Latinasof Latinas

EPIDEMIOLOGYEPIDEMIOLOGY

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).”

““Hispanic adolescents are more likely Hispanic adolescents are more likely to abuse drugs, especially crack to abuse drugs, especially crack cocaine, heroin, and ‘ice,’ than are cocaine, heroin, and ‘ice,’ than are adolescents from other ethnic groups adolescents from other ethnic groups (Johnston, O’Malley & Bachman, (Johnston, O’Malley & Bachman, 2003). 2003).

Inhalants- epidemicInhalants- epidemic

Latino youth are more likely to Latino youth are more likely to report having been approached by report having been approached by someone selling drugssomeone selling drugs

Latinos experience more serious Latinos experience more serious consequences of drug use (e.g., consequences of drug use (e.g., school drop out, prison, HIV)school drop out, prison, HIV)

Such consequences may be a Such consequences may be a function of lower access to drug function of lower access to drug abuse treatment services. abuse treatment services.

Hispanics report as much need for Hispanics report as much need for services as Whites, but are more services as Whites, but are more likely to report not receiving likely to report not receiving services and to be less satisfied services and to be less satisfied with the services they receive.with the services they receive.

EpidemiologyEpidemiology NativityNativity

US born Latinos in all sub-groups report US born Latinos in all sub-groups report higher rates of use, abuse and higher rates of use, abuse and dependence than immigrantsdependence than immigrants

Many studies show that higher Many studies show that higher acculturation leads to more drug use, but acculturation leads to more drug use, but this does explain drug use for all Latino this does explain drug use for all Latino groupsgroups

Risk and Protective Factors Risk and Protective Factors for Drug Use for Drug Use

Social Context EffectsSocial Context Effects

Familism (family as referent, value family) Familism (family as referent, value family) is uniquely important in the Latino culture is uniquely important in the Latino culture and is seen as protective against drug use; and is seen as protective against drug use; and should be studied as a protective and should be studied as a protective factor factor

Factors that diminish the positive influence Factors that diminish the positive influence of the family should be investigated.of the family should be investigated.

Future ResearchFuture Research

Empirically validated measures for Empirically validated measures for acculturation (cultural change) need acculturation (cultural change) need further evaluation.further evaluation.

What are the mechanisms by which What are the mechanisms by which acculturation influence drug use? acculturation influence drug use?

YOUTHSYOUTHS

PARENTSPARENTSINTER-GENERATIONAL/

INTER-GENERATIONAL/

ACCULTURATIONAL DIFFERENCES

ACCULTURATIONAL DIFFERENCES

TIMETIME

AC

CU

LT

UR

AT

ION

AC

CU

LT

UR

AT

ION

(Szapocznik, Scopetta, Aranalde & Kurtines, 1978)(Szapocznik, Scopetta, Aranalde & Kurtines, 1978)

In First Generation Hispanic immigrant families,In First Generation Hispanic immigrant families,

In second generation adolescents, In second generation adolescents,

.13

.48**

.23**

.15

-.68**

** = p<.01** = p<.01

(Santisteban, et al., 2000)(Santisteban, et al., 2000)

AdolescentDeviancy

Parenting

Mother’s Familism Values

Mother’s Behavioral Hispanicism

Human Genome and Human Genome and NeurobiologyNeurobiology

Hispanics are biologically Hispanics are biologically heterogeneousheterogeneous Human studies on candidate Human studies on candidate

genes as well as on genes as well as on neurobiology should consider neurobiology should consider biologically homogeneous biologically homogeneous subpopulations of Hispanicssubpopulations of Hispanics

Global Recommendation: Global Recommendation: Hispanic PopulationsHispanic Populations

Biological Differences Biological Differences Related to HealthRelated to Health

Hispanic subpopulations show biological Hispanic subpopulations show biological differences in comparison with other differences in comparison with other populationspopulations genes, proteins and risk for diseasegenes, proteins and risk for disease

p53 genes and lung p53 genes and lung cancercancer

Androgen receptors Androgen receptors and prostate cancerand prostate cancer

NAD(P)H quinone NAD(P)H quinone oxido-reductase and oxido-reductase and lung cancerlung cancer

Mn superoxide Mn superoxide dismutase and dismutase and colorectal cancercolorectal cancer

Microsomal epoxide Microsomal epoxide hydrolase and lung hydrolase and lung cancercancer

Folate pathway and Folate pathway and neural tube defectsneural tube defects

Recommendations: Recommendations: GenesGenes

Target Hispanic populations Target Hispanic populations for research on candidate for research on candidate genes related to addiction genes related to addiction

Genetic vulnerability-Genetic vulnerability-environment interactions, environment interactions, for example, may account for for example, may account for the very high rates of drug the very high rates of drug use among use among Puerto RicansPuerto Ricans

PREVENTIONPREVENTION

Hybrid InterventionsHybrid Interventions

Developing Developing “Hybrid Prevention “Hybrid Prevention Interventions,”Interventions,” that build-in cultural that build-in cultural adaptation as a formal design feature adaptation as a formal design feature of the prevention programof the prevention program

TREATMENTTREATMENT

Adolescents: Adolescents: What we knowWhat we know

Group therapy has iatrogenic effects on Group therapy has iatrogenic effects on delinquent and drug abusing adolescents delinquent and drug abusing adolescents – also true for Hispanics– also true for Hispanics

One family therapy treatment has been One family therapy treatment has been found to be efficacious with Hispanic drug found to be efficacious with Hispanic drug using adolescentsusing adolescents

Treatment Research with Treatment Research with Hispanic Women: Hispanic Women:

There are no published randomized There are no published randomized clinical trials of a behavioral treatment clinical trials of a behavioral treatment with Hispanic women.with Hispanic women.

Hispanic Women: Hispanic Women: RecommendationsRecommendations

Test Motivation Enhancement Therapy, Test Motivation Enhancement Therapy, Contingency Management and Contingency Management and Engagement Moms interventions - to Engagement Moms interventions - to improve engagement, retention and improve engagement, retention and treatment outcomes.treatment outcomes.

Test trauma treatments because exposure Test trauma treatments because exposure to trauma is high among drug using to trauma is high among drug using Hispanic womenHispanic women

Differences in response to pharmacotherapy Differences in response to pharmacotherapy for depression and schizophrenia in Hispanic for depression and schizophrenia in Hispanic populations vs. otherspopulations vs. others

Only three published studies have explored Only three published studies have explored pharmacotherapy for drug abuse in Hispanic pharmacotherapy for drug abuse in Hispanic populations populations

Methadone treatment for heroin addicts Nicotine patch for smokers Naltrexone for alcoholism

PHARMACOTHERAPY PHARMACOTHERAPY RESEARCHRESEARCH

Recommendations: Recommendations: PharmacotherapyPharmacotherapy

Test the hypothesis that Naltrexone Test the hypothesis that Naltrexone may be more acceptable to Hispanics may be more acceptable to Hispanics when family involvement is a when family involvement is a component of treatmentcomponent of treatment

TrainingTraining

Establish a Establish a National Training Center on National Training Center on

Interdisciplinary, Translational Interdisciplinary, Translational Hispanic Drug Abuse ResearchHispanic Drug Abuse Research

www.HispanicScience.orgwww.HispanicScience.org

www.HispanicScience.orgwww.HispanicScience.org

BLENDING RESEARCH BLENDING RESEARCH AND PRACTICEAND PRACTICE

..

The workgroup selected a The workgroup selected a strategic research focus on:strategic research focus on:

Issues impacting the training of Hispanic Issues impacting the training of Hispanic services providers in innovative treatmentsservices providers in innovative treatments

•The characteristics of organizations/providers The characteristics of organizations/providers that facilitate or hinder adoption of innovative that facilitate or hinder adoption of innovative treatments for Hispanics (e.g., Hispanic agencies treatments for Hispanics (e.g., Hispanic agencies are more likely to be small, and small agencies are more likely to be small, and small agencies are less likely to innovate). are less likely to innovate).

The nature of multilevel dissemination in the The nature of multilevel dissemination in the Hispanic communityHispanic community

 

Recommendations for Recommendations for Training Research:Training Research:

Research can be most productive by focusing on:Research can be most productive by focusing on:

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

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

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

II.II. OrganizationalOrganizational barriers/facilitators to adoption of barriers/facilitators to adoption of

innovative interventionsinnovative interventions Organizational variables including size of organization, Organizational variables including size of organization,

functional differentiation, number of years of operation, functional differentiation, number of years of operation, and level of training of the administrator appear to be and level of training of the administrator appear to be positively related to adoptionpositively related to adoption..

Also appearing in some literature: having patients Also appearing in some literature: having patients covered by HMOs, PPOs, or other managed care covered by HMOs, PPOs, or other managed care arrangements, client clinical characteristics, and having arrangements, client clinical characteristics, and having higher percentage of relapsers treated by the center. higher percentage of relapsers treated by the center.

Hodge, Cardenas, & Montoya (2001) – Staff reported Hodge, Cardenas, & Montoya (2001) – Staff reported that financial problems did not allow for rewarding of that financial problems did not allow for rewarding of innovation. Financial weaknesses did not allow agency innovation. Financial weaknesses did not allow agency to invest in a promising ATOD pilot programs.to invest in a promising ATOD pilot programs.

Implications for Hispanic/Latino Implications for Hispanic/Latino Serving OrganizationsServing Organizations

The potential impact on adoption rate of agency The potential impact on adoption rate of agency size and level of training and education of size and level of training and education of administrators may be particularly important administrators may be particularly important given that many Hispanic serving agencies may given that many Hispanic serving agencies may be smaller size.be smaller size.

The finding that individuals enrolled in HMOs and The finding that individuals enrolled in HMOs and managed care programs were more likely to managed care programs were more likely to receive innovations, is also problematic given that receive innovations, is also problematic given that Latinos/ Hispanics are over-represented among Latinos/ Hispanics are over-represented among the uninsured and thus, may be less likely to the uninsured and thus, may be less likely to receive innovative treatment intervention. receive innovative treatment intervention.

Recommendations for Research Recommendations for Research on Organizational factorson Organizational factors

1) 1) The makeup and characteristics of Hispanic-The makeup and characteristics of Hispanic-serving agencies and key organizational serving agencies and key organizational characteristics related to adoption.characteristics related to adoption.

2)2) Testing the generalizability of previous findings Testing the generalizability of previous findings with Hispanic serving agencies.with Hispanic serving agencies. 3) How the unique clinical 3) How the unique clinical characteristics of characteristics of Hispanics impact variables related to adoption, Hispanics impact variables related to adoption, such as clinical characteristics of caseload and such as clinical characteristics of caseload and high relapse rates.high relapse rates.

Research specifically focused on:

III.III. The Nature of Multilevel The Nature of Multilevel Dissemination in the Dissemination in the Hispanic CommunityHispanic Community

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

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

Recommendations for Recommendations for Research on Research on

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

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

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

HIV/AIDSHIV/AIDS

Sexual Risk within the Sexual Risk within the Context of Drug AbuseContext of Drug Abuse

Hispanics have more negative Hispanics have more negative attitudes towards safe sex attitudes towards safe sex practices and a corresponding practices and a corresponding tendency towards risky sexual tendency towards risky sexual behaviors such as not using behaviors such as not using condoms. condoms.

““with those less acculturated reporting with those less acculturated reporting the most negative attitudes” towards the most negative attitudes” towards safe sex practices.safe sex practices.

Initiation of Injection Risk Initiation of Injection Risk in Latino Youth & Young in Latino Youth & Young

Adults.Adults.

Pedagogy of technical skills Pedagogy of technical skills necessary to prepare and inject illicit necessary to prepare and inject illicit drugs.drugs.

Prospective studies of Latino IDUsProspective studies of Latino IDUs Evolution of social, behavioral, & Evolution of social, behavioral, &

environmental processes.environmental processes. Situate within context of key life-Situate within context of key life-

course changes.course changes.

Sexual Risk within the Sexual Risk within the Context of Drug AbuseContext of Drug Abuse

LatinosLatinos across all sexual orientations across all sexual orientations report more negative attitudes toward report more negative attitudes toward safer sex practice.Correlates with level of safer sex practice.Correlates with level of acculturation.acculturation.

High-risk heterosexual activities are High-risk heterosexual activities are the main predictor for HIV the main predictor for HIV seroconversion among Latinas.seroconversion among Latinas. Latinas have low overall sexual assertiveness.Latinas have low overall sexual assertiveness. Significant proportion believe they Significant proportion believe they nevernever have have

the right to make decisions about condom the right to make decisions about condom use.use.

Sexual Risk within the Sexual Risk within the Context of Drug AbuseContext of Drug Abuse

Enrich our understanding of personal &situational Enrich our understanding of personal &situational factors that will enable the development of factors that will enable the development of targeted interventions.targeted interventions.

Ways that normative beliefs brought from sending Ways that normative beliefs brought from sending cultures filter through sexual decision-making cultures filter through sexual decision-making contexts to increase risk behavior.contexts to increase risk behavior.

Ways in which drugs are imbedded in sexual Ways in which drugs are imbedded in sexual partnering processes.partnering processes.

Prospective intervention studies with Latina youth Prospective intervention studies with Latina youth that parallel developmental life-course changes that parallel developmental life-course changes and build sexual communication & negotiation and build sexual communication & negotiation capacity over time.capacity over time.

TRAININGTRAINING

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

NIDA Will Establish, or Collaborate or NIDA Will Establish, or Collaborate or Support:Support:

A Career Development Award (K01) for A Career Development Award (K01) for minority faculty minority faculty

A Minority Clinical Research Scholars A Minority Clinical Research Scholars Fellowship as part of NIDA’s CTN Fellowship as part of NIDA’s CTN program. program.

Establish Training Centers in the basic Establish Training Centers in the basic neurosciences, behavioral sciences, neurosciences, behavioral sciences, clinical neurosciences and intervention clinical neurosciences and intervention science at science at minority-serving Research I minority-serving Research I universities. universities.

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

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

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

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

Recommendation 5Recommendation 5. . Develop Diversity T32’s.Develop Diversity T32’s.

Recommendation 6Recommendation 6. Comprehensive training . Comprehensive training grants that:grants that: support infrastructure and faculty mentor time as support infrastructure and faculty mentor time as well as providing resources for trainees, andwell as providing resources for trainees, andsupport all levels of training across the early support all levels of training across the early career pipeline (graduate students, post-docs, career pipeline (graduate students, post-docs, junior faculty).junior faculty).

Recommendation 7Recommendation 7. Create interdisciplinary, . Create interdisciplinary, translational thinkers and research teams.translational thinkers and research teams.

Recommendation 8.Recommendation 8. Attend to the most critical Attend to the most critical training need: Behavioral prevention and treatment training need: Behavioral prevention and treatment intervention science.intervention science.

www.HispanicScience.orgwww.HispanicScience.org