Vickie M. Mays - US grants

African American; homosexuals; AIDS; disease /disorder proneness /risk;

human immunodeficiency virus; socioeconomics; African American; health behavior; AIDS therapy; AIDS; epidemiology; behavior; human T cell lymphotropic virus type 2; serotyping; communicable disease transmission; sexually transmitted diseases; disease /disorder proneness /risk; drug abuse; drug addiction; sickle cell anemia; antiviral antibody; immunopathology diagnosis; hepatitis B; human morbidity; homosexuals; sex behavior; Betaherpesvirinae; stress; human T cell lymphotropic virus type 1; enzyme linked immunosorbent assay;

The competing continuation proposal seeks support for the data analysis phase of an ongoing program of research, a national study of sexual behavior and HIV-related risk among Black gay and bisexual men. Although 27% of reported AIDS cases have occurred in Blacks and it has been estimated that Blacks may have a Human Immunodeficiency Virus (HIV) infection rate three times that of the Whites, very little is known about sexual behaviors of AIDS-related risk reduction strategies of Black gay and bisexual men. The first phase of this project involved extensive protocol development and the collection of data. Completion of this phase will result in two important data sets: 1> qualitative data gathered from focus groups conducted with Black gay and bisexual men at six sites including both low and high HIV incidence cities across the United States; 2> quantitative questionnaire data being collected from a large, nationally recruited sample of Black gay and bisexual men. At the present time support is requested to conduct in depth analyses of those two data sets collected. The proposed study seeks to identify psychosocial correlates of risk reduction among Black gay and bisexual men. Specifically, this research will 1> document patterns of sexual behavior, particularly as related to risk of HIV transmission in Black gay and bisexual men; 2> provide detailed information of AIDS-related knowledge, attitudes and perception of risk, including knowledge of AIDS-related community resources and barriers to utilization of AIDS education and health care in this population; 3> seek to identify predictor of risk detection behaviors using social psychological models of attitude-behavior relationships; 4> examine methodological issues in the area of assessing ethnic minority populations and HIV-related behaviors including appropriate language and symbolism for sexual behaviors and their determinants. The focus of the research is on increasing knowledge of relationships among sexual orientation and sexual experience, socioeconomic status, social and emotional stress, psychiatric morbidity, and AIDS-related knowledge, attitudes and high- risk behaviors.

Across all major risk groups for HIV infection in the United States, African American men and women are disproportionately represented among the rise in new cases of HIV infection. Seroprevalence surveys conducted since 1987 indicate that new cases of HIV infections will increasingly concentrate in particular segments of the African American population, adding to their current burden of excessive rates of morbidity and mortality. The proposed summit will attempt to identify HIV/AIDS research questions that are of specific relevance to African Americans as a way of focusing the HIV research agenda necessary to control and treat the HIV/AIDS epidemic in this population. This summit will initiate a dialogue among top HIV scientists with the goal of establishing a comprehensive research agenda on HIV/AIDS in African American for the coming years. It is hoped that by focusing the attention of top HIV research scientists on the unmet research questions relevant to the prevention and treatment of HIV infection and AIDS in the African American population, strategies to control the epidemic can be found.

The NIH Revitalization Act of 1993 mandated the inclusion of women and ethnic minorities in NIH clinical research studies. By 1994, NIH had developed a set of guidelines which stated that women and members of minority groups and their subpopulations were to be included in all NIH-supported biomedical and behavioral research projects which involved human participants. There has been an increase in the numbers of non-minorities involved in the collection of data in ethnic minority populations; however, there has been little in the way of training through the development of graduate, professional or continuing education courses emerging to educate researchers about the communities they are entering. The aim of this application is to develop two professional level campus-wide courses focused on human research participation. These courses were designed for graduate students, junior/senior level researchers and community members interested in human participant research and wishing to obtain continuing education credit. The focus of the two courses will be ethics of research participation in: (a) vulnerable populations and (b) special populations (ethnic minorities). While investigators are required to include women and ethnic minorities in federally funded studies, few continuing education, graduate or professional courses have prepared investigators to handle the complex, challenging burdens and responsibilities that arise in conducting research in these populations. Vulnerable populations include children, prisoners, the cognitively impaired, and those who exhibit diminished individual authority through circumstances, disability or illness. These courses will provide opportunities for researchers at all stages of their research careers to explore the ethics and cultural/racial/gender/class norms of research elements.

DESCRIPTION (provided by applicant): The UCLA Center for Research, Education, Training, and Strategic Communication on Minority Health Disparities (CRETSCMHD) will be guided by the sole priority of ensuring the reduction and elimination of health disparities in racial and ethnic minority populations. The UCLA Center's agenda is structured such that integrated through each of its Cores are three themes vital to effectively eliminate disparities in health: research, education and training, and communication and dissemination. Activities at the Center will be coordinated through the Administrative Core, Research Cores (made up of the Shared Resources, Research Cores and a Pilot Module), and the Education, Training, and Public Policy Cores (made up of the Minority Health and Health Disparity Education, Training, and Community Outreach and Information Dissemination Cores). The Administrative Core will provide the organizational leadership, coordination and review of all Core activities, and encourage inter-relationships and partnerships within the University and with the broader Los Angeles community. The Shared Resources Cores, composed of the Qualitative, Quantitative, and Communities-In-Context Cores, will function as the research backbone for the Center. It is also here that the theoretical, methodological, and contextual approaches to studying minority health will be revisited and refined. The Pilot Module and Research Core, working in collaboration with the Shared Resources Core, will examine the role of provider behavior as well as the use of traditional medicine in minority health. The Training and Minority Health Education Cores will work to increase the presence and involvement of racial/ethnic minority students and faculty in research focused on eliminating minority health disparities from a wide range of campus units such as the life/physical sciences to World Arts and Culture through education, mentorship, and research opportunities at the Center. The Community Core will serve as the backbone for the entire Center, informing the research and direction of the Center, undertaking the examination of the dissemination process through studying the importance of language in the education, dissemination and health care encounters. Part of the Community Core aims will be achieved through Center-organized events, where community leaders as well as Center members will engage in discussion of community needs. CRETSCMHD will be composed of a diverse group of faculty, community leaders, the minority media, local foundations and health professionals. It is with the intention of creating a forum for multiple perspectives that the Center has drawn members from disparate disciplines and organizations. The Center's agenda is a collective and comprehensive effort in the reduction and elimination of minority health disparities in the context of a community rich in ethnic/racial diversity. However this same community is the site of a large number of those racial/ethnic minorities being without access to care and who bear an unfair share of the burden of health inequalities.

The Center is an academic-community partnership dedicated to eliminating health disparities in our diverse Los Angeles community and the nation. To achieve this mission, the Administrative and Scientific Core (Admin Core) provides a leadership structure that ? creates synergy, integration and integrity among our cores, researchers and collaborators ? initiates and supports community, health department, and inter-institutional collaborations that would not exist without the Center, and ? provides scientific and fiscal oversight in strict adherence to all university, local, state, and federal policies and procedures. Admin Core, like the Center itself, builds on the successes of its predecessor center, the UCLA Center for Research, Education, Training and Strategic Communications on Minority Health (CRETSCMHD). Our leaders bring extensive and diverse scientific and administrative expertise that few teams can duplicate, ensuring that the productively and impact of our Center will be significantly greater than the sum of its individual parts. As a guiding principle. Admin Core supports a multidisciplinary team science approach to foster broad engagement, cooperation, communication, education/training, and translation and dissemination and engages the use of technology to foster inclusion of participation both within the Center and in research.

The Center for Bridging Research, Innovation, Teaching and Education Solutions for Minority Health (BRITE) is an academic-community partnership dedicated to eliminating health disparities in our diverse Los Angeles community and the nation. The BRITE Center for Minority Health draws on the expertise of UCLA and its diverse community partners to increase the number of individuals from health-disparity populations who are ¿ trained to conduct minority health and health disparities research ¿ participate in intervention, prevention and clinical trials research, and ¿ engaged in improving the health of their communities through sustained partnerships, workforce development and early detection screening activities. It has four strategic goals. 1) We will build on our strengths to provide an integrated, research home that facilitates and supports new and continued research on the health of racial/ethnic minorities and minority health disparities. 2) We will create effective, new community partnerships to conduct essential, leading-edge research with the tangible goal of improving minority health and reducing or eliminating health disparities. 3) We will initiate, improve, and strengthen existing research education and training activities to build a culturally competent healthcare workforce that will improve health and create living wage employment in health-disparities populations. 4) We will strengthen, increase and broaden partnerships between community and academic centers of knowledge to facilitate efficacious approaches to improve the health and health care services of racial/ethnic minority populations and eliminate health disparities. We will achieve these goals through Research Studies that address two big problems in our health-disparities population¿Korean youth cigarette smoking and diabetes in African American women¿and utilize cutting-edge, cost-effective and easily scalable health technology innovations for which UCLA is known. LA is an ethnic media capital and we have formed unique media partnerships to reach our population. Our community partners are involved and engaged in study design and recruitment, training, dissemination and implementation¿activities that will increase their capacity for research, improve minority health, build a culturally competent workforce, and create jobs.

PROJECT SUMMARY/ABSTRACT Lesbian, gay, bisexual, and transgender (LGBT) adolescents and adults, when compared to similar others, are at increased risk for suicide attempts and exposure to violence victimization. Suicide mortality is also elevated, especially among women, though research studies are sparse. Accordingly, NIH has formally designated sexual/gender minorities a health disparity population. Yet there remain large gaps in the scientific knowledge base that undermine development, dissemination and implementation of effective public health interventions to reduce risk in this vulnerable population. These include whether rates of homicide are similarly elevated among LGBT persons, whether suicide rates are elevated among the transgender population, what role gender and race/ethnicity play in shaping risk, as well as clarification of the contextual factors surrounding these deaths, including missed opportunities for intervention. The primary goal of the project is to identify patterns of risk and to characterize proximal factors associated with violent death due to suicide and homicide among LGBT individuals. Drawing from Minority Stress Theory and, for suicides, the `ideation-to-action' framework, we hypothesize that anti-gay stigma and discrimination creates a vulnerability for violent death among LGBT adolescents and adults. Capitalizing on new information classifying deaths for LGBT status in recent years of the National Violent Death Reporting System (NVDRS), we will make novel use of supervised machine learning techniques to recapture LGBT status among deaths in those 12 years and older in the 2003-2015 NVDRS (> 200,000 suicides, homicides, or homicide-suicides). Similar techniques will also be used to code NVDRS death narratives for co-occurring stigma-based contextual factors (e.g., gay disclosure, familial rejection), risk profiles (e.g. mental health, substance use), and recent services use in the immediate circumstances surrounding the death. This will allow us to achieve two study aims. For Aim 1, we will use NVDRS data and exogenous information estimating LGBT population size to generate state-level estimates of suicide and homicide rates, adjusted for population composition, among individuals 12 years and older. We hypothesize that LGBT population risk estimates for suicide and homicide will exceed those of non-LGBT populations. For Aim 2, we will identify sexual orientation and gender minority-linked differences in predisposing and proximal factors associated with suicide and homicide, including indicators of mental health and substance use, patterns of recent health care access, and characteristics of death circumstances, including HIV infection status. Consistent with theoretical predictions, we hypothesize that recent discrimination experiences will be strongly associated with sexual orientation and transgender status, that homicide deaths will more likely show evidence of hate-crime-related contextual factors, and that HIV-related issues will be an important though downward trending precipitant of suicide among sexual minority men. We also anticipate gender and ethnic/racial differences in these effects that will have important implications for future risk reducing interventions. Information obtained will greatly aid achieving the American Foundation for Suicide Prevention Project 2025 goal of reducing the suicide rate 20% by 2025 and NIMH's Zero Suicide efforts by providing interventionists with data to design screening and intervention efforts for the LGBT population.