James C. Anthony - US grants

This application proposes an 18 month renewal of NIDA support for analyses on the epidemiology of cocaine and other drug use by adults, including issues of psychiatric co-morbidity and risk of drug problems. The specific research question include: What is the current best estimate for the degree to which cocaine users are at increased risk of DSM-III mania and related serious psychiatric disturbances? What is the current best estimate for the degree to which cocaine users are at increased risk of DSM-III obsessive-compulsive disorder and related obsession-like or compulsion-like behaviors? What is the current best estimate for the relative risk of drug dependence and other specific types of drug problems in relation to the type of drug used illicitly, and in relation to daily versus non-daily use of these drugs? For example, which drug use pattern is associated with greater risk of drug dependence: daily marijuana use, or non-daily cocaine use? Are there differences in the patterns of drug problems reported by illicit drug users who have had drug abuse treatment encounters, as compared to all illicit drug users who have had drug abuse treatment encounters, as compared to all illicit drug users or to illicit drug users with no treatment history? If there are differences, what are their implications for new development of instruments to assess drug dependence and problems associated with psychoactive drug use? The applicants will use data from the 20,862 participants in the NIMH Epidemiologic Catchment Area Program in analyses to answer these questions, including data on 3925 illicit drug users who reported on their drug problem experiences. The data were gathered prospectively by administering the Diagnostic Interview Schedule at baseline and also at followup roughly one year later. The proposed conceptual models and related statistical models are based on work completed by the applicants during the initial award period and now being published, as well as new latent structure analyses appropriate to dichotomous and highly skewed diagnostic data.

The long-term goal for this research is to identify modifiable etiologic risk factors for illegal drug self-administration by children and teenagers. In the research, a preventive trial and a nested case-control study will be conducted to examine two potential risk factor relationships in detail. Specific hypothesis #1 concerns the potentially causal significance of the relationships between disobedience, aggression, and drug-related behavior. Specific hypothesis #2 concerns the potentially causal significance of the relationship between learning problems and drug-related behavior. In the field experiment to examine these hypotheses, randomization and other features of the experimental method will be used to control error. In addition, the data analysis plan is multivariate and provides for estimation of the experimental intervention effects, conditionally on other potential determinants of drug-related behavior. The sample for the field experiment consists of more than 2000 children in early elementary school classrooms of the Baltimore City Public Schools. Roughly 1/4 of the children are assigned to the Good Behavior Game intervention, which is designed to reduce the occurrence of disobedience and aggression; roughly 1/4 are assigned to a Mastery Learning intervention designed to reduce the occurrence of learning problems; the remainder receive no special intervention. If these interventions work as planned, disobedience, aggression, and learning problems will be less common. With a five-year followup, assessment of a potential impact on illegal drug self-administration should be possible. However, the research is designed to add substantially to our knowledge of potential determinants of drug self-administration, even if the interventions are weak or even inert.

This application is for renewal of NIDA support for a study of drug use by elementary schoolchildren who live in the inner city and other nearby areas of urban Baltimore. The study is a collaborative venture of the Johns Hopkins University and Baltimore City Public Schools. The epidemiologic sample of 2400 children was recruited when the children entered first-grade in 1985-86. The study is prospective and longitudinal, with an experimental design to test two classroom interventions that may delay or reduce occurrence of illicit drug use and other problems. One intervention seeks change in socially maladaptive behavior found to be a sturdy predictor of drug abuse. To date, the children have been assessed each year since Grade 1, including two post-intervention assessments. A recent NIMH grant supports continuation of group-administered questionnaires, teacher ratings, and school record retrieval for five more years. This renewal proposal seeks to continue the NIDA-supported personal interviews on drug-related behavior, concurrent with the NIMH assessments. During the proposed study period, the children will be entering Grades 4-8, when occurrence of illicit drug use will begin to accelerate. In addition to testing for preventive effects of the two interventions, the study also will examine other factors suspected to influence the occurrence and continuation of illicit drug use. A specific focus of this examination is co-occurrence of drug use, psychiatric disturbances, and behavioral disturbances such as fighting and delinquency, as well as a set of other personal, developmental, and adaptational characteristics of the children, which are manifest in self-report measures, ratings by peers, and ratings by teachers. Periodic parent interviews are used to augment these assessments, and to strengthen the study's measurement of neighborhood and family characteristics, such as family behavior management and monitoring strategies. A pilot study is underway to test the feasibility of nesting a case-control study of illicit drug use within this prospective study design, as an epidemiologic strategy to allow intensive measurement of drug use and the conditions under which drug use occurs. Pending results from the pilot study, a companion proposal to support the nested case-control study is planned for late 1989 or in 1990. If successful, this study holds promise as an important new step in understanding risk factors and conditions that affect initiation and early development of illicit drug use. The study's experimental design and intervention plan has a specific focus on socially maladaptive behavior that might be modified to delay or reduce later occurrence of illicit drug use. However, even if the intervention has no effect on drug use, the study is designed to produce important new information on the etiology of illicit drug use and drug-related behavior.

The long-term objectives of the proposed research are (a) to understand the characteristics of individuals, the conditions, and the processes that influence the occurrence of drug-taking, drug dependence, and other forms of serious drug involvement amongst Latin American youths, particularly drug involvement that occurs in clusters; and (b) to translate this understanding into practical public health strategies for the prevention and control of hazards associated with drug-taking in this important and growing segment of the world's population. The project involves a centrally coordinated multi-site cross-sectional survey of teenage drug involvement in the seven countries of Latin America that now participate in the Inter- American Drug Abuse Control Commission (CICAD): Dominican Republic, Panama, El Salvador, Costa Rica, Guatemala, Honduras, and Nicaragua. This project builds from the infrastructure of past CICAD efforts that were intended to quantify the prevalence of youthful drug-taking in these countries. As planned, the project will include the use of standardized classroom survey methods to produce the first nationwide probability sample survey estimates of teenage drug-taking in this region of the America. The research also will use a newly developed statistical procedure ("alternating logistic regression") to examine the degree to which non-medical drug use and other forms of drug involvement might appear in clusters within the boundaries of classrooms, schools, and other local area aggregations of these countries. When the proposed research is completed, the result will be a substantially increased understanding of the epidemiology of adolescent alcohol and drug involvement in the Central American region, as well as a more substantial foundation for NIH-supported international collaborative research in the participating countries. The research plan includes deliberate attention to publication of scientific articles in peer-reviewed journals, which will help to strengthen the participating countries infrastructure for collaborative research beyond the duration of this grant award.

DESCRIPTION: (Applicant's Abstract) This is a proposed extension of a longitudinal study of more than 2000 first-graders first recruited as an epidemiologic sample in 1985-86, and assessed annually through middle school. For this extension of the study, these youths will be interviewed when they are at a median age of 17, 18, and 19 years. The main objectives of this 5 year project are threefold. First, we will test hypotheses about how early onset of drug use might be associated with an increase in risk for drug problems during late adolescence. Second, we will test alternative hypotheses about childhood conditions and processes that might influence levels of risk, protective, and resiliency factors, including conduct problems, affiliations with deviant peers, and possible changes that occur after initial drug-taking (e.g., in parent monitoring levels). The set of possible effect-modifiers and mediators to be studied include hypothesized resiliency factors such as religiosity and social bonds. Third, we will test alternative hypotheses about how tobacco smoking and other drug use might influence the onset of psychiatric disturbances and account for psychiatric comorbidity over time. This work will have a primary focus on depression, self-harm, and suicide attempts. All three of these objectives will be addressed in a coordinated fashion, drawing upon the new waves of standardized data gathering of this longitudinal epidemiologic sample between 1997-2000. The long-term goal of this project is to identify malleable characteristics associated with increased risk for drug involvement in adolescence and later risk of drug dependence syndromes. These characteristics should warrant further evaluation as the targets of preventive interventions in future studies.

This proposed FIRCA project is for epidemiological research on the earliest stages of youthful drug involvement, including coca paste and other cocaine use. The research involves analyses of data from an already completed probability sample survey of more than 45,000 youths 12-21 years of age, who attended public and private schools in Chile during 1999. The survey included standardized assessments of drug involvement, mental health, and other constructs of interest. The project represents a collaboration between Professor James C. Anthony of the Johns Hopkins University School of Hygiene and Public Health (designated principal investigator), and Dr. Luis Caris of the University of Chile School of Public Health (designated foreign collaborator). Potential public health significance of the project is heightened by apparently increased levels of coca paste smoking and other cocaine use by young people in Chile over the past five years, a possible externality or unintended consequence of U.S. policies and programs to reduce cocaine demand and supply within our own borders. As planned, the project will yield new epidemiological evidence on cocaine use by young people, as well as new epidemiological evidence on tobacco smoking, another form of drug-taking of readily apparent public health importance. Innovation associated with this project is enhanced by the new evidence to be gained, and by a focus on the earliest stages of drug involvement (i.e., transitions from first chance to try a drug to actual use of the drug). The team will use methods not often seen in epidemiological analyses of school survey data, e.g., multivariate analyses and methods to study clustering of youthful drug use within schools and communities. With respect to coca paste, cocaine, and tobacco, the FIRCA research team will estimate clustering within schools and communities, derive provisional estimates of the recent incidence of drug involvement, prepare and submit scientific articles on these results, and prepare and submit RO1 proposals to enhance and sustain the international collaborative research. The proposed work will enhance the U.S. RO1 project and will strengthen the epidemiology research capacities of the University of Chile research team.

DESCRIPTION (provided by applicant): This is an application for an International Clinical, Operational, and Health Services Research Training Award from the National Institute on Drug Abuse and Fogarty International Center. It aims to increase the count of quantitatively adept scientists who can lead epidemiological studies of tobacco, cocaine, and other drugs, associated infections & medical consequences. Tobacco smoking and other drug use are health-related behaviors of growing importance, quantified in terms of burden of disease and disability in the U.S. and overseas. There is a real shortage of scientists with suitable training and research experience for NIDA-oriented epidemiological studies, not only within the U.S., but also in Latin America and elsewhere. Demand for NIDA-oriented epidemiological surveillance and probing epidemiological studies surpasses the supply of scientists. Peru is located in a major coca cultivation region in Latin America. Like most countries in the region, it faces important health and social problems associated with use of coca leaf products (e.g., cocaine hydrochloride powder) and other drugs such as tobacco. Some recent initial epidemiological surveys in Peru have confirmed an impression of increasing trends in use of coca paste (pastabas), a product of intermediate between coca leaf and cocaine HCL, sometimes mixed with kerosene and other toxic contaminants. Peru also is the site of an existing multi-faceted research and research training collaboration between Johns Hopkins University (JHU) and Universidad Peurana Cayetano Heredia (UPCH). Collaborations already link the UPCH faculty and trainees with a NIDA-supported T32 institutional NRSA training program, and with a separate program for research and training on epidemiology of infectious origins. The proposed award will sustain and extend this collaboration with an initial intermediate-length orientation course and faculty-supervised research experiences for a minimum of 20 predoctoral and postdoctoral Peruvian trainees at the UPCH site. Two will be selected for Ph.D. training at JHU, one PDF for Master of Science training, and three PDF for advanced postdoctoral training and PDF certificates awarded by JHU. They all will return to Peru sites for summer and thesis or PDF research training after completion of required coursework at JHU. The award also will support thesis and research projects for returning students and collaborating faculty members.

DESCRIPTION (provided by applicant): The purpose of this proposed Senior Scientist Award (K05) from the National Institute on Drug Abuse is to provide stability of support for Professor James C. Anthony of the Johns Hopkins University, Bloomberg School of Public Health, in relation to his program of continuing research, research training, mentoring, and science education on the topics of drug dependence epidemiology and enviromics. The research plan and career development activities are organized in relation to five main rubrics of epidemiology and associated research questions: (1) Within the population, how many people are becoming affected by clinically significant syndromes of drug dependence? How many cases have accumulated? (2) Within the population, where are we more (or less) likely to find drug dependence cases, in relation to characteristics of person, place, and time? (3) What accounts for some people becoming drug dependent while others are spared? (4) How do linked sequences of events and processes lead toward the transition from being a non-case to becoming a case of drug dependence, and the hazardous consequences of becoming or being a case? and (5) What can we do to prevent, delay, or reduce the risk of becoming a case of drug dependence, to reduce the duration, or to ameliorate the associated suffering? Whereas the 'genome' refers to the total ensemble of genetic material for a form of life, the 'envirome' is the total ensemble of environmental processes and circumstances required for life form viability and successful adaptation. In complement with genomics and proteomics, drug dependence enviromics is a deliberate search for specific environmental processes and circumstances that promote health by reducing the risk, prevalence, and problems of drug dependence. In drug dependence enviromics, the main objects of study are neither the gene nor the environment, but rather the gene-environment interactions that give rise to drug dependence, prevent or sustain it, interrupt its natural history, and reduce the global burden of drug dependence and associated disabilities.

DESCRIPTION (provided by applicant): This proposal seeks five years of R01 award support for cross-national comparative analyses of already gathered data on drug dependence epidemiology, the stages of drug involvement leading up to drug dependence, and sequelae of drug dependence, including remission, recovery, treatment, and suspected adverse consequences (e.g., psychiatric disturbances, and effects on social adaptation in school, work, and family life). The general population epidemiological survey data to be analyzed now are being gathered as part of the World Mental Health survey initiative, with currently 28 participating countries, including 16 countries with nationally representative samples of household residents and 12 countries with regionally representative samples. The proposed NIDA-supported research team for data analysis and scientific writing is led by Professors Jim Anthony (Johns Hopkins University) and Professor Ron Kessler (Harvard University). Working in coordination, during Year 01, the primary responsibility of the Harvard team is master data file creation and documentation responsibilities, including documentation of sampling frames and procedures, sampling weights, etc., with the Hopkins team focused upon creation of constructed variables for NIDA-oriented drug dependence analyses and assembly of ancillary elements of information that will help describe the country-level context of drug involvement in each of the participating countries (e.g., information about alcohol, tobacco, illegal drug, and medicinal drug availability by prescription or over the counter; availability of local inhalant drugs).The five year analysis and scientific writing plan will provide an enhanced view of the international comparative epidemiology of drug use and drug dependence problems, guided by a set of three operational aims and five subject-matter aims, each of which corresponds with the five main rubics in a conceptual model for epidemiologieal research on drug involvement and drug dependence. The main research questions to be answered in this cross-national and comparative study are: (1) Within the populations under study, how many are affected (e.g., as cases of drug dependence)? (2) Within these populations, where are the affected cases most likely to be found? (3) What accounts for some individuals to become cases while others do not become cases? (4) What are the causal mechanisms that drive the pathogenesis and etiology of drug dependence and its consequences in the form of psychiatric disturbances and social adaptation, and (5) What might we do to prevent and control drug dependence (e.g., by increasing the ratio of treated/untreated cases, and through primary care outreach)?

[unreadable] DESCRIPTION (provided by applicant): This proposal is for an initial five year period of support to establish a T32/NRSA institutional NIH/NIDA Drug Dependence Epidemiology Training Program within the Michigan State University College of Human Medicine. The proposed training program director is Professor James C. (Jim) Anthony, a current NIDA K05 Senior Scientist. Also leading the program is Professor Naomi Breslau, an expert on epidemiology of tobacco smoking and dependence, as well as two Assistant Professors, Drs. Philip J. Reed and Hwan Chung, both of whom recently completed two years of NIDA-supported or oriented postdoctoral research training. The long term goal of this training program is to increase the number and quality of quantitatively adept epidemiologists with a career commitment for NIDA's mission in relation to epidemiological research on drug dependence syndromes and related suspected hazards of psychoactive drug use. The NIDA predoctoral trainees first complete 2-3 years of coursework with research apprenticeships in the MSU medical school environment, pass qualifying exams to establish candidacy for a PhD in Epidemiology, and then complete 2-3 years of dissertation research and final defense of a monograph-length thesis representing significant contributions of new scientific evidence with ramifications for theory. Postdoctoral trainees complete an individualized program of postgraduate research training of at least 2 years duration, with a greater balance of research collaborations. For PhD & PDF trainees who also seek an MSc degree in Epidemiology or an MSc in pre-clinical Pharmacology/Toxicology, a minimum of 3 coursework and on-campus study is required. Both predoctoral and PDF fellows work to assemble a portfolio of first-authored, published scientific articles, and to complete final drafts of their own investigator-initiated NIDA grant award applications and K01 career development plans. The proposed research training plan builds from the director's 15 years of experience as a successful T32/D43 training director at Johns Hopkins University. It includes scientific integrity and ethics training. The initial request is for one predoctoral trainee and one postdoctoral trainee, with growth to three predoctoral trainees and three postdoctoral trainees within five years. There is a plan for outreach to historically disadvantaged minority trainees; the MSU Department of Epidemiology and training program director have an excellent past track record of success in this regard. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The proposed Conference on Drug Use and Dependence in East Africa will gather scientists, practitioners, policy makers and community organizations from different disciplines and countries to exchange progress on work in improving the health of urban populations and to foster cooperation among urban health stakeholders in improving policies and interventions for tobacco, alcohol, and other drug use (especially illegal or other nonmedical drug use). The conference will take place in Nairobi, Kenya in coordination with the overall Eighth International Conference on Urban Health, separately supported by the Gates Foundation and others. We propose to draw attention to current NIDA research developments in relation to tobacco and other drug involvement in urban environments and populations, with a focus upon applied aspects of NIDA's research portfolio, in an effort to showcase potentially internationally applicable models of research-to-practice collaborations for urban settings. As such, we are requesting approximately $30,000 of the total cost of the conference (~$1,400,000), which will support the following components of the proposed NIDA-sponsored conference track: (1) Support for plenary sessions with internationally recognized plenary speakers (e.g., NIDA PIs) during the conference, (2) Support for pre- and post-doctoral research trainee registration, (3) Non-plenary parallel or concurrent sessions on focused on NIDA-pertinent research, (4) Poster sessions focused on NIDA-pertinent research, (5) Publication of a supplement of the Journal of Urban Health that will include featured articles and poster abstracts on this NIDA-pertinent research, to be edited by J. Anthony &D. Vlahov. By holding this conference in Nairobi, one of the leading cities in the world, we intend to foster international research collaborations that seek a collective improvement of our understanding of the common health risks faced by urban residents and to influence the development of effective public health interventions across the globe. Perspectives and lessons from different countries can be valuable to share. We have now held seven prior conferences that have been well attended and look forward to continuing this series. A concentration or conference track on drug abuse has been present in earlier meetings and is a critical part of this effort. This type of track seeks to foster interdisciplinary collaborations among NIDA-oriented researchers who are interested in how urban settings influence drug involvement, including geographic and social structural features of urban settings that may serve as modifiable 'causes of incidence'of drug problems. Dissemination of evidence presented at the conference will come in the form of published abstracts and papers in the Journal of Urban Health;press conferences with radio, newspaper, television;and press interviews with key speakers.

This revised R25 summary clarifies that the proposed National Hispanic Science Network (NHSN) Early Career Stage Mentoring Program for NIDA Research (ECSM) addresses a current Hispanic minority under-representation among NIHINIDA principal investigators, and will provide training and men to ring for Hispanic early career stage sdentists, including future HN I AIDS researchers. The NSHN network of 40 NIDA-funded mentors is led by 3 senior scientists with HIV 1 AIDS research experience (Anthony, Castro, Pantin). Proposed HN I AIDS traininglmentoring components will be offered by the 18 experienced mentors with recent NIDA Ro1 or K-type awards for HIVIAIDS research projects. Background conditions for this program include treasured NIH clinicai research advances, but some inefficiency in NIH science education processes, untapped science leadership talent, and many NIH-eligible institutions and Congressional districts where NIH has limited or no research presence. Seeking to address such conditions, the ECSM model bridges a specific postdoctoral science education chasm now separating (1) initial research training on one side, and (2) successful receipt of a 1st NIH K- or ROl project award on the other side. Multi-year biomedical science education opportunities now exist for woos of pre- and post-doctoral trainees, but relatively few trainees achieve K- or Ro1 award success. Eligible ECSM fellows will be well-trained, advanced level faculty I staff scientists at early career stage, with priority given to those within institutions that qualify for NIH R15 Academic Research Enhancement Awards. An NHSN 'culture of mentorship'model matches mentor-guides with each fellow and provides weekly webinars and 2 annual meetings. A successful K- or R01 award is the planned outcome milestone for each of the 15 eligible NIDAand Hispanic-oriented fellows who will be trained and mentored. If tllis model for NIDA's Hispanic-oriented fellows succeeds, it may be adaptable as a more general NIH-wide 'K-lite' mentorship award mechanism to evoke otherwise untapped PI-level science leadership talents of our nation's many biomedical research trainees. All 15 ECSM fellows will be encouraged to make HIV I AIDS a facet of future research;targeted recruitment will ensure that some of the fellows will have a primary NIDA research career commitment to HIV I AIDS research.

DESCRIPTION (provided by applicant): This proposal is for 5 years of renewed institutional T32 NRSA support for the NIH/NIDA Drug Dependence Epidemiology Training Program (DDETP) located within Michigan State University College of Human Medicine Department of Epidemiology. DDETP founder/training program director is Professor James C. (Jim) Anthony, whose NIDA K05 Senior Scientist work between 2003 and 2010 included creation of the MSU DDETP, based upon his model for a successful DDETP at Johns Hopkins University (1990-2003), for which he received three mentoring awards. Also leading the program is Epidemiology Professor Naomi Breslau, and there is an interdisciplinary MSU faculty who represent epidemiology/biostatistics, quantitative methodology generally, clinical sciences/therapeutics, behavioral genetics, preclinical/clinical pharmacology, and allied fields (e.g., sociology, social work, family therapy). The main DDETP goal is to increase the number and quality of quantitatively adept epidemiologists and researchers in allied fields whose career commitment is toward NIDA's mission to prevent and control drug dependence syndromes and related suspected hazards of psychoactive drug use. The proposed 3 NIDA predoctoral trainees first complete 2-3 years of coursework with research apprenticeships, pass qualifying exams to establish candidacy for the PhD, and then complete 2-3 years of research before final defense of a monograph-length dissertation representing significant contributions of new scientific evidence that requires statistical estimation or formal hypothesis-testing in the NIDA epidemiology research context. The proposed 3 postdoctoral trainees at Levels 0, 3, & 7 complete an individualized program of postgraduate research training in drug dependence epidemiology, of 1-3 years duration (mostly 1-2 years), with a greater balance of time in NIDA research. Both types of trainees complete required integrity and ethics training, and work to assemble a portfolio of first-authored and co-authored articles in journals of the field, drafts of their own investigator-initiated NIDA grant award applications, and K-type career development plans, when appropriate. The program plan is designed to meet six challenges: (1) enhancing diversity outreach, (2) greater integration with MSU's new NIH clinical translational research and training initiatives, including HIV/AIDS research, (3) new educational modules on project management and on non-academic career paths toward health science and federal agency administration, small business and industry research (e.g., NIDA SBIR & STTR), (4) use of NIH and NIDA online career tracking programs, as well as online surveys to assess the mentoring process, (5) forging new solutions to a recently appreciated 'drift away' process that now detracts from post-program success in a competitive research funding environment, and (6) cultivation of a new generation of the program's Primary Advising Faculty (PAF) members in order to promote the success of the program during the proposed renewal award period and beyond. PUBLIC HEALTH RELEVANCE: Epidemiology and biostatistics are two of the most basic sciences for public health practice and program evaluation, helping us make unique discoveries about the causal determinants of population-level incidence rates and working toward discovery of individual-level 'causes of cases' as can be identified in community field studies and in clinicl and public health practice settings, often in collaboration with scientists from allied fields. Whe discoveries of a clinical translational character provoke change in clinical or public health practices, large sample evaluation and the epidemiology/biostatistics research approach often is required (Phase III effectiveness research, Phase IV surveillance, etc). Helping to foster success of the NIH/NIDA research mission, this NRSA T32 research training program seeks to increase the number and quality of quantitatively adept epidemiologists and researchers in allied fields whose career commitment is toward NIDA's mission to prevent and control drug dependence syndromes and related hazards of psychoactive drug use.

When we used NIH Project Reporter mapping tools in late 2018, we were able to see a major mid-America gap in NIDA investments for Epidemiology Branch research in relation to active training programs as well as active research projects. At the same time, the Epidemiology Branch and the NIH in general are fostering new workshops and expanding established workshop programs that are intended to increase the harvest of important epidemiological evidence from existing datasets (e.g., Monitoring the Future) and newly emerging datasets (e.g., ABCD, PATH, ?All of Us?). The proposed Epidemiology-focused R25 program seeks to address this ?Mid-America gap? in epidemiology focused clinical research training and to increase the numbers of epidemiologically adept scientists who can take advantage of these workshops and become more competitive in applications for NIDA F-type, entry K-type, and R-type awards to support their science discovery processes and apply their skills to better address substance abuse problems in mid-America. This application proposes five years of NIDA R25 support for a new ?Epidemiology in mid-American States? (EPIMAS) science education initiative with novel NIDA Epidemiology Branch-focused clinical research training plan that blends a core program of ?Research Experiences? (RE) with complementary ?Courses for Skills Development? (CSD). The EPIMAS program originates with a four-university consortium that was formed to address an imbalanced distribution of NIDA Epidemiology Branch T32 training programs and active R01 research projects in mid-America. The lead partner university in this consortium is Professor Jim Anthony at Michigan State University (MSU), who is joined by West Virginia University (WVU, local site PI: Professor Gordon Smith), Kansas University (KU, local site PI: Professor Richard Yi), and Indiana University (IU, local site PI: Professor David Allison), each of whom brings complementary strengths to the initiative. The specific aims and objectives of the EPIMAS program are: (1) To increase the number of epidemiologically adept scientists who can compete successfully for NIDA Epidemiology Branch funding; (2) To increase the pool of scientists capable of basic and advanced epidemiological analysis approaches in preparation for their participation in NIDA-supported workshops, and (3) To foster development of new NIDA Epidemiology- focused T32 programs at WVU, KU, and IU, and a renovation of the NIDA Drug Dependence Epidemiology Training Program at MSU. The proposed program seeks strength by having the four partner universities working together on this unprecedented NIDA Epidemiology-focused R25 initiative, and on R25 program enhancement of four epidemiology-focused NIDA T32 programs in these under-served states of mid-America.