Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas.

Hispanics/Latinos are expected to constitute 25% of the U.S. population by 2060. Differences in the prevalence of health risk factors, chronic diseases, and access to and utilization of health-care services between Hispanics/Latinos and other populations in the U.S. have been documented. This study aimed to describe and analyze the landscape of Research Program Grants (RPGs) funded by the National Institutes of Health (NIH) between 2008 and 2015 involving Hispanic/Latino health research in six health condition areas-asthma, cancer, dementia, diabetes, liver/gallbladder disease, and obesity-and to identify opportunities for continued research in these areas. Using an NIH internal search engine, we identified new and renewal Hispanic/Latino health RPGs searching for specific Hispanic/Latino identifiers in the Title, Abstract, and Specific Aims. We used descriptive statistics to examine the distribution of funded RPGs by NIH disease-based classification codes for the six health condition areas of interest, and other selected characteristics. The most prominent clusters of research subtopics were identified within each health condition area, and performance sites were mapped at the city level. Within the selected time frame, 3,221 Hispanic/Latino health-related unique RPGs were funded (constituting 4.4% of all funded RPGs), and of those 625 RPGs were eligible for review and coding in the present study. Cancer and obesity were the most commonly studied health condition areas (72%), while studies on mechanisms of disease-biological and non-biological-(72.6%), behavioral research (42.1%) and epidemiological studies (38.1%) were the most common types of research. Most of the primary performance sites were in California, Texas, the northeastern U.S., and Illinois. The predominance of mechanistic, behavioral, and epidemiological studies in our analysis poses opportunities to evaluate knowledge gained and their clinical application, explore new research questions, or to update some methods or instruments. The findings of the present study suggest opportunities to expand research in understudied mechanisms of disease that could explain differences in prevalence of conditions like diabetes and cancer among different heritage groups. In addition, our findings suggest that the impact of interventions or policies designed to reduce health disparities, innovative multi-level interventions, implementation and dissemination studies, the role of health information technology on health outcomes, and the intersectionality of individual, sociocultural, geographic, and other factors on health outcomes, among others, are understudied approaches, which could potentially advance research in Hispanic/Latino health and contribute to the achievement of better health outcomes in this diverse population.

Identifying Urban Immigrant Food-Cultivation Practices for Culturally-Tailored Garden-Based Nutrition Programs.

Garden-based nutrition programs are used to address food access and nutrition in low-income communities. In urban immigrant communities, food-growing practices may be shaped by environmental and cultural factors, and may not reflect the assumptions behind these curricula. Built-environment research was adapted to develop a protocol for assessing a community's gardening practices. A random sample of census blocks was generated and mapped, observational protocols developed, iteratively tested and refined, then fieldworkers trained and deployed. Daily debriefings were conducted to identify challenges in field implementation. Nearly all (93%) sampled blocks contained evidence of food cultivation. Garden structures, land-use patterns, and plant choices reflected cultural preferences, differing substantively from USDA home gardening curricula. This tool successfully identified food-growing practices within an urban immigrant Asian and Pacific Islander community, and provides a replicable methodology for community assessment. Results support the need to culturally-tailor garden-based nutrition programs for urban immigrant populations.

Using Concept Mapping in the Development of a School of Public Health.

Schools of Public Health have a wide variety of essential stakeholders. Broad input in program planning should assist in ensuring well-developed plans and strong community buy-in. The planning of a school can better address the needs of multiple stakeholders from systematic broad-based input from these constituents using concept mapping. In this study, we used concept mapping to prioritize a set of recommendations from diverse stakeholders to assist in the process of planning a school. A set of statements was generated on essential elements for the proposed school from a broad group of stakeholders. The statements were then distilled into unique themes, which were then rated on importance and feasibility. Cluster maps and pattern matches were used to analyze the ratings. Unique themes (N = 147) were identified and grouped into 12 clusters. Cluster themes included leadership, faculty, culture, school, and curriculum. Pattern matches revealed a significant, modest correlation between importance and feasibility (r = 0.27). A broad range of perspectives was used to identify relevant areas to address in the development of a school.

Avoiding a knowledge gap in a multiethnic statewide social marketing campaign: is cultural tailoring sufficient?

In 2007, the State of Hawaii, Healthy Hawaii Initiative conducted a statewide social-marketing campaign promoting increased physical activity and nutrition. The campaign included substantial formative research to develop messages tailored for Hawaii's multiethnic Asian and Pacific Islander populations. The authors conducted a statewide random digital dialing telephone survey to assess the campaign's comparative reach among individuals with different ethnicities and different levels of education and income. This analysis suggests that the intervention was successful in reaching its target ethnic audiences. However, a knowledge gap related to the campaign appeared among individuals with incomes less than 130% of the poverty level and those with less than a high school education. These results varied significantly by message and the communication channel used. Recall of supermarket-based messages was significantly higher among individuals below 130% of the poverty level and those between 18 and 35 years of age, 2 groups that showed consistently lower recall of messages in other channels. Results suggest that cultural tailoring for ethnic audiences, although important, is insufficient for reaching low-income populations, and that broad-based social marketing campaigns should consider addressing socioeconomic status-related channel preferences in formative research and campaign design.

The Influence of Age-Related Cues on Health and Longevity.

Environmental cues that signal aging may directly and indirectly prime diminished capacity. Similarly, the absence of these cues may prime improved health. The authors investigated the effects of age cues on health and longevity in five very different settings. The findings include the following: First, women who think they look younger after having their hair colored/cut show a decrease in blood pressure and appear younger in photographs (in which their hair is cropped out) to independent raters. Second, clothing is an age-related cue. Uniforms eliminate these age-related cues: Those who wear work uniforms have lower morbidity than do those who earn the same amount of money and do not wear work uniforms. Third, baldness cues old age. Men who bald prematurely see an older self and therefore age faster: Prematurely bald men have an excess risk of getting prostate cancer and coronary heart disease than do men who do not prematurely bald. Fourth, women who bear children later in life are surrounded by younger age-related cues: Older mothers have a longer life expectancy than do women who bear children earlier in life. Last, large spousal age differences result in age-incongruent cues: Younger spouses live shorter lives and older spouses live longer lives than do controls.

Food security issues for low-income Hawaii residents.

Support provided by the US Food Stamp Program (FSP) is intended to promote health. The objective of this qualitative study was to examine food security for low-income Hawaii residents. A sample of low-income Hawaii residents (n = 86) were recruited to participate in a series of focus group discussions. Most participants were female (73.5%), Native Hawaiian/Pacific Islander (61.6%), ages 18-39 (62.7%), high school educated (80.5%), low-income (50.6% < $10,000), used food stamps (73.5%), and had 4.07 +/- 2.89 persons per household. At 2 hour focus groups, participants received a healthy meal and a monetary incentive. Audio recordings were transcribed verbatim and analyzed using NVivo. Over 50% indicated FSP assistance was not enough. When this happened, most participants had alternatives including food banks, churches, friends and family members. Shopping strategies included budgeting, buying in bulk, or smarter shopping practices. Several participants were concerned about high living costs. Food insecurity should be addressed for FSP participants in Hawaii, with many residents not being able to meet nutritional and economic needs on their own.