Rina Das, PhDDivision of Extramural Scientific Programs

National Institute on Minority health and Health Disparities (NIMHD)

NIMHD Mission, Programs and Funding Opportunities

OUTLINE

NIMHD Mission Minority Health and Health Disparities NIMHD Research Framework NIMHD Programs Social Determinants of Health and Health Disparities COVID-19 Disparities and NIMHD Opportunities Funding Opportunity Announcements NIMHD Resources

NIMHD Mission The mission of NIMHD is to lead scientific research to improve minority health and eliminate health disparities.

To accomplish this, NIMHD: • Plans, reviews, coordinates, and evaluates all minority health

and health disparities research and activities of the National Institutes of Health

• Conducts and supports research in minority health and health disparities

• Promotes and supports the training of a diverse research workforce

• Translates and disseminates research information • Fosters innovative collaborations and partnerships

Minority Health Definition

• Minority Health-Distinctive health characteristics and attributes of the minority racial and/or ethnic groups in the U.S.

Minority Health Populations- OMB categories• Black or African American• Asian • American Indian or Alaska Native• Native Hawaiian or Other Pacific Islander• Latino or Hispanic

Health Disparities Definition

• Health Disparity-A health disparity is defined as a health difference that adversely affects disadvantaged populations, based on one or more of the health outcomes.

• Health disparity populations include racial/ethnic minorities, low SES, sexual and gender minorities, and underserved rural populations.

https://nimhd.nih.gov/about/overview/research-framework/nimhd-framework.html

NIMHD SCIENCE VISIONNew Perspectives to Advance Minority Health and Health Disparities Research

AJPH 2019, Vol 109, No. S1

• Editor’s choice by NIMHD Director Dr. Eliseo J. Pérez-Stable and NIH Director Dr. Francis S. Collins

• Definitions for minority health, health disparities, and NIMHD Research Framework

• Thirty research strategies in methods and measurement, etiology, and interventions

• Multi-year process with more than 100 authors, including NIH intramural and extramural scientific staff, along with external scientists

https://www.nimhd.nih.gov/about/overview/science-visioning/

Strategies to Promote the Advancement of Health Disparities Science

► Indicators for Measuring Health Disparities

► Methods for Analyzing Health Determinants Contributing to Health Disparities

► Evaluating Health Disparities Research► Health Disparities in The Era of

Big Data

Methods and Measurement► Social Determinants► Environmental Exposures, Biological

Pathways and Mechanisms► Life Course Approaches► Health Services

Etiology► Guiding Principles► Approaches► Methods and Evaluation► Dissemination and Implementation

(Scalability)

Interventions

https://www.nimhd.nih.gov/about/overview/science-visioning/visioning-strategies.html

Extramural Programs at NIMHDNIMHD funds programs in diseases relevant to racial/ethnic minorities and other health disparity populations Focus on basic, translational and applied biomedical research Infrastructure and Training grants to build capacity for biomedical researchPrograms include:

Investigator Initiated Research Project Grants (R01, R21, R03 ) Centers of Excellence (COE) Program, (U54) Research Centers in Minority Institutions (RCMI) Program (U54) Community-Based Participatory Research (CBPR) Initiative (U01) Transdisciplinary Collaborative Centers (TCC) Initiative (U54) Small Business Innovation Research/Small Business Technology Transfer

(SBIR/STTR) Program (R43, R44/ R41, R42) Science Education Program (R25) Loan repayment program (L32, L60) Conference Grants (R13) Academic Research Enhancement Awards (AREA, R15) Training Grants (T37, K01, K08, K23, K99, K18)

Research Training Programs at NIMHD Diversity Supplements T37 MHRT Minority Health and Health Disparities Research Training NRSA Pre-doctoral fellowships

• F30 -Individual Predoctoral MD/PhD or Other Dual-Doctoral Degree Fellowship (Parent F30)

• F31 -Individual Predoctoral Fellowship (Parent F31) • F31D -Individual Predoctoral Fellowship to Promote Diversity

in Health-Related Research (Parent F31 - Diversity) NRSA Post-doctoral fellowships: F32- Individual Postdoctoral

fellowships Career Development Program: K01, K08, K23, K99 mechanisms Loan Repayment Program

• L32 -Loan Repayment Program for Clinical Research for Persons from Disadvantaged Backgrounds

• L60 -Loan Repayment Program for Minority Health and Health Disparities Research

NIMHD Extramural Scientific Program Areas

Clinical and Health Services

Research

Integrative Biological and

Behavioral Sciences

Community Health and Population Sciences

Clinical and Health Services Research (CHSR)

This research area focuses on clinical research to generate new knowledge to improve health outcomes and quality of healthcare for minority and other disparity populations. The scientific portfolio includes extramural grants, cooperative agreements and training awards related to the following:

Development of preventive, diagnostic and therapeutic healthcare interventions that can contribute to reducing health disparities;

Research in clinical settings that addresses access to health care, improvement of patient safety, reduction of medical errors and healthcare delivery costs, coordination of care, impact of health information technology on coordination and quality of care, shared decision making on patient satisfaction and health outcomes, patient-clinician communication and quality of health care; and

How healthcare financing and organizational structure of healthcare systems affect access, quality and costs of care in minority and other disparity populations

Focus on understanding biological and behavioral mechanisms and pathways by which sociocultural and environmental factors become embodied within individuals to influence resilience and susceptibility to adverse health conditions at the individual, interpersonal and family levels.

Integrative Biological and Behavioral Sciences (IBBS)

Research on interpersonal, family, neighborhood, community and societal-level mechanisms and pathways that influence disease risk, resilience, morbidity, and mortality in health disparity populations.• Epidemiology• Pathways and Determinants of Population Health• Pathways and Determinants of Community Health• Community-Based Prevention and Health Promotion

Interventions

Community Health and Population Sciences (CHPS)

Social Determinants & Health Disparities

SES Place Education Discrimination

Relative risk of All-Cause Mortality by U.S. Annual Household Income Level

Life Expectancy at Birth for U.S. Census Tracts, 2010-2015 (CDC)

Place Matters

• Life expectancy in Washington D.C. area can vary by neighborhood

• The average life expectancy in the District of Columbia and Prince George's County is 78 years - 8 years shorter than for babies born in either Arlington or Fairfax Counties with 86 years.

• https://societyhealth.vcu.edu/work/the-projects/mapping-life-expectancy.html

Prevalence Obesity among Youths by Head of Household, ≤ HS vs. College Degree, US, 2011-14

% Males % Females

Whites 16.9 / 9.6 22.5 / 7.5

Blacks 21.1 / 14.5 21.0 / 16.3

Latinos 24.4 / 12.9 23.9 / 14.0

Asian 16.9 / 7.9 9.2/ 3.3

MMWR February 16, 2018; 67: 186-189

Societal Discrimination and Health Outcomes

Structural racism associated with obesity and obesogenic environment in Blacks. Racial residential segregation/neighborhood disadvantage and

inequality in poverty, unemployment, and homeownership were associated with higher obesity rates in blacks; Associations varied by county racial composition. (Bell et al, 2019; Int J Environ Res Public Health. 2019 Mar; 16(5): 861).

Societal discrimination and adverse behavioral health outcomes in adolescents. Societal discrimination is common (45%) and was associated with

increased substance use and greater odds of depression and ADHD (Leventhal AM et al, JAMA Pediatrics online August 20, 2018)

COVID-19 & Disparities

JAMA Viewpoint: COVID-19 and Racial/Ethnic Disparities Webb Hooper M, Nápoles AM, Pérez-Stable EJ

• Published online JAMA, May 11, 2020 • The article addresses the disproportionate burden of COVID-19

on racial and ethnic minority populations • Possible underlying causes of this burden related to long-

standing disparities and disadvantage, higher rates of co-morbid conditions and crowding in housing and communities

• Imperative need for implementing prevention and healthcare strategies aligned with the needs of these communities to address effects of pandemic and mitigation efforts as well as underlying inequities

• https://jamanetwork.com/journals/jama/fullarticle/2766098

COVID-19 Hospitalization Data from CDC

New York City Data on COVID-19 Disparities

Age-adjusted rates of lab confirmed COVID-19 non hospitalized cases, estimated non-fatal hospitalized cases, and patients known to have died 100,000 by race/ethnicity group as of April 16,2020

Non-hospitalized Non-fatal hospitalized Known to have died Black/African

American 335.5 271.7 92.3

Hispanic/Latino 271.6 198.6 74.3

White 190.4 114.5 45.2

Asian 95.1 82.2 34.5

0 100 200 300 400 0 100 200 300 400 0 100 200 300 400

Age-adjusted case rate per 100,000

Non-hospitalized Non-fatal hospitalized Known to have died

Source-CDC reports

Data on COVID-19 Disparities in Louisiana and Georgia

• Study included data from large cohort in Louisiana with 3481 Covid-19–positive patients in Ochsner Health System.

• Blacks represent only 31% of the patients routinely cared for, but they made up 76.9% of Covid-19–positive patients hospitalized within the health system.

• Blacks represent approximately 80% of the patients who received critical care or mechanical ventilation.

• Blacks were overrepresented (70.6%)among all patients who died in the hospital.

• Comorbidities, obesity, diabetes, access to care, occupation, etc.

For details see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269015/N Engl J Med. 2020 May 27

Number of hospitalized patients with COVID-19 (N = 305) from 8 hospitals in Georgia; Blacks were overrepresented (over 80%).For details see:Gold JA, et al. March 2020. MMWR Morb Mortal Wkly Rep 2020;69:545-550 http://dx.doi.org/10.15585/mmwr.mm6918e1

Georgia DataLouisiana Data

Impact of COVID-19 Outbreak on Minority Health and Health DisparitiesNOT-MD-20-019 is soliciting research with health disparitypopulations that seeks to understand:

Learn more at https://grants.nih.gov/grants/guide/notice-files/NOT-MD-20-019.html

• How state and local policies and initiatives mitigate or exacerbate disparities in health services use and health outcomes

• The role that community-level protective and resilience factors and interventions have in mitigating the effects of the sector disruptions that the COVID-19 outbreak causes

• How behavioral and/or biological mechanisms may contribute to COVID-19 manifestations

• Receipt date: May 2020- May 2021

RADx-UP InitiativesNOT-OD-20-112

• Notice that NIH plans to publish four Funding Opportunity Announcements (FOAs) as part of the Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative to solicit research on COVID-19 diagnostic testing in underserved and vulnerable populations.

• To conduct community-engaged research to understand COVID-19 disparities and to increase access and effectiveness of diagnostic testing interventions among underserved COVID-19 medically and/or socially vulnerable populations.

• Supplement to existing grants for large consortia, multi-site trials, centers and other current networks that have adequate capacity, infrastructure, and established community-engaged relationships to support large-scale testing interventions or have the capacity to ramp up quickly to reach underserved or vulnerable populations

• First Estimated Application Due Date: July 2020Earliest Estimated Award Date: September 2020

• https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-112.html

Supplements to Promote Community Interventions for COVID-19

NOT-MD-20-022 is soliciting research for Community Interventions to Reduce the Impact of COVID-19 on Health Disparity and Other Vulnerable Populations.

Learn more at https://grants.nih.gov/grants/guide/notice-files/NOT-MD-20-022.html

• Research to test community interventions focused on the prevention (or slowing) of COVID-19 transmission, evaluate local and state policies and programs intended to mitigate COVID-19 exposure and improve adherence, and reduce the negative impact of the multifaceted consequences on the health of US health disparity and other vulnerable populations.

• Receipt date: June 10-Dec 29, 2020• Budget: 250K direct cost for one year

NIH COVID-19Information for Applicants and Recipients

• This is a rapidly evolving situation • Visit the NIH grants page often for the

latest updates

29

Stay Up to Date https://grants.nih.gov/policy/natural-disasters/corona-virus.htm

Funding Opportunities at NIMHD

https://nimhd.nih.gov/funding/nimhd-funding/active_foa.html

Research FOAs

Number ActivityCode(s) Title Expiration

DatePA-18-484PA-18-345

R01 Research Project Grant (Parent R01) 01-08-2021

PAR-20-150 R21*NIMHD Exploratory/Developmental Research Grant Program (R21)

05-08-2023

PAR-19-135PAR-19-134

R15 Research Enhancement Award Program (REAP) for Health Professional Schools and Graduate Schools

01-08-2021

PA-18-648 R13, U13 NIH Support for Conferences and Scientific Meetings (Parent R13/U13) 01-08-2021

Fellowships

Number ActivityCode(s) Title Expiration

Date

PA-18-671 F31 Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship

01-08-2021

PA-18-666 F31 NRSA Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research

01-08-2021

PA-18-673PA-16-306 F30

NRSA Fellowship for Students at Institutions With/Without NIH-Funded Institutional Predoctoral Dual-Degree Training Programs

01-08-2021

PA-18-670 F32NRSA Individual Postdoctoral Fellowship

01-08-2021

Training Number Activity

Code(s) Title ExpirationDate

PAR-18-881PAR-18-882

K18

Short-term Mentored Career Enhancement Awards for Mid-Career Investigators to Integrate Basic Behavioral and Social Sciences

07-13-2020

PA-18-397PA-18-398

K99/R00NIH Pathway to Independence Award

01-08-2021

PA-18-369PA-18-363

K01Mentored Research Scientist Development Award

01-08-2021

PA-18-373K08

Mentored Clinical Scientist Research Career Development Award

01-08-2021

PA-18-374PA-18-375

K23Mentored Patient-Oriented Research Career Development Award

01-08-2021

NIMHD Extramural Scientific Program Areas

Clinical and Health Services

Research

Integrative Biological and

Behavioral Sciences

Community Health and Population Sciences

CHSR FOAs

Number ActivityCode(s) Title Expiration

Date

PAR-18-747PAR-18-745

R01R21

Addressing the Challenges of the Opioid Epidemic in Minority Health and Health Disparities Research in the U.S. (Clinical Trial Optional)

11-14-2020

PAR-18-286PAR-18-287

R01R21

Health Services Research on Minority Health and Health Disparities

Renewal soon

PAR-20-079R01 Surgical Disparities Research 07-06-2022

PAR-19-093 R01

Leveraging Health Information Technology (Health IT) to Address Minority Health and Health Disparities (R01 Clinical Trial Optional)

12-05-2021

CHSR FOAs

Number ActivityCode(s) Title Expiration

Date

PAR-18-189PAR-18-190

R01R21

Multidisciplinary Studies of HIV/AIDS and Aging

09-08-2020

PAR-19-162PAR-19-163

R01R21

Accelerating the Pace of Child Health Research Using Existing Data from the Adolescent Brain Cognitive Development (ABCD) Study (Clinical Trial Not Allowed)

09-08-2021

PA-20-172 R01 Long-Term Effects of Disasters on Health Care Systems Serving Health Disparity Populations (R01- Clinical Trial Optional)

09-08-2023

Minority Health and Health Disparities in Maternal Mortality and Morbidity

NOT-OD-20-104 aims to support administrative supplements to support research on how to mitigate preventable Maternal Mortality, decrease severe maternal morbidity, and promote health equity in the U.S.Due: June 22,2020

RFA-MD-20-008 aims to support research that tests clinical, social behavioral and health care system system interventions to address racial disparities in maternal mortality and morbidity (MMM) in the U.S.

Learn more at https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-104.html

http://nimhd.nih.gov/funding

IBBS FOAs

Number ActivityCode(s) Title Expiration

Date

PA-17-041R01

Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations

Renewal soon

PA-18-284R01

Addressing Health Disparities through Effective Interventions Among Immigrant Populations

Renewal soon

PAR-20-088PAR-20-081

R01R21

Mechanisms of Disparities in Chronic Liver Diseases and Cancer

04-02-2022

PAR-20-164 R01Mechanisms and Consequences of Sleep Disparities in the U.S.

07-15-2022

Mechanisms and Consequences of Sleep Disparities in the U.S.

Research should focus on U.S. Health Disparity Populations:(1) Underlying pathways and mechanisms that explain sleep

deficiencies and/or(2) Whether sleep deficiencies explain disparities for health

outcomesConsidering causes from socioecological framework and demonstrating integration of expertise on sleep and health disparities is considered highly responsive.

Contact: Drs. Rina Das and Nancy Jones, NIMHD

PAR-20-164 (R01) NIMHD, NCI, NHLBI*,NIA, NIAAA, NINDS

IBBS FOAs

Number ActivityCode(s) Title Expiration

Date

PAR-19-372R01

Social Epigenomics Research Focused on Minority Health and Health Disparities

11-07-2021

PAR-19-018PAR-19-019

R01R21

Mechanisms of Disparities in Etiology and Outcomes of Lung Cancer in the U.S.: The Role of Risk and Protective Factors (R01 Clinical Trial Not Allowed)

03-05-2021

PAR-19-373 R01

Research on biopsychosocial factors of social connectedness and isolation on health, wellbeing, illness, and recovery (R01 Clinical trial not allowed)

03-18-2021

Social Epigenomics Research Focused on Minority Health and Health Disparities.

Research should focus on U.S. Health Disparity Populations:(1) Understand mechanisms by which social factors lead to epigenetic

changes that affect minority health and/or health disparities, and (2) Promote epigenetics research to better predict disease risk or

resiliency among health disparity populations.

Social determinants of health are the conditions in which people are born, grow, live, work and age. Help understand how social determinants (both positive and negative) may affect human biology and ultimately health outcomes.

Contact: Dr. Rina Das, NIMHD

PAR-19-372 (R01) NIMHD, NIA, NHGRI

CHPS FOAs

Number ActivityCode(s) Title Expiration

Date

PAR-20-180 R01

Identifying Innovative Mechanisms or Interventions that Target Multimorbidity and Its Consequences (R01 Clinical Trial Optional)

09-08-2023

PA-18-729PA-18-728

R01 R21

Research on the Health of Transgender and Gender Nonconforming Populations (R01 Clinical Trial Optional)

01-08-2021

PA-18-651 R01Developmentally Tailored HIV Prevention and Care Research for Adolescents and Young Adults

01-08-2021

CHPS FOAs

Number ActivityCode(s) Title Expiration

Date

PAR-17-484R01

Collaborative Minority Health and Health Disparities Research with Tribal Epidemiology Centers

Renewal soon

PAR-20-048 U24

Building Population Health Research Capacity in the U.S. Affiliated Pacific Islands (U24 – Clinical Trial Not Allowed)

07-16-2022

PAR-18-324 R01Testing Interventions for Health-Enhancing Physical Activity

01-08-2021

PA-17-444PA-17-446

R01R21

Ethical, Legal, and Social Implications (ELSI) of Genomics Research Project Grant Program

09-08-2020

Rural Health Disparities Research Resource HubsNOT-MD-20-010 aims to understand challenges to conducting rural health disparities research, particularly for early stage investigators

• Supplements to current Centers of Excellence and RCMI awardees to develop multi-sectoral coalitions to enhance capacity to conduct rural health disparities research.

• Initiative is one of NIH’s contributions to the HHS Rural Health Strategic Plan.

• If successful, this program can serve as a pilot for a larger initiative involving other NIH ICs and Federal partners.

For details: https://grants.nih.gov/grants/guide/notice-files/NOT-MD-20-010.html

NIMHD Health Disparities Research Institute

The National Institute on Minority Health and Health Disparities (NIMHD) hosts the Health Disparities Research Institute (HDRI) every year for one week (~August 2020). The HDRI aims to support the research career development of promising minority health/health disparities research scientists early in their careers and stimulate research in the disciplines supported by health disparities science.The program will feature lectures, mock grant review, seminars, small group discussions on research relevant to minority health and health disparities. It will also include sessions with NIH scientific staff engaged in related health disparities research across the various institutes and centers.Check our website NIMHD Health Disparities Research Institute website.

Resources

Common Data Elements for Social Determinants of Health

Adoption of CDEs and standard measures will promote and facilitate:• Data harmonization.• Domestic and international

cross-study analysis.• Accelerated translational

research.• Greater understanding of the

causes of health disparities.• Effective interventions to

reduce disparities.• COVID-19 measures

Toolbox of Measures on SDOH

Addressing Health Disparities Through the Utilization of Health Information Technology

Supplement to Medical CareJune 2019, Vol 57, Supplement2

This special supplement, sponsored by NIMHD, with an introductory editorial led by NIMHD Director Eliseo J. Pérez-Stable, M.D., with NIMHD Health Scientist Administrator Beda Jean-Francois, Ph.D., and NIMHD Chief of Staff Courtney Ferrell Aklin, Ph.D., reports on the use of health information technologies to reduce disparities in health care access and outcomes by increasing access to care, improving quality of healthcare and by promoting better patient-clinician communication

Workshop Report on the Causes and Consequences of Sleep Health Disparities Report on 2018 NIMHD, NHLBI, OBSSR Workshop where experts from sleep and health disparities developed strategies to address SHDs:• Develop and promote integrative

research to investigate causes and consequences

• Develop interventions• Build research infrastructure and

training opportunities• PAR-20-164 on SHD renewed:

http://nimhd.nih.gov/funding

Sleep Health Disparity (SHD): A difference in one or more dimensions of sleep health (regularity, quality, alertness, timing, efficiency, and duration)—on a consistent basis—that adversely affects designated disadvantaged populations.

Precision Medicine & Health Disparities ResearchEthnicity & Disease Supplement Vol. 30, April 2020

• Presents initial findings from NIMHD’s Transdisciplinary Collaborative Centers on Precision Medicine

• First set of NIH-funded papers focused on precision medicine research addressing minority health and health disparities

Foreword by Drs. Nishadi Rajapakse, Michael H. Sayre, Eliseo J. Pérez-Stable

NIMHD RESOURCEShttps://hdpulse.nimhd.nih.gov/

NIMHD Resources

For Research ApplicantsThe resources highlighted on this page may be helpful to research applicants interested in current fundingopportunities as well as NIH policies that guide NIH-funded grant program operations.Grant Policies and Guidance

• NIH Office of Extramural Research• Grants Process Overview• New and Early Stage Investigator Policies• Clinical Trial Requirements for Grants & Contracts• Video: NIH Grant Basics• Video: How to Apply – Four Interactive Tutorials• Video: NIH Peer Review Briefing for Basic Research Applicants and Reviewers• Video: 8 Ways to Successfully Navigate NIH Peer Review and Get an R01 Grant• Video: 8 Ways to Successfully Navigate NIH Peer Review and Get a Fellowship Grant• Video: What Happens to Your NIH Grant Application• Video: Insights from Peer Review• Video: Top 10 Peer Review Q&As for NIH Applicants

Learn More: https://nimhd.nih.gov/resources/

https://nimhd.nih.gov/programs/extramural/research-areas/index.html

Advice for New InvestigatorsSubscribe to the NIH Guide (http://grants.nih.gov/grants/guide/)

Clinical Trial Requirements https://grants.nih.gov/policy/clinical-trials.htm

Look at funded projects on NIH RePORTER(http://projectreporter.nih.gov/reporter.cfm)

Watch CSR Videos for Applicants (https://public.csr.nih.gov/Pages/csrwebinar.aspx)

Sample applications https://www.niaid.nih.gov/grants-contracts/sample-applications

Rina Das: dasr2@mail.nih.gov