Department of Health and Human Services
	Research, Demonstration, and Evaluation Activities FY 2003 Plan and Budget February 2002

RESEARCH AND DEMONSTRATIONS

(by HHS Strategic Plan Objective)

ELIMINATE DISPARITIES IN HEALTH ACCESS AND OUTCOMES (OBJECTIVE 3.2)

FY 2003 Priorities

PUBLIC HEALTH IMPROVEMENT (CDC)

Demonstrations: Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) is a demonstration program to reduce racial and ethnic health disparities in infant mortality, breast and cervical cancer, cardiovascular disease, and other diseases/conditions.

• CDC will work closely with 30 communities and 5 American Indian/Alaska Native Tribes to address health priorities, gaps in prevention and service delivery interventions for their proposed communities.
• Activities in the area of improving general access to health care include locating permanent sources of health care closer to under-served communities; establishing breast cancer education programs in senior centers and retirement communities; reducing financial barriers to community member participation in physical activity; increasing access to low-cost or free early and adequate prenatal care; and establishing and supporting peer educator programs in youth organizations, middle schools, and high schools Activities in the area of improving ge
• Activities to address diabetes include providing guides in local restaurants that describe the healthy meal alternatives offered; distributing low-fat menus and recipes at local supermarkets tied to current sales items offered by local retailers; and offering awareness seminars about Type II diabetes at local senior centers and retirement communities.
• Activities to address infant mortality include awarding grants to agencies that will provide training and services in preconception counseling to reduce risk for low birth weight and infant death. Activities specific to breast and cervical cancer include providing incentives (e.g. reduced insurance premiums) to women who routinely get mammography and pap smear tests.

Evaluations: REACH communities will also evaluate their progress. CDC is supporting the development of an evaluation network entitled CENTERED (Community Evaluation Networks Targeting Entrenched Racial and Ethnic Communities). The primary goal of this network is to make appropriate evaluation strategies and models available and accessible to the community- based initiatives. CDC will also continue to support two evaluation contractors to provide qualitative and quantitative assessments of REACH 2010 program.

INFECTIOUS DISEASE - SEXUALLY TRANSMITTED DISEASES (CDC)

Research: CDC will support research to eliminate disparities to health access and outcomes.

FY 2003 priorities include research program to implement and evaluate a community level intervention to prevent transmission of primary and secondary syphilis in rural and urban communities by training key community members (i.e. opinion leaders) within the affected communities to promote risk reduction and health seeking behaviors. The intervention that will be evaluated by this project is the Popular Opinion Leader model.

HEALTH SERVICES RESEARCH (NIH)

Research: In FY 2003, NIH funds will be used to support research on health disparities in areas such as aging, mental health, and cancer. FY 2003 priorities include:

Research studies supported by the National Institute on Aging (NIA) will focus on:

• the extent of racial and ethnic disparities in life-expectancy, health, and disability and the extent to which these disparities can be attributed to differences in lifestyle risk factors, access to health care, and other social and economic factors.
• ethnic/race differences in the use of, processes associated with, and outcomes of various health care delivery systems and settings, and on the design of interventions for improving minority access to health-care services.
• increasing the effectiveness of disseminating health education and research findings to older minority populations.
• effects of psychoeducational support groups, behavioral skills training programs, family- based systems interventions, environmental modifications, and technological computer- based information services for Caucasian, Hispanic, and African American caregivers.

The National Institute of Mental Health (NIMH) will support research to:

• develop preventive interventions tailored to underserved racial and cultural groups, such as family group therapies for Latinos and African Americans with schizophrenia or depression.
• enhance the provision of mental health services to low income women seen for treatment of trauma in public primary care facilities and to disadvantaged women seen in the context of prenatal health care services.
• gain information needed to more effectively meet the treatment needs of children in migrant and formerly migrant populations.
• examine the role of ethnocultural factors in the manifestation of severe mental disorders and the manner in which these factors affect course, treatment (including medical adherence), and rehabilitation for these disorders.
• explore school and parent factors in the service entry pathway that may result in differential racial/ethnic representation in school-based and traditional mental health services.

An epidemiologic study supported by the National Institute of Child Health and Human Development (NICHD) will combine public health surveillance data with census and zip code data to establish area-based measurers of socioeconomic position. This tool will create a more powerful determinant of population health, disease and well-being and will greatly augment the capacity to: monitor socioeconomic inequalities in health, analyze the contribution of socioeconomic inequality to racial/ethnic inequalities in health, and guide the allocation of health and other resources and interventions to attain social equity in health.

NICHD will also continue to support a large, ongoing study of inner-city minority populations that addresses among other things: barriers, motivators, and facilitators to prenatal care; adolescent pregnancy prevention; childhood injury prevention; community capacity building, and accessing computer-based medical records on the World Wide Web, among others. In addition, research will address cost-effectiveness of health care, applications of modern technologies for improved health management, and strategies to impact lack of age-appropriated immunizations.

Research studies will be undertaken by the National Cancer Institute (NCI) to:

• expand the understanding of the social and environmental determinants of cancer and the psychosocial, behavioral, and biologic factors that mediate them.
• develop hypotheses for cancer control research at social, institutional and policy levels.
• develop, apply, and evaluate interventions to improve cancer outcomes and reduce outcome disparities.
• assist institutions to build a technical and human resource infrastructure and supportive environment over time to conduct oncology research trials.
• bring the advantages of state-of-the-art treatment and cancer prevention and control research to minority individuals in their own communities.
• increase the involvement of primary health care providers and other specialists in cancer prevention and control studies.
• increase capacity to extend cancer prevention and control and reduce cancer incidence, morbidity, and mortality in minority populations.

HEALTH DISPARITIES GRANTS IN MINORITY HEALTH (OPHS)

Demonstrations: The purpose of this program is to reduce health disparities among racial and ethnic populations through local pilot and small scale projects which address a demonstrated health problems or health related issue. This program intends to demonstrate the merit of using local organizations to develop, implement, and conduct pilot or small scale community-based projects which address a wide range of health problems and issues related to health disparities in local minority communities. In FY 2003, OPHS will continue this demonstration program to: further strengthen the ability of grassroots organizations in providing innovative approaches that address a wide range of health issues affecting local minority communities, particularly those health issues identified in Healthy People 2010.

BILINGUAL/BICULTURAL SERVICE DEMONSTRATIONS (OPHS)

Demonstration: The purpose of this program is to improve and expand the capacity for linguistic and cultural competence of health care professionals and paraprofessionals working with limited-English-proficient (LEP) minority communities; and improve the accessibility and utilization of health care services among the LEP minority populations. These grants are intended to demonstrate the merit of programs that involve partnerships between minority community-based organizations and health care facilities in a collaborative effort to address cultural and linguistic barriers to effective health care service delivery and to increase access to effective health care for the LEP minority populations living in the United States. In FY 2003, OPHS will continue this demonstration program to: foster development of more culturally and linguistically appropriate health services for target minority populations, particularly in relation to the health issues identified in Healthy People 2010.

COMMUNITY PROGRAMS TO IMPROVE MINORITY HEALTH (OPHS)

Demonstration: The purpose of this program is to improve the health status of targeted minority populations through health promotion and disease risk reduction intervention programs. These grants are intended to demonstrate the effectiveness of community-based coalitions in developing, implementing, and conducting demonstration projects which coordinate integrated community-based educational, screening and outreach services, and include linkages for access and treatment to minorities in high-risk, low income communities; and addressing sociocultural and linguistic barriers to health care. OMH will continue this demonstration program to:

• forge partnerships to further enable minority communities to effectively respond to identified health needs, particularly those health issues identified in Healthy People 2010.
• develop innovative approaches to health promotion and risk reduction in minority communities.

MINORITY COMMUNITY HEALTH COALITION DEMONSTRATION GRANT PROGRAM, HIV/AIDS (OPHS)

Demonstration: This program supports projects designed to improve the health status, relative to HIV/AIDS, of targeted minority populations through health promotion and education activities. These grants are intended to demonstrate the effectiveness of community-based coalitions involving non-traditional partners in:

• developing an integrated community-based response to the HIV/AIDS crisis through community dialogue and interaction.
• addressing sociocultural and linguistic barriers to HIV/AIDS treatment to increase the number of individuals seeking and accepting services.
• developing and conducting HIV/AIDS education and outreach demonstration projects for hardly reached populations.

We will continue this demonstration program to:

• forge partnerships that will further enable minority communities to effectively respond to the HIV/AIDS epidemic.
• develop innovative approaches to health promotion and risk reduction in minority communities.

STATE AND TERRITORIAL MINORITY HIV/AIDS DEMONSTRATION PROGRAM (OPHS)

Demonstration: This program supports State and Territorial Offices of Minority Health in carrying out projects to assist in the identification of needs within the state for HIV/AIDS prevention and services among minority populations, facilitate the linkage of minority community-based organizations with other state and local recipients of federal funds for HIV/AIDS to develop greater resource capacity and interventions, and assist in coordinating federal resources coming into high need, minority communities. The program is intended to demonstrate that the involvement of State and Territorial Offices of Minority Health in coordinating a statewide response to the HIV/AIDS crisis in minority communities can have a greater impact on the communities’ understanding of the disease and the coordination of prevention and treatment services for minority populations, than agencies/organizations working independently. OMH will continue this demonstration program to: further empower states to respond to the needs of minority communities in addressing the HIV/AIDS epidemic.

TECHNICAL ASSISTANCE AND CAPACITY DEVELOPMENT DEMONSTRATION PROGRAM FOR HIV/AIDS - RELATED SERVICES IN HIGHLY IMPACTED MINORITY COMMUNITIES (OPHS)

Demonstration: The purpose of the program is to stimulate and foster the development of effective and durable service delivery capacity for HIV prevention and treatment among organizations closely interfaced with the minority populations highly impacted by HIV/AIDS. By engaging in a community-based approach to providing technical assistance and capacity development within a defined geographic area, the program intends to strengthen indigenous leadership and service delivery organizations, and address HIV/AIDS issues within the context of related socioeconomic factors. In FY 2003, the Office of Minority Health (OMH) will continue this demonstration program to further:

• enhance the delivery capability of minority community based organizations.
• increase the capacity of minority community based organizations to successfully compete for federal and other non-federal dollars.