The purpose of our integrated research core and project components is to reduce health disparities, which disproportionately affect women, minorities, and low income individuals. The goal of our research core is to develop replicable models for preventing and managing disease and, ultimately, reducing health disparities in underserved communities. For much of the last 50 years, academic institutions have conducted research in communities but not necessarily with communities at risk for disease; this historical approach has yielded important but limited benefits. Successfully addressing health disparities requires linking clinical care and epidemiology to existing community programs and organizations that are grounded in the interests and priorities of community residents, and with the active involvement of community members and community researchers.
Our research core's approach to reducing health disparities blends concepts of CBPR and translational research. Successful disease prevention interventions must balance the needs of researchers (research-driven model) with the needs of communities (community-driven model). Balanced approaches require blending the science of prevention with the practice of prevention, utilizing local resources, and tailoring interventions to fit the at-risk target population. Additionally, interventions must respond to the specific neighborhood and community, by utilizing an approach that is sensitive to the context in which a program or intervention will be operating. By combining the efforts of basic, clinical, and community based participatory researchers with the efforts of community members, prevention research can be translated into actions that will improve the health of those at risk in a target community.
Our research core builds on our institution's tradition of serving those in need through innovative care delivery and research programs. Our approach expands existing relationships and develops new partnerships which will contribute to creating a CBPR translational research cycle extending from the community to the laboratory bench, and back again (Figure 1).
Figure 1: CBPR Translational Research Cycle
As the figure indicates, significant health problems are articulated by society or the community to the academic setting, where basic science researchers can investigate disease mechanisms, which allows clinical investigators and practitioners to evaluate the approaches in the clinical setting. The resulting knowledge can then be translated, disseminated, and evaluated in the community setting by community health scientists, after which the process begins again. Although an idealized scenario, the unique aspect of the CBPR translational cycle is the involvement of the community in the research process, in a way that facilitates resolving health problems of importance to the community and offers greater hope for reducing persistent health disparities.
Research Core Projects
Our long-term goal remains to eliminate health disparities in HIV/AIDS, Breast Cancer, and Obesity through high-quality core research supported by our research core projects.
C.2.1.1. Research Project #1
Project 1: Dr. Anuja Ghorpade, PI. Health Disparities &sCD40L: Novel Biomarkers for HIV-1 Disease Progression. Description: In this project we will study the levels of soluble CD40L as a prognostic biomarker for HIV/AIDS disease progression in the context of race and gender.
Project Summary: Approximately one half of the 40 million people in the world who live with live with Human Immunodeficiency Virus (HIV)-1 disease and associated Acquired Immune Deficiency Syndrome (AIDS) are women. HIV/AIDS has affected more women than any other disease over the past two decades. Women of color - especially African-American and Hispanic-American women - carry the most significant burden of this disease. Almost 50% of HIV/AIDS patients suffer from some form of neurocognitive impairment. Thus, studies pertaining to the identification of novel biomarkers that predict disease progression and neurocognitive impairment are critical. Recent data demonstrate that sCD40L, a novel biomarker, is significantly elevated in HIV-infected patients with neurocognitive impairment. However, no information is available regarding patterns of sCD40L changes in the context of race and gender. Understanding these patterns is important, since expression of disease characteristics in HIV/AIDS can be race- and/or gender-specific. Viral loads, metabolic parameters and body composition, plasma lipid levels, and other factors differ with regard to specific race and gender characteristics. In this application, we propose to investigate the role of sCD40L as a prognostic marker for disease progression in HIV-1 neurological manifestations in the context of race and gender. Although limited to evaluations of race and gender as statistical risk factors, this work will synergize basic science with issues related to health disparities. Specifically, we will identify and analyze plasma sCD40L levels in a cohort of HIV+/- patients and correlate these to standard disease variables and cognitive function. All parameters will be correlated with each other and against neurocognitive measures to test the hypothesis that sCD40L levels correlate with neurocognitive impairment in the context of race and gender. We will also analyze the immune activation status of diverse patient leukocytes. Levels of sCD40L & other proinflammatory cytokines including TNF-α will be analyzed. Ours will be one of the first studies to fully describe the HIV-1-positive population characteristics in relation to specific cognitive outcomes, socioeconomic strata and sCD40L, and will likely yield data that will have direct therapeutic implications.
C.2.1.2. Research Project #2
Project 2: Dr. JK Vishwinatha, PI. Triple Negative Breast Cancer: Novel Biomarkers and Therapeutic Strategies. Description: In this project the expression characteristics of Annexin A2 will be linked to the evolution of triple-negative breast cancer in African-American women.
Project Summary: The occurrence of breast cancer is disproportionate in premenopausal and African-American women. African-American women develop highly aggressive tumors and have a higher mortality rate than other groups. Premenopausal African-American women are not only at a higher risk of breast cancer (33%) compared to Caucasian women (25%), but also are at a high risk of developing Triple Negative Breast Cancer (TNBC). African American women with TNBC have poor survival and high mortality rates. TNBC lacks the three widely used diagnostic markers (Her-2, PR and ER) and, therefore, these women are unable to benefit from the available novel therapies based on these biomarkers. The disparities in breast cancer seen in African American women may arise due to biological and environmental causes. Lifestyle and genetic differences correlate with the high incidence of basal breast carcinoma in African American women. Socio-economic factors such as family income, education, occupation, lack of health insurance, family history of breast cancer, early onset of menarche, late menopause, lower age when they give birth to first child, increased breast density, obesity, high fat diet and lack of exercise may account for the disparities in breast cancer. Additionally, genetic variables like BRCA1 and p53 gene mutations and higher polymorphism rates are common in African Americans.
TNBC mainly affects women under the age of 50 and accounts for about 30% of total breast cancer cases. African American women with BRCA1 mutation carriers are at increased risk of TNBC. TNBC in African American women is characterized by larger tumors, high grade histology, lymph node involvement, poor prognosis, higher risk of recurrence and poor survival. TNBC has a unique protein expression pattern and this may determine the pathological response to different treatments and also in prognosis of the disease. There are no systematic studies to understand the biology of TNBC and delineate the mechanism of carcinogenesis. There is an urgent clinical need to identify new biomarker(s) that can be used as diagnostic tools and provide targets for therapeutic intervention and it is critical that African American patients should be included in these studies.
Current barriers to participation in cancer research among African Americans include lack of awareness of such opportunities, mistrust of research and health care systems, fear, fatalism, competing priorities and responsibilities, and perceived harm for participation. In order to ensure meaningful participation in the proposed study from African American women, we will first provide education about the basics of TNBC. The proposed population of women for this study resides in South Dallas, where breast cancer screening recommendation adherence for women age 40 and older is approximately 50%, with more than 20% having never had a screening mammogram. Stage IV diagnosis is highest in this area for Dallas County. Based on our work in this population for the past 3 years, the abnormal rate for mammograms is more than 4 times the national average, and knowledge regarding the value of early detection is poor. Our team built a breast cancer primary prevention program in this population using a CBPR approach and continues the program today under the guidance of a community advisory board comprised of residents from the area (Please see CAB under Administrative Core). We propose to incorporate TNBC as a key topic for discussion in the existing prevention program in order to: a) build awareness and knowledge related to TNBC, and, 2) enhance participation in TNBC etiologic research. Perceptions related to screening as well as cancer research participation are strongly influenced by knowledge, and we will impact both in our program. These educational activities will be conducted with our project's Community Outreach Core.
C.2.1.3. Research Project #3
Project 3: Dr. Heather Kitzman-Ulrich, PI. Reducing Obesity in African American Women through Lifestyle Enhancement. Description: In this project we will evaluate a means for reducing weight among African-American women through a CBPR partnership with African-American congregations.
Project Summary: African-American women experience disproportionately high risk of obesity and obesity-related complications. According to the National Health and Nutrition Examination Survey (2007 - 2008), women have a higher obesity prevalence (35.5%) than men (32.2%) and non-Hispanic blacks have a higher prevalence (44.1%) than non-Hispanic whites (32.8%), with non-Hispanic black women having the highest prevalence reported (49.6%). Obesity is associated with increased risk of hypertension, diabetes, dyslipidemia, and metabolic syndrome; and increased risk of death from diabetes, kidney disease, some cancers, and primarily cardiovascular diseases. Although lifestyle factors account for 50% of premature mortality, the lack of evidence-based clinical trials has discounted the value of lifestyle interventions as a dependable strategy for reducing obesity prevalence in high-risk populations.
The goal of the proposed project is to conduct a randomized clinical trial for promoting weight loss among African-American women, through a community-based participatory research (CBPR) partnership among African-American congregations and investigators in a high-minority, low-income, underserved community. The proposed study will test the effects of a novel lifestyle-based weight loss program for obese women in their churches, which incorporates the direct participation of Senior Pastors into the program intervention. If obesity trends continue unabated, recent reductions in the incidence of coronary heart disease, which have been attributed largely to decreased smoking rates and improved cholesterol and blood pressure in the population, are expected to reverse in the United States.