The Program on Health Disparities

Projects

Current Projects

• Project EXPORT:UNC-Chapel Hill/Shaw Partnership for the Elimination of Health Disparities – Building on the existing close relationship between Shaw University and UNC-Chapel Hill, the research expertise at UNC-Chapel Hill is being combined with Shaw University’s expertise in strengthening African-American communities and training minority leaders. The Partnership is addressing issues such as enhancing the existing research infrastructure at Shaw University by establishing an institutional review board and upgrading its grants management office; facilitating the recruitment of black adults into research programs focusing on health disparities and minority health; investigating how black churches can function as both sources of health-related information to parishioners and access points for gathering research information from community members; expanding the investigator base and the research by soliciting, mentoring, and funding new investigators with innovative projects; and developing and disseminating a novel health disparities curriculum at UNC-CH and Shaw University. more info...

  Principal Investigator: Paul A. Godley, M.D., Ph.D.

  Funding Source: National Center for Minority Health and Health Disparities, NIH

  Total Project Period: 09/30/02 – 08/31/07
  
  

• A Case-Control Study of Prostate Cancer Screening Among African-American and Caucasian Medicare Recipients – The objective of this study is to evaluate whether 1) prostate cancer screening with PSA reduces prostate cancer mortality, 2) PSA screening is less efficacious in black men than in white men, and 3) prostate cancer screening with PSA becomes more efficacious in reducing risk of death from prostate cancer the more recently the test was performed. These questions will be examined through analysis of SEER-Medicare data on a nationwide sample of individuals. This research will help determine the efficacy of PSA screening, which will contribute to the development of effective prostate cancer prevention strategies for all men.

  Principal Investigator: Paul A. Godley, M.D., Ph.D.

  Funding Source: U.S. Department of Defense

  Total Project Period: 09/15/04 – 09/14/07 (extended)
  
  

• Lay Health Pilot Study: On Our Own Terms – This pilot study designs and tests the feasibility of a Lay Health Advisor intervention with the overall objective of improving treatment for pain and suffering for African American patients with cancer. To achieve this objective, a successful research partnership between the UNC-CH School of Medicine and Shaw University, a historically black university is being used. An interdisciplinary group of faculty with expertise in palliative care and in community-based research are recruiting 30 Palliative Care Lay Health Advisors (PCLHA) from 6 African American churches. The specific aims of this project are to: 1) explore the acceptability and comprehensiveness of an existing measure of quality of life at the end of life (QUAL-E) in focus groups of African-American cancer patients and family caregivers; 2) test the feasibility of proposed methods for recruiting and training PCLHAs from African-American churches; 3) test the feasibility of proposed methods for pairing PCLHAs with African-American patients with advanced cancer and their family caregivers; and 4) describe the impact of PCLHAs on these cancer patients’ knowledge of local providers of pain and symptom treatment, communication about life-sustaining treatment choices, quality of life, and perceived unmet need for treatment of pain and suffering.

  Principal Investigator: Laura C. Hanson, M.D., M.P.H.

  Funding Source: National Institute of Nursing Research, NIH

  Total Project Period: 09/12/05 – 08/31/08
  
  

• Lung Cancer Surgery: The Anatomy of Decisions Against Life Saving Care – Lung cancer is the leading cause of cancer death in the United States. Non-small cell histology represents about 80% of all cases; surgical resection during stage I or II disease remains the only reliable treatment for cure. Despite the mortality associated with rejecting surgery, 24% of white patients and 36% of black patients diagnosed with stage I or II disease do not proceed to operation. This prospective cohort study in four sites in NC (two university and two community settings, including chest surgery, pulmonary medicine, and thoracic oncology) includes 380 newly diagnosed, early stage lung cancer patients (approximately 60% white, 40% black). It allows patient factors (age, race, comorbidity, pulmonary physiology, spirituality, trust in physicians, functional status) and physician factors (specialty, experience, beliefs regarding operative morbidity, decision-making style) affecting the decision-making process to be identified.

  Principal Investigator: Samuel Cykert, M.D.

  Funding Source: American Cancer Society

  Total Project Period: 07/05 – 06/09
  
  

• Shaw UNC-CH Center for Prostate Cancer Research (SUCPCR) – As a subcontractor, UNC-CH is providing a structured program of training and skill-building for Shaw University investigators that will include monthly seminar/colloquia series, skills building workshops, one-on-one meetings, and weekly telephone conferences.

  Principal Investigator: Paul A. Godley, M.D., Ph.D.

  Funding Source: U.S. Department of Defense

  Total Project Period: 7/05 – 7/08
  
  

• Project GRACE: A Participatory Approach to Address Health Disparities – This planning grant builds on the infrastructure of the NCMHD funded Carolina-Shaw Partnership for the Elimination of Health Disparities (Project EXPORT) and existing academic-community partnerships that share the common goal of eliminating health disparities in the African American communities and uses a community-based participatory research (CBPR) framework for partnership development and intervention design. The long-term goal is the development of feasible and sustainable interventions that reduce the spread of HIV in Edgecombe and Nash counties. To that end this project aims to: 1) expand, strengthen and evaluate The Project GRACE Consortium; 2) identify community needs and assets to support the development of multilevel interventions to address individual and environmental/contextual factors that influence the spread of HIV; 3) define culturally appropriate multilevel interventions that draw on community insights and available resources to address individual and environmental/contextual determinants of the spread of HIV; and 4) test the feasibility of proposed methods for recruiting and training lay health advisors to address both individual and environmental/contextual determinants of the spread of HIV. more info...

  Principal Investigator: Giselle Corbie-Smith, M.D.

  Funding Source: National Center for Minority Health and Health Disparities (NCMHD), NIH

  Total Project Period: 09/30/05 – 06/30/08
  
  

• HIV/AIDS Research Among African American Women in Rocky Mount, NC – This is a cross-sectional study of 500 African American women in two North Carolina counties with high rates of sexually transmitted diseases and HIV to examine risk factors for these infections. Specifically, the prevalence of Neisseriae gonorrhoeae (GC), Chlamydia trachomatis (CT), and HIV and estimate HIV incidence is being determined. In particular, the project aims to increase understanding of socio-cultural factors (for example, religiosity and spirituality) and proximate determinants (e.g., epidemiologic factors and high-risk sexual behaviors and practices, such as concurrent partnerships) that influence HIV/STI transmission and determine the strength of their association with GC, CT, and HIV infection. Qualitative research is also being conducted using focus groups among 70-80 African American women to obtain a more in-depth understanding of socio-cultural, structural, socioeconomic, and other contextual factors that influence HIV transmission among African American women in the study population; and behavioral and other proximate determinants identified as important in the cross-sectional study. Understanding these factors is a critical first step in designing effective HIV interventions for this population.
  more info...

  Principal Investigator: Adaora A. Adimora, M.D.

  Funding Source: Centers for Disease Control and Prevention

  Total Project Period: 09/30/05 – 09/29/09
  
  

• Shaw University M-RISP Minority Elderly Research Center (SUMMER CENTER) – Faculty members at UNC-CH are providing the following to Shaw University and its investigators: 1) a program of training and skills-building; 2) research support including assistance with grant and budget preparation, data management, analysis, and report writing; 3) mechanisms for the development and evaluation of new study proposals that ensures their relevance to eliminating racial and ethnic disparities in health; 4) workshops for minority, health services research, and service communities to promote and disseminate Shaw findings; 5) assistance in recruiting more senior research-oriented faculty; 6) promotion of more scholarly research publications; and 7) expansion into other substantive areas and study population as Shaw expertise evolves.

  Principal Investigators: Timothy S. Carey, M.D., M.P.H.

  Funding Source: Agency for Healthcare Research and Quality (subcontract with Shaw University)

  Total Project Period: 12/05 – 11/10
  
  

• Glaxo-Smith-Kline (GSK)/University of North Carolina at Chapel Hill Latino Health Partnership – The overall goal of this project is to identify gaps in current knowledge and the need for future research on emerging Latino health issues.

  Principal Investigator: Betsy L. Sleath, Ph.D.

  Funding Source: Glaxo-Smith-Kline

  Total Project Period: 07/06 – 06/07 (renewable)
  
  

• Increasing Access to HIV Trials for Rural Minorities – Despite an epidemic of new HIV infections in racial and ethnic minorities and continued emphasis on minority inclusion in research, minority participation in HIV/AIDS trials has not kept pace. In rural minority communities many barriers limit access to clinical trials, at the community and individual levels. This project will fully characterize individual and community influences on research participation of rural African Americans and Latinos and develop innovative, theory-based, culturally responsive interventions. In Phase 1 focus groups with community leaders and health care/service providers will be held and semi-structured interviews with individuals with HIV will characterize influences on willingness to participate in research. Phase 1 participants will give feedback on a culturally responsive outreach strategy for the community and providers, individual enrollment sessions, and a mobile trials unit. In Phase 2 these data will be used to modify the conceptual model and the model will be used to develop and refine the outreach strategy. Cognitive interviews with community leaders, providers and individuals with HIV will determine the acceptability of each component. In Phase 3 a 12-month assessment of the individual enrollment session and mobile unit, alone and in combination, will be conducted in a single site. more info...

  Principal Investigator: Giselle Corbie-Smith, M.D.

  Funding Source: National Institute for Nursing Research (NINR), NIH

  Total Project Period: 09/18/06 – 06/30/10
  
  

• Disparities in the Diffusion of State-of-the-Art Prostate Cancer Treatments – The project will explore the hypothesis that racial disparities in prostate cancer mortality are associated with disparities in the diffusion of new prostate cancer treatments to African American patients. SEER Medicare data will be used to identify prostate cancer patients and longitudinally follow the adoption of new treatments among Caucasian and African Americans. Seer site, age, disease stage, and socio-economic status will be controlled for. The results of the study could lead to increased understanding of how delayed access to state-of-the-art treatments can affect racial disparities in cancer outcomes.

  Principal Investigator: Paul A. Godley, M.D., Ph.D.

  Funding Source: U.S. Department of Defense

  Total Project Period: 02/07 – 03-09
  
  

• High-Risk Heterosexual Partnering in the Age of AIDS: A Multilevel Analysis – Mathematical modeling demonstrates that concurrent partnerships speed transmission of HIV through sexual networks much more effectively than does serial monogamy with the same total number of sexual partners. The social and economic environment in which many African Americans live discourages long-term monogamy and promotes concurrent partnerships. Extensive involvement in concurrency may be a critical factor in the epidemic of HIV and other sexually transmitted infections (STIs) among African Americans. This study will test the following hypotheses through multilevel analyses of a nationally representative data set, Cycle 6 of the 2002 National Survey of Family Growth: 1) African American men and women are more likely than white men and women to have had heterosexual concurrent partnerships during the preceding 12 months and 2) involvement in concurrent partnerships is related to lower community sex ratio, education, and marriage rates, and to higher unemployment, poverty and crime rates.

  Principal Investigator: Adaora A. Adimora, M.D.

  Funding Source: National Institute of Child Health and Human Development (NICHD), NIH

  Total Project Period: 04/20/07 – 03/31/09
  
  

• Initiative to Identify and Eliminate Racial Ethnic Disparities within UNC Health Care – Disparities in the health and health care of racial and ethnic minorities in the U.S. are well recognized and their causes are known to be many, but there are few tested models for reducing disparities, particularly for patients within a particular practice organization. This project aims to 1) use analyses of a wide variety of available health care system data to identify differences in access to care, use of health care services and care experiences for African American, Hispanic and non-Hispanic white patients of UNC Health Care; 2) use analysis of health system data and the methods of continuous quality improvement (CQI) to help clinical departments identify the causes for identified racial-ethnic disparities in care and design, implement and monitor interventions to reduce the disparities; and 3) to formally evaluate the usefulness of these approaches in identifying and reducing racial-ethnic disparities in care within UNC Health Care and to broadly disseminate the findings.

  Co-Principal Investigators: Donald E. Pathman, M.D., M.P.H.

  Funding Source: UNC School of Medicine, Investments in the Future

  Total Project Period: 07/07 – 06/10
  

• The UNC-Chapel Hill/Shaw University Comprehensive NCMHD Research Center – With the Goal of eliminating health disparities, the UNC-Shaw NCMHD Research Center aims to be a research incubator that will conduct innovative minority health research among adult African –American populations in North Carolina. This project builds on the previously funded Carolina-Shaw University Partnership for Health Disparity Research. The NCMHD Center will be organized into three cores. The Administrative Core enhances the comprehensive research center structure developed during the initial Project EXPORT grant period through which the partnership between UNC and Shaw University implements research activities, pilot projects, and community engagement efforts. The Research Core leverages the recently enhanced research infrastructure at Shaw University and the existing research resources by managing three-component research projects and seven pilot projects in an effort to foster research leading to measurable improvements in health disparities. The Community Engagement Core supports and conducts innovative research activities involving the DC2 church network established in the initial grant. This core seeks to know and understand better the components of black churches organizational readiness to engage in research, in particular the kinds of research that are effective for 1) engaging clergy, laity, and faculty in disseminating evidence based interventions and 2) engaging African- American communities and individuals as active participants in the research process.

  Principal Investigator: Paul A. Godley, M.D., Ph.D.

  Funding Source: National Center for Minority Health and Health Disparities (NCMHD), NIH

  Total Project Period: 09/30/07 – 05/31/12

Recently Completed Projects

• Center for Excellence on Overcoming Racial Health Disparities (CEORHD) – In conjunction with the Program on Health Outcomes at the School of Public Health and North Carolina Central (NCCU) and Shaw Universities, the causes and contributing factors leading to racial inequities in access to health care and health outcomes are being studied. The CEORHD focuses on adults, including elderly, black populations. Its structure maximizes exchange of scientific and programmatic activity among UNC, NCCU, and Shaw University, as well as numerous community organizations and leaders across North Carolina. The CEORHD brings minority trainees at the undergraduate and graduate levels into all aspects of the Center’s activities through assistantships and internships. The students participate in the funded research projects and also work with investigatorson related projects of interest to the students. The UNC-CH CEORHD carries out research projects and educational activities organized into the following four primary themes: causal analysis, intervention and outcome assessment, study of the health status of rural minority populations and the geographic issues in rural areas, and measurement and methods. Study designs range from qualitative surveys of decision makers to case-control etiologic studies to community-based time series studies and randomized trials.

  Co-Principal Investigators: Timothy S. Carey, M.D., M.P.H. and Paul A. Godley, M.D., Ph.D.

  Primary Funding Source: Agency for Healthcare Research and Quality

  Total Project Period: 09/15/00 – 08/31/06 (extended)

  Matching Source #1: UNC-CH School of Public Health (SPH)

  Total Project Period: 09/15/00 – 08/31/03

  Matching Source #2: UNC-CH Program on Health Outcomes (PHO) (funds from Glaxo Wellcome)

  Total Project Period: 09/15/00 – 08/31/03

  Matching Source #3: UNC-CH Program on Health Outcomes (PHO) (funds from Duke Endowment)

  Total Project Period: 01/01 – 12/01
  
  

• Shaw University Project EXPORT R24 (SUPER) Program on Racial Health Disparities Research – Faculty members at UNC-CH are serving as mentors to the pilot project lead investigators at Shaw University. All projects will address important issues for the minority elderly: 1) racial differences in continuity of care and prescribed treatment for hypertension; 2) racial differences in continuity of care and prescribed treatment for diabetes; and 3) racial variations in sentinel health events—preventable and avoidable disease and death.

  Principal Investigator: Timothy S. Carey, M.D., M.P.H.

  Funding Source: Agency for Healthcare Research and Quality (subcontract with Shaw University)

  Total Project Period: 09/30/02 – 09/29/06 (extended)
  
  

• Learning About Research in North Carolina (LeARN) – The aims of this project are to describe: 1) North Carolina Colorectal Cancer Study (NCCCS) participants’ perceptions of causality of colorectal cancer and how perceptions of causality of colorectal cancer change after participation in the NCCCS determinants of colorectal cancer interview; 2) what motivates research participants to participate in the NCCCS study; 3) NCCCS participants’ perceptions of positives and negatives related to collecting genetic data in epidemiologic research; and 4) how NCCCS research participants understand the purpose of the NCCCS research. more info...

  Principal Investigator: Giselle Corbie-Smith, M.D.

  Funding Source: National Human Genome Research Institute, NIH

  Total Project Period: 06/13/03 – 05/31/07 (extended)