A major new research initiative
known as El Centro-funded by the
National Institutes of Health and based at
the School of Nursing and Health Studies-
will open doors to better health care
for Hispanics in the U.S.
Hispanic-Americans are changing the face of the nation. Hailing from
throughout South and Central America as well as the Caribbean, more than 40 million people living in the United States
are of Hispanic descent-the nation's largest minority population. And their numbers are expected to
triple by 2050.
While their numerous contributions to popular culture are splashed across the media, the
reality of life for millions of American residents of Latino descent is much less well known. Hispanic-
Americans suffer disproportionately from HIV/ AIDS, drug abuse, and domestic violence, as well as
associated mental health disorders such as depression. Researchers are just starting to examine the
complex factors that account for these disparities and to seek effective, culturally tailored interventions.
This September the School of Nursing and Health Studies received a $7 million, five-year grant
from the NIH-National Center on Minority Health and Health Disparities to establish El Centro-the
University of Miami Center of Excellence for Hispanic Health Disparities Research (El Centro de
Investigación de Salud Hispana). One of five new comprehensive NIH-funded centers for health disparities
research nationwide (up to 16 grants to both new and existing centers will be made over the next several
months), it is to date the only such initiative to be based at a nursing school and the only one in Florida.
"Few studies have considered how factors such as culture or ethnicity impact the incidence, prevalence,
and burden of specific health conditions among Hispanic-Americans," says Dean Nilda P.
Peragallo, Dr.P.H., R.N., F.A.A.N., who has conducted extensive research focusing on Hispanic
health disparities and serves as the program's director and lead investigator. "El Centro will promote
investigations targeted toward issues that disproportionately affect Hispanics as a way to help improve
the health and lifespan of this significant portion of our population."
Combined Expertise
Based at the M. Christine Schwartz Center for Nursing and Health Studies, El Centro marshals the combined expertise of researchers within the School of Nursing and Health Studies and the Center for Family Studies. "These researchers have a 16-year history of collaboration in training, mentorship, and research," says Peragallo. "Both entities have a track record of dedication to research on Hispanic health, while each brings a distinctive perspective and area of expertise."According to Marina Alvarez, B.S., director of El Centro's administration core, the initiative will also draw on the expertise of the Departments of Medicine and OB/GYN, the dean of the School of Education, the chairs of the Departments of Psychiatry and Behavioral Sciences and of Anthropology, and other community partners. In the months to come, the El Centro leadership plans to align its activities with those of other initiatives with similar or complementary goals. Among these are the six-year Hispanic Community Health Study, for which the University of Miami is one of four NIH-funded sites.
This intensive level of coordination is crucial for behavioral research, according to Victoria Behar Mitrani, Ph.D., who directs El Centro's research core. "Scientific strides are made by research that builds on other research," says Mitrani, who conducts collaborative studies of family-oriented interventions at the Center for Family Studies. "In bench research, that cycle of inquiry and insight can often proceed at a fairly steady pace. By contrast, studies that seek to develop behavioral interventions can take years.
"Historically, it's also been difficult to gather the number of participants needed to accurately evaluate the effec- tiveness of new approaches," Mitrani adds. "The El Centro partnerships will provide a multidisciplinary synergy that would seldom be possible among investigators working independently- and the critical mass needed to propel such studies to fruition."
National Perspective
In addition to sponsoring two full studies and two pilot studies in its first year of operation, El Centro will launch an ongoing program to selectively fund proposals for health disparities pilot studies originating throughout the University community. While Hispanics in South Florida, with its robust, economically vigorous Latin population and multicultural environment, do not face issues identical to those in other areas of the U.S., Mitrani says the evaluation of new interventions with local Hispanic populations will yield insights that can be disseminated on a national level.Rosina Cianelli, Ph.D., interim associate dean for the school's undergraduate program, serves as co-investigator for one of the initiative's multi-year studies, led by Dean Peragallo: a three year investigation of the effectiveness of a Hispanic-oriented health education program called SEPA as a tool to reduce HIV risk among Hispanic women. To be effective, says Cianelli, such interventions must address issues such as drug use and sexual activity in a way to which Hispanic women will be receptive-a special challenge in a culture that does not value candor about such sensitive topics.
By combining cultural sensitivity with scientific rigor and a large study population, Cianelli says, "We hope to identify and foster HIV/AIDS prevention behaviors that will benefit both individual women and their communities." The study's methodical design and ambitious goals exemplify El Centro's approach and aspirations, she adds: "Over the next several years, we envision the initiative as a leader in improving the health of the Hispanic community and expanding scientific knowledge."
Learning by Doing
As director of El Centro's research training and education core, Denise Korniewicz, Ph.D., R.N., F.A.A.N., oversees the efforts of new investigators. "We plan to put students ranging from freshmen to post-doctoral candidates to work on El Centro studies so they'll see firsthand the role that culturally sensitive, carefully designed investigations can play in creating effective interventions for this population," Korniewicz says. "To help aspiring investigators build the skills to conduct meaningful research, we'll provide coursework on addressing health disparities and designing and running studies, as well as special seminars, fellowship programs, and research forums." El Centro faculty will mentor investigators seeking to write fullfledged grant proposals after completing pilot studies."All of these activities will provide abundant opportunities for students to learn from each other as well as from faculty," Korniewicz says. "A whole constellation of ideas will be inspired by their experiences and insights, so it will be a continually evolving process."
The data gleaned from these activities could benefit millions of Hispanics who currently struggle for survival, dignity, and hope in the shadow of the American dream. Ultimately, says Peragallo, such efforts make the nation a better place for all of us- whatever our ethnic heritage or the particular place we call home: "As our population continues to diversify, the vision of equality so central to our concept of America deserves to be realized in every aspect of each citizen's life."
STRUCTURAL SYNERGY
El Centro is composed of three cores that provide a synergistic infrastructure for research, education, and dissemination of findings.
- The administration core oversees both day-to-day management and overall direction, and serves as a liaison among the University, the NIH, and the community.
- The research core provides leadership in building an environment that promotes scientific innovation, rigor, and collaboration, as well as dissemination of findings.
- The research education and training core is designed to impart the knowledge and skills necessary for culturally competent health disparities research among students, emerging investigators, and health providers.
MULTI-YEAR STUDIES
HIV Intervention Reducing Health Disparities Among Hispanic Women
Nilda Peragallo, Dr. P.H., R.N., F.A.A.N., Principal Investigator;Rosina Cianelli, Ph.D., Project Director and Co-Investigator;
Jose G. Castro, M.D., Co-Investigator
HIV/AIDS is the fourth leading cause of death among Hispanic women between the ages of 25-34.This three-year randomized study will evaluate the effectiveness of an HIV risk-reduction intervention led by and tailored to Hispanic women while gaining insights into the roles of acculturation and family functioning.
“Learning more about why Hispanic women engage in risky behaviors will help health professionals provide effective, culturally competent care while advancing the development of individual and population-based interventions targeted toward this group.”
Nilda Peragallo, Dr. P.H., R.N., F.A.A.N.
Preventing Health Disparities in Hispanic Youth
Daniel Santisteban, Ph.D., Principal Investigator;Lourdes Suarez-Morales, Co-Investigator
Hispanics represent nearly one in five of all U.S.AIDS cases, and Hispanic adolescents are using controlled substances at alarming rates.This five-year randomized clinical trial will study a family therapy intervention that aims to reduce/prevent substance abuse and risky sexual behaviors among Hispanic adolescents while addressing co-occurring mental disorders.
"My work is designed to learn more about the unique values and life experiences of Hispanic adolescents and families-and to develop a drug abuse treatment model that effectively addresses the stresses and utilizes the strengths of the Hispanic family."
Daniel Santisteban, Ph.D.
PILOTS STUDIES
Modifying Structural Ecosystems Therapy for HIV+ Hispanic Women in Prenatal Care
Victoria Mitrani, Ph.D., Principal InvestigatorMitrani studies an approach known as SET (Structural Ecosystems Therapy) to improve the health and well-being of HIV-positive minority women.This 18-month study will adapt SET for Hispanic HIV-positive women in prenatal care.
Project VIDA:Violence, Intimate Relationships, and Drugs Among Latinos
Elias Vazquez, Ph.D., N.P., F.A.A.N., F.A.A.N.P., Principal Investigator; Joseph De Santis, Ph.D.,A.R.N.P.; Rosa M. Gonzalez, R.N., M.S.N., M.P.H., Co-InvestigatorsData from this 12-month study will inform the adaptation of a program known as SEPA (Salud-Health, Educación-Education, Promoción-Promotion,Autocuidado-Self-Care), developed for Hispanic women by Dean Nilda Peragallo, for Hispanic men.
