March 2009 Communique by American Psychological Association

March 2009

CommuniquĂ&#x2030;

Special Issue: Psychological & Behavioral Perspectives on

Health Disparities

AMERICAN Psychological Association American Office of Ethnic Minority Affairs PSYCHOLOGICAL Public Interest Directorate ASSOCIATION 750 First Street, NE Washington, DC 20002â&#x20AC;&#x201C; 4242

Staff of the Office of Ethnic Minority Affairs Bertha G. Holliday, PhD, Senior Director Alberto Figueroa-García, MBA, Assistant Director Sonja M. Preston, MSW, Project Administrator Dennis R. Bourne, Jr., Prog. Officer, Research & Spec. Projects Sherry T. Wynn, Senior Program Associate Kevin M. Crawford, Administrative Office Coordinator Isaac Rosen, Intern (202) 336-6029 (202) 336-6040 FAX (202) 336-6123 APA TDD oema@apa.org www.apa.org/pi/oema

The Communiqué Newsjournal is now available on the OEMA Web site.

IN THIS ISSUE… OEMA UPDATE Bertha G. Holliday, PhD, Senior Director. . . . . . . . . . . . . . . . . . . . . . . . . . . 1 THE SPECIAL ISSUE EDITORS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OVERVIEW ON HEALTH DISPARITIES Health Disparities: A Multidimensional Approach. . . . . . . . . . . . . . . . 7 The Case for Racial/Ethnic Disparities in Mental Health. . . . . . . . . . 10 CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES U.S. Senator Daniel K. Inouye–Health Disparities: Is 2009 the Year for Solutions?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 U.S. Senator Byron L. Dorgan– Health: A Crisis in Indian Country. . . . . . . . . . . . . . . . . . . . . . . . . . . 19 U.S. Congresswoman Donna M. Christensen– Not Just Getting Something Done, but Getting It Done Right: The CBC Health Braintrust's Mental Health Priorities. . . . . . . . . . . . 22 Critical Future Issues of Mental Health Disparities: An Interview With Dr. David Satcher. . . . . . . . . . . . . . . . . . . . . . . . . 26 National Institute on Drug Abuse–Health Disparities Research at the National Institute on Drug Abuse: Progress and Continuing Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Office of Minority Health–Eliminating Mental Health Disparities in Racial and Ethnic Minority Populations Through the Integration of Behavioral and Primary Healthcare: Recommendations and Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

IN THIS ISSUEâ&#x20AC;Ś THE MANY FACES OF HEALTH DISPARITIES LGBTQ African American Youth. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Ethnic Minority & Immigrant Women.. . . . . . . . . . . . . . . . . . . . . . . . 43 Cancer & Socioeconomic Disadvantage. . . . . . . . . . . . . . . . . . . . . . . 45 Persons With HIV & AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Mental Health Needs of Asian Americans/Pacific Islanders.. . . . . . . 52 Persons With Disabilities.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Sexual Minority Women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Older Adults.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Environmental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Latino Mental Health Services Needs. . . . . . . . . . . . . . . . . . . . . . . . . 66 A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES The Role of Psychology Public Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Scientific Research.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Mental/Behavioral Health Services Workforce. . . . . . . . . . . . . . 78 Cultural Competence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Advocacy Toolkit on Health Disparities. . . . . . . . . . . . . . . . . . . . . . . 84

IN THIS ISSUE… EMERGENT PSYCHOLOGICAL DISPARITIES

RESEARCH

HEALTH

Psychological Assessment of African Americans on Dialysis. . . . . 101 Mental, Social, and Emotional Factors Associated With Economically Disadvantaged Adolescents' Violent/Aggressive Behavior.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Obesity and Weight Concern Among Black Women. . . . . . . . . . . . 105 The Impact of Family Religious/Spiritual Beliefs on Enhancing Mental and Physical Health Outcomes Among African Americans With End-Stage Renal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Project SMART (Supporting Minority Adolescent Research Training): A Needs Assessment. . . . . . . . . . . . . . . . . . . . . 109 Posttraumatic Stress and Risky Sexual Behaviors Among African American Women. . . . . . . . . . . . . . . . . . . . . . . . . . 112

FOR YOUR INFORMATION… RESEARCH AND TRAINING ISSUES SCHOLARSH IPS , FELLOW SH IPS , GRANTS , AND INSTITUTES

APA Science Directorate Advanced Training Institutes for 2009.. . . . . . 115 2009 Summer Institute in Political Psychology.. . . . . . . . . . . . . . . . . . . . 115 Asian American Center for Disparities Research Postdoctoral Internship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Black Metropolis Research Consortium Offers Research Funding for Scholars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 2009 CHADD Young Scientist Research Fund Awards. . . . . . . . . . . . . . 117

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IN THIS ISSUE… FOR YOUR INFORMATION… The Chicago School Fellowship in Academic Community Leadership Postdoctoral Fellowship Position Announcement 2009 – 2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Call for Applications for the NCRECE Research Mentoring Program for Minority Scholars. . . . . . . . . . . . . . . . . . . . . . . . 118 Postdoctoral Research Fellowship in Behavioral Sciences Research in HIV Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Postdoctoral Research Fellowship in Treatment Dissemination and Implementation Research With Children/Youth.. . . . . . . . . . . . . . . . 119 The National Cancer Institute Postdoctoral Fellowship in Health Behavior Theory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Request for Proposals (RFP): Promoting Psychological Research and Training on Health Disparities Issues at Ethnic Minority Serving Institutions (ProDIGs). . . . . . . . . . . . . . . . . . 120 The Robert Wood Johnson Foundation Investigator Awards in Health Policy Research Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Stanford University 2009 Summer Institute in Political Psychology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Two NIMH-Funded Postdoctoral Fellowships in Stress and Trauma Clinical Research.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 United States Institute of Peace Jennings Randolph Senior Fellowship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 CALL FOR PAPERS

Call for Papers: Diversity in Health and Care. . . . . . . . . . . . . . . . . . . . . . 122

IN THIS ISSUE… FOR YOUR INFORMATION… Call for Proposals: 3rd Annual Conference for the Society for Humanistic Psychology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Call for Proposals: The 9th Annual Diversity Challenge: Racial Identity and Cultural Factors in Treatment, Research, and Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Call for Proposals: Interactive Sessions, Symposia, & Poster Sessions—Asian American Psychological Association 2009 Annual Convention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Call for Papers: Journal of Muslim Mental Health— Special Issue on Refugees and Forced Migrants. . . . . . . . . . . . . . . . . . . . 124 Reviewers and Manuscripts Sought for New Journal. . . . . . . . . . . . . . . . 125 Call for Papers: Rethinking the Mangrove: Second Symposium of Critical Practices in Caribbean Cultural Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 CALL FOR NOMINATIONS AND AW ARDS

APA Committee on Ethnic Minority Affairs Seeks Two New Members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 2009 Jeffrey S. Tanaka Memorial Dissertation Award in Psychology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Call for Nominations: 2009 Honorary Membership for Infusing Diversity Into Teaching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Call for Nominations: Carolyn Wood Sherif Award. . . . . . . . . . . . . . . . . 128 UPCOMING CONFERENCES AND CONVENTIONS. . . . . . . . . . . 129

IN THIS ISSUE… FOR YOUR INFORMATION… IMPORTANT RESOURCES BOOKS

Norma E. Cantú, Ed.: Paths to Discovery: Autobiographies From Chicanas With Careers in Science, Mathematics, and Engineering.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Journal of Muslim Mental Health: "Islamic Religiosity: Measures and Mental Health" - 2007 Volume 2, Issue 2 & 2008 Volume 3, Issue 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Jeffrey M. Ring, PhD, Julie Nyquist, PhD, Suzanne Mitchell, MD, Hector Flores, MD, and Luis Samaniego, MD: Curriculum for Culturally Responsive Medical Care: The Step-by-Step Guide to Cultural Competence Training.. . . . . . . . . . . 132 Helen A. Neville: Handbook of African American Psychology. . . . . . . . 133 ON THE W EB

Products of the 2008 APA Presidential Task Force on Posttraumatic Stress Disorder in Children and Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 NIMH Workgroup Releases Report on Training Next Generation of Researchers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Researching Migration: Stories From the Field.. . . . . . . . . . . . . . . . . . . . 134 Catholic Legal Immigration Network, Inc. (Clinic) Announces 5th Edition of Citizenship for Us. . . . . . . . . . . . . . . . . . . . . . 134 Financial Planning for Early Career Psychologists. . . . . . . . . . . . . . . . . . 135

IN THIS ISSUE… FOR YOUR INFORMATION… The Intersection of Diversity and Learning: Capturing a Conversation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Online Bookseller Targets Spanish-Only Market. . . . . . . . . . . . . . . . . . . 135 America's Children in Brief: Key National Indicators of Well-Being, 2008.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 National Organization for People of Color Against Suicide. . . . . . . . . . . 135 Toolkit on Community Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 October 8th, 2008 Is Health Cares About Domestic Violence Day!. . . . . 136 Dating Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Toolkit for Community Based Service Providers. . . . . . . . . . . . . . . . . . . 136 Research in Indian Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 McGruff in Indian Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 U.S. DHHS Administration for Family and Children 2008 Tribal Resource Directory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 State Ethnic/Racial Child Indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 U.S. Department of Justice Tribal Youth Program Report: Building Brighter Futures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 CDC Finds Alcohol Taking Deadly Toll on Native Americans. . . . . . . . 137 Intergenerational Trauma Resource.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Corporal Punishment of American Indian Students. . . . . . . . . . . . . . . . . 137 Broken Justice in Indian Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Indian Country Drug Threat Assessment 2008. . . . . . . . . . . . . . . . . . . . . 137

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OEMA UPDATE Bertha G. Holliday, PhD President Obama and his administration have promised much in the way of transformation of government and individual lives. One transformation of special interest to the American Psychological Association (APA) is health care reform. Indeed, this issue is at the top of APA’s public advocacy goals. The APA Public Interest Directorate’s Office of Ethnic Minority Affairs (OEM A) is additionally committed to ensuring that the elimination of health disparities— especially among racial and ethnic communities— is recognized as a critical component of health care reform. Consequently, OEMA partnered with the Public Interest Directorate’s Government Relations Office to put together this Special Issue (the first ever!) focused on Psychological & Behavioral Perspectives on Health Disparities. This Special Issue seeks to inform federal legislators and their staff, federal officials and other public policy advocates, psychologists and behavioral scientists, and the general public about the impact of health disparities and their disproportionate impact on communities of color. The Special Issue also seeks to make the case that significant improvements in these disparities cannot be made without the inclusion of psychological and behavioral science perspectives. This means that effective public policy in support of the elimination of health disparities must ensure the participation of not only medical and public health scientists and health care providers, but also psychological and other behavioral scientists and providers W e believe the contents of the Special Issue fully tell the story as to why. W e hope that by getting this message to the new Congress and Administration officials early in their tenure, it will significantly shape attitudes, perspectives, debate, and policy on health disparities— and promote reform in the nation’s health care. To our regular readers, we offer our regrets for canceling the Com m uniqué’s regular features to make way for the Special Issue’s content. W e have, however, included our usual For Your Information section, which contains time-sensitive announcements. W e will return to our usual format in our next issue. The Special Issue editors extend their deepest appreciation to those who shared our vision and drafted articles for the Special Issue on short timelines. W e fully recognize and thank you for the special effort you put forth. Thanks also are extended to Sonja M . Preston, MSW , and OEM A Project Administrator, who solicited the issue’s emergent research articles. W e also extend appreciation to Joanne Zaslow and Deborah Farrell, who provided overall editorial assistance on this Special Issue, and to Elizabeth Woodcock, who designed its cover, with

OEMA COMMUNIQUĂ&#x2030; exceptional professionalism and cooperation under very tight timelines. Appreciation is given for their strong support of the Special Issue project to Gwendolyn P. Keita, PhD, Executive Director of APA's Public Interest Directorate, and Annie Toro, JD, M PH, Associate Executive Director, Public Interest Government Relations Office. And special acknowledgments and thanks go to Sherry T. W ynn, OEMA Senior Program Associate extraordinaire, who managed the Special Issueâ&#x20AC;&#x2122;s manuscripts, laid out its contents, and oversaw its production and dissemination. As always, I wish you health and peace and power.

THE SPECIAL ISSUE EDITORS If you have questions or comments about the Com m uniqué Special Issue on Psychological and Behavioral Perspectives on Health Disparities, please feel free to contact one of its editors. Bertha G. Holliday, PhD Senior Director Office of Ethnic Minority Affairs bholliday@apa.org

Daniel E. Dawes, JD Sr .Officer, Legislative & Federal Affairs Public Interest Directorate Government Relations Office ddawes@apa.org

Day Al-M ohamed, JD Sr. Officer, Legislative & Federal Affairs Public Interest Directorate Government Relations Office dwilliamsal-mohamed@apa.org

Alberto Figueroa-García, M BA Assistant Director Office of Ethnic Minority Affairs afigueroa@apa.org

OVERVIEW ON HEALTH DISPARITIES

OVERVIEW ON HEALTH DISPARITIES Health Disparities: A Multidimensional Approach Norman B. Anderson, PhD APA CEO On behalf of APA, I'd like to welcome you to this special issue of the CommuniquĂŠ devoted to health disparities. I appreciate the invitation to provide this overview article, since I have had a longstanding interest in the elimination of such disparities. In this special issue, you will read about how health disparities are manifested across different populations and different health outcomes. For example, health disparities may vary based on whether the topic is mortality, morbidity, access to care, self-rated health, or specific mental or physical health outcomes. Health disparities may also vary depending on Norman B. Anderson, PhD which racial or ethnic groups are being compared, and whether gender, age, or other demographic factors are included. And although not all ethnic minority groups have poorer health than W hites in all illness categories, it is clear from the articles in this issue that the burden of illness and death is substantially greater among ethnic minorities. A major challenge in understanding and "What accounts for the illness or ultimately eliminating health disparities is death rates for one outcome (e.g., answering the "why" question: W hy do hypertension) in one population such racial and ethnic-based health may or may not account for high disparities exist in a country such as ours? illness or death rates for another Arguably, answering this question outcome in that same population represents a scientific challenge of (e.g., HIV/AIDS). What accounts for the high rates of an illness in unparalleled complexity. This is because one population (e.g. Latinos/as) there is not one type of health disparity, may or may not account for the and therefore not one answer that explains high rates of the same illness in each type of disparity. W hat accounts for another population." the illness or death rates for one outcome (e.g., hypertension) in one population may or may not account for high illness or death rates for another outcome in that same population (e.g., HIV/AIDS). W hat accounts for the high rates of an illness in one population (e.g. Latinos/as) may or may not account for the high rates of the sam e illness in another population (e.g., Asian Americans). Therefore, both between-group variation (racial and ethic

OVERVIEW ON HEALTH DISPARITIES differences) and within-group variation (differences within one racial or ethnic group) are important considerations in understanding health disparities. The complexity of health disparities necessitates a much broader, multidimensional approach to understanding and eliminating them. Such an approach requires that we draw upon the best of what we have to offer in psychology, but also incorporate the best of many other relevant fields, including public health, clinical medicine, anthropology, sociology, and genetics, to name a few. This transdisciplinary approach is needed because all health problems are due to some interaction among environmental, sociocultural, behavioral, psychological, emotional, and biological processes. Thus, to truly understand health disparities, we must consider these types of interactions across levels of analysis. Clearly no one discipline "owns" the complete knowledge base to accomplish this. Fortunately for psychology, we have much to contribute from our disciple to understanding health disparities, and we have a strong history of leadership in developing transdisciplinary collaborations. "This transdisciplinary approach is needed because all health problems are due to some interaction among environmental, sociocultural, behavioral, psychological, emotional, and biological processes."

If we accept that health disparities are ultimately due to interactions across several different levels of analysis (e.g., social processes interacting with biological processes), what are some of the specific factors that need to be considered? Space limitations do not allow me to provide an exhaustive list (if I could), but here are a few factors that might be important in determining both between-group and within-group variations in health outcomes: â&#x20AC;˘ â&#x20AC;˘

â&#x20AC;˘

Biological factors such as the functioning of the immune, cardiovascular, or neuroendocrine systems, gene expression, etc; Social factors such as religious participation, social integration or isolation, social support, socioeconomic status (e.g., income, education, occupational status, self-rated social class), neighborhood environment (e.g., location, job opportunities, crime, toxic substances, poverty), marital status, exposure to racial discrimination, etc.; Sociocultural factors such as acculturation, immigrant status (e.g., years in the U.S., generational status), selection processes in immigration (e.g., are only the healthiest able to immigrate), language, effects of culture on behavior (see below);

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Behavioral factors such as smoking, diet, physical activity, sexual risk behaviors, or substance abuse; Psychological and em otional factors such as resilience, anger, anxiety, depression, perceived stress, emotional expression, optimism, etc.; Access to and quality of health care; The interaction of all of the aforementioned across the life course, from prenatal to the later years.

Clearly, health disparities represent a major public health challenge that will require not only transdisciplinary collaborations and cooperation but the wherewithal to make this effort a national priority for the United States with respect to health care and research. I am glad the field of psychology and APA are at the forefront of the movement to understand and eliminate these disparities. For Further Reading Anderson, N. B., Bulatao, R. A., & Cohen, B. (2004). Critical perspectives on racial and ethnic differences in health in later life. Washington, DC: National Academies Press. Bulatao, R., & Anderson, N. (2004). Understanding racial and ethnic differences in health in late life: A research agenda. Washington, DC: National Academies Press. Williams, D. R. (1997). Race and health: Basic questions, emerging directions. Annals of Epidemiology, 7, 322-333. Norman B. Anderson, PhD, is the Chief Executive Officer and Executive Vice-President of the American Psychological Association. He earned a doctorate in clinical psychology from the University of North Carolina at Greensboro and was a postdoctoral fellow in psychophysiology and aging at Duke University School of Medicine. Dr. Anderson has served as a professor at both Duke University Medical School and the Harvard School of Public Health. He was also the founding associate director of the National Institutes of Health (NIH) in charge of behavioral and social sciences research and was the first director of the NIH Office of Behavioral and Social Sciences Research. Dr. Anderson is a Past-President of the Society of Behavioral Medicine and served as President of the Board of Directors for the Starbright Foundation.

OVERVIEW ON HEALTH DISPARITIES The Case for Racial/Ethnic Disparities in Mental Health Daniel E. Dawes, JD Senior Officer, Legislative & Federal Affairs APA Public Interest Government Relations Office Amy M. Carrillo Graduate Student Intern APA Public Interest Government Relations Office Racial and ethnic mental health disparities have been consistently documented and continue to exist today. For example, the suicide rate among minority populations provides a clear depiction of the disparities in mental health status. The suicide rate among American Indians and Alaska Natives (AI/AN) is 50% higher than the national average. Additionally, Asian women have the highest suicide rate of all women over age 65. It has been reported that from 1980 - 1995, suicides among Black teenagers increased 233%, compared to 120% in Whites. Finally, although suicide rates among H ispanics are Daniel E. Dawes, JD often reported as lower than the national average, Hispanic adolescents report more thoughts about suicide and attempts than W hites and Blacks (U.S. Department of Health and Human Services, 2001). Despite these statistics and others showing grave racial/ethnic disparities in mental health status, some studies report similar rates of mental health problems between minorities and W hites. However, these studies often have limitations that serve to marginalize or minimize consideration of the mental health status of many of those ethnic/racial minority persons who are most vulnerable to mental illness. For example, epidemiological studies often fail to include data on vulnerable, highrisk subgroups such as persons who are exposed to violence, or who are homeless, incarcerated, institutionalized, or in foster care. Such high-risk persons also are disproportionately ethnic minorities and tend to have lower socioeconomic and health status than W hites (W illiams, 2006). These high-risk persons also have "â&#x20AC;Śepidemiological studies often fail to include data on v u l n era ble, h ig h - r i s k subgroups such as persons who are exposed to violence, homeless, incarcerated, institutionalized, or in foster care."

OEMA COMMUNIQUĂ&#x2030; higher rates of mental disorders than the general population. Furthermore, the rates of mental disorders are not adequately studied in many racial and ethnic groups, resulting in a scarcity of quality research (U.S. Department of Health and Human Services, 2001). Finally, mental health problems in minority groups may go unidentified due to the reluctance of racial and ethnic minority groups to report mental health problems and other cultural factors that may lead to difficulty in diagnosis. Amy M. Carrillo According to the Bureau of Justice Statistics, in June of 2007, 814,700 Black males and 410,900 Hispanic males were held in a state or federal prison or local jail in comparison to 755,500 W hite males in custody (Sabol & Couture, 2008). This presents a great disparity when considering that adult Black males and adult Hispanic males comprise only 11% and 14% of the adult male population, respectively, whereas W hite males comprise 70% of the adult male population (U.S. Census Bureau, 2007). Additionally, AI/AN represent only 1.5% of the U.S. population, but constitute 8% of all homeless individuals (U.S. Department of Health and Human Services, 2001). Unfortunately, national studies, such as the National Comorbidity Survey Replication (NCS-R), National Study of American Life (NSAC), and the National Latino and Asian American Study of Mental Health (NLAAS), exclude institutionalized persons (i.e., individuals in prisons, jails, nursing homes and long-term medical or dependent care facilities) and do not include people who are homeless. Therefore, these vulnerable populations are often overlooked by largescale, well-published epidemiological research studies. Additionally, minority individuals may ex p erien ce sym p to m s tha t a re "â&#x20AC;Śminority individuals may undiagnosed, underdiagnosed, or experience symptoms that are undiagnosed, under-diagnosed, or misdiagnosed for cultural, linguistic, or misdiagnosed for cultural, historical reasons. For example, it has linguistic, or historical reasons." been reported that American Indians are at lower risk for major depression (Beals et al., 2005). However, possible explanations for this finding include: (a) "depression" and other mental health problems may be conceptualized differently in American Indian groups, who may attribute symptoms of mental illness to other sources (M anson, Shore, & Bloom, 1985); and (b) studies often fail

OVERVIEW ON HEALTH DISPARITIES to probe, discuss, and clarify questions with participants during surveys designed to identify mental health problems and often fail to use trained mental health professionals to identify disorders. Likewise, other minority populations may be reluctant to disclose their symptoms to research staff for cultural reasons or due to mistrust from the historical treatment of their racial or ethnic group by the government, medical communities, or other research-related entities. Specifically, immigrants may be afraid to discuss mental health problems or concerns due to fear of deportation or other types of retribution, and Asians may not freely disclose information or symptoms that may cause themselves or their families shame (Lee, Lei, & Sue, 2001). The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity (2001), found that somatization, which is experiencing mental health problems as physical symptoms, is more common among Blacks (15%) than among Whites (9%). Other overlooked symptomatology includes culture-bound syndromes. For instance, Black individuals may experience paralysis while falling asleep or waking up or sudden collapses. Hispanics may experience susto (fright), nervios (nerves), or mal de ojo (evil eye), while Asians and Pacific Islanders may experience neurasthenia characterized by fatigue, weakness, and a number of other physical symptoms. As a result of the diversity in their symptoms, minority individuals may have mental health problems that remain undiagnosed because they do not correspond directly to western categories of illness and mental disorder. The considerations presented above support the need for both careful thought concerning mental health disparities among racial and ethnic minorities and for expanded research. W hile research continues to be conducted in the area of racial and ethnic mental health disparities, persistent disparities in mental health status require us to continue to work together to find ways to close the gap because "[t]he greater disability burden to minorities is of grave concern to public health, and it has very real consequences" (U.S. Department of Health and Human Services, 2001)." Therefore, the federal government has a critical role to play in addressing the issue of racial and ethnic disparities in mental health and mental health care by supporting legislation and regulations that will improve the lives of minorities. "The considerations presented above support the need for both careful thought concerning mental health disparities among racial and ethnic minorities and for expanded research."

OEMA COMMUNIQUĂ&#x2030; References Beals, J., Manson, S., Whitesell, N., Spicer, P., Novins, D., & Mitchell, C. (2005). Prevalance of DSM-IV disorders and attendant help-seeking in two American Indian reservation populations. Archives of General Psychiatry, 62, 99-108. Lee, J., Lei, A., & Sue, S. (2001). The current state of mental health research on Asian Americans. Journal of Human Behavior in the Social Environment, 3(3-4), 159-178. Manson, S. M., Shore, J. H., & Bloom, J. D. (1985). The depressive experience in American Indian communities: A challenge for psychiatric theory and diagnosis. In A. Kleinman & B. Good (Eds.), Culture and depression (pp. 331-368). Berkeley: University of California Press. Sabol, W. J. & Couture, H. (2008, June). Prison inmates at mid-year 2007. Bureau of Justice Statistics Bulletin, 1-24. U.S. Census Bureau. (2007). Current population survey, annual social and economic supplement. Retrieved December 17, 2008, from http://www.census.sus.gov/cps U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicityâ&#x20AC;&#x201D;A supplement to Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Williams, D. R. (2006). The health of U.S. racial and ethnic populations. Journals of Gerontology, Series B, Psychological Sciences, 60, 53-62. Daniel E. Dawes, JD, is a Senior Legislative and Federal Affairs Officer at the American Psychological Association (APA) and a licensed attorney. In his capacity at APA, Daniel is responsible for issues involving public health, health care and labor/employment legislative and regulatory issues. Prior to working for the APA, Daniel worked on the Senate Health, Education, Labor, and Pensions (HELP) Committee under the leadership of Senator Edward M. Kennedy and the Congressional Black Caucus (CBC) Health Braintrust under the leadership of Congresswoman Donna M. Christensen. Daniel holds a Juris Doctorate from the University of Nebraska - College of Law and a Bachelor of Science degree from Nova Southeastern University. Amy M. Carrillo is a fifth-year doctoral student at the University of Maryland, Baltimore County. She is currently pursuing a degree in Human Services Psychology with an emphasis on Community and Applied Social Psychology. Her research interests include minority mental health, minority student achievement, and women and resilience.

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES Health Disparities: Is 2009 the Year for Solutions? U. S. Senator Daniel K. Inouye (D-HI) America has tremendous healthcare disparities. For example, American Indians/Alaska Natives (AI/AN) and Asian and Pacific Islanders have higher uninsured rates than Non-Hispanic W hites (NHW ). Just in 2008, I have sponsored or co-sponsored bills on nutritio n, fitness, cardiovascular disease, diabetes, disabilities, mental health, cancer, education for allied health professionals, and several other health issues. P ro viding funding for American Indian (AI)/Native Hawaiian (NH)/Alaska Native (AN) healthcare, rural programs, Native American U. S. Senator Daniel K. Inouye (D-HI) Caregiver support, aging grants to AI/AN/AN, NH education, through the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriation Bill, 2009 (Senate Report 110-410) was a priority for me. I have also been a supporter of improving access to health care. Health status is related to access to care, socioeconomic status, genetics, and personal behavior. The Institute of Medicine (IOM, 2003) reports that changes are necessary, to refocus America's healthcare system. An area that offers great opportunity for reducing morbidity and mortality is behavioral health including lifestyle changes and prevention activities. These changes could affect most of the top 10 causes of death in America. To accomplish this we will need to integrate behavioral healthcare providers onto primary care teams. The best medications and treatments will be unsuccessful in improving health outcomes without addressing the individual's psycho-social conditions. "An area that offers great opportunity for r ed u cin g morbidity and mortality is behavioral health including lifestyle changes and prevention activities.â&#x20AC;ŚTo accomplish this we will need to integrate behavioral healthcare providers onto primary care teams."

AI/ANs are twice as likely to report fair or poor health as compared to NHW s (Kaiser Family Foundation, 2008). Quality of care is also compromised for these

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES groups. In 21 healthcare measures AI/ANs scored lower than NHW s in 38 percent of the measures. Asian/Pacific Islanders scored lower in 22 percent of the measures. The rate of obesity among AI/ANs is 65 percent which is higher than all other races combined (CDC, 2005). Native Hawaiians (NH) obesity is 35 percent, which is also higher than NHW s (Cancer Research Center of Hawaii, Hawaii Cancer Facts and Figures 2003-2004). Obesity, a risk factor for diabetes, is 2.6 times as common among AI/ANs as among any other racial or ethnic group. Their death rate from diabetes is 73 per 100,000 as compared to 25 per 100,000 for the rest of the population (Indian Health Service (IHS) Statistics, 2003). NH's diabetes prevalence is twice that of NHW s (Office of Health Statistics Management, 2004 Hawaii Diabetic Report). Cancer is the number one cause of death in Asians and Pacific Islanders, while heart disease is the number one cause of death for all other races/ethnicities. Asian/Pacific Islanders are least likely to have breast, cervical, or colon cancer screening. Only African American males and AN females have higher cancer rates than NH (National Cancer Institute). The five year survival rate for NHs is 18 percent lower than NHW and 15 percent lower than the general population (National Cancer Institute). Substance abuse is more common among AI/ANs. A total of 12.8 percent of AI/ANs use illicit drugs while only 8.1% percent of N HW and 3.1 percent of Asians (CDC, 2005) do so. Data are not available for Pacific Islanders. Alcohol is the third leading cause of preventable death in Americans. AI/ANs have 42 deaths per 100,000, while the overall population has only 8 per 100,000 (IHS Statistics, 2003). Alcoholism is multi-generational and just the tip of the iceberg for other social and health problems. Suicide is the second leading cause of death in AI/ANs ages 15 to 34 years old, which is twice the national average (CDC, 2005). Mental health parity was another bill that I supported. From the above statistics, you can easily see that more work in the area of healthcare disparities is needed. Healthcare professionals need to work as integrated teams. More needs to be done to integrate behavioral health into primary care, and prevention needs to be the centerpiece of care. Yes, there is an inherent need to act on healthcare disparities, and I am optimistic that 2009 promises to be a year to see the needed changes.

OEMA COMMUNIQUĂ&#x2030; Daniel K. Inouye is the chair of the Senate Appropriations Committee and the third most senior member of the U.S. Senate. He is known for his distinguished record as a legislative leader, and as a World War II combat veteran who earned the nation's highest award for military valor, the Medal of Honor. Inouye, who was wounded on the battlefield, is well aware of the importance of medical care for both service members and civilians; he is an advocate of improved healthcare for all Americans. Although he was thrust into the limelight in the 1970s as a member of the Watergate Committee and in 1987 as Chairman of the Iran-Contra Committee, he has also quietly made his mark as a respected legislator able to work in a bipartisan fashion to enact meaningful legislation.

Health: A Crisis in Indian Country U.S. Senator Byron L. Dorgan (D-ND) The 4.1 million American Indians currently living in the United States are a crucial part of this nation's history and invaluable to our culture and society. Yet, this is not a thriving population. Today, our First Americans suffer from health disparities comparable to those in the Third W orld, a dire health status unparalleled in the United States. Unlike other Americans, more than half of the Native Americans receive their health care through a system run by the federal government: the Indian Health Service (IHS). The federal government has been providing Native Americans with health care for over 200 years. Since 1954, health care has been provided through the IHS, a health care system located within the Department of Health and Human Services. IHS' mission is to "to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level." It includes over 700 health facilities located mostly on Indian reservations. Its annual budget is about $3.2 billion, employs over 15,000 people and makes over 58,000 inpatient admissions and 10 million outpatient visits annually.

U.S. Senator Byron L. Dorgan (D-ND)

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES For nearly 60 percent of Native Americans, IHS is the only option for health care. Private hospitals and clinics do not exist on Indian reservations and are often located several hours away. The current federal system, however, has failed to provide adequate health care to our First Americans. The health statistics in Indian Country are staggering. American Indians have a life expectancy over 2 years shorter than that of the general United States population. The incidence and mortality rates of many illnesses are dramatically higher than in the general population: Infant mortality rate is 12 per 1,000, compared to 7 per 1,000 in the general population. In addition, compared with the general population, American Indians have a 510% higher rate of dying from alcoholism, a 189% higher rate of suffering from diabetes, a 600% higher rate of tuberculosis, and a 62% higher rate of suicide. Although obesity and diabetes are becoming problematic in the general population, they are reaching epidemic levels within our Native communities. Native Americans have the highest rate of type 2 diabetes in the United States. For example more than 80 percent of Pima Indians in Arizona develop diabetes by age 55. The Special Diabetes Program for Indians has produced measurable progress, most notably a 40 percent decrease in diabetes-related complications like kidney failure and blindness, since its establishment in 1997. W e need to focus on programs like this which are working and addressing health disparities. These statistics make a grave statement about the failure of the United States to fulfill its commitment to providing adequate health care to our First Americans. I believe it is time for a comprehensive review of IHS and new innovative ideas for improving the system.

"I believe it is time for a comprehensive review of IHS and new innovative ideas for improving the system."

First, any federal health care system for Native Americans must be properly funded. Currently, the IHS reports that the annual appropriations meet only 52 percent of the health care needs, leaving our Native American communities drastically underserved. The result of the federal government's failure to adequately fund IHS has resulted in full-scale rationing, in many cases only providing "life or limb" emergency care.

OEMA COMMUNIQUĂ&#x2030; Beyond addressing funding constraints, any health care system for our Native American communities must have sufficient facilities and clinicians. The current IHS priority list of unfunded health care facilities has a backlog of $2.56 billion, probably putting the backlog of needed renovation, maintenance, and construction of health care facilities well over $3 billion. Furthermore, significant vacancy rates exist within IHS: 17% for physicians, 18% for nurses, and 31% for dentists. Although recruitment and scholarship programs currently exist, they are clearly not meeting the goal of obtaining the necessary clinicians needed to serve this population. In addition, changes to the current system need to focus on how to better deliver services to rural, and often times, isolated communities with unique cultural characteristics. Any changes must also look to allowing an increase in local control, with management oversight in W ashington, DC. Too often, the current system gets bogged down in federal bureaucracy. As Chairman of the Senate Committee "I will continue to work to improve the on Indian Affairs, this effort is my top current federal health care system priority. I will continue to work to serving Native Americans. â&#x20AC;ŚIdeas improve the current federal health care must not only come from those working system serving Native Americans. W e within the current system, but also from need to develop innovative and creative those in the private and non-profit solutions to improve or completely health care industries who are working with cutting-edge technology to revamp the current system. Ideas must improve health care systems globally." not only come from those working within the current system, but also from those in the private and non-profit health care industries who are working with cutting-edge technology to improve health care systems globally. The United States must not allow for our indigenous population to continue to suffer health disparities comparable to those of third world nations. More information on the federal Indian health care system and efforts to improve it can be found on the web site of the Committee on Indian Affairs within the United States Senate at www.indian.senate.gov.

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES References Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) and Office of Injury Mortality, Division of Violence Prevention. (2007). Atlas of injury mortality. Retrieved September 22, 2008, from http://www.cdc.gov/ncipc/pub-res/American_Indian_Injury_Atlas/05Summary.htm. Indian Health Service. (2008, June). About Indian Health Service. Retrieved December 17, 2008, from http://info.ihs.gov. Indian Health Service. (2008, June). Fact sheet: Indian health disparities. Retrieved September 17, 2008, from http://info.ihs.gov/Disparities.asp. Byron L. Dorgan (D-ND) was re-elected to a third term in the Senate in November 2004 with nearly 70 percent of the vote after serving two previous terms in the Senate and six terms in the U.S. House of Representatives. He has served in the Democratic Leadership since 1996, first as an Assistant Democratic Floor Leader and currently as Chairman of the Senate Democratic Policy committee, a position that he has held since 1998. Senator Dorgan has served as the Chairman of the Senate Indian Affairs Committee since 2007 and as a member of the Committee since his induction in 1993. Senator Dorgan was instrumental in passing the Indian Health Care Improvement Act Amendments of 2008, which was the first update of Indian Health Care legislation in 16 years.

Not Just Getting Something Done, but Getting It Done Right: The CBC Health Braintrust's Mental Health Priorities Donna M. Christensen U. S. Congresswoman, Virgin Islands Overview As we welcome in a new Administration that has made health care reform a priority, it is important that mental health is not forgotten, as it is sometimes not mentioned in the health care reform debate. Mental health is integral to maintaining overall well-being. As a family physician who practiced for more than two decades prior to coming to Congress, I have seen â&#x20AC;&#x201D; firsthandâ&#x20AC;&#x201D; how

The Honorable Donna M. Christensen, Virgin Islands

OEMA COMMUNIQUÉ dysfunction in the mind-body connection and our failure to acknowledge, recognize and address it not only affects the health and well-being of the individual, but families and even communities. Recognition of this by the Congressional Black Caucus has ensured that our efforts at health and health care disparity elimination also "…in the 111th Congress, include the elimination of the disconnect we will continue to between physical and mental health, and the introduce and support disparity between mental health and other legislation that not only health care. champions mental health parity, but that eliminates The Congressional Black Caucus (CBC) the racial and ethnic Health Braintrust has consistently addressed disparities in mental health and in mental health current and emerging mental health and care…" mental health care issues, particularly as they pertain to health equity and minority health. Additionally, as we move forward in the 111th Congress, we will continue to introduce and support legislation that not only champions mental health parity, but that eliminates the racial and ethnic disparities in mental health and in mental health care that detrimentally affect millions of Americans. M ental Health Disparities: An Under-Addressed Public Health Issue The Centers for Disease Control and Prevention estimates that every year, one in every two Americans is affected by a diagnosable mental disorder. W hile many of these disorders are as disabling as acute and chronic conditions that receive a great deal of attention, mental disorders are often overlooked and under-addressed. This is particularly true of the racial and ethnic disparities in mental health and mental health care that detrimentally affect the lives and life opportunities of millions of people of color every year. Additionally, while mental health disorders affect all people, studies show that racial and ethnic minorities suffer a disproportionate burden of mental illness. For example: •

Studies show that while serious mental disorders occur in all people, racial and ethnic minorities are disproportionately more likely than whites to be over-represented among the homeless and the poor; the incarcerated and institutionalized; and the survivors of traumatic experiences— all of whom are the most vulnerable and in need of mental health services and treatment.

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES •

Racial and ethnic minorities afflicted with major mental health disorders are disproportionately more likely than their W hite counterparts to face often insurmountable barriers to needed care, including: un- and under-insurance, which delay and even prevent access to needed care; language barriers; stigma about mental health disorders and mental health care; a lack of availability of mental health practitioners in certain geographic locations; and an absence of cultural competency among some existing mental health providers and practitioners, which often leads to misdiagnoses among racial and ethnic minorities.

Not Just Getting Something Done, but Getting It Done Right: The CBC Health Braintrust's M ental Health Priorities As the face of the nation changes to one that is increasingly brown, this diversity— which this nation is embracing more with every generation— does present new health and health care challenges which demand strong and innovative solutions. Consequently, it is imperative that as we proceed with health care reform efforts that truly transform our nation's health care system, we ensure that we appropriately address not only the mental health crises in this nation, but also the social determinants of health that not only sustain, but exacerbate mental health disparities. The CBC Health Braintrust, therefore, will "…the CBC Health remain resilient in its support for the Braintrust will assume a congressional TriCaucus health disparity leadership role in ensuring elimination effort. In the 110th Congress, this that mental health and bill was entitled The Health Equity and mental health care are Accountability Act (H.R. 3014) and reflects the r e c o g n i ze d — a n d t h u s joint health equity efforts of the CBC, the treated—as integral components of—and not C o n g r e ss io n a l H i s p a n i c C a u c u s , t h e accessories to—our health Congressional Asian Pacific American Caucus, care reform efforts." and the Native American Caucus. Additionally, this legislation— which we will re-introduce in the 111th session and of which we will encourage inclusion in the forthcoming health care reform package— addresses the root causes of the health inequities in not only mental health and mental health care, but in all aspects of health care. It offers a sound and comprehensive public health approach to solving our nation's most pressing public health issues. Additionally

OEMA COMMUNIQUÉ and equally as important, it incorporates mental health reform and the elimination of mental health disparities as necessary elements in health equity. In Closing… As we find the common ground necessary to truly transform our health care system, the CBC Health Braintrust will assume a leadership role in ensuring that mental health and mental health care are recognized— and thus treated— as integral components of— and not accessories to— our health care reform efforts. In doing so, I am confident that we will build on the successes that have been made by Reps. Jackson Lee, W atson, Napolitano, Kennedy, and so many others around mental health care and take another giant step forward to ensure that millions of innocent men, women, and children have reliable and appropriate access to quality mental health care to manage their conditions and live longer, fuller, and more productive lives. The time for change has come and that change, that hope that this nation has clung to, must be incorporated into our health care reform efforts. This is particularly true of our mental health care system. Together, we can do it. Together, we must do it. And, together, we will become a stronger and healthier— physically and mentally healthier— nation! For more information about the CBC Health Braintrust, please feel welcome to contact Britt Weinstock, Senior Health Policy Advisor in the Office of Congresswoman Donna Christensen, at britt.weinstock@mail.house.gov or at 202.225.1790.

Donna M. Christensen, a member of the House Energy and Commerce Committee, continues to distinguish herself as a leader in the United States Congress. As a Member serving her sixth term, she is the first female physician in the history of the U.S. Congress, the first woman to represent an offshore Territory, and the first woman Delegate from the United States Virgin Islands. Christensen began her medical career in the Virgin Islands in 1975 as an emergency room physician. She served as staff physician at the Maternal & Child Health program, Medical Director of the Nesbitt Clinic in Frederiksted, Director of the Frederiksted Health Center, Director of Maternal and Child Health and Family Planning, served as the Medical Director of the St. Croix Hospital and rounded out her medical career as the Territorial Assistant Commissioner of Health and as the Acting Commissioner of Health. She maintained a private practice in family medicine from 1975 until her election to Congress in 1996.

Critical Future Issues of Mental Health Disparities: An Interview With Dr. David Satcher Dennis R. Bourne, Jr. Interviewer and OEMA Program Officer As the 16th Surgeon General of the United States, David Satcher, MD, PhD, was the driving force behind the groundbreaking 1999 report, Mental Health: A Report of the Surgeon General. The report detailed the large number of people with mental illnesses who are not receiving treatment and the barriers to accessing appropriate treatment. A supplement to the report, Mental Health: Culture, Race, and Ethnicity, spoke directly to the effect of race and culture on these issues. Since leaving his post as Surgeon General and Assistant Secretary for Health in David Satcher, MD, PhD 2001, Dr. Satcher has assumed the role as Director of the National Center for Primary Care at the Morehouse School of Medicine. The Communiqué spoke with Dr. Satcher to get his perspective on the past, present and future of disparities in mental health and the treatment of mental illness.

Com m uniqué: W hat was the motivation for the focus on mental health in your report? Dr. Satcher: People had been requesting more of a focus on mental health. And, as Surgeon General, I appointed the first director on behavioral health. It ties back to interests I had in medical school at Case W estern Reserve University. I tended to be interested in things that were neglected or discriminated against. Many people are suffering with mental illnesses because of the stigma involved. Com m uniqué: How do the disparities in mental health care differ from those in other areas of health care, if at all? How do the solutions to these disparities differ? Dr. Satcher: Reimbursement for insurance is the difference. The government just passed the Mental Health Parity Act. In 2001, President Clinton issued an executive order mandating mental health coverage for all Federal employees. Howard Goldman did a study to see how the mandate to cover mental health care would impact Federal spending on employee health care. Goldman found that the total cost was not affected by adding the mental health care coverage.

OEMA COMMUNIQUÉ The difference is also related to the stigma against mental illnesses. There is a stigma "…the inherent discrimination and an inherent discrimination in programs of against mental illness goes back to biblical times. We haven't medicine. There are also differences in the overcome it yet, because there is quality and access to mental health care. The no watchdog to make sure that discrimination against mental health was parity is implemented." legitimized by policy. And the inherent discrimination against mental illness goes back to biblical times. W e haven't overcome it yet, because there is no watchdog to make sure that parity is implemented. Com m uniqué: W hat immediate impact did you see after the publication of the report? Dr. Satcher: The discussion at the national level rose to a new level. It created an environment where people were more comfortable talking about mental illness. It reduced the stigma, and created a new environment in which to view the problem. The report marked the start of the process that culminated in the parity act. Shortly after, President Bush created a task force on mental health, which resulted in the creation of a service center for mental illness. Com m uniqué: In the preface to your report, you made the following statement: Promoting mental health for all Americans will require scientific know-how but, even more importantly, a societal resolve that we will make the needed investment. The investment does not call for massive budgets; rather, it calls for the willingness of each of us to educate ourselves and others about mental health and mental illness, and thus to confront the attitudes, fear, and misunderstanding that remain as barriers before us. W ith nearly ten years having passed since the report was published, what progress have you seen toward promoting mental health care for all Americans? Dr. Satcher: The parity act. States have passed legislation before, but this was the first national legislation. There has been a change in the attitudes of the health care providers. I've also seen greater investment in partnerships between psychologists, psychiatrists, and primary physicians. And there have been improvements in the numbers of people receiving mental health care.

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES Com m uniqué: W hat is your vision for the future of health care with respect to the treatment of our nation's increasingly diverse population? Dr. Satcher: My vision for the future includes universal health care without any uninsured. There won't be any disparity in the quality and access to healthcare. There will be "My vision for the future equality in healthcare outcomes and in access to includes universal health the possibility of a healthy lifestyle and care wi th o ut any environment. uninsured. There won't C om m uniqué: W hat encouragem ent and challenges do you see in reaching this vision, in light of the recent changes in presidential administration and the economic situation?

be any disparity in the quality and access to healthcare. There will be equality in healthcare outcomes and in access to the possibility of a healthy lifestyle and environment."

Dr. Satcher: I am pleased with President-elect Obama's commitment to universal healthcare. I am confident that he will bring the best minds to bear on the issue. M ental health parity was a part of his platform. I also think he will bring people together across party lines to get things accomplished. It's hard to predict the economy, but it's not just about the money. W e need long-term plans. W e need to make plans for balanced community health programs. The economic situation will delay implementation of any plans, but keeping people healthy will save us all of the money it costs to treat chronic diseases. Com m uniqué: Is there anything you'd like to add? Dr. Satcher: It is important to note that there is a disparity because of race in quality of care and in the burden of mental illness. However, regardless of race, people with mental illnesses are being stigmatized and discriminated against.

OEMA COMMUNIQUĂ&#x2030; Health Disparities Research at the National Institute on Drug Abuse: Progress and Continuing Needs Lula A. Beatty, PhD Special Populations Office National Institute on Drug Abuse Since Congress passed the Minority Health and Health Disparities Research and Education Act in 2000, which required federal agencies to develop strategies to reduce health disparities, there has been substantial growth in health disparities initiatives. This attention to disparities in morbidity and mortality rates between racial/ethnic minority groups is not new. In 1985 the Report of the Secretary's Task Force on Black and Minority Health called for national action to decrease the disproportionate burden of disease experienced by Black and other minority groups. The N ational Institute on Drug Abuse Lula A. Beatty, PhD (NIDA), National Institutes of Health, has been engaged for over 20 years in efforts to address drug abuse research needs in racial/ethnic minority populations through a variety of programs and the development of a strategic plan on health disparities (http:// www. nida. nih. gov/ StrategicPlan/HealthStratPlan.html).

"Drug abuse and addiction affect all U.S. populations at nearly the same lifetim e prevalence rateâ&#x20AC;ŚThe health disparity concern is the disproportionate negative impact that drugs and addiction have on racial/ethnic minority populations. This is most apparent in the high rates of incarceration/other criminal j u st i ce i n vo lvem ent an d HIV/AIDS and other infectious diseases seen in racial/ethnic minority populations as a result of drug involvement."

W e have made progress in advancing our health disparities research program and, like others, we continue to experience challenges in meeting some of our research and training goals. Major advances include the following: Clarifying and defining health disparities in drug abuse and addiction and supporting research in special areas of need. Drug abuse and addiction affect all U.S. populations at nearly the same lifetime prevalence rate, with some notable differences between and within groups by varying factors such as age and gender. The health disparity concern is

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES the disproportionate negative impact that drugs and addiction have on racial/ethnic minority populations. This is most apparent in the high rates of incarceration/other criminal justice involvement and HIV/AIDS and other infectious diseases seen in racial/ethnic minority populations as a result of drug involvement. Clarifying this relationship has helped in identifying research areas of need, setting research priorities and developing new research opportunities. For example, NIDA is one of the largest NIH supporters of behavioral research on HIV/AIDS. The area of health disparities is among NIDA's top domestic HIV/AIDS priorities (http://www. nida. nih.gov/ about/organization/ arp/arp-current.htm). Investigators are encouraged to submit research applications in this area. There is an active program on criminal justice issues called the Criminal Justice/Drug Abuse Treatment Studies (http://www.cjdats.org/ka/index.cfm). Although it was not developed as a health disparities initiative, researchers are encouraged to pursue health disparities research within CJ/DATS and to submit applications on criminal justice issues to NIDA. Establishing expert work groups. NIDA has work groups that advise the Special Population Office and NIDA Director on drug abuse research development needs for African Americans, American Ind ians/A laskan N atives, Asian Americans/Pacific Islanders, and Hispanics (National Hispanic Science Network on Drug Abuse http:// www. nhsn.med.miami.edu/). W ork group members represent various scientific disciplines and communities outside of NIDA. These work groups also have programs to assist new and established researchers interested in pursuing drug abuse research. For example, the National Hispanic Science Network provides a summer research training institute for graduate students and the American Indian work group has recently begun a mentoring program for Native students. Supporting career and capacity developm ent program s. Few people of color receive NIDA or NIH research funding. N IDA works to increase that number by introducing students and faculty to addiction research through a number of programs including the Diversity Supplement Program, Summer Research with NIDA (for high school and undergraduates), internships at NIDA's intramural laboratory, and technical assistance to aspiring researchers. In addition, NIDA has co-sponsored programs offered by other NIH institutes and professional associations including APA. NIDA also offers research capacity development support to colleges and universities that serve minority and other underrepresented groups but are not research intensive through the Diversity-promoting Institutions Drug Abuse Research Program. (http://grants.nih.gov/grants/guide/pa-files/PAR-09-011.html).

OEMA COMMUNIQUĂ&#x2030; Exam ining diversity within populations. A shortcoming of research on racial/ethnic minority populations is the lack of attention to diversity within the populations by such factors as country/place of origin and SES. For example, African Americans are comprised of persons who may identify as Jamaican/Caribbean or African. Recognizing the diversity within groups allows for better targeted prevention and treatment approaches. NIDA encourages and supports research sensitive to these issues. M oving beyond the individual. An exciting development in health disparities research is the increased focus on social and economic systems to explain disparities. This type of social justice/inequities approach has been advocated for years, especially for disenfranchised communities. Increased awareness, advocacy, collaborations, and technological and statistical analysis have converged to make these sometimes complex studies possible. Studies examining, for example, neighborhood characteristics, organizational variables, and health policies are being supported. Continuing major challenges include funding and developing leadership in drug abuse health disparities research. Support for NIH funding has not increased essentially over the last 5â&#x20AC;&#x201C;6 years; health disparities research has not been exempt from this decrease. Perhaps as important as money is our need for more researchers of color to fully embrace the role as leaders in health disparities research. W e need them as active sponsored researchers and research advisors, critics and mentors to push the field forward in ways that will honor the needs of their communities, reduce the impact of drugs on racial/ethnic populations and subsequently improve the health of all our communities. The Special Populations Office welcomes inquiries and ideas (301-443-0441). Lula A. Beatty, PhD, is Director of the Special Populations Office, Office of the Director, at the National Institute on Drug Abuse. Her responsibilities include developing racial/ethnic minority research and health disparities programs, developing initiatives to encourage the increased participation of underrepresented scholars in drug abuse and addiction research, and monitoring NIDA's support of racial/ethnic minority and health disparities research. Before joining NIDA, she was Director of Research at the Institute for Urban Affairs and Research at Howard University. She received her AB degree from Lincoln University (PA), and her masters and doctoral degrees in psychology from Howard University.

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES Eliminating Mental Health Disparities in Racial and Ethnic Minority Populations Through the Integration of Behavioral and Primary Healthcare: Recommendations and Strategies Teresa Chapa, PhD, MPA Office of Minority Health, HHS In 2007, the U.S. Census Bureau (2007) announced that for the first time ever, racial and ethnic minority populations in the United States reached over 100 million— 34% in total— and will likely become the majority population in less than 30 years. Our continued population growth, coupled with evidence of health and behavioral health disparities, will challenge us all to seek new solutions. Although seminal reports have inspired a new group of studies and papers that focus on the scientific, clinical, Teresa Chapa, PhD, and policy issues surrounding the quality of care and MPA health and behavioral health disparities (Smedley, Stith, & Nelson, 2002; U.S. Department of Health and Human Services [DHHS], 1999, 2001, 2007), there remains a significant need for a more diverse, knowledgeable, trustworthy, and culturally and linguistically competent workforce and system of care.

"We know that behavioral healthcare in the U.S. is fragmented and fraught with barriers, regardless of the point of entry. For m inority populations it includes poor quality, limited access to care, and a lack of utilization and little care coordination—often leading to more chronic and disabling mental health conditions."

The relationship between mental health disparities, access to care and quality of care is complex. W e know that behavioral healthcare in the U.S. is fragmented and fraught with barriers, regardless of the point of entry. For minority populations it includes poor quality, limited access to care, and a lack o f utilization and little care coordination— often leading to more chronic and disabling mental health conditions (DHHS, 2003).

OEMA COMMUNIQUÉ Racial and ethnic minorities receive medical interventions more often than mental health interventions, and research indicates that the dramatic differences in the utilization of mental health services are not due to differences in rates of mental illnesses (Alegría et al., 2007, 2008; Takeuchi et al., 2007). Additionally, the uninsured face even greater challenges in gaining access to high quality care, an obstacle that is particularly salient for minority populations who are already overrepresented in our nation's most vulnerable populations, such as the poor and uninsured. In fact, individuals who successfully reach care may find many treatments and services not available, or that the quality of care is inadequate or unsatisfactory. Some attribute poor treatment rates to a lack of minority representation in the mental health "…the mental health provider workforce and suggest that enhancing encount er is unique: quality in mental healthcare could potentially lead Requiring a higher level of to the elimination of mental health disparities understanding, empathy, and sensitivity. Racial and (Miranda, McGuire, W illiams & W ang, 2008). ethnic minorities experience This makes sense because the mental health issues of trust and/or encounter is unique: Requiring a higher level of linguistic barriers and understanding, empathy, and sensitivity. Racial emphasize a greater need for and ethnic minorities experience issues of trust cultural sensitivity." and/or linguistic barriers and emphasize a greater need for cultural sensitivity. Continued unmet needs and substandard mental health services to minority populations can only lead to a negative impact on the well-being of our nation— with both costly economic and negative social consequences. The U.S. Department of Health and Human Services, Office of Minority Health, works "We know that primary care is in partnership with Federal Partners to often the first point of contact for minority populations seeking develop and support new efforts aimed at behavioral health interventions, eliminating disparities among racial and and that this portal to service is ethnic minority populations (Federal perceived as less stigmatizing…" Partners Senior Workgroup on Mental Health Transformation Integration of Primary Care and M ental H ealth W orkgroup, 2008). One particular approach is the integration of mental health and substance abuse with primary care. W e know that primary care is often the first point of contact for minority populations seeking behavioral health interventions,

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES and that this portal to service is perceived as less stigmatizing than specialty behavioral health settings (W orld Health Organization, 2008). Coordinating services and finding the right recipe for integrative care are essential in creating an equal partnership between the primary care provider and the behavioral health professional. The W orld Health Organization has called integrating mental health services into primary healthcare the most viable way of closing the treatment gap for mental health prevention as well as for untreated mental illnesses. They found that treating mental disorders as early as possible, holistically, and as close as possible to the person's home and community leads to the best health outcomes. Remember that the success of this intervention weighs heavily on the quality of the relationship between the consumer and provider, and the treatments received through the integration paradigm (Butler et al., 2008; W orld Health Organization, 2008). Steps towards eliminating mental health disparities: • • • •

Improve the quality and access through integrative care. Be sensitive to the role of communication between provider and patient/consumer. Build a diverse, cultural, and linguistically competent workforce. Provide health coverage for all.

In summary, minority populations appear to utilize the primary care setting more often, for mental health interventions. Therefore, supporting a model of integration for behavioral health services with primary healthcare is a more viable approach to eliminating mental health disparities. To do this will require coordinating and integrating supports and services needed for those with mental health/substance abuse disorders, but also building a viable cultural and linguistically competent workforce. Remember that a person's mental health outcome weighs heavily on the quality of the relationship between the provider and the patient/consumer, and the secondary benefit of the additional attention received in treatment as a result of integrated behavioral health and primary care services. As such, it is in our best interest to nurture and further develop this entry point into treatment. References Alegría, M., Mulvaney-Day, N., Woo, M., Torres, M., Gao, S., & Oddo, V. (2007). Correlates of past year mental health service use among Latinos: Results of the

OEMA COMMUNIQUÉ National Latino and Asian American Study. American Journal of Public Health, 97, 68-75. Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C., Takeuchi, D., Jackson, J., & Meng, X. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59, 1264-1272. Butler M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., & Wilt, T. J. (October, 2008). Integration of mental health/substance abuse and primary care (AHRQ Pub. No. 09-E003). Rockville, MD: Agency for Healthcare Research and Quality. Federal Partners Senior Workgroup on Mental Health Transformation Integration of Primary Care and Mental Health Workgroup. (2008). Compendium of primary care and mental health integration activities across various participating federal agencies. Retrieved January 17, 2009, from http://www.samhsa.gov/Matrix/MHST/Compendium_Mental%20Health.pdf Miranda, J., McGuire, T. G., Williams, D. R., & Wang, P. (2008). Commentary: Mental health in the context of health disparities. The American Journal of Psychiatry, 165, 1102-1108. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2002). Unequal treatment: Confronting racial and ethnic disparities health care. Washington, DC: Institute of Medicine. Takeuchi, D. T., Zane, N., Hong, S., Chae, D. H., Gee, G. C., Walton, E., Sue, S., & Alegría, M. (2007). Immigration-related factors and mental disorders among Asian Americans. American Journal of Public Health, 97, 76-83. U.S. Census Bureau News. (2007). Minority population tops 100 million. Retrieved January 17, 2009, from http://www.census.gov/Press-Release/www/releases/archives/population/010048.html U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author. U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services. (2003). Mental health: Achieving the promise: Transforming mental health care in America. Final report (DHHS Pub. No. SMA-03-3832). Rockville, MD: U.S. Department of Health and Human Services, New Freedom Commission on Mental Health. U.S. Department of Health and Human Services. (2007). 2007 national healthcare disparities report. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. World Health Organization.(2008). Integrating mental health into primary care: A global perspective. Retrieved January 17, 2009, from http://www.who.int/mental_health/resources/mentalhealth_PHC_2008.pdf

CONGRESSIONAL AND FEDERAL PERSPECTIVES: CRITICAL HEALTH DISPARITIES ISSUES Teresa Chapa, PhD, MPA, serves as the Senior Policy Advisor for Behavioral Health for Minority and other underserved populations with the U.S. Department of Health and Human Services (HHS), Office of Minority Health. Her current areas of focus and development include primary and behavioral healthcare integration and mental health disparities elimination, building a minority mental health pipeline, and the state of Hispanic mental healthcare. Previously, she served as Director of Policy and Data for the Office of Minority Health where she led the way for making Minority Mental Health a part of the overall health and health disparities agenda.

THE MANY FACES OF HEALTH DISPARITIES With A Focus On: LGBTQ African American Youth Ethnic Minority & Immigrant Women Cancer & Socioeconomic Disadvantage Persons With HIV & AIDS Mental Health Needs of Asian American/Pacific Islander Populations Persons With Disabilities Sexual Minority Women Older Adults Environmental Health Latino Mental Health Services Needs

THE MANY FACES OF HEALTH DISPARITIES Resilience in LGBTQ African American Youth James Bogden, MPH APA Public Interest Directorate Healthy, Lesbian, Gay, and Bisexual Students Project Efua Andoh APA Public Interest Directorate Children, Youth, and Families Office Recent research indicates that African American adolescents who are gay, lesbian, bisexual, or transgendered, or questioning their sexual orientation (LGBTQ youth) experience significant disparities in mental and physical health: High rates of depression, suicidal ideation, substance abuse, and risk for STD and HIV infection (Consolacion, Russell, & Sue, 2004; Garofalo, DeLeon, Osmer, Doll, & Harper, 2006; Millet, Peterson, W olitski, & Stall, 2006; O'Donnell, O'Donnell, W ardlaw, & Stueve, 2004). APA has called for in-depth research on James Bogden, MPH "…(LGBTQ youth) risk and protective experience significant factors influencing disparities in mental healthy growth and development in LGBTQ and physical health: African American youth (APA, 2008). Current High rates of research disproportionately focuses on African depression, suicidal ideation, substance American men who have sex with men often within abuse, and risk for STD the context of HIV or STD prevention. Inadequate and HIV infection…" research examines the diverse experiences of LGBTQ African American adolescents. Adolescence is an especially complex phase of development for sexual minority African American youth, dominated by the need to integrate multiple identities—race/ethnicity, gender, social class, religion, and sexual orientation— into a cohesive whole. This task is rendered more challenging when certain identities are stigmatized by larger society (Consolacion et al., 2004). Family, peer, school, and faith contexts are often unwelcoming to open expression of LGBTQ status; e.g., a 2007 nationwide survey of LGBTQ middle and high school students of color found they experienced disproportionate verbal harassment (48%), physical harassment (27%), and physical assault (15%) that year (GLSEN, 2008).

THE MANY FACES OF HEALTH DISPARITIES Same-gender-loving African American youth often suffer dual discrimination, i.e., racism within the gay community and homophobia within the African American community (Pittman, W ilson, Adams-Taylor, & Randolph, 1992; Ryan & Gruskin, 2006). Some feel pressure to choose between their ethnic and sexual identities (Dube & Savin-W illiams, 1999). For African American males in particular, there can be a reluctance to self-identify as gay or bisexual (Rosario, Schrimshaw, & H unter, 2004). In fact, many sexual minority youth engage in unprotected sex with members of the opposite sex and are twice as likely to cause pregnancy or become pregnant (Massachusetts Department of Education, 2006). Profound shame can cause LGBTQ youth to retreat into isolation or stifle their desires, damaging their mental health long into adulthood, or engage in furtive casual sex while desperately searching for intimacy and acceptance (Fullwood & Robinson, Efua Andoh 2003). "…a 2007 nationwide survey of LGBTQ middle and high school students of color found they experienced disproportionate verbal harassment (48%), physical harassment (27%), and physical assault (15%)…"

APA has proposed a portrait of resilience in African American youth consisting of critical mindedness, active engagement, flexibility, and communalism (APA, 2008). This theoretical structure is useful for framing discussion of resilience in LGBTQ African American youth. •

•

Critical mindedness buffers against experiences of discrimination and empowers youth to critique existing social inequities. Research suggests that formative encounters with racial discrimination may also help develop coping skills for anti-gay stigma (Savin-W illiams, 1996). Active engagement consists of agentic behavior by which resilient youth positively impact their environments and their own lives. For instance, increasing the collective capacity of same-gender-loving African American youth to change peer norms by encouraging condom use shows promise as an HIV prevention intervention (Hart, Peterson, & the Community Intervention Trial for Youth Study Team, 2004).

OEMA COMMUNIQUÉ •

•

Flexibility promotes adaptation to different situations and includes fluency across multiple cultural contexts. Research on identity development in gay African American men shows that fusion of ethnic and sexual identity into an integrated whole, coupled with social participation in both African-American and gay subcultures, improved overall psychosocial health (Crawford, Allison, Zamboni, & Soto, 2002). Communalism consists of an appreciation of the importance of social bonds, social duties, and collective well-being. Peterson, Folkman, and Bakeman (1996) found that social support, as a psychosocial resource, critically mediates the relationship between stress and depressive mood in gay and bisexual African American men. O'Donnell et al. (2004) also found family support crucial for protecting African American youth from risk of suicidal ideation.

Further inquiry is needed on factors contributing to resilience among LGBTQ African American youth. In the meantime, it is clear that families, schools, health providers, and faith institutions must provide safe and nurturing environments in which sexual minority youth can grow and express themselves without fear of harassment or assault. Interventions should be widely implemented that simultaneously address racism as well as homophobia, while providing safe and nurturing environments as these youth negotiate the complex developmental challenges of sexual orientation, gender identity, and race/ethnicity. References American Psychological Association, Task Force on Resilience and Strength in Black Children and Adolescents (2008). Resilience in African American children and adolescents: A vision for optimal development. Washington, DC: Author. Retrieved from http://www.apa.org/pi/cyf/resilience.html Consolacion, T. B., Russell, S. T., & Sue, S. (2004). Sex, race/ethnicity, and romantic attractions: Multiple minority status adolescents and mental health. Cultural Diversity and Ethnic Minority Psychology, 10, 200-214. Crawford, I., Allison, K. W., Zamboni, B. D., & Soto, T. (2002). The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men. Journal of Sex Research, 39, 179-189. Dube, E., & Savin-Williams, R. C. (1999). Sexual identity development among ethnic sexual-minority male youths. Developmental Psychology, 35, 1389-1398. Fullwood, S. G., & Robinson, C. (Eds.). (2003). Think again. Los Angeles: New York State Black Gay Network, Inc. and AIDS Project Los Angeles. Garofalo, R., DeLeon, J., Osmer, E., Doll, M., & Harper, G. W. (2006). Overlooked, misunderstood, and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. Journal of Adolescent Health, 38, 230-236.

THE MANY FACES OF HEALTH DISPARITIES Gay, Lesbian, and Straight Education Network [GLSEN]. (2008). The 2008 National School Climate Survey: The Experiences of lesbian, gay, bisexual, and transgender youth in our nation's schools. New York: Author. Hart, T., Peterson, J. L., & the Community Intervention Trial for Youth Study Team. (2004). Predictors of risky sexual behavior among young African American men who have sex with men. American Journal of Public Health, 94, 1122-1123. Massachusetts Department of Education. (2006). 2005 Youth Risk Behavior Survey. Boston: Author. Millett, G. A., Peterson, J. L., Wolitski, R. J., & Stall, R. (2006). Greater risk for HIV infection of Black men who have sex with men: A critical literature review. American Journal of Public Health, 96, 1007-1019. O'Donnell, L., O'Donnell, C., Wardlaw, D. M., & Stueve, A. (2004). Risk and resiliency factors influencing suicidality among urban African American and Latino youth. American Journal of Community Psychology, 33(1-2), 37-49. Peterson, J. L., Folkman, S., & Bakeman, R. (1996). Stress, coping, HIV status, psychosocial resources, and depressive mood in African American gay, bisexual, and heterosexual men. American Journal of Community Psychology. 24, 461-487. Pittman, K. J., Wilson, P.M., Adams-Taylor, S., & Randolph, S. (1992). Making sexuality education and prevention programs relevant for African American youth. Journal of School Health, 62, 339-44. Rosario, M., Schrimshaw, E. W., & Hunter, J. (2004). Ethnic/racial differences in the coming-out process of lesbian, gay, and bisexual youths: A comparison of sexual identity development over time. Cultural Diversity and Ethnic Minority Psychology, 10, 215-228. Ryan, C., & Gruskin, E. (2006). Health concerns for lesbians, gay men, and bisexuals. In D. F. Morrow & L. Messinger (Eds.), Sexual orientation and gender expression in social work practice: Working with gay, lesbian, bisexual, and transgender people (pp. 307-342). New York: Columbia University Press. Savin-Williams, R.C. (1996). Ethnic and sexual minority youth. In R.C. Savin-Williams & K. M. Cohen (Eds.) The lives of lesbians, gays, and bisexuals: Children to adults. Ft. Worth, TX: Harcourt Brace College Publishers. Since July 2008 Jim Bogden, MPH has served as Project Director of the CDC-funded Healthy Lesbian, Gay, and Bisexual Students Project within the APA Office on Lesbian, Gay, Bisexual, and Transgender Concerns. Jim has worked in health education since 1979, beginning as a Peace Corps Volunteer in the Marshall Islands. He came to APA after 17 years doing school health policy development with the National Association of State Boards of Education and holds a Masters in Public Health degree from the University of California at Berkeley.

OEMA COMMUNIQUĂ&#x2030; Efua Andoh is Manager, Children, Youth and Families (CYF) Program and has worked in APA's CYF Office since February 2006. She received her BA in Anthropology from the University of Pennsylvania in 2001.

Health Disparities in Ethnic Minority and Immigrant Women Lydia P. Buki, PhD APA Committee on W omen in Psychology In my research, I examine issues of health disparities in immigrant women. A Spanish monolingual participant in one of my studies once shared information that was shocking to me. She told me that she withheld information from the doctor because she did not want the interpreter to hear what she would say, even though she knew the doctor needed this information. The communication barrier between healthcare providers and immigrant women contributes to disparate outcomes in immigrant populations. Moreover, a myriad of institutional, sociocultural, and individual factors influence health behaviors in ethnic minority and immigrant women.

Lydia P. Buki, PhD

For example, 40% of Latinos do not have health insurance. Among those who are Spanish speaking, the rate is 61% (Doty, 2003). Their lack of access to healthcare is further compounded by the fact that 80% of Spanish speaking adults have incomes below 200% of the poverty level (Doty, 2003). In addition to poverty and lack of access to healthcare, institutional issues such as limited access to trained interpreters and the complexity of our healthcare system impact health outcomes in ethnic minority and immigrant populations. American Indian and Alaska Natives not only suffer from a disproportionate poverty burden, but they also have a unique challenge when it comes to healthcare access. Those who live on or near reservations are likely to receive care from the Indian Health Service, a part of the U.S. public health system "The communication barrier between healthcare providers and im m igrant wom en co ntributes to d ispa ra te o u tc o m e s in im m ig ra n t populations. Moreover, a m yria d o f in s ti tu ti o n al, sociocultural, and individual facto rs influence health behaviors in ethnic minority and immigrant women."

THE MANY FACES OF HEALTH DISPARITIES

"Those who live on or near reservations are likely to receive care from the Indian Health service, a part of the U.S. public health system .â&#x20AC;Ś This system is funded at 54% of the level of needâ&#x20AC;Ś"

(Office of Research on W omen's Health, 2006). This system is funded at 54% of the level of need, despite documented disparities in chronic disease (such as diabetes) and risk factors (such as smoking; American Lung Association, 2008; Commonwealth Fund, 2008).

Among African American women, genetics, health behaviors and environmental context, including racism, have been identified as factors that have the greatest influence on health (Office of Research on W omen's Health, 2006). In addition, other factors that influence women's healthcare outcomes include attitudes, beliefs, and knowledge about health and illness, as well as the patient-healthcare provider interaction (Institute of Medicine, 2002). For example, among Asian American women, stigma is thought to play a role in healthcare seeking for certain conditions (e.g., cancer; Centers for Disease Control and Prevention, 2008). An emerging construct that is associated with health outcomes is health literacy (Institute of Medicine, 2004). Health literacy has been defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Ratzan & Parker, 2000, as cited in Institute of Medicine, 2004). Because the meaning of health constructs can vary across cultures (Kleinman, 1980), theories and programs should fit a population's cultural context (Institute of Medicine, 2004). By creating programs that are matched to individuals' levels of print literacy, oral literacy, numeracy (e.g., individuals' ability to understand dosage instructions on medication labels), and cultural and conceptual knowledge, we have the potential to greatly improve healthcare outcomes in populations that experience health disparities (Schillinger & Davis, 2005). References American Lung Association (2008). Smoking and American Indians/Alaska Natives fact sheet. Retrieved January 5, 2009, from http://www.lungusa.org/site/c.dvLUK9O0E/b.35999/k.EBAD/Smoking_and_Amer ican_IndiansAlaska_Natives_Fact_Sheet.htm Centers for Disease Control and Prevention. (2008). Office of minority health and health disparities: Asian Americans. Retrieved January 5, 2009 from http://www.cdc.gov/omhd/Populations/AsianAm/AsianAm.htm#3

OEMA COMMUNIQUĂ&#x2030; Commonwealth Fund. (2008). Quality Matters: Quality Improvement in the Indian Health Service. Retrieved January 5, 2009 from http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=7 26484 Doty, M. M. (2003). Hispanic patients' double burden: Lack of health insurance and limited English. New York: The Commonwealth Fund. Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press. Institute of Medicine. (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academies Press. Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, CA: University of California Press. Office of Research on Women's Health. (2006). Women of Color Health Databook: Adolescents to seniors. Bethesda, MD: National Institutes of Health. Schillinger, D., & Davis, T. (2005). A conceptual framework for the relationship between health literacy and health care outcomes: The chronic disease exemplar. In J. G. Schwartzberg, J. B. VanGeest, and C. C. Wang (Eds.), Understanding health literacy: Implications for medicine and public health. Chicago, IL: American Medical Association Press. Lydia P. Buki, PhD, earned her doctorate in Counseling Psychology from Arizona State University in 1995. She recently developed a measure of immigrant womenâ&#x20AC;&#x2122;s health literacy with respect to breast and cervical cancer, in collaboration with Dr. Barbara W. K. Yee. The work was funded through a grant from the National Cancer Institute; she was principal investigator. Her main area of interest is health literacy, with a focus on psycho-oncology and the psychosocial, cultural, individual, and institutional factors that contribute to health disparities in medically underserved Latina/o populations.

APA's Response to SES Related Cancer Disparities: Cancer Control and Prevention in Socioeconomically Disadvantaged Communities Helena Dagadu, MPH Program Manager, APA Addressing Socioeconomic Status Related Cancer Disparities Program (SESRCD) Disparities in cancer are caused by the complex interplay of social position, economic status, culture, and environment (NCI, 2002). Socioeconomic indicators

THE MANY FACES OF HEALTH DISPARITIES such as income, education, and health insurance coverage influence cancer risk factors including tobacco use, poor nutrition, physical inactivity, and obesity (Institute of Medicine, 2003). Residents of counties that have greater than 20% of people below the poverty level have a 13% higher death rate in men and 3% higher death rate in women for all cancers combined (W ard et al., 2004). Additionally, a recent IOM report— Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs—noted Helena Dagadu, MPH that SES factors such as lack of information or skills needed to manage the illness, lack of transportation or other resources, and disruptions to work create and/or exacerbate psychosocial problems that cause additional suffering, weaken adherence to treatment, and threaten a patient's return to health (Adler & Page, 2008). Although the recent U.S. Annual Report to the Nation on the Status of Cancer reported a decline in cancer incidence and mortality rates, there is apprehension that these decreases are only temporary given the growing economic crisis (Jemal et al., 2008). Moreover, the relationship between SES and race and ethnicity cannot be ignored. In general, compared with non-Hispanic "…racial/ethnic minorities W hites, racial and ethnic minorities are at a have higher death rates from socioeconomic disadvantage with higher cancer than non-Hispanic poverty rates, lower educational status, and Whites. For example, the less access to health care coverage (W ard et death rate from cancer among African American al., 2004). A disproportionate percentage of males is 1.4 times higher than African Americans (2 4 % ) and among White males…" Hispanics/Latinos (22%) live below the poverty line compared with 8% of White Americans (Proctor & Dalaker, 2002). Also, racial/ethnic minorities have higher death rates from cancer than non-Hispanic W hites. For example, the death rate from cancer among African American males is 1.4 times higher than among W hite males (W ard et al., 2004). Despite these challenges, APA continues to take substantive steps in addressing socioeconomic related disparities. Recognizing that psychology has a significant role to play in promoting the scientific understanding of poverty and SES in health, education, and human welfare, APA created an Office on Socioeconomic Status

OEMA COMMUNIQUÉ (OSES) in 2007. Recently, APA's newest office entered into a five year, $1.75 million cooperative agreement with the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control (CDC-DCPC). The award funds the SES Related Cancer Disparities (SESRCD) Program, a broad national strategy to mobilize psychologists and other behavioral and social scientists to provide community cancer serving organizations and stakeholders with individualized capacity building assistance (CBA) to access, adopt, adapt, and utilize evidence-/practice-based strategies that address SES related cancer disparities. As part of its CBA, the SESRCD will develop, publish, and disseminate a professional development training resource designed to provide participants with a process to act on and advocate for organization or community change to improve cancer prevention and control in socioeconomically disadvantaged communities. The important role sound public policies play in addressing SES related cancer disparities is clear to the SESRCD Program. Systemic, environmental, and political barriers in the community can make modifying unhealthy behaviors c ha llenging. S p ecific ally, p o o r environmental quality; inadequate access to affordable, nutritious food; lack of healthcare coverage; and safety concerns often make healthy living impractical, particularly in low-income communities and communities of color. The SESRCD Program will leverage APA's advocacy experience related to areas such as access to high quality and affordable health care; safe, nontoxic environments in all communities; and access to quality education at all levels to assist socioeconomically disadvantaged communities in addressing some of these policy barriers. "…the SESRCD program will develop, publish, and disseminate a professional development training resource designed to provide participants with a process to act on and advocate for organization or community change to improve cancer prevention and control in socioeconomically disadvantaged communities."

The SESRCD Program draws on a diverse network of behavioral and social scientists to provide technical assistance in response to social, economic, cultural, and environmental needs of underserved communities. Ten psychologists—national leaders in cancer research, prevention, care, and survivorship— provide critical guidance as part of the SESRCD Scientific Steering Committee. Their participation as well as the participation of other psychologists is integral to APA's response to SES related cancer health disparities.

THE MANY FACES OF HEALTH DISPARITIES For more information about OSES and the SESRCD Program, contact Helena Dagadu at hdagad@apa.org or visit http://www.apa.org/pi/ses. References Adler, N. E. & Page, A. (Eds.). (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press. Institute of Medicine. (2003). Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press. Jemal, A., Thun, M. J., Ries L., Howe, H. L., Weir, H. K., Center, M. M., et al. (2008). Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. Journal of the National Cancer Institute, 100, 1672-1694. National Cancer Institute. (2002). Reducing cancer-related health disparities. Retrieved December 8, 2008, from http://plan2002.cancer.gov/infreduce.htm Proctor B. D. & Dalaker J. (2003). Poverty in the United States: 2002. In U.S. Census Bureau Current Population Reports (pp. 60-222). Washington, DC: U.S. Government Printing Office. Ward, E., Jemal, A., Cokkinides, V., Singh, G. K., Cardinez, C., Ghafoor, A., & Thun, M. (2004). Cancer disparities by race/ethnicity and socioeconomic status. A Cancer Journal for Clinicians, 54, 78-93. Helena Dagadu, MPH, is Program Manager of the SESRCD Program and assumes primary responsibility for the nationwide implementation of activities associated with the goals and objectives of the Program. Ms. Dagadu completed her Masters in Public Health from the George Washington University School of Public Health and Health Services.

The HIV/AIDS Epidemic and Racial Disparitiesâ&#x20AC;&#x201D;The Role of Psychologists Edna Davis-Brown, MPH Project Director APA Behavioral and Social Science Volunteer (BSSV) Program During the mid-to-late 1990s, advances in HIV treatments slowed the progression of HIV infection to AIDS and led to dramatic decreases in deaths among persons with AIDS living in the 50 states and the District of Columbia. In general, the trend in the

Edna Davis-Brown, MPH

OEMA COMMUNIQUÉ estimated numbers of AIDS cases and "However, on August 6, 2008, CDC deaths remained stable from 2002 modified estimates of annual incidence through 2005. The Centers for Disease rates of HIV in the United States from Control and Prevention (CDC) 40,000 to 56,300 (Hall et al., 2008). This estimates for 2006 suggest that the means that there are approximately 40% number of AIDS cases remained stable more new HIV infections each year than and that the number of deaths we previously thought." decreased (CDC, 2008a). Better treatments have also led to an increase in the number of persons who are living with AIDS. However, on August 6, 2008, CDC modified estimates of annual incidence rates of HIV in the United States from 40,000 to 56,300 (Hall et al., 2008). This means that there are approximately 40% more new HIV infections each year than we previously thought. Racial Disparities Other key findings from the new incidence analysis have to do with "…young Black MSM, 13–29 years racial disparities (CDC, 2008b). old, were infected at twice the rate of Although men who have sex with men their White and Hispanic/Latino (M SM ) continue to account for most counterparts. In general, African of the infections, a closer look at this Americans are disproportionately affected by HIV/AIDS such that they population finds that young Black are 12% of the total U.S. population, MSM , 13–29 years old, were infected but represent 46% of the new HIV at twice the rate of their White and infections." H ispanic/Latino counterparts. In general, African Americans are d isp ro p o rtio n a te ly a ffe cte d b y HIV/AIDS such that they are 12% of the total U.S. population, but represent 46% of the new HIV infections. Hispanics/Latinos comprise 15% of the US population but accounted for 17% of all new HIV infections occurring in the United States in 2006. Although Asians and Pacific Islanders account for approximately 1% of the total number of HIV/AIDS cases in the 33 states with long-term, confidential name-based HIV reporting, the Asian and Pacific Islander population in the United States is growing. HIV/AIDS is also a growing problem among American Indians and Alaska Natives. Even though the numbers of HIV and AIDS diagnoses for American Indians and Alaska Natives represent less than 1% of the total number of HIV/AIDS cases reported to CDC's HIV/AIDS Reporting System, when population size is taken into account, American Indians and Alaska Natives in 2005 ranked 3rd

THE MANY FACES OF HEALTH DISPARITIES in rates of HIV/AIDS diagnosis, after Blacks (including African Americans) and Hispanics. Sharing syringes and other equipment for drug injection is a well known route of HIV transmission, yet injection drug use contributes to the epidemic's spread far beyond the circle of those who inject. People who have sex with an injection drug user (IDU) also are at risk for infection through the sexual transmission of HIV. Children born to mothers who contracted HIV through sharing needles or having sex with an IDU may become infected as well. Since the epidemic began, injection drug use has directly and indirectly accounted for more than one-third (36% ) of AIDS cases in the United States (CDC, 2008c). W omen account for more than one quarter of all new HIV/AIDS diagnoses (CDC, 2008d). W omen of color are especially affected by HIV infection and AIDS. In 2004 (the most recent year for which data are available), HIV infection was: • • • •

the leading cause of death for Black women (including African American women) aged 25-34 years; the 3rd leading cause of death for Black women aged 35-44 years; the 4th leading cause of death for Black women aged 45-54 years; and, the 4th leading cause of death for Hispanic women aged 35-44 years.

Young people in the U nited States continue to be at persistent risk for HIV infection. This risk is especially notable for youth of minority races and ethnicities, especially young MSM (CDC, 2008e). In the seven cities that participated in CDC's Young Men's Survey during 1994-1998, 14% of African American MSM and 7% of Hispanic MSM aged 15-22 were infected with HIV. "Psychologists…have a critical role to play in the epidemic HIV infection The Role of Psychologists by providing technical assistance to health departments, community Psychologists, as scientists with expertise based organizations (CBOs), and in the integration of research and practice, other entities across the United have a critical role to play in the epidemic States.…APA also develops and HIV infection by providing technical supports training in behavior assistance to health d ep artm ents, change, measurement, program community based organizations (CBOs), design, and evaluation to those organizations in need of their and other entities across the United States. APA through its Behavioral and Social expertise." Science Volunteer Program (BSSV)

OEMA COMMUNIQUĂ&#x2030; continues to play a lead role in encouraging and supporting psychologists to partner and consult with governments, national-based organizations (NBOs), and CBOs to implement, adapt, and evaluate interventions that are theoretically-based, culturally sensitive, and empirically validated such as those developed under CDC's Diffusion of Evidenced-Based Interventions Project (DEBI), www.effectiveinterventions.org. APA also develops and supports training in behavior change, measurement, program design, and evaluation to those organizations in need of their expertise. For more information about APA's BSSV Program, contact Edna Davis-Brown, Program Director, or visit www.apa.org/pi/aids/bssv.html. References Centers for Disease Control and Prevention. (CDC; 2008a). HIV/AIDS in the United States. Retrieved on October 5, 2008 from http://www.cdc.gov/hiv/resources/factsheets/us.htm Centers for Disease Control and Prevention. (CDC; 2008b). MMWR analysis provides new details on HIV incidence in U.S. populations. Retrieved on October 5, 2008 from http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/MMWR-incidence .htm. Centers for Disease Control and Prevention. (CDC; 2008c). Drug-associated HIV transmission continues in the United States. Retrieved on October 5, 2008, from http://www.cdc.gov/hiv/resources/factsheets/idu.htm. Centers for Disease Control and Prevention (CDC; 2008d). HIV/AIDS among women. Retrieved on October 5, 2008 from, http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm. Centers for Disease Control and Prevention (CDC; 2008e). HIV/AIDS among youth. Retrieved on October 5, 2008 from http://www.cdc.gov/hiv/resources/factsheets/youth.htm. Hall, H.I., Song, R., Rhodes, P., et al. (2008). Estimation of HIV incidence in the United States. JAMA, 300, 520-529. Edna Davis-Brown, MPH, joined APA in October 2008 and has over 18 years experience in program management, implementation, and evaluation. Her background includes managing and implementing federally funded initiatives in areas such as training and technical assistance, conference and events management, emergency disaster mental health services, and publications support.

THE MANY FACES OF HEALTH DISPARITIES The Mental Health Needs of Asian American/Pacific Islander Populations Gayle Y. Iwamasa, PhD Logansport State Hospital (Indiana) According to the U.S. Census Bureau, in 2006, persons of Asian heritage comprised 4.7% of the "single race" population and 28.1% of the multiracial population (U.S. Census Bureau, 2006). Asian Americans/Pacific Islanders (AAPIs), encompassing more than 50 distinct racial/ethnic groups speaking 30 different languages, is one of the fastest growing visible racial/ethnic groups. W hile prevalence of mental illness among AAPIs is not different from that of other Americans, there is a difference in manifestation of psychological distress among AAPIs. For example, depression rates are similar among AAPIs and W hite Americans, but substance abuse rates are significantly lower among AAPIs. Gayle Y. Iwamasa, PhD

For many AAPIs, mental health is "For many AAPIs, mental health is believed to be strongly influenced by believed to be strongly influenced by physical health, interpersonal harmony, physical health, interpersonal and willpower. As such, many AAPIs harmony, and willpower. As such, associate admitting to psychological many AAPIs associate admitting to problems with loss of face, and are more psychological problems with loss of face, and are more likely to report likely to report somatic manifestations of somatic manifestations of stress." stress. Consequently, mental illness prevalence rates are likely to reflect underreporting of mental health problems by AAPIs. Limited English proficiency, differing concepts of distress, and limited access to culturally competent services also contribute to underutilization of professional treatment and premature termination. Many AAPIs have traditionally relied on indigenous healingâ&#x20AC;&#x201D; including some controversial practices, like coiningâ&#x20AC;&#x201D; performed by religious leaders, community leaders, or family elders. Spirituality, community and family may also be seen as

OEMA COMMUNIQUĂ&#x2030; protective factors against psychological distress and as a strong built-in social support system against the environmental stressors affecting AAPIs. Institutional and individual discrimination against AAPIs in the United States is a historic and contemporary problem. The sense of collectivism and group identity results in a shared experience of this discrimination. Research has also documented the effects of transgenerational trauma, in which victims of trauma pass down the psychological impact to their progeny. This concept is particularly important given the large number of AAPIs who have immigrated from countries ravaged by economic and political upheaval. In addition, AAPIs are regularly bombarded with messages that their culture and heritage are not valued. The English-only movement, for example, demonstrates intolerance for non-English speakers. Such initiatives discourage individuals learning to communicate with AAPI immigrants whose first language is Asian, which affects the number of treatment providers offering services in the clients' first language. Inadequacies in mental health care for AAPIs are caused by the lack of AAPI practitioners, accessible mental health services, a p p ro p riate tre atm ent models, and bilingual and culturally competent therapists. AAPIs also have a longstanding and valid mistrust of mental health service providers. Biased nosological systems do not adequately represent culture-bound syndromes and treatment orientations of many AAPIs, leading to misdiagnosis and underdiagnosis of serious mental illness. In addition, providers who lack cultural sensitivity have been shown to provide different diagnoses, typically more severe, to ethnic minority individuals. Given the current emphasis on psychopharmacology, there is concern that AAPIs are over-prescribed medications, exacerbating their psychological distress. Research indicates that many AAPIs metabolize medications at different levels than other ethnic groups. "Inadequacies in mental health care for AAPIs are caused by the lack of AAPI practitioners, accessible mental health services, appropriate treatment models, and bilingual and culturally competent therapists."

As the population of AAPIs continues to grow, demand for appropriate services will continue to grow. This growing need must be addressed from a systemic and multilevel perspective. Multilingual AAPIs should be recruited, trained, and valued as mental health professionals. All treatment providers should continually examine their own personal stereotypes and biases and seek training and skills needed to provide culturally competent services to AAPI clients. Training programs and

THE MANY FACES OF HEALTH DISPARITIES supervisors must be accountable and prepared to address issues of cultural competence in training and supervision. Reference U.S. Census Bureau. (2006). 2006 American Community Survey: Race - universe: Total population. (Table B02003). Retrieved February 10, 2009, from http://factfinder.census.gov/servlet/DTTable?_bm=y&-geo_id=01000US&-ds_nam e=ACS_2006_EST_G00_&-mt_name=ACS_2006_EST_G2000_B02001 Note: This article is based on an earlier and more elaborate version: Iwamasa, G.Y. (2003). Recommendations for the treatment of Asian American/Pacific/ Islander Populations. In Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, Psychological treatment of ethnic minority populations (pp. 13-18). Washington, DC: Association of Black Psychologists.

Gayle Iwamasa, PhD, received her doctorate in Clinical Psychology from Purdue University. She has authored numerous articles and book chapters on Asian American mental health. Her research on the mental health of Japanese American older adults was funded by the National Institute of Mental Health. After spending much of her career in academia as a tenured faculty member, Dr. Iwamasa currently serves as Psychology Director at Logansport State Hospital in Indiana. She is learning firsthand how to ensure that effective psychological services are being provided to those individuals most in need during economic difficulties and with less than adequate resources.

Health Disparities and Persons With Disabilities Anju Khubchandani, MSW Director, APA Disability Issues Office W ith the launch of Healthy People 2010, the United States, for the first time, identified eliminating disparities as one of its overarching national goals (USDHHS, 2000). Also for the first time, this working document included an entire section dedicated to the health of people with disabilities: "Disability and Secondary Conditions." However, the continuing disparities in health experienced by people with disabilities remains a major obstacle to improving the nation's well-being.

OEMA COMMUNIQUÉ Unequal access to care is one key contributor to these disparities. W hile the Americans W ith Disabilities Act (ADA) of 1990 requires health care providers to offer services to persons with disabilities that are accessible and equal in quality, inaccessibility within the healthcare system is prevalent. Healthcare providers' offices, for example, are often not wheelchair accessible or lack the proper medical equipment to assess and treat people who use wheelchairs and other assistive Anju Khubchandani devices. Exam tables that do not elevate and inaccessible mammography equipment have been cited as serious barriers to women with physical disabilities seeking breast and cervical cancer screenings (Thierry, 2000). The particular healthcare needs of "The Surgeon General has stressed the persons with disabilities— e.g., importance of individuals with disabilities having a condition that may be engaging in health-promoting activities to progressive, being at increased maintain wellness. However, a number of risk of secondary conditions, and factors contribute to disparities in accessing the c um u la tiv e e ffe cts o f disease prevention and health promotion aging— may be addressed more programs, such as transportation difficulties, effectively by including health lack of disability-knowledgeable staff…" promotion. In fact, the Surgeon G e n e r a l h a s s tr e s s e d th e importance of individuals with disabilities engaging in health-promoting activities to maintain wellness (USDHHS, 2005). However, a number of factors contribute to disparities in accessing disease prevention and health promotion programs, such as transportation difficulties, lack of disability-knowledgeable staff (Rimmer et al, 2004), inaccessibility of health promotion facilities and equipment, and a lack of information in accessible formats (Cardinal & Spaziani, 2003). People with disabilities are also vulnerable to adverse health care experiences due to health provider training (Iezzoni et al., 2001). People with disabilities routinely report difficulties in identifying a practitioner who has adequate training in disability issues (Oshima et al., 1998). Psychologists, for example, tend to focus on the person's disability, rather than attending to the needs and questions that brought the person to the provider in the first place. General practitioners frequently

THE MANY FACES OF HEALTH DISPARITIES underestimate the quality of life of people with disabilities, resulting in biased medical advice and limited treatment options being offered (Oshima et al, 1998). D isabilities are disp ro portionately represented among racial and ethnic "Disabilities are disproportionately represented among racial and ethnic m inority groups, who are often minority groups, who are often marginalized from services. Evidence marginalized from services." suggests that poor access to information, communic atio n b a rriers, lack o f sensitivity to culture and traditions, and discrimination on the basis of race and disability may have a detrimental effect on the health, mental health, and social well-being of disabled people from ethnic minority backgrounds. It is unclear to what degree psychologists and other health care providers have heeded the call to adopt a cultural lens when providing services to populations with disabilities. A more thorough understanding of trends in racial/ethnic and socioeconomic disparities is critical not only for measuring progress in eliminating the gaps, but also for targeting interventions and planning for the likely future course of population-level disability. References Cardinal, B .J., Spaziani, M. D. (2003). ADA compliance and accessibility of physical activity facilities in western Oregon. American Journal of Health Promotion, 17, 197-201. Iezzoni, L. I., McCarthy, E. P., Davis, R. B., Harris-David, L., & O'Day, B. (2001).Use of screening and preventative services among women with disabilities. American Journal of Medical Quality, 16, 135-144. National Organization on Disability/Harris. (2004). Detailed results from the 2004 N.O.D./Harris survey of Americans with disabilities. New York: National Organization on Disability & Harris Interactive, Inc. Oshima, S., Kirschner, K., Heinemann, A., & Semik, P. (1998). Assessing the knowledge of future internists and gynaecologists in caring for a woman with tetraplegia. Archives of Physical Medicine and Rehabilitation 79, 1270-1275. Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity participation among persons with disabilities: Barriers and facilitators. American Journal of Preventive Medicine, 26, 419-425. Thierry, J. M. (2000). Increasing breast and cervical cancer screening among women with disabilities. Journal of Women's Health & Gender-Based Medicine 9, 9-12. U.S. Department of Health and Human Services. (2000). Healthy people 2010. Hyattsville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service.

OEMA COMMUNIQUÉ U.S. Department of Health and Human Services. (2005). The surgeon general's call to action to improve the health and wellness of persons with disabilities. U.S. Department of Health and Human Services, Office of the Surgeon General. Anju Khubchandani, MSW, has served as Director of APA's Office on Disability Issues in Psychology since 1997. She received her Master's degree in social service administration and policy from the University of Chicago and directed the Department of Social Services at Miami Lighthouse for the Blind before joining APA.

Health Disparities Among Sexual Minority Women Keren Lehavot University of W ashington Jane M . Simoni, PhD APA Committee on W omen in Psychology An estimated 2.3 million women in the United States describe themselves as lesbian (O'Hanlan, 1995), and between 1.4% and 4.3% of all women may be lesbian or bisexual on the basis of either behavior or self-defined identity (Sell, W ells, & W ypij, 1995). Unfortunately, women have been underrepresented in the study of sexual identity, and there is a dearth of information about lesbian health (Solarz, 1999). However, available research suggests that lesbians are at risk for health disparities and are a medically underserved population (Healthy People 2010; USDHHS, 2000).

Keren Lehavot

Overall, lesbians appear to be at higher risk than heterosexual women for mental health disorders, including depression and anxiety. Indeed, some data have indicated that lesbians are at twice the risk for any mood and anxiety disorder compared to heterosexual women, and at three times greater risk for a mood disorder compared to heterosexual women over the last year (Gilman et al., 2001). Data from population-based health studies also suggest that sexual minority status among "…some data have indicated that lesbians are at twice the risk for any mood and anxiety disorder compared to heterosexual women…"

THE MANY FACES OF HEALTH DISPARITIES women is associated with health-risk behaviors. In particular, compared to their heterosexual counterparts, lesbians appear to be at greater risk for alcohol and drug use (e.g., Cochran, 2001), smoking (e.g., Hughes & Jacobson, 2003), and obesity (e.g., Boehmer, Bowen, & Bauer, 2007), which puts them at greater risk for major health problems such as cancer and heart disease.

Jane M. Simoni, PhD

Minority stress theory suggests that these differential health outcomes are associated with greater exposure to life stress associated with one's stigmatized status (Meyer, 2003). Indeed, the lack of societal acceptance of sexual minorities in the United States, where negative social attitudes and behaviors toward lesbian, gay, and bisexual (LGB) people are still widespread, may contribute to lesbians' risk of adverse health outcomes. Other factors also may influence health disparities, including internalized homophobia, stigma consciousness, and concealment of one's sexual orientation (M eyer, 2003). W hile the minority stress model has yet to be fully empirically supported, it offers a valuable framework for understanding the experiences of stigmatized groups, including lesbians.

Beverly Greene (1994) has written extensively about the "triple jeopardy" that lesbians of "â&#x20AC;Śstudies have found that color experience as women, lesbians, and lesbians of color report people of color. She argues that lesbians of higher rates of childhood abuse, domestic violence, and color must deal with multiple levels of sexual assault than their oppressio n and d iscrim ination while White counterpartsâ&#x20AC;Ś" negotiating the integration of two major identities. Although they tend to value familial and ethnic community ties, they may not feel fully integrated into any one group. Existing literature focusing on LGB people of color suggests that this group may face unique minority stressors including racism in predominantly W hite LGB communities, heterosexism in racial/ethnic communities, and multiple prejudices in society at large (Harper, Jernewall, & Zea, 2004). Some studies have found that lesbians of color report higher rates of childhood abuse, domestic violence, and sexual assault than their W hite counterparts (Balsam & Syzmanski, 2005; Morris & Balsam, 2003). Discrimination and victimization due to multiple minority statuses are likely to have implications for health outcomes for lesbians from racial/ethnical minority backgrounds.

OEMA COMMUNIQUĂ&#x2030; Research that examines who is at greatest risk in this population, what are the stressors that are most potent and predictive of adverse outcomes, and what are the strengths of these individuals that may explain resilience in the face of adversity is needed. Such research may provide clues as to the most effective prevention and intervention components targeting this large but largely unstudied group. References Balsam, K. F., & Szymanski, D. M. (2005). Relationship quality and domestic violence in women's same-sex relationships: The role of minority stress. Psychology of Women Quarterly, 29, 258-269. Boehmer, U., Bowen, D. J., & Bauer, G. R. (2007). Overweight and obesity in sexual-minority women: Evidence from population-based data. American Journal of Public Health, 97, 1134-1140. Cochran, S. D. (2001). Emerging issues in research on lesbians' and gay men's mental health: Does sexual orientation really matter? American Psychologist, 56, 931-47. Harper, G. W., Jernewall, N., & Zea, M. C. (2004). Giving voice to emerging science and theory for lesbian, gay, and bisexual people of color. Cultural Diversity & Ethnic Minority Psychology, 10, 187-199. Hughes, T. L., & Jacobson, K. M. (2003). Sexual orientation and women's smoking. Current Women's Health Reports, 3, 254-261. Iwamasa, G.Y. (2003). Recommendations for the treatment of Asian American/Pacific Islander populations. In Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, Psychological treatment of ethnic populations (pp. 13-18). Washington, DC: Association of Black Psychologists. Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91, 933-939. Greene, B. (1994). Lesbian women of color: Triple jeopardy. In L. Comas-Diaz and B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp.389-427). New York: Guilford Press. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. Morris, J. F., & Balsam, K. F. (2003). Lesbian and bisexual women's self-reported experiences of victimization: Mental health and sexual identity development. Journal of Lesbian Studies, 7, 67-85. O'Hanlan, K. A. (1995). Lesbian health and homophobia. Current Problems in Obstetrics, Gynecology and Fertility, 18, 93-136. Sell, R. L., Wells, J. A., & Wypij, D. (1995). The prevalence of homosexual behavior and attraction in the United States, the United Kingdom and France: Results of national population-based samples. Archives of Sexual Behavior, 24, 235-248.

THE MANY FACES OF HEALTH DISPARITIES Solarz, A. L. (1999). Lesbian health: current assessment and directions for the future. Washington, DC: National Academies Press. U.S. Department of Health and Human Services. (2000). Healthy people 2010. Washington, DC: Author. Keren Lehavot is a graduate student in the clinical psychology program at the University of Washington. Her research interests span feminist psychology, the influence of gender and sexuality on health, and LGBT psychology, especially relating to diverse lesbian and bisexual women's well-being. Jane M. Simoni, PhD, is a Professor in the Department of Psychology at the University of Washington, where she teaches and supervises doctoral students and runs an active research team. She studies trauma, chronic illness, and other stressful life events and is particularly interested in whether individuals from historically oppressed or stigmatized groups such as LGBT individuals experience unique stressors or exhibit culturally specific coping processes. She is currently working in Beijing and on the U.S.-Mexican border to develop and evaluate culturally relevant interventions to assist individuals living with HIV adhere more consistently to their antiretroviral medications.

Health Disparities and Older Adults Peter Lichtenberg, PhD, ABPP APA Committee on Aging (Past Chair) Deborah DiGilio, MPH Director, APA Office on Aging The United States and the world are witnessing unprecedented growth in the "â&#x20AC;Śethnic minority elders [will] older adult population. In the United constitute over 1/3 of the older States alone, this growth has been from population by 2050â&#x20AC;Ś" 4 million adults over the age of 65 in 1900, to 20 million in 1970, 37 million currently and toward a projected 80 million in 2050.The growing aging population is also becoming more racially and ethnically diverse, with projections for ethnic minority elders to constitute over 1/3 of the older population by 2050, from 16% in 2000. One of the great challenges of our society is to eliminate health disparities that so vividly exist today.

OEMA COMMUNIQUĂ&#x2030; Ethnic minority elders are at greater risk of poor health, social isolation, and poverty compared to W hites. Excessive deaths and excess morbidity and disability are prevalent among racial and ethnic minority elders. A higher incidence of obesity, diabetes, and hypertension as well as an earlier onset of chronic illness is evident in minority compared with majority older adults (AOA, 2004). Health outcomes, whether measured by relative incidence of death, disease or disability, are disproportionately unfavorable among minority elders (Agency for Peter Lichtenberg, PhD, Healthcare Research and Evaluation, 2002). ABPP Non-Hispanic Black and Hispanic older persons are less likely to report good health than non-Hispanic "A higher incidence of obesity, white persons (AOA, 2004). Compared diabetes, and hypertension as well as with native-born Americans, older an earlier onset of chronic illness is persons who are foreign-born are less evident in minority compared with educated, more likely to live in poverty, majority older adults." and less likely to obtain health care coverage (He, 2002). A wide variety of challenges are faced by minority older adults attempting to access health care. Minority aged persons delay seeking health care, have less access to specialists, and have greater problems with treatment compliance. The Institute of Medicine's Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (2002) demonstrated the complexities of health care disparities. The problems of health disparities are present even when income and access are plentiful. African American older adults, for example, are much less likely to receive routine diagnostic screenings for cancer, and are less likely to be referred to specialists for heart disease, Deborah DiGilio, MPH pain control and a host of other disorders. T he IOM report concluded that many social factors were at the root of disparities, including racism and unconscious stereotyping.

THE MANY FACES OF HEALTH DISPARITIES W ithin geropsychology practice, the Guidelines for Psychological Practice with Older Adults (APA, 2004) states: "Psychologists strive to understand diversity in the aging process, particularly how sociocultural factors such as gender, ethnicity, socioeconomic status, sexual orientation, disability status, and urban/rural residence may influence the experience and expression of health and of psychological problems in later life." Specific to aging research, in 1998, the National Institute on Aging (NIA) was one of the first National Institutes of Health (NIH) to create a health disparities center grant program, the Resource Centers for Minority Aging Research (RCMAR). This widely heralded program, approaching its 13th year, has increased minority elder participation in research and increased the number of minority scholars engaged in health research among older ethnic minority populations. One of the programs, the M ichigan C en ter fo r U rban African Am erican Aging Research (http://mcuaaar.iog.wayne.edu/), is co-led by two psychologists, James Jackson, PhD, and Peter Lichtenberg, PhD. References Agency for Healthcare Research and Quality (2002). National Healthcare Disparities Report. Rockville: MD. Administration on Aging. (2004). Older Americans 2000: Key indicators of well-being, Appendix A: Detailed Tables. http://permanent.access.gpo.gov/lps58292/OA_2004.pdf. American Psychological Association. (2003). Guidelines for psychological practice with older adults. Washington, DC: Author. Retrieved February 11, 2009, from http://www.apa.org/practice/adult.pdf. He, W. (2002). The older foreign-born population of the United States: 2000 (U. S. Census Bureau Current Population Reports, Series P23-211). Washington, DC: U.S. Government Printing Office. Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington DC: National Academy Press. Peter A. Lichtenberg, PhD, ABPP, is director of The Institute of Gerontology and a Professor of Psychology, Psychiatry and Physical Medicine and Rehabilitation at Wayne State University. Dr. Lichtenberg is also the PI on the Michigan Center for Urban African American Aging Research which, in partnership with the University of Michigan, targets issues of importance to urban African American older people. Dr. Lichtenberg, the past chair of the APA Committee on Aging, has made contributions to the practice of psychology across a variety of areas including in long-term care, in medical rehabilitation with those suffering from late life depression, and age-related dementias.

OEMA COMMUNIQUĂ&#x2030; Deborah A. DiGilio, MPH, is Director of the APA Office on Aging and Chair of the National Coalition on Mental Health and Aging. Her current efforts focus on increasing the availability of mental health services for older adults, support for geriatric mental health research, and geropsychological education and training opportunities for all psychologists. Ms. DiGilio has worked in the health and aging field for over 25 years â&#x20AC;&#x201C; including positions with AARP, the American Public Health Association and Kaiser Perrmanente.

The Role of Environmental Factors in Health Disparities Among Minority Groups: An Intervention Point for Psychologists Gayle S. Morse, PhD The Sage Colleges and Utah State University David O. Carpenter, MD University of Albany Ap p ro ximately 1,304 federally recognized Superfund sites are deemed the worst toxic waste sites in the United States, and approximately 11 million people live within a one mile radius of these sites. Those who live near these or other hazardous waste sites are at increased risk of a variety of diseases (Hall, Price-Green, Dhara, & Kaye, 1995), including birth defects (Croen, Shaw, Sanbonmatsu, Selvin, & Buffler, 1997), asthma and respiratory disease (Kudyakov, Baibergenoza, Zdeb, & Gayle S. Morse, PhD Carpenter 2004; Ma, Kouznetsova, Lessner, & Carpenter 2007), diabetes (Kouznetsova, Huang, Ma, Lessner & Carpenter, 2007), and heart disease (Sergeev & Carpenter, 2005). Environmental health disparities arise when people are inordinately exposed to environmental toxins by virtue of their ethnicity or socioeconomic status. Indeed, evidence suggests minority groups with few resources are disproportionately represented "Environmental health among those living at or near toxic waste sites disparities arise when people (Andeola, 1994; Salinger, 2005; Santiago, are inordinately exposed to Morse, Haase, & McCaffrey, 2007) and environmental toxins by socioeconomic factors and race seem to preclude virtue of their ethnicity or movement away from these toxic environments socioeconomic status." (Hunter, W hite, Little, & Sutton, 2004).

THE MANY FACES OF HEALTH DISPARITIES W hile the adverse health effects of living near to Superfund sites have been studied, the associated psychological or mental health effects have not, with a few exceptions such as the Exxon Valdez oil spill, the Three Mile Island radioactive site and the Akwesasne Superfund site (Baum & Fleming 1993; Newman et al., 2005; Palinkas, Pettersen, Russell, & Downs, 1993; Santiago et al., 2007). These authors have examined mental illness such as depression, decrements in cognitive functioning and the relationship of culture to mental illness after exposure to toxic chemicals. Additionally they have David O. Carpenter, MD documented the difficulty conducting research in such communities, including scarce funding, researchers not trained in culturally sensitive community research procedures (Santiago, Morse, Hunt, & Lickers, 1997), hostile interactions with corporations, and antagonistic relationships with governmental agencies. These issues exacerbate an environment of distrust in a community already suffering from a multitude of difficulties created by exposure to environmental toxins with little hope of escape or recovery because of economic circumstances and discrimination. Psychologists occupy a unique and useful position in which to identify the negative "Psychologists occupy a unique psychological effects of those living near and useful position in which to toxic waste sites, to act as advocates for identify the negative those who are unable to speak for psychological effects of those themselves, and to develop interventions to living near toxic waste sites, to ease the pain experienced by residents of act as advocates for those who these areas. Indeed their training in are unable to speak for co m p lex research skills, th e ir themselves, and to develop understanding of differing multicultural interventions to ease the pain experienced by residents of these views, their community advocacy skills, areas." and their broad understanding of human behavior make psychologists particularly qualified both to conduct research in residential areas where health disparities exist and to develop appropriate intervention strategies, critical approaches noted in APA's Monitor on Psychology ("A Call for Data Collection," 2004).

OEMA COMMUNIQUĂ&#x2030; References A call for data collection to eliminate health disparities. (2004). Monitor on Psychology, 37, 44-45. Andeola, F.O. (1994) Environmental hazards, health, and racial inequity in hazardous waste distribution. Environment and Behavior, 26, 99-126. Baum, A., & Fleming, I. (1993). Implications of psychological research on stress and technological accidents. American Psychologist, 48, 665-672. Croen, L. A., Shaw, G. M., Sanbonmatsu, L., Selvin, S., & Buffler, P. A. (1997). Maternal residential proximity to hazardous waste sties and risk for selected congenital malformations. Epidemiology, 8, 347-354. Hall, H. I. Price-Green, P. A., Dhara, V. R., & Kaye, W. E. (1995). Health effects related to releases of hazardous substances on the Superfund Priority List. Chemosphere, 31, 2455-2461. Hunter, L. M., White, M. J., Little, J. S., & Sutton, J. (2004). Environmental hazards, migration, and race. Population Environment, 25, 23-39. Kouznetsova, M., Huang, X., Ma, J., Lessner, L., & Carpenter, D. O. (2007). Increased rate of hospitalization for diabetes and residential proximity of hazardous waste sites. Environmental Health Perspectives, 115, 75-79. Kudyakov, R., Baibergenoza, A., Zdeb, M., & Carpenter, D. O. (2004). Respiratory disease in relation to patient residence near to hazardous waste sites. Environmental Toxicology Pharmacology, 18, 249-257. Ma, J., Kouznetsova, M., Lessner, L., & Carpenter, D. O. (2007). Asthma and infectious respiratory disease in children: Correlation to residence near hazardous waste sites. Paediatric Respiratory Reviews, 8, 292-298. Newman, J., Aucompaugh, A. G., Schell, L. M., Denham, M., DeCaprio, A. P., Gallo, M., et al. (2005). PCBs and cognitive functioning of Mohawk adolescents. Neurotoxicology and Teratology, 4, 439-445. Palinkas, L. A., Pettersen, J. S., Russel, J., & Downs, M. A. (1993). Community patterns of psychiatric disorders after the Exxon Valdez Oil spill. American Journal of Psychiatry, 150, 1517-1523. Salinger, L. M. (2005). Encyclopedia of white-collar & corporate crime. Thousand Oaks, CA: Sage. Santiago-Rivera, A., Morse, G., Haase, R., & McCaffrey, R. (2007). Exposure to environmental contamination, quality of life, and psychological distress. Environmental Psychology, 7, 33-43. Santiago-Rivera, A., Morse, G., Hunt, A., & Lickers, H. (1997). A new paradigm in community research: Lessons from a Native American community. Journal of Community Psychology, 26, 163-174. Sergeev, A. V., & Carpenter D. O. (2005). Hospitalization rates for coronary heart disease in relation to residence near areas contaminated with POPs and other pollutants. Environmental Health Perspectives, 113, 756-761.

THE MANY FACES OF HEALTH DISPARITIES Gayle S. Morse, PhD, is a licensed psychologist and assistant professor affiliated with The Sage Colleges and Utah State University. She has conducted research in the areas of environment health, Native American culture, and mental health. She has presented findings in peer reviewed articles, as well as international and national conferences. David O. Carpenter, MD, is a Professor at the University at Albany and a public health physician who has published over 300 peer reviewed papers in areas of neuroscience and human disease resulting from environmental exposures.

Meeting the Mental Health Needs of Latino Communities: The Chicago School of Professional Psychology Strategy Latinos represent the nation's largest and fastest growing ethnic group, yet there remains a striking lack of knowledge regarding the unique mental health needs facing the Latino populationâ&#x20AC;&#x201D; and a troubling shortage of culturally competent mental health professionals prepared to meet those needs. To help address this issue, The Chicago School of Professional Psychology has started a new Center for Latino Mental Health that will work to bolster understanding of and access to culturally competent mental health services through scholarly research, community service, and education. According to Chicago School President Michael Horowitz, "Latinos account for only 1 percent of U.S. psychologists. W e asked the questions: W hat does the Latino community need and how can we help? W e started with dialogue, not with prescriptions. The aim of this center is to learn more about the issues and needs at hand while putting the people and programs in place to address the shortage of mental health professionals trained to work with the Latino population." The critical need for such efforts is supported by statistics from the U.S. Census Bureau, the American Psychological Association, and the National Council of La Raza: â&#x20AC;˘

Fewer than one in 20 Latino immigrants with a mental disorder accesses mental health services. Of those who do, more than 70 percent never return after the initial visit.

"Fewer than one in 20 Latino immigrants with a mental disorder accesses mental health services. Of those who do, more than 70 percent never return after the initial visit."

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According to new Census Bureau projections released in August 2008, minority groups that now make up about a third of our country's population will grow to well over 50 percent of the people in the United States by 2042. This change will result in large part from a tripling of the country's Hispanic population, from 46.7 million now to 132.8 million by 2050. By then, according to the Census Bureau, nearly one in three U.S. residents will be Hispanic. The U.S. currently has only 20 mental health professionals for every 100,000 Latino residents.

The center will work with the school's academic departments to create academic programs centered on Latino mental health. The school's Counseling Department has a new Latino Mental Health Concentration this fall and two certificate programs: a Postgraduate Certificate in the Assessment and Treatment of Latino Mental Health and a Post-Bachelor's Certificate in Latino Mental Health. The center also will operate a research lab to help advance the knowledge base of diagnoses, treatments, and prevention of mental disorders among the Latino population. Finally, through its community service initiatives, the center will serve as a hub for students and faculty to lend their expertise at organizations that serve Latino communities by providing culturally competent mental health services, conducting culturally relevant research, developing new treatment models, and more. According to Hector Torres, PhD, assistant professor and Center Coordinator, "Our aim is to become a premier location that promotes understanding of the pressing mental health issues within the Latino/a community, both at domestic and international levels." For more information about the Center for Latino Mental Health, visit: www.thechicagoschool.edu/CLM H. For more information about The Chicago School, visit: www.thechicagoschool.edu.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES With A Focus On: The Role of Psychology ! Public Policy Efforts ! Scientific Research ! Mental/Behavioral Health Workforce ! Cultural Competence Advocacy Toolkit ! Why you should participate in advocacy ! Ways to support psychology in legislation ! Policy Points ! Action Points ! Federal Legislative Proposals

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES The Role of Psychology in Policy Efforts to Eliminate Health and Health Care Disparities: A 10-Year Review and Future Priorities Day Al-Mohamed, JD Senior Officer, Legislative and Federal Affairs APA Government Relations Office Lori Valencia-Greene, M S Founder and Principal Consultant, Advocacy Plus

Day Al-Mohamed, JD

Culture influences many aspects of health and health care, including identity, affect and communication, coping, family and community supports, and willingness to seek health care services. W hile there are efforts to improve services for diverse populations, racial and ethnic minorities, individuals with low English proficiency, low-income, individuals with disabilities, individuals living in rural communities, and those without health insurance continue to experience significantly poorer overall health and barriers to accessing appropriate and timely health care.

The behavioral and social sciences hold the key to eliminating health and health care disparities. Six of the ten leading causes of death in the U.S. are based on behavioral factors such as: diet, substance use, smoking, sedentary lifestyle, violence, accidents and stress. The impact of habits, personality factors, and social environments contribute to the development and course of a health condition has been supported by research.

"The behavioral and social sciences hold the key to eliminating health and health care disparities. Six of the ten leading causes of death in the U.S. are based on behavioral factorsâ&#x20AC;Ś"

Psychologists have a unique perspective through their work as researchers, clinicians and educators offering insights relating to the study of culture, socioeconomic status, geographic location, bio-behavioral factors, and multiple levels of social contexts (e.g., small groups and cultural/national systems) that can aid in the Lori Valencia-Greene, MS

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES development of effective behavioral strategies to reduce disease risk, and assist in preventing, improving, and managing health conditions. Over the last 10 years, members of the American Psychological Association have put forward significant efforts to address health and health care disparities through policy activities and supporting additional research, programming and targeted legislation and regulations. Highlights of these efforts include: 10-Year Timeline of APA's Health Disparities Policy Efforts 1999

APA, along with the National Association of Social Workers and the Society for Public Health Education, co-found the National Coalition on Health and Behavior. This coalition has grown to be become one the largest and strongest advocates for the inclusion of legislative language recognizing the critical role of behavior in eliminating racial and ethnic, and other health disparities, including rural health.

2000

Over 100 Congressional staff members and representatives of advocacy groups attend the APA-sponsored briefing Research on Minority Health Disparities at the Rayburn House Office Building. President Bill Clinton signs into law the Minority Health and Health Disparities Research and Education Act of 2000 at a White House ceremony attended by APA's Chief Executive Officer Raymond D. Fowler, PhD, who was invited to the event in recognition of the significant role played by APA members in achieving congressional passage of the legislation.

2001

APA members play a significant role in the development of Surgeon General David Satcher's supplemental report: Mental Health: Culture, Race, and Ethnicity. The exemplary feature of this Supplement is its consideration of the relevance of history and culture to our understanding of mental health, mental illness, and disparities in services, and offering recommendations for a targeted plan to eliminate racial and ethnic disparities in mental health.

2002

The Institute of Medicine (IOM) releases its landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. This research indicates that U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services as compared to non-minority populations, even when differences in health care access-related factors such as insurance status and ability to pay for care are controlled. APA member Brian Smedley, PhD, served as director for this IOM study.

2003

APA's Committee on Ethnic Minority Affairs (CEMA) and the Public Interest component of the Public Policy Office (PPO) begin an historic partnership in implementing Phase 1 of PPO's Coordinated Advocacy Campaign. Across the country, members of CEMA met with their Senators' staff to discuss minority health disparity legislation. This new campaign successfully uses digital organizing and mobilization to grow and sustain advocacy efforts at the local level, and influence congress members to consider the importance of the integration of behavioral and mental health into any health disparities legislation.

OEMA COMMUNIQUĂ&#x2030;

10-Year Timeline of APA's Health Disparities Policy Efforts 2004

The APA Committee for the Advancement of Professional Practice Task Force on Serious Mental Illness and Serious Emotional Disturbance (TFSMI) chair, Dr. Arthur Evans, organized and chaired a panel on health disparities at the 2004 APA Convention in Hawaii. Participants included Drs. Lonnie Snowden, Larke Huang, Mario Hernandez and Candace Fleming. It was the Committee's intention that the panel serve as a springboard for broader concern and discussion about psychologists' role in addressing health disparities.

2005

APA co-sponsors a congressional briefing on the mental health and resilience of ethnic-minority children with the Congressional Asian Pacific American Caucus at the request of chair Rep. Mike Honda (D-Calif.), along with the Congressional Hispanic Caucus and the Congressional Black Caucus Health Braintrust. Presenters included Barbara Bonner, PhD, of Indian Country Child Trauma Center and the University of Oklahoma Health Sciences Center, Larke Nahme Huang, PhD, of the American Institutes for Research, Portia Hunt, PhD, of Temple University, Alicia Lieberman, PhD, of the National Child Traumatic Stress Network in San Francisco, and Luis Vasquez, PhD, of New Mexico State University, with APA CEO Norman B. Anderson, PhD, serving as moderator.

2006

The National Committee on Vital and Health Statistics, which advises Secretary Mike Leavitt and HHS on health data and health statistics, releases the report Eliminating Health Disparities: Strengthening the Collection of Data on Race, Ethnicity and Primary Language calling for the development of better techniques for studying health disparities. Contributing to the report was APA member Vickie Mays, PhD, who also chairs the Subcommittee on Populations which draws together experts from federal agencies, diverse racial and ethnic groups and private health-care researchers to testify about the data needed to overcome disparities.

2007

APA hosts a major congressional briefing, Childrens Mental Health: Strategies: Tactics and Effective Solutions during which Ken Martinez, PhD, presents on cultural and linguistic competence, and offers recommendations to address health and health care disparities as they apply to the development of racial and ethnic minority children.

2008

APA members are instrumental in urging Congress to continue funding for the long-standing (30+ years) Minority Fellowship Program. This interdisciplinary health professions training initiative encompasses the core mental health disciplines, including psychology, psychiatry, social work, and nursing and has supported the graduate psychology training of almost 1000 ethnic and racial minority students. In addition, Gail Porter, PsyD, offers an exceptionally successful presentation on health and health care disparities at the Congressional Black Caucus Spring Health Braintrust.

Future Efforts As we look to the future, the role of psychology will grow even broader and its potential impact even greater. Psychological research is:

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES • • •

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Developing survey research techniques that enhance our understanding of health status variations among diverse populations; Investigating access to health services, utilization rates, and patient attitudes towards health care as important factors in prevention and treatment; Evaluating potential sources of disparities, including the role of discrimination and stereotyping, nutrition, geographic factors at the individual and system levels; Identifying behaviors and protective factors related to the cause and course of many diseases and disorders disproportionately identified among ethnic and racial minorities; W orking to increase the numbers of racial and ethnic minorities among our nation's healthcare providers and to provide culturally competent health care services to our communities of color; and, Developing interventions and services that improve health outcomes.

Health and health care disparities impact psychologists working in all areas of the profession and it is the psychologist's expertise that will aid Congress in developing the most appropriate means to address health and health care disparities. As we move forward in 2009, APA will continue to advocate for integrated comprehensive policies that work towards the elimination of health disparities and we invite all APA members to participate in this vital process. Day Al-Mohamed, JD, currently serves as a Senior Legislative and Federal Affairs Officer with the American Psychological Association (APA). She manages APA’s legislative and regulatory activities related to a broad array of public interest policy issues including health care, education, immigration, disability and specific international issues. Before her legislative work at APA, Ms. Al-Mohamed’s career has included work in advocacy and legislative initiatives on behalf of many disenfranchised groups. Ms. Al-Mohamed worked as Director of Governmental Affairs for the American Council of the Blind; and served on the planning committee for the Civil Rights Group of the Cambio de Colores conference. Prior to that, she was a representative of the ISC-ICC to the Preparatory Commission of the International Criminal Court (ICC) at the United Nations, reporting on the activities of the Victim’s Trust Fund Working Group which addressed the needs of victims of genocide on a global scale. Lori Valencia Green, MS, has over 20 years of public policy experience, from over 10 years of working on Capitol Hill, to lobbying on behalf of the National Black Women's Health Project, Planned Parenthood Federation of America, and most recently the American Psychological Association. She is currently the

OEMA COMMUNIQUÉ founder and principal of Advocacy Plus, a policy based consulting firm focused on issues impacting women and their families, including health disparities, adoption, and education.

The Role of Psychological Science in Health Disparities Research APA Science Directorate Staff APA's Science Directorate, in collaboration with APA President Alan E. Kazdin's Grand Challenges Initiative, has identified the elimination of health disparities as a critical social issue that psychological research can address. In December 2008, the Directorate published Health Disparities, an educational booklet highlighting the contributions of psychological scientists to health disparities research. W orking with collaborators across disciplines, psychologists play leading roles in defining the "…wealth, education, problem, developing solutions and evaluating the gender, race, ethnicity and effectiveness of interventions. They know that the neighborhood one lives in predict how healthy wealth, education, gender, race, ethnicity and the people will be…" neighborhood one lives in predict how healthy people will be during their lifetime. Stress from financial worries, feelings of powerlessness, and discrimination is heaped disproportionately on the most vulnerable. As researchers continue to define the problem, they are beginning to understand how these factors interact to exert such a strong effect on the risk of premature birth, high blood pressure, diabetes, heart disease and a host of other illnesses. They are using their findings to develop interventions that will allow everyone the same chance at a healthy life. The Health Disparities booklet provides an overview of several contributing factors to health disparities and describes the work of individual psychologists who are addressing these issues in their research. Poverty Psychologists have looked at the long-term impact of poverty on a number of health and education outcomes and have discovered that lower socioeconomic status (SES) affects brain development in infancy and childhood, influences achievement in school and work, and compromises health through it all. In fact, psychologist Nancy

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES Adler and her colleagues at the John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health find that even if people rise out of poverty as adults, their early experiences shape their health for the rest of their lives. Chronic Stress Ground-breaking research by psychologists over the past twenty years has linked stress — especially chronic stress— to increases in a person's vulnerability to cardiovascular and other diseases, in part by altering immune system functioning. Linda Gallo and other researchers at San Diego State University find that the same people who have the biggest health disparities experience the most chronic "Ground-breaking research by stress from racism and discrimination, psychologists over the past financial strain, safety risks, interpersonal twenty years has linked conflict, major life events, and other stress—especially chronic environmental factors. Consequently, one stress—to increases in a of the best ways to decrease chronic stress person's vulnerability to among the most needy is to deal with the cardiovascular and other broader issues of discrimination, racism, diseases, in part by altering immune system functioning." poverty and poor living conditions on a national scale. Psychologists have also developed interventions that help patients at a more individual level. Sense of Control Psychologists are examining the importance of an individual's need to have a sense of control in his/her life. Ethnic minority populations, people at the bottom of the corporate and economic ladder, as well as the unemployed and disenfranchised often feel the least amount of personal control and often show the steepest health disparities. Policy-makers have begun to take note of these kinds of findings. For example, a National Institute for Occupational Safety and Health report, written by a team headed by occupational health psychologist Steven Sauter, encourages companies to organize jobs and workplaces in ways that allow workers more control. The recommendations include making improvements in the design of tasks and workloads, increasing worker participation in decision-making, and enabling greater communications among workers and managers.

OEMA COMMUNIQUÉ Discrimination Like any form of chronic stress, the strain "…the more African American of discrimination— sometimes overt, but women experienced even subtle often subtle— exacts a toll on health. Many discrimination—measured as a studies link discrimination to mental feeling of being ignored or treated health problems such as depression and with a lack of courtesy or respect—the more likely they were anxiety as well as physical ailments related to show signs of calcium build-up to chronic stress. In one study, Yale in their coronary arteries…" University health psychologist Tené Lewis and her colleagues found that the more African American women experienced even subtle discrimination— measured as a feeling of being ignored or treated with a lack of courtesy or respect— the more likely they were to show signs of calcium build-up in their coronary arteries, which is an early sign of heart disease. Unconscious Bias Discrimination has another, less visible influence on health. Psychologists have discovered a more subtle form of bias— often unconscious even to those who harbor it— that may directly affect the kind of medical treatment people receive. The work started with several studies showing that doctors treat African Americans and other ethnic minorities differently from W hites presenting with the same symptoms. The Health Disparities booklet, as well as other Grand Challenges booklets, Prolonging V it a li ty a nd Gl o ba l C li ma t e C h an g e, is a va ila b le on li n e a t: http://www.apa.org/science/GCBooklets.html.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES The Role of Psychology in Health Disparities and the Mental/Behavioral Services Health Workforce Nina Gail Levitt Associate Executive Director for APA Education Government Relations Jessica Goshow Legislative Assistant for APA Education Government Relations Two main issues related to health disparities and the mental/behavioral health workforce that should be considered in the context of public policy include: increasing the number of racial and ethnic minority mental/behavioral health professionals and creating a culturally competent workforce to meet the needs of the expanding minority population of the United States. The Annapolis Coalition, a group of mental/ behavioral health experts and stakeholders commissioned by the U.S. Substance Abuse and Nina Gail Levitt M ental Health Services Administration (SAMHSA), published an action plan for the mental/behavioral health workforce in 2007 that found not only a need to address the workforce size in general and its inadequate geographic distribution but also the notable lack of racial "…an action plan for the and cultural diversity among mental health mental/behavioral health disciplines. Currently the only federal workforce in 2007 found not programs for addressing the diversity of the only a need to address the m e n t a l / b e h a v io r a l h e a l t h w o r k f o r c e workforce size in general development are SAM HSA's M inority and its inadequate Fellowship Program funded at approximately geographic distribution but $4 million, the Indian Health Service Indians also the notable lack of into Psychology Program at $750,000 and the racial and cultural diversity am ong m ental health H ealth Resource s and Service disciplines." A d m i n i s t r a t i o n 's ( H R S A ) G r a d u a t e Psychology Education Program funded at $2 million. T he American Psychological Association (APA) has played a critical role in the establishment and continuation of each of these important programs.

OEMA COMMUNIQUĂ&#x2030; One of the most significant challenges our nation's mental health care workforce faces is the increasing gap in health care access and health outcomes for racial and ethnic minorities. According to the Annapolis Coalition report, a large majority (approximately 90%) of mental/behavioral health professionals are non-Hispanic W hite, whereas, according to the 2004 U.S. Census Bureau, racial and ethnic minorities make up 30% of the U.S. population. It is projected that by 2060, ethnic minorities will have become the majority, constituting 50.4% of the resident population of the United States (Hispanic 26.6%, African American 13.3%, Asian American/Pacific Islander 9.8% , American Indian .08%).

Jessica Goshow

The percentage of racial and ethnic minorities (i.e., Hispanic, Black, Asian, and American Indian) in the mental/behavioral workforce according to SAMHSA's Mental Health USA 2004 was estimated to be as follows: 6.2% for psychology, 8.7% for social work, 24.2% for psychiatry, 17.5% for psychiatric nursing, 15.4% for counseling, 5.5% for marriage and family therapists, and 5.3% for school psychology. Some of the disciplines included non-specific populations that boost their percentages. These data reveal the need to increase the pipeline of racial and ethnic minorities in mental/behavioral health professions. In fact this is occurring in psychology; according to 2006 data, 25% of new PhDs were racial and ethnic minorities (Hoffer et al., 2007) The psychology data show that the pipeline is diversifying; however, the percentage of racial and ethnic minorities is still inadequate given the rate of growth in minority communitiesâ&#x20AC;&#x201D; and the mental and behavioral health needs present in those communities. The same discrepancy exists for racial and ethnic minorities social and behavioral researchers. According to NSF (2007) individuals from racial and ethnic groups are underrepresented among doctoral recipients in 2005. In neuroscience for example, 77.5 % of the doctorates were awarded to non-Hispanic white, 5.4 % to Hispanic persona and only 1.9% to African Americans. Not only are there fewer racial and ethic minority mental/behavioral health professionals qualified to treat a wide range of needs, the demand for these professionals is growing dramatically. As of September 2008, there were 3,059 Mental Health Professional Shortage Areas with 77 million people according to

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES HRSA Office of Shortage Designation ( U.S. DHHS, 2004). It would take 5,145 practitioners to meet the need for a population to practitioner ratio of 10,000:1. These startling statistics are derived from communities that self-reported their shortages; the need is likely much greater. W ithin these shortage areas there is a high population of racial and ethnic minorities. W hile the need for more mental and b e h a v io ra l h ea lth p ro fe s s io n a ls is "The Annapolis Coalition documented and clear, there is also a Report states: 'The issue is not pressing need for a higher level of cultural only one of access but also, in many cases, of a profound competency of all mental and behavioral lack of culturally and health professionals, regardless of their race. linguistically competent care According to the 2007 Annapolis Coalition because of the dearth of report, new healthcare professionals are less providers who are grounded in than ready to meet the behavioral health diverse langu a g es and needs of an increasingly diverse population. cultures.'" This is a crisis point for communities of color. The Annapolis Coalition Report states: "The issue is not only one of access but also, in many cases, of a profound lack of culturally and linguistically competent care because of the dearth of providers who are grounded in diverse languages and cultures." In terms of serving the American Indian and Alaskan Native populations, whose suicide rates are nearly double the national average, there are approximately 1, 300 American Indian and Alaskan Native psychologists. In 2006, American Indian and Alaskan Native represented only 0.5 percent of students earning psychology doctorates, down from 0.9 percent in 2003. In an effort to better meet the mental and behavioral health needs of our nation and ensure adequate preparation in cultural competencies, public policies must target investments that address this deficit and which span from early collegiate education through the early careers of the trained mental and behavioral health workforce. The projected national demographic changes create an urgent need for better representation of racial and ethnic minorities in the profession of psychology and other mental/behavioral health professions. Further, the growing multiculturalism of those seeking mental and behavioral help across the nation demands an improved level of cultural competence of future and current mental and behavioral health professionals. The improvement of care and the transformation of systems of care depend entirely on a workforce that is adequate in size and effectively trained and supported.

OEMA COMMUNIQUĂ&#x2030; References American Psychological Association, Office of Ethnic Minority Affairs. (2008). A portrait of success and challenge: Progress report: 1997-2005. Washington, DC: Author. Retrieved from, http://www.apa.org/pi/oema/CEMRRAT_progress_report_success_challenges.pdf. Annapolis Coalition. (2007). An action plan for behavioral health workforce development: A framework for discussion (SAMHSA/DHHS Publication No. 280-02-0302). Rockville, MD: Department of Health and Human Services. Hoffer, T. B., Hess, M., Welch, V., Jr., & Williams, K. (2007). Doctorate recipients from United States universities: Summary report 2006. Chicago: National Opinion Research Center. U.S. Department of Health and Human Services. (2004). Mental health, United States, 2004. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services (2008, November). Shortage designation: HPSAs, MUAs & MUPs. Retrieved on December 5, 2008 from, http://bhpr.hrsa.gov/shortage/. Nina Levitt, EdD, Associate Executive Director for the APA Education Government Relations Office, has been APAâ&#x20AC;&#x2122;s Senior lobbyist with Congress on authorizing and appropriations legislation on behalf of the psychology education and training for 16 years. Prior to that, Dr. Levitt worked in the US Senate, US House, US Department of Education and at George Washington University with a focus on disabilities and education. Jessica Goshow, Legislative Assistant for the APA Education Government Relations Office, holds a BA in psychology from Eastern Mennonite University in Harrisonburg, Virginia. Originally from Perkasie, Pennsylvania, Jessica has lived in Washington, DC for two and a half years. Before coming to APA, Jessica worked at the DC Employment Justice Center which seeks to secure, promote, and protect workplace justice in the District of Columbia.

The Role of Psychology in Promoting Cultural Competency as a Means of Reducing Mental Health Disparities Lonnie Snowden, PhD University of California, Berkeley Cultural competency is widely viewed as a key element in the effort to reduce minority-W hite disparities, including well-documented disparities in access to and quality of mental health care (U.S. Department of Health and Human Services,

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES 2001a). On its web site, the U.S. Department of Health and Human Service's Office of Minority Health describes cultural competency in language taken from a founding document: Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. (Adapted from Cross, Bazron, Dennis, & Isaacs, 1989) (www.omhrc.gov) The Office of Minority Health issued National Standards for Culturally and Linguistically Appropriate Services in Health Care (U.S. Department of Health and Human Services Office of Minority Health, 2001b). These "CLAS Standards" are designed to bring effective, respectful care to persons from ethnically and culturally diverse backgrounds in a language that they can understand, and that is compatible with their community's health beliefs and practices. CLAS Standards require that organizations employ a culturally and ethnically diverse staff and provide education and training in diverse cultural perspectives, as well as requiring that written materials be translated, no-cost interpreter and bilingual staff-provided language assistance be available at all points of contact, and notification be provided of the right to receive language assistance. CLAS Standards also require that organizations conduct strategic planning to implement cultural competency, that they collect information on ethnicity Lonnie Snowden, PhD and language proficiencies of service recipients, and that they collaborate with local ethnic and culturally diverse communities and compile demographic, cultural, and epidemiologic profiles characterizing those communities. In defining cultural competence, the Agency for HealthCare Policy and Research and other agencies embrace CLAS Standard-like characteristics (Brach & Fraser, 2000).

OEMA COMMUNIQUÉ In view of the intense, language-dependent interactions through which they provide assistance, psychologists' contributions to the cultural competence literature often focus on clinical relationships more than on cultural competency's community and organizational aspects. Key contributions (e.g. Sue, 1998) underscore the clinician's need to adapt his or her interpersonal style and cultural frame of reference to match those of clients when treating persons from diverse cultural backgrounds. As we seek to implement cultural competency on a widespread basis, critics sometimes note limitations that ought to be addressed. They seek definition of underlying cultural characteristics— established cultural dimensions like "individualism vs. collectivism," and cultural "explanatory models" of mental illness— that affect the presentation of mental illness, and how culturally competent responses successfully engage these characteristics. These and other challenges will be met as cultural competence fulfills its promise to reduce disparities. References Brach, C., & Fraser I. (2000). Can cultural competency reduce racial and ethnic health disparities? Medical Care Research and Review, 57 (Suppl. 1), 181-217. Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care (Vol. 1). Washington, DC: CASSP Technical Assistance Center, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center. Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 54, 440-448. U.S. Department of Health and Human Services. (2001a). Mental health: Culture, race, and ethnicity. A supplement to Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service. U.S. Department of Health and Human Services. (2001b). Mental health: Culture, race, and ethnicity. Rockville, MD: U.S. Department of Health and Human Services, Office of Minority Health. Lonnie R. Snowden, PhD, is Professor in the University of California, Berkeley's Health Policy and Administration Program in UC Berkeley's School of Public Health. Concentrating on minority-white disparities in access to and quality of mental health care, Professor Snowden has contributed about 140 publications to the scholarly literature. He wrote sections of Mental Health: A Report of the Surgeon General and served as Co-Scientific Editor of the supplement: Mental Health: Culture, Race, and Ethnicity.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES Advocacy Toolkit on Health Disparities Day Al-Mohamed. JD Senior Officer, Legislative & Federal Affairs APA Public Interest Government Relations Office Daniel E. Dawes, JD Senior Officer, Legislative & Federal Affairs APA Public Interest Government Relations Office Amy C. Carrillo University of Maryland, Baltimore County Devika Srivastava Fordham University The following information is provided to encourage and assist you to actively engage in advocacy for legislation in support of health disparities at the federal, state and local levels. If additional information is needed to assist you with such advocacy efforts, please contact APA's Public Interest Government Relations Office at 202-336-6166 or gro@apa.org. W hy YOU Should Participate in APA Public Policy Advocacy The American Psychological Association's (APA) public interest advocacy is guided by the philosophy that public policy should be based on available scientific knowledge, and that psychological research can contribute to the formulation of sound public policy to address specific social problems and to improve human welfare. APA maintains a vigorous and effective public interest advocacy program, and member contact with Congress as a constituent and a subject-matter expert is a vital component of this program. Psychologists have special training and expertise that uniquely qualify them to contribute to the development of public interest policy and to the reshaping of political attitudes toward the field of psychology. The new Administration and Congress have identified addressing health disparities as a priority. The Public Interest Government Relations Office (PI-GRO), in partnership with OEMA, calls on APA members in their roles as educators, researchers and clinicians to join us in providing policymakers with the necessary knowledge to address health and health care disparities.

OEMA COMMUNIQUĂ&#x2030; W ays to Support Psychology in Federal Legislation Contact PI-GRO and express a willingness to lobby your Congressional delegation Psychologists working with minority populations have unique and valuable expertise in addressing health disparities. Participation in APA's policy efforts to address these inequities through sharing your experiences and expertise is an opportunity to impact legislation that will directly affect both your profession and the communities you serve. Please contact PI-GRO at 202-336-6166 or gro@apa.org if you would like additional information regarding ways to engage in advocacy. Sign up for the Public Policy Advocacy Network (PPAN) PPAN is a non-interactive, electronic network through which brief information notices and action alerts are sent regarding important and timely legislative activities. Forwarding these alerts to colleagues and students can increase awareness of psychology's role in working to address health care disparities. To join PPAN, please visit: http://capwiz.com/apapolicy/mlm/signup. Urge your legislator to co-sponsor health disparities legislation You can be connected with the W ashington office of your legislator through the U.S. Capitol Switchboard at (202) 224-3121. In addition, many legislators have electronic means of contact which can be found through the House and Senate web sites at: http://www.House.gov and http://www.Senate.gov. For details about specific legislation, please contact the PI-GRO office. PI-GRO Web sites Visit the PI-GRO website for policy updates on health disparities legislation or to sign up for the Public Interest Newsletter. The PI-GRO website and newsletter offer the latest information on health disparities legislation including letters, fact sheets, and hearing testimony. Please visit our website at: http://www.apa.org/ppo/pi. To subscribe to the PI newsletter, please visit: http://www.apa.org/pi/newsletter.html.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES Sign up for PI-GRO advocacy training PI-GRO advocacy training sessions are designed to provide APA members with an overview of the federal legislative process as well as effective strategies for informing and influencing federal policy. For additional information on how to offer your expertise to APA initiatives that will impact health and health care disparities, please contact APA's Public Interest Government Relations Office at 202-336-6166 or gro@apa.org. Policy Points On Health Disparities The following points may be used when writing to elected officials, drafting op-eds, or talking with community and professional groups. Mental health is a critical and frequently unaddressed matter in racial and ethnic minority communities. According to the Surgeon General's report, Blacks, Hispanics, and American Indians/Alaska Natives are over-represented in populations that are particularly at risk for mental illness. Additionally, minority individuals may experience symptoms that are undiagnosed, underdiagnosed, or misdiagnosed for cultural, linguistic, or historical reasons. Mental disorders are highly disabling for all populations (Druss et al., 2000; Murray & Lopez, 1996), but racial and ethnic minorities are less likely than W hites to receive needed services and more likely to receive poor quality of care (HHS, 2001). Failure to receive effective treatment produces lost workdays and limitations in daily activities (HHS, 2001). %

Minorities are underrepresented in outpatient care, overrepresented in inpatient and emergency treatment, more likely to leave treatment prematurely (Cheung & Snowden, 1990; Hu et al. 1991; Snowden & Cheung, 1990). Elderly patients, men, and Blacks are more likely to see primary care physicians than a mental health professional for mental health treatment (Pingitore et al., 2001). Several barriers deter all persons from receiving treatment, including cost, fragmentation of services, lack of availability of services, and societal stigma toward mental illness. Additional barriers deter racial and ethnic minorities from receiving treatment, including mistrust/fear of treatment, racism and discrimination, differences in communication (HHS, 2001), and lack of culturally and linguistically appropriate services (Swartz et al., 1998).

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% %

Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status are associated with Hispanics' use of mental health services (Alegria et al., 2007). Genetic differences between races mean that diagnostic criteria refined in one racial group may not be directly and simply applicable to other racial groups, such that instruments of assessment and diagnosis may be less appropriately applied in genetically different groups (Low & Hardy, 2007). There is a greater unmet need for alcoholism, substance use treatment, and mental health care among Blacks and Hispanics relative to Whites (W ells et al., 2001). Disparities are observed in most aspects of health care, including care for chronic conditions such as mental health disorders and substance use, HIV/AIDS, cancer, diabetes, heart disease, respiratory diseases, and end stage renal disease (AHRQ, 2006). Although Hispanic girls ages 12 to 17 were at higher risk for suicide than other youths, only 32% of Hispanic girls at risk for suicide received mental health treatment (SAMHSA, 2003). In 2006, the rates of treatment for mental health conditions for W hites age 18 or older were 15.2% compared to 7.4% for Blacks and 7.0% for Hispanics (SAMHSA, 2003). Hispanic children are nearly 3 times as likely as W hite children to have no regular source of health care (AHRQ, 2000). Many racial and ethnic individuals are more likely to experience poor communication and more difficulties interacting with their health care providers, and difficulty accessing health care information (AHRQ, 2004).

Action Points On Health Disparities The lack of attention to the mental and behavioral health needs of racial and ethnic minorities and the inadequate provision of appropriate mental health care in racial and ethnic minority communities demonstrate a clear need for encouraging collaboration and finding ways to close the gap in care. The federal government has a critical role to play in addressing the issue of racial and ethnic disparities in mental health and mental health care by supporting legislation and regulations that will improve the lives of minorities. The American Psychological Association recommends the following: %

Increase the availability of culturally and linguistically competent mental and behavioral health services accessible to racial and ethnic minorities.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES % % % % % %

% % % %

Develop, implement, and support systems, programs, and policies that promote cultural and linguistic competence and reduces discrimination. Encourage racial and ethnic minorities to participate in policymaking. Train mental health service providers in strength-based culturally and linguistically relevant assessments and therapies. Develop intervention programs serving racial and ethnic minority youth to reduce at-risk behaviors which lead to mental illness. Support public policy, which focuses on mental and behavioral health disparities that are based on psychological and behavioral research. Develop policy and implement programs ensuring that racial and ethnic minorities are empowered through culturally informed and evidence-based strategies. Understand racial and ethnic minorities' cultural differences, such as somatization, culture bound-syndromes, and perceptions of mental illness. Increase psychological and behavioral research, which focuses on mental and behavioral health disparities. Increase collaboration across federal funding organizations involved in racial and ethnic minority resiliency research. Advocate for local and national funding agencies to incorporate culturally competent guidelines into proposals for programs for racial and ethnic minority children, youth, and families. Stimulate discussion and action by researchers, clergy, policy makers, business, health insurance leaders, and the community to eliminate disparities in mental health and mental health care by examining the complexities and intersections of multiple statuses/identities (socioeconomic status, disability) and how these may contribute to psychological health. Foster positive relationships and programs within racial and ethnic minority communities to increase awareness of mental health issues and prevent environmental factors that may place individuals at risk. Facilitate partnerships among physicians, mental and behavioral health providers, educators, community leaders, government agencies, and families to ensure development and implementation of culturally and linguistically competent and evidence-based treatment.

Legislative Proposals on Health Disparities Despite advancements in eliminating health and healthcare disparities, most racial and ethnic minority populations continue to experience poorer health, have more psychological problems, and less access to healthcare services than ever beforeâ&#x20AC;&#x201D; resulting in higher levels of sickness and death (U.S. Department of Health

OEMA COMMUNIQUĂ&#x2030; and Human Services, 2007; Centers for Disease Control and Prevention, 2007). The American Psychological Association (APA) is deeply committed to addressing health and healthcare disparities. APA has supported efforts focused on increasing knowledge and research related to racial and ethnic minority mental health, ensuring that culturally and linguistically appropriate services are delivered to these populations, and advocating for federal initiatives to reduce health and healthcare disparities. Two pieces of legislation that have previously focused on health disparities and which are anticipated to be re-introduced in the new Congress include: (H.R. 3014) Health Equity and Accountability Act of 2007 and (S. 1576) Minority Health Improvement and Health Disparity Elimination Act, with companion bill (H.R. 3333) Minority Health Improvement and Health Disparity Elimination Act. The Congressional Black Caucus (CBC), the Congressional Hispanic Caucus (CHC), and the Congressional Asian/Pacific Islander American Caucus, collectively known as the Tri-Caucus, along with the help of the CBC Health Braintrust, under the leadership of Representative Donna Christensen (D-VI), developed the Health Equity and Accountability Act of 2007 (HR 3014). On July 12, 2007, Representative Hilda Solis (D-CA), Chair of the CHC Task Force on Health and the Environment, introduced the Health Equity and Accountability Act of 2007, which is comprehensive legislation aimed at resolving the root causes of the current health disparities crisis and improving the health of minority individuals. Introduced July 6, 2007 by Senator Edward Kennedy (D-MA) ( S. 1576), the Minority Health Improvement and Health Disparity Elimination Act and its companion bill, (H.R. 3333), introduced by Representative Jesse Jackson, Jr. (D-IL), focus on enhancing health and healthcare of racial and ethnic minority groups. Together, these bills tackle numerous healthcare problems facing racial and ethnic minorities in the U.S. These bills seek to improve linguistic and culturally competent services; increase physical and mental health services; increase knowledge regarding diversity; expand healthcare; ensure adequate funding of the Office of Minority Health, and the National Center for M inority Health and Health Disparities; call for community and direct care services focusing on racial and ethnic minority communities; support racial, ethnic, linguistic, and socioeconomic data collection to identify solutions for health disparities; and advocate for the creation of programs to reduce disparities.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES Below is an analysis of (H.R. 3014) and (S.1576)/ (H.R. 3333). H.R. 3014

S. 1576/H.R. 3333

Summary

To improve the health of minority individuals.

A bill to amend the Public Health Service Act to improve the health and healthcare of racial and ethnic minority groups.

Sponsor

Representative Hilda Solis (D-CA-32)

Senator Edward Kennedy (D-MA) Representative Jessie L. Jr. Jackson (D-IL-2)

Committee Referrals

Referred to the Energy and Commerce; Ways and Means; Education and Labor; Natural Resources; and Judiciary Committees in the House.

(S. 1576) was referred to the Senate Committee on Health, Education, La bor, and Pensions. (H.R. 3333) was referred to the House Committee on Energy and Commerce

Mental Health Study and Services Access

Amends various provisions in Sec.1861 and Sec.1832 of the SSA to provide coverage for mental health counselor services under Medicare Part B.

Requires the Administrator of SAMHSA to conduct a study to determine the mental health professional needs of the United States, assess the competency of mental health providers to provide cultural and linguistically appropriate services, and to submit a report to Congress.

Linguistic/ Cultural Competence

Establishment of the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care, Office of Minority Health within specified agencies. Reestablishes the Indian Health Service as an agency within the Public Health Service of HHS to be

Development of an Internet Clearinghouse within the Office of Minority Health. Sets forth duties for the Office of Minority Health. Requires the Secretary to establish the Advisory Committee on activities relating to disease prevention, health workforce, health service delivery, health

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Community Services

H.R. 3014

S. 1576/H.R. 3333

administered by an Assistant Secretary of Indian Health. Requires federal health-related agencies to improve access to care by English-limited individuals. Agencies must also implement a plan to eliminate racial/ethnic and linguistic disparities.

promotion, and research concerning racial and ethnic mi n o r i t i e s . E s t a b l i s h e s public-private collaborations to identify and create strategies to improve health and healthcare for ethnic and racial minorities.

Calls for the development of health empowerment zone programs in communities that are impacted by health disparities in health and healthcare. Directs the President to execute, administer, and enforce provisions to address environmental justice in minority and low-income populations. Authorizes the Secretary to make grants or contracts with community healthcare facilities to conduct health disparities research. Authorizes grants with community-based health agencies to conduct research on health disparities. Awards grants to entities developing community-based training programs to prepare health professions students to serve in health disparities populations. Provides grants to community health centers to increase medical service providers. Authorizes grants to community health centers for building and construction.

Requires the establishment of the Health Action Zone Initiative demonstration program to support comprehensive state, tribal, or local initiatives to improve the health of racial and ethnic minority groups.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES

H.R. 3014

S. 1576/H.R. 3333

Workforce Diversity: Education and Training

Provides for healthcare workforce diversity activities and the establishment of a technical clearinghouse on health workforce diversity. Creates Regional Minority C enters of Excellence Programs. Awards grants to researchers to examine the association between health workforce diversity and quality healthcare. Presents grants to educational institutions that train significant numbers of underrepresented individuals in minority health professions. Presents grants to minorityserving institutions and Hispanic serving professional schools that recruit underrepresented individuals. Provides scholarships for d isa d van taged students. Reauthorizes the Health Professions Student Loan Fund.

Provides for programs of excellence in health professions education for underrepresented minorities. Promotes scholarships for disadvantaged students and educational assistance for disadvantaged students in health professions.

Professional Development grants/scholarships

Requir es heal th-related programs of the Department of Health and Human Services to collect data on race, ethnicity, and p rimary language. Provides for grants for strategies to eliminate racial and ethnic health and health care disparities. Awards grants to healthcare and educational i n s t it u ti o n s to d e s i g n approaches focusing on cultural an d li n gu istic competence. Establishes loan reimbursement programs for

Provides for grants promoting positive health behaviors, culturally and linguistically appropriate, evidence-based, a n d c o m mu n i t y - d r i v e n sustainable strategies to eliminate racial and ethnic health and health care disparities. Develops systems of primary care helping to eliminate disparities and improving the delivery of health care. Requires the Secretary to ensure the collection of data from

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Direct Services/ Health Systems

H.R. 3014

S. 1576/H.R. 3333

researchers who study racial and ethnic disparities in health. Provides grants to test, implement and evaluate models of cultural competence for healthcare providers. Awards grants to healthcare professionals who work with health disparities populations or study needs of underserved communities. Presents grants to researchers who expand opportunities for underrepresented minorities in health professions.

federally conducted or supported health programs by race, ethnicity, geographic location, socioeconomic position, primary language, and, when practicable, health literacy. Aims to expand research on barriers that limited English proficient experience and related health outcomes.

Directs each federal health agency to implement a strategic plan to eliminate disparities and improve the health and health care of minority populations. Requires the Secretary to designate centers of excellence at public hospitals and other health systems that demonstrate excellence in providing care to minority populations and reducing health disparities. Requires the Secretary to expand the Minority HIV/AIDS Initiative. Makes immigrants from certain U.S. territories and possessions eligible for specified federal programs.

Su pport s d emonstration projects designed to improve the health and health care of racial and ethnic minority groups through improved access to health care, patient navigators, primary prevention activities, health promotion and disease prevention activities, and health literacy education and services.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES

Rural Health Outreach

H.R. 3014

S. 1576/H.R. 3333

Requires the Secretary to establish the Rural Health Quality Advisory Commission and to develop and implement a national plan for rural health quality improvement. Awards grants to rural public or nonprofit entities that promote healthcare to rural populations.

Provides grants addressing the health needs in the Mississippi Delta through the Delta Health Initiative Rural Health, Education, and Workforce Infrastructure Demonstration Program.

H.R. 3014 increases cultural and linguistic competence in mental healthcare; increases funding opportunities for researchers investigating cultural competence, race, ethnicity, health and healthcare disparities; barriers to healthcare; rural health; health experiences of underserved populations; solutions to end health disparities; and expands HIV care. H.R. 3014 also provides grants, loan assistance, and educational aid for training, service delivery to mental health professionals working in underserved communities, and extends mental health counselors' coverage under Medicare Part B. This bill provides community programs initiatives and addresses environmental justice in ethnic minority populations; bolsters research on race, workforce diversity, and the quality of health service delivery. S. 1576/H.R. 3333 calls for mental health organizations to identify and address critical mental health needs of the population and to evaluate cultural competency of mental health professionals. T his bill provides funding for individuals from disadvantaged populations who desire to train in health professions and provides grants to community centers and health agencies. This bill also offers strategies to reduce mental disparities in hospitals and clinics and improves the delivery of health services to ethnic minorities. W ith the 111th Congress and the new O bama administration, the APA has great opportunities to ensure that eliminating health disparities is a major component of healthcare reform. The Public Interest Government Relations Office will continue to advocate for legislation and regulations that strongly and comprehensively target health and health careâ&#x20AC;&#x201D; especially the under-addressed mental health and mental healthcare disparities. For more information and updates on federal legislative proposals on health disparities go to: http://www.apa.org/ppo/pi/.

OEMA COMMUNIQUĂ&#x2030; References AlegrĂa, M., Mulvaney-Day, N., Woo, M., Torres, M., Gao, S., & Oddo, V. (2007). Correlates of past-year mental health service use among Latinos: Results from the National Latino and Asian American Study. American Journal of Public Health, 97, 76-83. Agency for Healthcare Research and Quality. (2000). "Addressing racial and ethnic disparities in health care" fact sheet. AHRQ Publication No. 00-PO41, Rockville, MD. http://www.ahrq.gov/research/disparit.htm Agency for Healthcare Research and Quality. (2004). National healthcare disparities report: Summary. Rockville, MD. http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm Agency for Healthcare Research and Quality. (2006). National healthcare disparities report. Rockville, MD. http://www.ahrq.gov/qual/nhdr06/nhdr06.htm Beals, J., Novins, D., Whitesell, N., Spicer, P., Mitchell, C., & Manson, S. (2005). Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: Mental health disparities in a national context. American Journal of Psychiatry, 162, 1723-1732. Beals, J., Manson, S. Whitesell, N., Spicer, P., Novins, D., & Mitchell, C. (2005). Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Archives of General Psychiatry, 62, 99-108. Breakey, W. R., Fischer, P. J., Kramer, M., Nestadt, G., Romanoski, A. J., Ross, A., Royall, R. M., & Stine, O. (1989). Health and mental health problems of homeless men and women in Baltimore. Journal of the American Medical Association, 262, 1352-1357. Breslau, J., Aguilar-Gaxiola, S., Kendler, K., Maxwell, S., Willaims, D., & Kessler, R. (2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36 (1), 57-68. Center for Disease Control (CDC). (2007). Table 61. Health, United States, 2007 (with chartbook on trends in the health of Americans). Hyattsville, MD. U.S. Department of Health and Human Services. Cheung F., & Snowden L. (1990). Community mental health and ethnic minority populations. Community Mental Health Journal, 26, 277-291. Chun-Chung Chow, J., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93, 792-797. Druss, B. G., Marcus, S. C., Rosenheck, R. A., Olfson, M., Tanielian, T., & Pincus, H. A. (2000). Understanding disability in mental and general medical conditions. American Journal of Psychiatry, 157, 1485-1491. Hu, T., Snowden, L., Jerrell, J., & Nguyen, T. (1991). Ethnic populations in public mental health: services choice and level of use. American Journal of Public Health, 81, 1429-1434. Kales, H., Neighbors, H., Valenstein, M., Blow, F., McCarthy, J., Ignacio, R.,et al. (2005). Effect of race and sex on primary care physicians' diagnosis and treatment of late-life depression. Journal of the American Geriatrics Society, 53(5), 777-784.

A PUBLIC POLICY PRIMER ON HEALTH DISPARITIES Kales, H., Neighbors, H., Blow, F., Taylor, K., Gillon, L., Welsh, D., Maixner, S., & Mellow, A. (2005). Race, gender, and psychiatrists' diagnosis and treatment of major depression among elderly patients. Psychiatric Services, 56 (6), 721-728. Kessler, R., Chiu, W., Demler, O., & Walters, E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627. Kendler, K., Gallagher, T., Abelson, J., & Kessler, R. (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Archives of General Psychiatry, 53 (11), 1022-1031. Koegel, P. M., Burnam, A., & Farr, R. K. (1988). The prevalence of specific psychiatric disorders among homeless individual in the inner city of Los Angeles. Archives of General Psychiatry, 45, 1085-1093. Lawson, W. (1986). Racial and ethnic factors in psychiatric research. Hospital & Community Psychiatry, 37(1), 50-54. Low, N. & Hardy, J. (2007). Psychiatric disorder criteria and their application to research in different racial groups. BMC Psychiatry, 7(1), doi: 10.1186/1471-244X-7-1. Murray, C. & Lopez, (Eds.). (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard School of Public Health. Neighbors, H., Jackson, J., Campbell, L., & Williams, D. (1989). The influence of racial factors on psychiatric diagnosis: A review and suggestions for research. Community Mental Health Journal, 25 (4), 301-311. Pingitore, D., Snowden, L., Sansone, R., & Klinkm,an, M. (2001). Persons with depressive symptoms and the treatments they receive: A comparison of primary care physicians and psychiatrists. International Journal of Psychiatry in Medicine, 31(1), 41-60. Smith, S., Stinson, F., Dawson, D., Goldstein, R., Huang, B., & Grant, B. (2006). Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 36 (7), 987-998. Snowden, L., & Cheung F. (1990). Use of inpatient mental health services by members of ethnic minority groups. American Psychologist, 1990 (45), 347-355. Strakowski, S., Flaum, M., Amador, X., & Bracha, H.. (1996). Racial differences in the diagnosis of psychosis. Schizophrenia Research, 21(2), 117-124. Substance Abuse and Mental Health Services Administration (SAMHSA). (2003). Risk of Suicide among Hispanic females aged 12 to 17. National Household Survey on Drug Abuse Report. Retrieved from http://www.oas.samhsa.gov/2k3/LatinaSuicide/LatinaSuicide.htm Substance Abuse and Mental Health Services Administration (SAMHSA). (2007). Results from the 2006 National Survey on Drug Use and Health: National findings. (Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293). Rockville, MD.

OEMA COMMUNIQUĂ&#x2030; Swartz, M., Wagner, R., Swanson, J., Burns, B., George, L., & Padgett, D. (1998). Administrative update: Utilization of services. Community Mental Health Journal, 34 (2), 133-144. Teplin, L. A. (1990). The prevalence of severe mental disorder among male urban jail detainees: Comparison with the epidemiologic catchment area program. American Journal of Public Health, 80, 663- 669. U.S. Department of Health and Human Services (HHS), Public Health Service, Office of the Surgeon General (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author. U.S. Department of Health and Human Services (HHS), Public Health Service, Office of the Surgeon General (2001). Mental health: Culture, race and ethnicity - A supplement to mental health: A report of the Surgeon General. Rockville, MD. Vernez, G. M., Burnam, M. A., McGlynn, E. A., Trude, S., & Mittman, B. (1988). Review of California's program for the homeless mentally ill disabled (Report No. R3631-CDMH). Santa Monica, CA: RAND. Wells, K., Klap, R., Koike, A., Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry, 158, 2027-2032. Williams, D., GonzĂĄlez, H., Neighbors, H., Nesse, R., Abelson, J., Sweetman, J., &Jackson, J. (2007). Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: Results from the National Survey of American Life. Archives of General Psychiatry, 64, 305-315. Worthington, C. (1992). An examination of factors influencing the diagnosis and treatment of Black patients in the mental health system. Archives of Psychiatric Nursing, 6 (3), 195-204.

EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES The American Psychological Association has established a small grants program (ProDIGS) to encourage early career psychology faculty at minorityserving institutions to engage in preliminary or pilot health disparities research studies necessary for developing highly competitive research programs or services proposals for federal or foundation funding. We take this opportunity to share the cutting edge work of some of our ProDIGS grantees and in doing so, to encourage increased small grants support for young health disparities researchers and service providersâ&#x20AC;&#x201D;especially at minority-serving institutions. It is an investment that yields great benefits!

For more information on applying for 2009 ProDIGs awards go to: http://www.apa.org/pi/oema/prodigs-2009-rfp.pdf

EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES Psychological Assessment of African Americans on Dialysis Daniel Cukor, PhD SUNY Downstate Medical Center This study sought to explore the range and the extent of psychopathology in African American patients who had End Stage Renal Disease (ESRD) and were treated with hemodialysis. Information on 70 randomly selected patients was gathered. Overall, the population had a high rate of psychiatric diagnoses (74%), as determined by the clinician-administered measures. This is the first known report on the full spectrum of psychiatric disorders determined systematically in a hemodialysis population. Rates of depression were comparable to other studies in ESRD and other medically ill populations. W e found that the rate of major depression (20%) and dysthymia (9%) Daniel Cukor, PhD in the current study were in good agreement with other ESRD studies. The rate of anxiety disorders (27%) was somewhat higher than expected. Despite the high rates of mental health difficulty there were very low rates of treatment. "Overall, the population had a high rate of psychiatric diagnoses (74%), The results of this study have been as determined by the clinicianpublished and served as the starting point administered measures.â&#x20AC;ŚDespite the for other similar projects. I am also happy high rates of mental health difficulty to report that I have been awarded a K-23 there were very low rates of (career development award) through the treatment.." National Institutes of Diabetes, Digestive Disorders and Kidney Disease (NIDDK) of the National Institutes of Health (NIH). The title of the application is "Cognitive Behavioral T reatment of Depression in End Stage Renal Disease Patients treated with Hemodialysis." The ProDIGS award, along with an additional internal award from SUNY Downstate, served to support collection of the essential preliminary data. I am convinced that without the ProDIGs award I would not have received the federal funding.

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES For Further Reading Cukor, D., Coplan, J., Brown, C., Friedman, S., Cromwell Smith, A., Peterson, R. A., & Kimmel, P. L. (2007). Depression and anxiety in urban hemodialysis patients. Clinical Journal of the American Society of Nephrology, 2, 484-490. Cukor, D., Coplan, J., Brown, C., Friedman, S., Newville, H., Safier, M., et al. (2008) Anxiety disorders in adults treated by hemodialysis: A single center study. American Journal of Kidney Diseases, 52, 128-136. Cukor, D., Coplan, J., Brown, C., Peterson, R. A. & Kimmel, P. L. (2008). Course of depression and anxiety diagnosis in patients treated with hemodialysis: A 16 month follow-up. Clinical Journal of the American Society of Nephrology, 3, 1752-1758. Daniel Cukor, PhD, is currently an assistant professor of psychiatry and behavioral sciences at SUNY Downstate Medical Center. He also serves as the associate director of the Cognitive Behavioral Treatment clinic and the Director of externship training. He lives in NJ with his wife and three small children.

Mental, Social, and Emotional Factors Associated With Economically Disadvantaged Adolescents' Violent/Aggressive Behavior Patterns: Students' Perspectives Veda E. Brown, PhD Prairie View A&M University Throughout many communities, the escalation of youth violence has not only challenged the delivery limits of juvenile justice systems, school systems, community groups, and others but has also compelled health and mental health professionals to reconsider traditional evidence-based approaches by integrating real-world treatment strategies (W oo & Keatinge, 2008). Despite the increase of research in this area, there seems to be little first-hand contextual reports of underlying mental, social, and emotional factors linked with violence among urban youth. Specifically, a careful analysis of adolescents' beliefs about contributing factors to youth behavior conduct problems opens a promising avenue of discovery for effective real-world treatment

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Veda E. Brown, PhD

OEMA COMMUNIQUĂ&#x2030; approaches. W ith this premise in mind, I was able to discover several interesting insights into middle school students' relevant viewpoints. First, based on preliminary findings from my study, middle school participants revealed suppressed anger and hostility in response to unsympathetic parental provocations. Adolescents who have been victims of violence learned to rely on violence as an effective problem-solving response (Landsberg, Spellman, & Alvarez-Canino, 1995). From the victim's point of view, early harsh and insensitive parenting practices may have begun a trajectory of aggressive behavior patterns that were constantly reinforced by authoritarian parental practicesâ&#x20AC;&#x201D; as is common in homes of disadvantaged African American children. In these environments, children often experience repeated corporal punishment, over-usage of discouraging and prohibiting words, inadequate opportunities for negotiations and very few encouragements and decision-making opportunities. Most of the children in my study believed that physical aggression could be ameliorated through increased opportunities for youth to make progressively complex decisions about things that impacted their behavior. Next, most of the adolescents in my study told us that suppressive authoritarian parents made them feel emotionally discontented and helpless while they wanted to be respected for their maturing decision-making skills. T heir reports indicated that parents often meted out harsh punishment unfairly, inconsistently, and such punishments seemed to override possible logical resolutions to problems. These reports were consistent with research findings that parents who controlled children's behavior by asserting power over them unconsciously reinforced self-regulatory deficiencies (Maccoby, 1992), persistent feelings of inadequacy, and pervasive violent response patterns. Interestingly, young adolescents in my study were able to identify an emerging pattern of self-debilitation that they attributed almost directly to the quality of parent-child interactions. "Interestingly, young adolescents in my study were able to identify an emerging pattern of self-debilitation that they attributed almost directly to the quality of parent-child interactions."

Finally, from the adolescents' perspectives, frustration, anger, and depression resulting from rigid inflexible parenting caused them to resort to violence as one means to reduce stress-induced debilitation. The cumulative effects of parent-child interactions characterized as mutually disrespectful, hostile, harsh, or

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES over-controlling contributed to broad range of childhood psychopathologies including learned helplessness, depression, and aggression. Children expressed an awareness of many other social factors that may have contributed to youth aggression, but the unique aspect of my study was their willingness to reflect on cultural contextual factors discussed in this report and to express how those factors may lead to intergenerational cycles of violence/aggression, substance abuse, and criminal activity. Based on the preliminary findings, the value of input from young adolescents in "â&#x20AC;Śthe value of input from young the integration of real-world mental adolescents in the integration of health treatment strategies for youth real-world mental health treatment violence is worth further investigation. strategies for youth violence is worth further investigation." For example, scientists should look closer at the relationship between techniques disadvantaged parents use in behavior modification and the level of violent behavioral outcomes exhibited by those children. Additionally, it would be interesting to note the extent to which corporal punishment shapes African American children's sense of self, problem-solving repertoires, and propensity for other childhood psychopathologies. References Landsberg, G., Spellman, M., & Alvarez-Canino, T. (1995, November 27). Violence begets violence. The New York Times. Maccoby, E. E. (1992). The role of parents in the socialization of children: An historical overview. Developmental Psychology, 28, 1006-1017 Woo, S. M., & Keatinge, C. (2008). Diagnosis and treatment of mental disorders across the lifespan. Hoboken, NJ: Wiley.

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OEMA COMMUNIQUĂ&#x2030; Obesity and Weight Concern Among Black Women Hearing Their Voices: Black Women in Mississippi Discuss Issues Related to Overweight and Obesity Safiya R. Omari, PhD Jackson State University The purpose of my APA ProDIGS funded pilot study was to investigate psychosocial correlates of obesity and overweight as they relate to body image and weight concern in Black females in M ississippi. This study was prompted by the alarming statistics about obesity rates in Mississippi overall ("fattest state" for 3 years in a row) and because of the association of obesity and overweight with significant health risk factors such as diabetes, cancer, cardiovascular disease, stroke and other major illnesses (Mississippi Department of Health, 2007). For example, compared to W hite women, Safiya R. Omari, PhD Black women have a higher incidence of hypertension, are at higher risk for strokes and suffer from excess stroke mortality, and have a 50 percent to 60 percent higher "â&#x20AC;Ścompared to White women, prevalence of diabetes (Rexrode & Black women have a higher Hennekens, 1997). For Black women, incidence of hypertension, are at however, other personal costs have been higher risk for strokes and suffer reported, including difficulty with from excess stroke mortality, and finding employment or economically have a 50 percent to 60 percent higher prevalence of diabetes." viable mates (Sonne-Holm & Sorensen, 1986). St. Jean and Feagin (1998) also posited that body size is one of several "double burdens" of the everyday racism that African American women must endure in American society. The focus groups conducted in this research allowed African American women in Mississippi to speak to their concerns about obesity, overweight, and body image.

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES Several prominent themes emerged from the participants' comments on body image and weight concern. The majority of women (67%) in the focus groups reported that they perceived themselves as overweight, and that they were concerned about being overweight. Although 100 percent of the sample reported "Although 100 percent of the sample understanding that exercise is reported understanding that exercise is a very a very important aspect of a important aspect of a healthy lifestyle, less healthy lifestyle, less than a than a third of participants reported third of participants reported exercising regularly. Role strain was the most exercising regularly. Role frequently given reason…" strain was the most frequently given reason as exemplified in the following statement from one of the participants:"… as Black women, we have too many roles. I think we're doing this and doing that ... We don't have time to go and exercise." W hen asked to discuss issues about Black culture and communities that promoted obesity and overweight in Black women, issues related to food preferences and food preparation emerged as themes. "When we get depressed, we go eat... comfort food. W hen we're happy, we go eat. W hen we're stressed, we go eat." This statement about the importance of food and its "…the importance of food and its centrality in the lives of this sample of centrality in the lives of this sample African American women is powerful of African American women is because it indicates how food is involved powerful because it indicates how across the emotional spectrum, from food is involved across the emotional spectrum, from depression to depression to happiness to stress. happiness to stress." Additionally, participants acknowledged that a cultural "tolerance" of obesity may inadvertently send the message that it is okay to be overweight. W hen asked to describe the physical characteristics of the ideal Black woman, the participants indicated that it was not necessarily a thin body as the ideal image, but a well-proportioned body. One participant stated, "The ideal body … thin waist, big thighs, big butt, and big breasts… it all has to be proportioned, well proportioned." Many of the participants felt that the charts and/or formulas that are used to determine overweight and obesity status were not based on Black women's body

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OEMA COMMUNIQUĂ&#x2030; types, and therefore should not be used as a standard to judge Black women's weight status. A key finding of interest in this study is that although African Americans tend to be more tolerant of larger body size than the dominant culture in general, this tolerance does not necessarily indicate that African American women do not feel that they are overweight, and does not indicate that they are not interested in losing weight. These findings also speak to the need for the development of culturally specific interventions that speak to the complexity of this issue in African American communities. References Mississippi Department of Health. Mississippi behavioral risk factor surveillance system: Annual prevalence report. Retrieved from http://www.msdh.state.ms.us/brfss/brfss2007ar.pdf Rexrode, K. M., & Hennekens, C. H. (1997). A prospective study of body mass index, weight change, and risk of stroke in women. Journal of the American Medical Association, 277, 1539-1545. Sonne-Holm, S., & Sorensen, T. I. A. (1986). Prospective study of attainment of social class of severely obese subjects in relation to parental social class, intelligence, and education. BMJ: British Medical Journal, 292, 596-599. St. Jean, Y., & Feagin, J. R. (1998). The family costs of white racism: The case of African American families. Journal of Comparative Family Studies, 29, 297-312. Safiya R. Omari, PhD, is Associate Professor of Social Work and Health Services and Director of the Southern Institute for Mental Health Advocacy, Research and Training at Jackson State University in Mississippi.

The Impact of Family Religious/Spiritual Beliefs on Enhancing Mental and Physical Health Outcomes Among African Americans With End-Stage Renal Disease: An Update Jocelyn Turner-Musa, PhD Morgan State University End-stage renal disease (ESRD), the stage of kidney impairment in which the kidneys have stopped functioning, disproportionately impacts African Americans. Religious and/or spiritual beliefs may play a role in coping with the illness. Research examining religiosity/spirituality and health outcomes has examined

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES "Research examining religiosity/ spirituality and health outcomes h as e x a m i n e d r elig io us experience at the individual level and has not sufficiently considered its role at the level of the family."

religious experience at the individual level and has not sufficiently considered its role at the level of the family. Because families play a significant role in illness management, discordance in religious beliefs or practices within a family may lead to poor outcomes for the patient. This has not been adequately explored.

Utilizing secondary data collected from a study of family process and structure on disease progression and survival in a prevalent sample of African Americans with ESRD, this study examined the extent to which religious beliefs aggregate within a family and how this relates to patient health outcomes. The sample consisted of 35 African American families with an adult member diagnosed with ESRD. Families were comprised of 3 to 4 members. Measures included demographic characteristics, psychological distress, illness severity questions, and a semi-structured interview designed to assess the family's religious/spiritual beliefs and experience in coping with ESRD in a member. Descriptive analyses from the interview suggest that families share a belief in: The illness as a source of strength (73%), having a personal relationship with God (77%), and being involved in a religious community (54%). Chi square analyses suggest that there is an association between shared family perceptions and some patient outcomes. A greater proportion of patients in families who share a belief that the illness is a source of strength for their family have low illness Jocelyn Turner-Musa, PhD severity scores, Chi square = 7.0 (1), p < .05. A greater proportion of patients in families who share a belief that church attendance has increased since illness onset have lower symptoms of psychological distress, Chi square = 6.0(1), p<.01. A content analysis of the transcribed interviews also was conducted. Findings suggest a need to better understand patient/family knowledge of kidney disease and specific stressors associated with it. Several patients also indicated that they believe the illness could have been prevented if their primary care physician provided them with sufficient tests to determine if they had poor kidney functioning. Others

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OEMA COMMUNIQUĂ&#x2030; believed that African Americans might need to be educated about kidney disease, treatment, and organ donation. This point was supported by data from a focus group held with research coders. Coders said they did not realize the impact that ESRD has on African Americans and felt that this needs to be addressed with young African Americans. Given this, a preliminary focus group designed to understand college student knowledge of kidney disease and interest in kidney disease education programs was conducted. Most students (n = 12) had some knowledge about kidney disease, did not know it disproportionately affects African Americans, and were interested in educational programs about kidney disease. Current plans are to expand the study to develop an educational intervention with an emphasis on kidney disease prevention targeting African American college students. Jocelyn Turner-Musa, PhD, received her doctoral degree in Social Psychology from Howard University in 1994 and completed a post-doctoral fellowship in mental health services research at Johns Hopkins University Bloomberg School of Public Health (1998 - 2000). Dr. Turner-Musa is currently an Associate Professor in the Department of Psychology at Morgan State University and has recently served as principal investigator of an NIMH funded undergraduate mental health education program in prevention research. Dr. Turner-Musa's primary research interests are in psychosocial factors implicated in disease prevention. She has several publications in the area of African Americans and health and has received numerous awards, including an American Fellow award from the American Association of University Women.

Project SMART (Supporting Minority Adolescent Research Training): A Needs Assessment to Inform a Behaviorally Focused Health Disparities Research Program for Racial and Ethnic Minority High School Students Scyatta A. W allace, PhD St. John's University Mary Jane Ojie, MA Disparities continue to persist in the health status of US racial and ethnic minority populations (NCHS, 2007). Psychologists are well suited to contribute to eliminating health disparities given their expertise in understanding psychological factors that influence health disparities and their knowledge of how to effect behavior change. Racial and ethnic minority psychologists are uniquely poised to

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES help identify cultural factors associated with health disparities (IOM, 2004). Unfortunately, according to the American Psychological Association (2002), racial and ethnic minority populations are underrepresented at all educational levels in psychology (i.e., undergraduate, masters, doctoral). M ethod The goal of Project SMART is to develop a curriculum to expose racial and ethnic minority high school students to behavioral careers in health research. The APA OEM A ProDIGS grant funded Project SMART to conduct a needs assessment to inform the curriculum. Project SMART interviewed staff from existing pipeline programs for lessons learned and curriculum suggestions. In addition, a survey was conducted with racial and ethnic minority high school students who were participants in a health and science focused pipeline program in New York City.

Scyatta A. Wallace, PhD

Results Interviews with staff of ten health and science pipeline programs geared towards high school students revealed that most programs do not focus on behavioral health research. There was a great deal of interest in this type of curriculum but the staff did not feel properly trained to provide such a program to their students. Our survey included responses from 96 racial and ethnic minority high school students attending a health and science pipeline program. Results indicated that students were interested in learning more about and possibly pursuing careers in behavioral health research, but lack information about the field. Findings from the survey also showed that most students learn about careers from teachers and the internet. Teachers may not be able to adequately inform students about careers in behavioral health because it is not their field of expertise, and the internet has a lot of unorganized information that is difficult to filter through without guidance. Conclusion There is a dearth of information that racial and ethnic minority high school students have about behavioral health research careers. Psychologists and other behavioral health professionals are encouraged to provide education about our careers to this

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OEMA COMMUNIQUÉ population since we have the most accurate, comprehensive, and updated information about the field. A curriculum to encourage racial and ethnic minority high school students to pursue "A curriculum to encourage behavioral health careers may be a valuable racial and ethnic minority high school students to pursue long term strategy for addressing health behavioral health careers may disparities in our nation. Our needs assessment be a valuable long term strategy highlighted an interest in such a curriculum to addressing health disparities from both existing health and science focused in our nation." pipeline program staff and students. W e will be using the results of the needs assessment as the basis for a grant proposal geared towards curriculum development of the Project SMART program. References American Psychological Association, (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Washington, DC: Author. Institute of Medicine, (2004). In the nation's compelling interest: Ensuring diversity in the health care workforce. Washington DC: The National Academies Press. National Center for Health Care Statistics, (2007). Health United States, 2007: With chart book on trends in the health of Americans. Hyattsville, MD: DHHS. Scyatta A. Wallace, PhD, is an Associate Professor of Psychology at St. John’s University. Dr. Wallace’s research focuses on the influence of neighborhood context and social norms on HIV risk among urban Black youth. Her work also includes the design and implementation of culturally-tailored interventions to promote health and health care utilization among Black youth. In addition, she is interested in the promotion of community consultation as a tool for addressing ethical concerns in behavioral and mental health research with vulnerable populations.

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES Posttraumatic Stress and Risky Sexual Behaviors among African American Women Jeffrey L. Kibler, PhD Center for Psychological Studies, Nova Southeastern University Mindy Ma, PhD Katherine M. Dollar, PhD Charnette D. Munroe, PhD The increasing rate of HIV/AIDS among African American women in the United States represents a significant public health problem (Center for Disease Control [CDC], 2003a, 2003b). African American women represent the fastest growing demographic group with regard to new HIV cases (CDC, 2003a). The majority of HIV+ African American women contract HIV through heterosexual contact (CDC, 2003a, 2003b). Therefore, examination of behavioral and psychological factors that contribute to sexual Jeffrey L. Kibler, PhD risk behavior in this population is warranted. Posttraumatic stress disorder (PTSD) symptoms may be associated with high-risk sexual behavior (Hutton et al., 2001; Rosenberg et al., 2001). However, the study of sexual behavior in PTSD is typically limited to cases of sexual abuse, and the role of alcohol use in this relationship remains unclear. M ethod In the present project, we assessed the association between PTSD symptoms [measured with the PTSD Checklist (PCL) - Civilian Version] and sexual risk behaviors, as well as the potential mediating roles of perceived control over own sexual behavior (Perceived Sexual Control scale), sexual sensation-seeking (Sexual Sensation Seeking scale), and compulsive sexual behavior (Sexual Compulsivity Scale). Analyses were conducted for 30 African American undergraduate women (M Âą SD age = 23 Âą 6) with history of sexual intercourse. Family income was generally low (57% < $20,000).

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OEMA COMMUNIQUÉ Results Posttraumatic stress symptom scores on the PCL (M ± SD = 39 ± 19) were associated with number of lifetime sexual partners (r = .41, p < .05), frequency of vaginal sex without a condom (r = .33, p = .08), and whether participants reported sex while under the influence of a substance (past 3 mos.) (F = 5.09, p < .05). The PCL was significantly correlated with perceived sexual control (r = -.39, p < .05), but not sexual impulsivity or sexual sensation-seeking. Sexual control was significantly correlated with frequency of vaginal sex without a condom (r = -.54, p < .01) but not number of sexual partners. W hen statistically controlling for the correlations of sexual control with PTSD symptoms on the PCL and unprotected sex, the PCL/unprotected sex correlation no longer approached significance (r = .15). Statistically controlling for the relationship between sexual control and sex while under the influence of a substance (using stepwise discriminant function analysis), revealed that PTSD symptoms on the PCL did not significantly predict sex under the influence of a substance after controlling for sexual control (F = 31.79, p < .001). Discussion These findings suggest posttraumatic stress is positively associated with sexual risk "Identifying the roles of PTSD among African American women, and that symptoms and alcohol use perception of sexual control is a key patterns in the sexual risk mediating variable. In other words, taking behaviors of African-American into account the level of perceived sexual women has implications for treatments designed to reduce control helps to explain relationships of the risk of HIV/AIDS among PTSD symptoms with sexual risks. high-risk trauma survivors." Identifying the roles of PTSD symptoms and alcohol use patterns in the sexual risk behaviors of African-American women has implications for treatments designed to reduce the risk of HIV/AIDS among high-risk trauma survivors. W hile interventions have been developed for women recovering form trauma to address emotional and behavioral dysregulation, treatments have not been developed to specifically address the use of alcohol and its relationship to sexual judgment and practices. Results of the proposed research will assist in the development of interventions to address these issues.

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EMERGENT PSYCHOLOGICAL RESEARCH ON HEALTH DISPARITIES References Center for Disease Control. (2003a). HIV/AIDS among African Americans. [On-line]. Available: www.cdc.gov/hiv/pubs/facts/afam.htm Center for Disease Control. (2003b). HIV/AIDS among US women: Minority and young women at continuing risk. [On-line]. Available: www.cdc.gov/hiv/pubs/facts/women.htm Hutton, H. E., Treisman, G. J., Hunt, W. R., Fishman, M., Kendig, N., Swetz, A., et al. (2001). HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners. Psychiatric Services, 52, 508-513. Rosenberg, S. D., Trumbetta, S. L., Mueser, K.T., Goodman, L. A., Osher, F. C, Vidaver, R. M., et al. (2001). Determinants of risk behavior for human Immunodeficiency virus/acquired immunodeficiency syndrome in people with severe mental illness. Comprehensive Psychiatry, 42, 263-271. Jeffrey L. Kibler, PhD, is an Associate Professor and the Director, Biofeedback and Health Psychology Center, Center for Psychological Studies at Nova Southeastern University.

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FOR YOUR INFORMATION… administrator at ati@apa.org or (202) 336-6000.

Research & Training Issues Scholarships, Fellowships, Grants, and Institutes

2009 Summer Institute in Political Psychology

APA Science Directorate Advanced Training Institutes for 2009

Stanford University will host the 2009 Summer Institute in Political Psychology (SIPP) this coming summer. Directed by Stanford Professor Jon Krosnick, SIPP is a three-week intensive training program introducing graduate students and professionals to the world of political psychology scholarship. The training experience is designed to: 1) provide broad exposure to theories, empirical findings, and research traditions; 2) illustrate successful cross-disciplinary research and integration; 3) enhance methodological pluralism; and 4) strengthen institutional networks. On-line applications are currently being accepted. For more information, please visit the SIPP web site at: www.stanford.edu/group/sipp.

The APA Science Directorate is pleased to sponsor four Advanced Training Institutes in the summer of 2009. These intensive training programs are hosted each summer at major research institutions across the country. ATIs expose advanced graduate students, post-doctoral fellows, new and established faculty, and other researchers to state-of-the-art research methods and emerging technologies. A list of this year's programs is included below. Complete information about these exciting programs can be viewed at: http://www.apa.org/science/ati.html. • Non-Lin ear Methods for Psychological Science (June 8-12, Univ. of Cincinnati) • Research Methods with Diverse Racial & Ethnic Groups (June 22-26, Michigan State Univ.) • Structural Equation Modeling in Longitudinal Research (June 29-July 1, Univ. of Virginia) • Exploratory Data Mining in Behavioral Research (July 20-24, Univ. of Southern California) Application deadlines begin in March. Applications are available at http://www.apa.org/science/ati.html and must be submitted electronically through each program's web page. Tuition for all ATIs is substantially lower than for other similar summer academic programs. For more information, contact the ATI

Asian American Center for Disparities Research Postdoctoral Internship The Asian American Center on Disparities Research (an advanced center for mental health disparities research funded by the National Institute of Mental Health) is seeking doctoral level clinicians who are interested in participating in the first randomized effectiveness trial of cognitivebehavioral therapy with Chinese American clients with major depression. This work is part of the Clinical Effectiveness Research Program of the Center and is directed by Drs. Gordon Nagayama Hall and Nolan Zane. Interns will be able to accrue supervised clinical

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FOR YOUR INFORMATIONâ&#x20AC;Ś hours towards licensure and have the opportunity to be trained in formal Cognitive Behavioral Therapy. After formal training, interns will provide clinical care to clients at one of the participating mental health clinics in the San Francisco Bay Area and will receive supervision by licensed psychologists. A doctoral degree in psychology and eligibility for licensure are required. Cantonese language proficiency is desirable, but not required. Applicants should send a cover letter, vita, summary of professional and research interests, and the names of three references to Oanh Meyer, University of California, Davis, Department of Psychology, One Shields Avenue, Davis, CA 95616. Please contact Ms. Meyer [olmeyer@ucdavis.edu, 530-752-7686] concerning any questions about the position.

1) The BMRC Short-Term Fellowship Program in African-American Studies supports scholars, professional artists, and writers who wish to conduct research in BMRC member institutions' collections relating to African-American and African diasporic culture, history, and politics. The fellowship period is for one or two months during the summer of 2009. Fellows will receive a stipend of $3,000 per month while conducting research in Chicago. Qualified scholars, composers, media artists, musicians, visual artists, and writers are encouraged to apply. 2) The BMRC is also administering the Timuel D. Black, Jr. Short-Term Fellowship in African-American Studies. The Timuel D. Black, Jr. Fund, a standing committee of the Vivian G. Harsh Society, Inc., is providing short-term research fellowships related to the Vivian G. Harsh Research Collection of Afro-American History and Literature housed at the Carter G. Woodson Regional Library of the Chicago Public Library. The fellowship program supports scholars, writers, educators, and institutional researchers who would benefit from research conducted at the Vivian G. Harsh Collection. The fellowship period is for one or two months during the summer of 2009. Fellows will receive a stipend of $2,000 per month while conducting research in Chicago. For more information on how to apply, visit the BMRC Web site: http://www.blackmetropolisresearch. org/. To see the complete RFP, log onto: http://www.blackmetropolisresearch. org/shortTerm.html.

Black Metropolis Research Consortium Offers Research Funding for Scholars The Black Metropolis Research Consortium, an unincorporated Chicago-based association of libraries, universities, and other archival institutions whose mission is to make broadly accessible members' holdings of materials that document African-American and African diasporic culture, history, and politics, with a focus on materials relating to Chicago. The University of Chicago serves as the BMRC's host institution. The Black Metropolis Research Consortium is accepting applications for two fellowship programs:

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OEMA COMMUNIQUÉ 2009 CHADD Young Scientist Research Fund Awards

The Chicago School Fellowship in Academic Community Leadership Post-Doctoral Fellowship Position Announcement 2009 – 2010

Children and Adults with Attention Deficit/Hyperactivity/CHADD is now taking applications for its Young Scientist Research Fund Awards, a program to recognize young researchers making c o n t r i b u t i o n s to th e understanding of AD/HD. Through the Fund, CHADD will support three researchers with: 1) an unrestricted cash award of $5,000 each; (2) paid travel and hotel expenses, registration and a meal allowance to the 2008 20th Annual CHADD International Conference, where they will be recognized; and, (3) a one-year CHADD professional membership. Applicants must be in the process of completing a doctoral degree or must have completed such a degree within the last three years. Research may address any area relevant to AD/HD including, but not limited to: • biological/genetic underpinnings of the disorder; • treatment efficacy; • impact on the individual or family; • school or workplace accommodations; • social stigma and discrimination; • public health; • epidemiology. Deadline for applications is April 8, 2009. For an application or for more information, go to: www.chadd.org/youngscientist.

The Chicago School of Professional Psychology partners with local, community service agencies to sponsor a one-year, full-time post-doctoral training program in academic and community leadership. The post-doctoral fellowship program aims to develop leaders in the field who are both clinically skilled as well as prepared for leadership and administrative roles in an academic or community setting. The fellowship program is seeking six to ten Post-Doctoral Fellows, interested in developing their clinical skills, community-based leadership capabilities, and higher education administrative experience. These are one-year, full-time positions that meet licensure requirements. Fellows complete two, half-time, full-year rotations, one in an administrative placement at The Chicago School and one in a community partner clinical placement. Applicants must have completed their doctoral degree from an APA-accredited program. The program is highly competitive, and the position requires solid clinical , ad ministrative, organizational, and communication skills. Fellows must demonstrate the ability to serve as an excellent representative of the school and their clinical agencies to the community and as a mentor and supervisor to students. Successful candidates must have strong clinical training experiences and academic histories. Both The Chicago School and its community partners have

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FOR YOUR INFORMATIONâ&#x20AC;Ś received recognition for their commitment to diversity and multicultural education. Therefore, candidates must have an appreciation and enthusiasm for this aspect; ideally they bring expertise and background in this area. Applicants bilingual in Spanish are strongly encouraged to apply.

http://www.ncrece.org/wordpress/produ cts/research-mentoring-program-for-mi nority-scholars/.

For questions or additional information, please contact: Hector Torres, PhD, CLMH Coordinator/Assistant Professor The Chicago School of Professional Psychology; (312) 467-8604.

Positions will open as of July 2009 in a NIMH-funded institutional research training program at the HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute. Our program is an innovative research fellowship in human sexuality as applied to HIV-related risk, health and prevention.

Postdoctoral Research Fellowship in Behavioral Sciences Research in HIV Infection

Call for Applications for the NCRECE Research Mentoring Program for Minority Scholars

The HIV Center is a large interdisciplinary research program on behavioral aspects of HIV (and other sexually transmitted infections) with a special emphasis on sexuality and gender. Among the many ongoing projects are studies on the determinants and contexts of sexual behavior in various adolescent and adult populations, on the prevention of sexual risk behavior, and on HIV treatment adherence. Both qualitative/ ethnographic and quantitative methodologies are being applied.

The National Center for Research on Early Childhood Education (NCRECE) is sponsoring a fellowship program in 2009-2010 for research training and publication for up to five teaching or research faculty or postdoctoral researchers from underrepresented groups. The focus of the program is on secondary analysis of existing data sets that can be used to address issues of importance in the field of education, applied developmental psychology, child development, and related fields, with an emphasis on early childhood education. One of the Center's current foci of research is English language learning (available data sets include a large number of Spanish-speaking English Language learners); therefore applicants with interests in that area are especially encourage to apply. See the NCRECE web site for application information

Best suited for these positions are applicants with interdisciplinary research interests and appropriate research training in psychology or related behavioral and social sciences. The program also accepts applications from persons with medical training. Applicants must have obtained their doctoral degree (PhD, MD or other) by the time of their appointment.

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OEMA COMMUNIQUĂ&#x2030; Trainees receive up to three years of support for stipends, health insurance, travel for conferences, and research. Applicants must be U.S. citizens or permanent residents. Persons with an ethnic minority background are strongly encourage to apply.

A good grounding in CBT/parent training with children/adolescents and their families, exposure to vulnerable and underserved populations, and familiarity with applied research in developmental psycho-pathology, is encouraged. Candidates for this T-32 fellowship also must be U.S. citizens.

Information about the program and a downloadable application form are available on the internet at: http://www.hivcenternyc.org/training/n rsa.html.

For preliminary discussions: Please contact David J. Kolko, PhD, Professor of Psychiatry, Psychology, and Pediatrics (412-246-5888; Kolkodj@upmc.edu).

Postdoctoral Research Fellowship in T reatmen t Disse mi n a ti o n a n d Implementation Research with Children/Youth

SAMHSA is now accepting applications for its Campus Suicide Prevention grants for the 2009 fiscal year. http://www.samhsa.gov/grants/2009/sm _09_001.aspx.

In the context of a post-doctoral research fellowship in the Division of Child and Adolescent Psychiatry at the University of Pittsburgh School of Medicine/Western Psychiatric Institute and Clinic (NIMH T-32), candidates are sought for a program that specializes in translational research at the university and community (efficacy-effectiveness) interface. The program provides specialized training to clinicalresearchers who wish to acquire the skills necessary to design and conduct treatment dissemination/ implementation trials in "real-world" settings.

The National Cancer Institute Postdoctoral Fellowship in Health Behavior Theory The National Cancer Institute (NCI), the largest Institute at the National Institutes of Health (NIH), invites applications from qualified candidates for a one to five-year post-doctoral position in the area of health behavior theory. The Cancer Research Training Award (CRTA) Fellowship is a full-time position within the Basic and Biobehavioral Research Branch of the Behavioral Research Program in the Division of Cancer Control and Population Sciences (DCCPS) at the National Cancer Institute and will be based in their Rockville, Maryland office. The fellow will function as a member of the Behavioral Research

Individuals with a PhD in psychology (clinical/quantitative preferred) from an APA-accredited program who have an interest in addressing the efficacyeffectiveness continuum, potential for excellence in scholarship/academic research, and the ability to work creatively and collaboratively are sought.

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FOR YOUR INFORMATIONâ&#x20AC;Ś Program and work with scientists on projects aimed at advancing the development, use and testing of health behavior theory in basic and applied cancer prevention and control research.

research and encourage student involvement in health disparities research training at early levels of the educational pipeline. Small grants ($5000 to $6500) will be awarded to support activities associated with the preparation of an initial research or program/curriculum development application for federal or foundation funding. All program/curriculum development applications must incorporate provisions for student research training and whenever possible, research training applications should include student researchers. All applicants are required to submit a detailed concept paper at least 2 to 4 pages in length.

Recruitment for this position is currently open and will end once position is filled. Please send inquiries or application materials by electronic mail only directly to Kara L. Hall, PhD at hallka@mail.nih.gov. See the following Web site for previous and ongoing examples of theory-related projects: http://cancercontrol.cancer.gov/brp/the ories_project/index.html. For more information visit http://cancercontrol.cancer.gov/brp/abo ut/docs/hbt_postdoc_nih.pdf and http://dccps.nci.nih.gov/brp/.

Awardees are expected to attend a mandatory 5 to 7 day professional development institute in Washington, DC during the summer of 2009 and to submit a funding application to a federal agency or private foundation within 24 months after the award is made. Submission deadline: March 20, 2009. The complete RFP can be found at: http://www.apa.org/pi/oema/prodigs-20 09-rfp.pdf. Questions should be directed to Sonja Preston in the Office of Ethnic Minority Affairs (OEMA) at 202-336-6029 spreston@apa.org.

Request for Proposals (RFP): Promoting Psychological Research and Training on Health Disparities Issues at Ethnic Minority Serving Institutions (ProDIGs) Funded by APA's Science Directorate' s "Academic Enhancement Initiative," administered by the Public Interest Directorate's Office of Ethnic Minority Affairs (OEMA) in collaboration with the APA Minority Fellowship Program, the ProDIGS grants will be awarded to early career faculty for specific, limited, and highly focused activities that are both preliminary and related to the preparation of a federal or foundation funding proposal, and able to be fully implemented during a 12 to 18 month period. The ProDIGS project seeks to increase the capacity of ethnic minority serving postsecondary institutions and faculty to engage in health disparities

The Robert Wood Johnson Foundation Investigator Awards in Health Policy Research Program The Robert Wood Johnson Foundation requests for applications for its Investigator Awards in Health Policy Research program, which is designed to support scholars from a range of fields

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OEMA COMMUNIQUÉ who have innovative projects that can enhance policy to improve health or health care in the U.S. The program, which provides grants of up to $335,000 for policy-relevant projects of 2-4 years’ duration, is not intended to support a discrete research project but rather to allow a scholar to devote considerable time to a project of greater scope than the usual RO1 grant. The program also offers an unrivaled opportunity to meet and often collaborate with outstanding scholars in fields including medicine, economics, political science, sociology, psychology, law, epidemiology, history, nursing, public health, and journalism among others. The Call for Applications, tips for applicants, and samples of past successful letters of intent are posted on the RWJF website at: www.investigatorawards.org/applicatio ns/. The deadline for receipt of 4-page letters of intent is March 25, 2009.

professionals in fields such as organizational behavior, international relations, and public communication are also welcome. Our maximum enrollment will be 60 participants. For additional information visit: http://www.stanford.edu/group/sipp/.

Two NIMH-Funded Postdoctoral Fellowships in Stress and Trauma Clinical Research The National Center for Posttraumatic Stress Disorder (PTSD) at the VA Boston Healthcare System is recruiting two individuals for our NIMH-funded postdoctoral fellowship program. These positions would start September, 2009. The fellowships have a two-year term and primarily aim to train clinical psychologists in the scientific study of stress, trauma, and PTSD. The postdoctoral program provides opportunity for supervised clinical activities and mentored professional development in addition to research. Postdoctoral fellows will work at the two Boston divisions of the National Center (Behavioral Science and Women’s Health Sciences). These positions have typically been of interest to individuals seeking academically-oriented careers in university or medical center settings. In addition to the NIMH postdoctoral program, we have numerous other postdoctoral training positions that will also be available. Our training staff would be happy to meet with interested individuals during the upcoming APA convention. If you are interested in

Stanford University 2009 Summer Institute in Political Psychology The 2009 Summer Institute in Political Psychology (SIPP) is a three-week intensive training program that introduces graduate students, faculty members, and professionals to the world of political psychology scholarship. The curriculum is designed to accomplish one preeminent goal: to produce skilled, creative, and effective scholarly researchers who will do more and better work in political psychology as the result of their attendance at SIPP. The Summer Institute primarily serves graduate students in political science, psychology, sociology, and related social science disciplines. Government and private

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FOR YOUR INFORMATION… arranging a meeting or would like additional information please contact Dr. Denise Sloan at Denise.Sloan@va.gov.

Call for Papers Call for Papers: Diversity in Health and Care Volume 6 (2009) Papers are invited which address any or all of the following topics: • The equitable provision of health care and services for members of diverse social groups and settings in all countries in the world; • Papers on the themes of race, culture and ethnicity, sexual orientation, gender, migrants, carers, disabilities (including physical, communication and learning), spirituality and underserved or marginalised populations. • Papers may present qualitative or quantitative research, put forward arguments for debate or discuss educational matters. Papers which address multi-professional perspectives and attention to the views of service users and carers, and papers exploring the international dimensions of diversity across and within cultures are particularly encouraged. Please send all contributions via email to the editors: Professor Paula McGee, Faculty of Health, Birmingham City paula.mcgee@bcu.ac.uk:.

United States Institute of Peace Jennings Randolph Senior Fellowship The United States Institute of Peace (USIP) is an independent, nonpartisan, national institution established and funded by the U.S. Congress. The goals of the USIP are to help prevent and resolve violent international conflicts; promote post-conflict stability and development; and to increase conflict management capacity, tools, and intellectual capital worldwide. One way the USIP meets those goals is through the Jennings Randolph Program for International Peace, which awards Senior Fellowships to outstanding scholars, policymakers, journalists, and other professionals from around the world to conduct research at the USIP. The Fellowship Program began in 1987, and 253 Fellowships have been awarded through 2007. For more information visit: http://books.nap.edu/catalog.php?recor d_id=12547&utm_medium=etmail&ut m_source=National%20Academies%20 Press&utm_campaign=New+from+NA P+12.23.08&utm_content=Downloader &utm_term=

Call for Proposals 3rd Annual Conference for the Society for Humanistic Psychology The Third Annual Humanistic Psychotherapies Conference will be held on the campus of The University of the Rockies in Colorado Springs, CO, October 8-11, 2009. Proposals for

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OEMA COMMUNIQUÉ presentations, symposiums, papers, and posters are requested. This year’s conference will include an experiential track, a research/theory track, and two open tracks. Additionally, this year will be including an additional track during 1 or 2 days of the conference that will feature presentations on leadership, organizational leadership, an d consulting. We hope to have a strong student representation at the conference and students are particularly encouraged to submit poster presentations.

in 2000 at Boston College, under the direction of Dr. Janet E. Helms, to promote the assets and address the societal conflicts associated with race and culture in theory and research, mental health practice, education, business, and society at large. Each year the Institute addresses a racial or cultural issue that could benefit from a pragmatic, scholarly, or grassroots focus through its Diversity Challenge conference. The theme of Diversity Challenge 2009 is Racial Identity and Cultural Factors in Treatment, Research, and Policy. The conference will be held October 23–24, 2009 at Boston College. The proposal submission deadline is April 17, 2009. For more information visit: http://www.bc.edu/schools/lsoe/isprc/d c.html.

Please direct any inquiries about the conference to: Louis Hoffman (louis.hoffman@rockies.edu; subject line Humanistic Conference); Brent Dean Robbins (brobbins@pointpark.edu). Conference Proposals can be submitted through one of the following web sites: http://www. d 3 2 co n feren ce.co m/; http://www.rockies.edu. Special Student Information: In order to make the conference more affordable to students, we are working to set up free student lodging. If you are interested in this, please co n t ac t M at t Th elen (mlthelen@yahoo.com).

Call for Proposals: Interactive Sessions, Symposia, & Poster Sessions—Asian American Psychological Association 2009 Annual Convention The Asian American Psychological Association (AAPA) invites submissions of proposals for the AAPA 2009 Annual Convention to be held in Toronto, Canada on Wednesday, August 5th, 2009 addressing the theme "Strengthening Our Diverse Families and Communities in Times of Change." AAPA members at all levels of training (professional, graduate level, and undergraduate level), including non-psychologists, interested in psychological issues affecting Asian Americans are encouraged to submit proposals. Undergraduate proposals are encouraged. Non-AAPA members at all

Call for Proposals: The 9th Annual Diversity Challenge: Racial Identity and Cultural Factors in Treatment, Research, and Policy The Institute for the Study and Promotion of Race and Culture at Boston College invites proposals for the Institute's ninth annual national conference in Boston, a city known for its struggles and efforts to address issues of racial and ethnic cultural diversity in U.S. society. The Institute was founded

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FOR YOUR INFORMATION… levels may also submit proposals. All presenters are required to officially register for the convention. Deadline for all submissions is March 16, 2009. All submissions will be online at: http://forms.apa.org/aapa. For additional information visit the AAPA convention page at: http://www.aapaonline.org/conventions /conventions.shtml.

individual or community level interventions with refugees and IDPs. This request for papers is for empirical research and papers that discuss or evaluate interventions, programs, and policies for refugees and IDPs worldwide including, but not limited to the following topics: Broad Topic Areas • Definitions, designations, and data on refugees and IDPs • Theoretical frameworks • Psychosocial wellbeing of refugees and IDPs • Consequences of lives in limbo, i.e. warehousing • Integration of refugees in countries of first asylum or resettlement countries • Refugee and IDP repatriation and the right of return

Call for Papers: Journal of Muslim Mental Health—Special Issue on Refugees and Forced Migrants Issue Co-editors: Fariyal Ross-Sheriff, PhD, Altaf Husain, PhD, M. Taqi Tirmazi, PhD According to the United Nations High Commissioner for Refugees (UNHCR), there are 67 million forcibly displaced persons worldwide, of whom 16 million are refugees and the remaining 51 million are internally displaced persons (IDPs) as a result of conflicts and natural disasters (UNHCR, June 2008). Being forcibly uprooted from one's homeland poses tremendous and complex hardships on multiple levels to these men, women and children.

Additionally, articles related to this theme are requested for the regular Journal sections: • Case studies: clinical case studies following the DSM-IV Cultural Formulations format, especially relevant for clinicians • Faith-based practice: articles exploring the role of faith in the lives of refugees, as well as the interface between spirituality and practice with refugees, especially relevant for religious leaders • Book reviews

The purpose of this thematic issue is to generate refugee-centered scholarship on theory development, research, education, practice, program development and policymaking. JMMH seeks empirical and conceptual articles related to forced migration of refugees and IDPs in their own countries, countries of first asylum, or in resettlement countries. There is a need for research reports as well as documentation on practice based

The Journal of Muslim Mental Health (JMMH) is an interdisciplinary refereed journal providing an academic forum for the exploration of social, cultural, historical, theological, medical, and

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OEMA COMMUNIQUĂ&#x2030; psychological factors affecting the mental health of Muslims globally. Information about the Journal can be found at: http://www.tandf.co.uk/journals/titles/1 5564908.asp.

mediate health compromising behaviors, community- engaged research that creates tangible products or directly translational results, or other prevention practice and research projects developed with and for communities. Community involvement in the preparation of articles is required for publication in the International Journal of Prevention Practice and Research.

Interested authors should submit a 1-2 page abstract by February 1, 2009 to Dr. Ross-Sheriff at fross-sheriff@howard.edu. Please submit electronic versions of the abstracts as an e-mail attachment.

For more information on the journal, visit: http://www.gocpub.org/International-Jo urnal-of-Prevention-Practice-and-Resea rch.php. To register as a reviewer, log onto: http://www.gocpub.org/ojs/index.php/ij ppr/user/register.

The deadline for full-length papers will be March 31, 2009. Manuscripts should be written according the guidelines of the Publication Manual of the American Psychological Association (5th edition). Papers will be peer-reviewed following the policies of the Journal.

Call for Papers: Rethinking the Mangrove: Second Symposium of Critical Practices in Caribbean Cultural Studies

Inquiries may be sent to Fariyal Ross-Sheriff, PhD, School of Social Work, Howard University, 601 Howard Place, NW, Washington, DC 20059, (fross-sheriff@howard.edu). . Limited inquires may also be sent to Dr. Husain (ahusain@howard.edu) or Dr. Tirmazi (taqi12@yahoo.com).

"Rethinking the Mangrove" is an invitation to reconceptualize Caribbeanness beyond the limitations of nation, language and culture, focusing on the crosscurrents that traverse the multiple and overlapping spaces and subjectivities of the Caribbean. The roots of the mangrove, which hang above the water, evoke a Caribbean alternative to an ethno-linguistically monolithic ideal of identity symbolized by the terrestrial root. This conference solicits papers and panels in English, Spanish and French from across humanistic and scientific disciplines that explore notions of "Caribbeanness," "Antillanismo" or "AntillanitĂŠ" or any of its many aspects. The conference will be held October

Reviewers and Manuscripts Sought for New Journal The International Journal of Prevention Practice and Research is a peer-reviewed journal that publishes high quality articles reporting the development and results of community-driven prevention programs, i n n o va t i v e co mmu n i t y / c a mp u s partnerships that seek to prevent or

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FOR YOUR INFORMATION… 15–17, 2009 at the University of Puerto Rico–Mayagüez.

Call for Nom inations and Awards APA Committee on Ethnic Minority Affairs Seeks Two New Members

Papers and panel proposals in the following areas are invited: • Cultural theory of the anglophone, francophone and hispanophone Caribbean • Caribb ean anthropologies, histories and/or literatures • Gender and sexuality in Caribbean cultural studies • Caribbean diasporas and migrations • Cultural policies in the Caribbean • Caribbean popular culture • Ecologies of the Caribbean archipelago • (Post)foundational voices of Caribbean cultural studies • (Counter)national discourses of the Caribbean • Colonialism, neocolonialism and postcolonialism in the Caribbean • Caribbean integration initiatives (political, economic, cultural) • Atlantic studies and the Caribbean • Discourses of race in the Caribbean • Historical legacies of slavery in the Caribbean • Afrodiasporic cultures and identities in the Caribbean • Transcaribbean cultural expression • Latin American/Latino cultures and the Caribbean • Visual arts in the Caribbean

The Committee on Ethnic Minority Affairs (CEMA) is seeking nominations for two new members to begin three-year terms on January 1, 2010. The committee functions as a catalyst for action on ethnic-minority issues and concerns by in teracting with and ma ki n g recommendations to the various components of APA's governing structure, membership and other groups. Committee members plan, develop and coordinate activities related to advocacy and promoting an understanding of the cultures and psychological well-being of ethnic-minority populations, monitoring and assessing institutional barriers to equal access to psychological services and research, and ensuring equitable ethnic/racial representation in the psychology profession. To fulfill its mandate for ethnic representation and its commitment to gender equity, the two vacant slates are for Asian American/Pacific Islander female and male psychologists. CEMA also welcomes nominations from candidates who possess knowledge and expertise of other diverse populations (such as, disability, early career, national origin, sexual orientation, etc.). CEMA members must participate in no less than two committee meetings a year. No more than two meetings will be convened at APA headquarters in Washington, DC. Members also work on CEMA priorities when necessary between meetings. If possible, CEMA members attend the APA annual convention at their own expense to participate in CEMA

To submit paper or panel proposals visit http://academic.uprm.edu/manglar/. Please send proposals by March 31, 2009. Queries may be addressed to mangroveuprm@gmail.com.

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OEMA COMMUNIQUĂ&#x2030; convention programming. Nomination materials should include the nominee's qualifications (including a statement of relevant experience), a curriculum vita and a letter of interest. Self-nominations are encouraged. Nominations and supporting materials should be sent no later than Sept. 5, to the APA Office of Ethnic Minority Affairs at the APA address.

through a masked review process of applicants' abstracts. Criteria include impact on ethnic-minority populations; completeness and clarity; creativity; and effectiveness of the research design. The subcommittee will choose semifinalists, who will be required to submit copies of their dissertations for the final selection process. The winner receives $500 and a $300 travel award sponsored by APA's Science Directorate, and will be invited to briefly present her or his dissertation at the APA's 2009 annual convention, August 6 -9, in Toronto, Ontario, Canada. Non-APA member/student affiliate applicants will b e required to be an AP A member/student affiliate prior to commencement of the competition review process. Deadline for submission of abstracts is May 1.Provide five copies of an abstract (no more than 1,000 words). The dissertation title should appear on all five copies of abstracts submitted; however, only one abstract should identify the author, and also provide the author's mailing address and telephone number. All submissions should be sent to the Office of Ethnic Minority Affairs at the APA address. For additional information, call (202) 336-6029.

2009 Jeffrey S. Tanaka Memorial Dissertation Award in Psychology APA's Committee on Ethnic Minority Affairs (CEMA) seeks nominations for the 2009 Jeffrey S. Tanaka Memorial Dissertation Award in Psychology, which reco gn izes ou tstan d i n g dissertations in psychology that increase understanding of the psychological issues and concerns facing persons or communities of color. CEMA welcomes applications from APA members/student affiliates who filed their dissertations in 2007 or 2008, on research involving one or more of the following areas: enhancing the psychological understanding of ethnic-minority populations or concerns; improving psychological service delivery systems to ethnic minorities; developing new concepts or theories relevant to ethnic-minority populations; and creating methodological paradigms that promote effective research and understanding of the values, beliefs, behaviors, and needs of ethnic-minority communities.

Call for Nominations: 2009 Honorary Membership for Infusing Diversity into Teaching The Diversity Committee of the Society for the Teaching of Psychology (STP; APA Division 2) is pleased to announce its first honorary membership program to recognize outstanding instructors who

A C EM A- a p p o i n t e d selectio n subcommittee will choose the winner

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FOR YOUR INFORMATION… infuse diversity (e.g., ethnic/racial, age, cultural, social, religious, class, gender, sexual orientation, abilities, or regions) into their psychology courses/teaching. Open to all instructors of psychology, including teaching assistants, in secondary schools, community and technical colleges, 4-year colleges and universities, and graduate schools. Non-members and current members of STP are eligible. Self-nominations are welcome.

should be e-mailed to: Linh Nguyen Littleford, PhD, Chair, STP Diversity Committee; lnlittleford@bsu.edu.

Call for Nominations: Carolyn Wood Sherif Award The Carolyn Wood Sherif Award Committee invites nominations for this annual award. The award is based on contributions to the field of Psychology of Women as a scholar, teacher, mentor, and leader. Selection requires evidence of excellence in teaching and mentoring, research and scholarship, and professional leadership in the area of the Psychology of Women.

Recognition: • Complimentary 1-year membership (Current members will have their annual membership waived for one year). • Four print issues of the Teaching of Psychology, a quarterly journal devoted to the improvement of teaching and learning. • STP newsletters • Eligible for Instructional Resource Awards, Mentoring Service, and Departmental Consulting Service Ad d itio n al b en efi ts, see http://www.teachpsych.org/memb ers/whyjoin.php • Your name posted on the STP Diversity Committee Web site under Honorary Membership for Infusing Diversity into Teaching

The recipient of the award will receive a cash prize and is invited to deliver the Sherif Memorial Lecture at APA in 2010. The winner also chairs the subsequent year’s award committee. For information contact: Jacquelyn W. White, PhD, Department of Psychology, P.O. Box 26170, University of North Carolina at Greensboro, Greensboro, NC 27402-6170; (336)-256-0014; (336) 334-5066 (fax); jackie_white@uncg.edu. Deadline: March 15, 2009.

Application Process: Complete one-page application (see http://www.teachpsych.org/diversity or e-mail lnlittleford@bsu.edu). Members of the diversity committee will review all applications. Within four weeks of receipt of applications, the committee chair will notify applicants of the committee's decision. The application deadline is May 15, 2009. Applications

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OEMA COMMUNIQUÉ Upcoming Conferences and Conventions

http://psych.colorado.edu/~dmartich/rm pa/convinfo.htm

April

Eastern Evaluation Research Society 32nd Annual Conference Evaluation in the Digital Age—Promises and Pitfalls Seaview Marriot Hotel & Spa, Absecon, New Jersey April 19 – 21, 2009

Southwestern Psychological Association Annual Meeting (SWPA) April 2 – 4, 2009 Sheraton Gunter Hotel, San Antonio, Texas For more information visit: http://www.swpsych.org/

For more information visit: http://www.eers.org/.

The 3rd National Dominican Student Conference April 10–12 City College, New York City, New York

27th Annual Protecting Our Children: National American Indian Conference on Child Abuse and Neglect April 19 – 22, 2009 Reno, Nevada

This conference will bring together Dominicans from throughout the United States in order to organize ourselves more effectively against the social and academic issues that continue to afflict our community, as well as to collectively celebrate the rich Dominican heritage that we all share and continue to keep alive in our respective college communities. The conference's focus will be "Transitioning from a Student to a Professional."For more information visit: http://www.dominicanstudentconferenc e.com/index.html.

For information visit the conference web site: http://www.nicwa.org/conference/

Xavier University of Louisiana College of Pharmacy’s Center for Minority Health & Health Disparities, Research and Education Third Annual Health Disparities Conference New Orleans, Louisiana April 19––21, 2009 For conference details visit: http://xula09.the1joshuagroup.com/ind ex2.html.

Rocky Mountain Psychological Association Annual Meeting (RMPA) April 16 – 18, 2009 Hotel Albuquerque at Old Town, Albuquerque, New Mexico

Western Psychological Association Annual Meeting (WPA) April 23 – 26, 2009 Portland Marriott Downtown Waterfront, Portland, Oregon

For conference details visit:

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FOR YOUR INFORMATION… The Society for Prevention Research (SPR) 17th Annual Meeting Power of Relationships: Implications for Prevention Science May 26 – 29, 2009 Washington, DC

For conference details visit: http://www.westernpsych.org/conferenc e/index.cfm

The Archives of the History of American Psychology Conference: Mental Health Care in America: Past, Present and Future April 23–24, 2009 The University of Akron at The Quaker Square Inn, Akron, Ohio

For more information, visit the conference web site: http://www.preventionresearch.org/mee ting.php June

In the span of 100 years mental health in America has unfolded against a backdrop of social, political, and economic changes. This two-day conference brings together leading experts in the field to examine where we have been, where we are, and to speculate on where we are going. For conference information visit: http://www3.uakron.edu/ahap/news/mh c_conference_2009.phtml.

Summer 2009 Knapsack Institute: Transforming the Curriculum University of Colorado, Colorado Springs, Colorado June 3– 6, 2009 The Knapsack Institute: Transforming the Curriculum welcomes faculty from across the nation to join us. Participants will create or revise courses and workshops to integrate issues of race/ethnicity, gender, sexuality, class and other forms of social inequality. The Knapsack Institute is a program of The Matrix Center for the Advancement of Social Equity and Inclusion, the home of the White Privilege Conference. For more information visit: www.uccs.edu/~knapsack.

Midwestern Psychological Association Annual Meeting (MPA) April 30 – May 2, 2009 Palmer House Hotel, Chicago, Illinois http://www.midwesternpsych.org/ May University of Minnesota's American Indian Studies Department First Meeting of the Native American and Indigenous Studies Association University of Minnesota - Twin Cities May 21 – 23, 2009

Texas A &M University Student Counseling Service Multicultural Conference College Counseling In A Multicultural World: Spirituality Courtyard by Marriott, College Station, Texas June 4–5, 2009

See conference web site for program and location details at: http://amin.umn.edu/NAISA2009/.

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OEMA COMMUNIQUÉ For information contact: Maggie Gartner, mgartner@scs.tamu.edu or Gisela Lin, Gisela@scs.tamu.edu, or call 979-845-4427.

Health; Direct Services Tribes; National Indian Health Board; Tribal SelfGovernance Advisory Committee Hyatt Regency Hotel, Denver, Colorado July 7––9, 2009

Critical Research Issues in Latino Mental Health: Translational Research in Latino Mental Health: Bench to Bedside, Adoption of Best Practices, and Integration in Community Presented by Robert Wood Johnson Medical School Hyatt Regency, New Brunswick, New Jersey June 11 – 13, 2009

The Health Summit will be a national gathering of Indian Health professionals an d ad ministrative leadership, community health advocates and activists, and Tribal leadership. Conference web site coming soon! August American Psychological Association Annual Convention August 6–9, 2009 Toronto, Ontario, Canada

This conference focuses on creating an opportunity for new investigators to present their work to senior researchers. The goal of this conference is to help the new investigators in the area of Latino Mental Health receive mentoring, constructive feedback, and network with established researchers. The conference will host a keynote speaker, a grant-writing workshop, and will provide the opportunity for several new investigators to present relevant research papers. For more information, see conference web site at: http://www2.umdnj.edu/crlmhweb/inde x.htm.

For convention information visit: http://www.apa.org/convention09/?imw =Y December 11th National Indian Nations Conference: Justice for Victims of Crime December 11 – 13, 2008 Palm Springs, California For details visit the conference web site: http://ovcinc.org/default.aspx

July For an extended listing of psychological conferences around the world, visit: http://www.apa.org/international/calen dar.html.

Indian Health Summit—Celebrating the Tapestry of Health and Wellness: Sharing Wisdom and Showcasing Innovation Presented by: The U.S. Department of Health and Humans Services, Indian Health Service with Tribal Partners: National Council of Urban Indian

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FOR YOUR INFORMATIONâ&#x20AC;Ś Curriculum for Culturally Responsive Medical Care: The Step-By-Step Guide to Cultural Competence Training Jeffrey M. Ring, PhD, Julie Nyquist, PhD, Suzanne Mitchell, MD, Hector Flores, MD, and Luis Samaniego, MD

Important Resources Books Paths to Discovery: Autobiographies From Chicanas With Careers in Science, Mathematics, and Engineering Edited by Norma E. CantĂş introduction by Aida Hurtado 2008

Contains detailed instructions for delivering a 33-hour creative and comprehensive course for health providers, medical students and residents toward the elimination of health disparities. Teaching sessions are cross-referenced by AAMC and ACGME Competencies and span Awareness/ Attitudes, Knowledge and Skills components of training. The second half of the book provides detailed support in enhancing teaching strategies to help the curricular concepts come alive in terms of relevance and practicality. $59.95; 2008;264 pages; Paperback; ISBN-10 1 84619 294 3 ISBN-13 978184619. To order contact: Orders Department, Rad cliffe Publishing Ltd, 30 Amberwood Parkway, Ashland OH 44805, 1 800 247 6553 or +1 800 266 5564 Fax: +1 419 281 6883. Email: order@bookmasters.com.

In Paths to Discovery a group of trailblazing Chicanas trace how their interest in math and science at a young age developed into a passion fed by talent and determination. Today they are teaching at major universities, setting public and institutional policy, and pursuing groundbreaking research. For more information or to purchase the book, go to the press web site: http://www.chicano.ucla.edu/press/path s.asp.

Journal of Muslim Mental Health: "Islamic Religiosity: Measures and Mental Health" - 2007 Volume 2, Issue 2 & 2008 Volume 3, Issue 1 The Journal of Muslim Mental Health announces a two-part thematic series that introduces instruments measuring Islamic religious identity and examines intersections of religious identity and mental health. In light of the dearth of validated instruments for use with Muslims, this will be an essential reference volume for researchers and clinicians working with Muslim populations.

Handbook of African Psychology Helen A. Neville

American

The purpose of the Handbook of African American Psychology is to provide a comprehensive guide to current developments in African American psychology. It is designed to present theoretical, empirical, and practical issues that are foundational to African American psychology. It synthesizes the debates in the field and research

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OEMA COMMUNIQUÉ designed to understand the psychological, cognitive, and behavioral development of African Americans. 584 pages; Sage Publications, Inc; Paperback.; ISBN:9781412956888; $84.95; Hardcover ISBN: 9781412956871; $125.00. To order visit: http://www.sagepub.com/booksProdDe sc.nav?prodId=Book231707&.

children, adolescents, and their families • Pitfalls to avoid when you encounter trauma and PTSD in children and adolescents http://www.apa.org/pi/cyf/kids-trauma-t ips.html

NIMH Workgroup Releases Report on Training Next G ene ration of Researchers

On The Web

The National Advisory Mental Health Council (NAMHC) Workgroup on Research Training released a report, Investing in the Future, on November 1 that advises NIMH on opportunities for attaining a workforce by 2020 with knowledge and expertise that will enhance the research mission of the Institute. The NIMH mission is more narrowly defined than in years passed with a greater focus on mental illness. As stated in its new Strategic Plan, NIMH's objective is to "transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure."

Products of the 2008 APA Presidential Task Force on Posttraumatic Stress Disorder in Children and Adolescents: Children and Trauma Update for Mental Health Professionals: This 16-page booklet provides a brief overview for mental health professionals on: • What we know about PTSD and trauma in children and adolescents • How you can help children, adolescents, and their families cope and recover from trauma • What we still need to learn about the complexities of PTSD and trauma Additional resources for professionals: http://www.apa.org/pi/cyf/child-trauma /update.html

In its report, the workgroup encourages the Institute to make changes to its portfolio in order to meet the needs of a new generation of health researchers. The report offers nine recommendations to help NIMH achieve its goal of recruiting and retaining an exceptional health research workforce.

Children and Trauma: Tips for Mental Health Professionals This tip sheet serves as a practical guide for professionals on: • Basic information every mental health professional should know about PTSD and trauma in children and adolescents • How to identify PTSD and/or trauma and provide care to

One of the recommendations is to refocus current funding in order to free up funds for other initiatives. As an example, the workgroup recommends

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FOR YOUR INFORMATIONâ&#x20AC;Ś Researching Migration: Stories From the Field DeSipio, Louis, Manuel Garcia y Griego, and Sherri Kossoudji, eds.

that NIMH discontinue its support of professional associations for training interdisciplinary investigators (through the T32 mechanism) because analyses showed that the additional training and mentoring "did not provide any detectable added value" with respect to NIMH's measured outcome - the proportion of trainees who applied for or received NIH funding. Several professional associations, including the American Psychological Association, the Society for Neuroscience, the American Sociological Association, and the Council for Social Work Education are already slated to lose their Minority Fellowship Programs, which are funded through the T32 grant mechanisms.

An New York: Social Science Research Council (SSRC) Book of essays by predoctoral and postdoctoral fellows designed to offer general lessons on the selection, combination, and use of various quantitative and qualitative research methods In this webpublication, fellows of the International Migration Program reflect upon their experience conducting research on international migration to the United States. http://www.ssrc.org/blogs/books/2007/ 12/21/researching-migration-stories-fro m-the-field/

The workgroup's other recommendations include targeting support to MD/PhD students; maintaining the NIMH budget for research training and career development at its current level; expanding support for systematic research training/education opportunities at NIMH-supported centers; implementing best practices for institutional training; assessing and monitoring programs; and strengthening dissemination and communication with the extramural research community.

Catholic Legal Immigration Network, Inc. (CLINIC) Announces 5th Edition of Citizenship for Us The 5th edition of the handbook, Citizenship for Us: A Handbook on Naturalization and Citizenship is available as a free resource that can be printed from the CLINIC web site: www. clinic.kintera.org/citzforus in pdf format. Citizenship for Us is a comprehensive guide to the naturalization process that includes 13 study units on the U.S. history/civics test with historic photos, timelines, and maps. The new edition has been updated to reflect the new citizenship test that will take effect on October 1, 2008. It also includes updated legal and policy information and a new chapter on civic participation.

To view the report, visit: (http://www.nimh.nih.gov/about/adviso ry-boards-and-groups/namhc/reports/in vesting-in-the-future.pdf)

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OEMA COMMUNIQUĂ&#x2030; Financial Planning for Early Career Psychologists

America's Children in Brief: Key National Indicators of Well-Being, 2008

Now available on-line at the Early Career Psychologists resource page on the APA web site. http://www.apa.org/earlycareer/resourc es.html. http://www.apa.org/earlycareer/pdf/Fin ancial_Handbook.pdf.

The Federal Interagency Forum on Child and Family Statistics has published a report on the well-being of children and families: America's Children: Key National Indicators of Well-Being. http://www.childstats.gov/americaschil dren/index.asp.

The Intersection of Diversity and Learning: Capturing a Conversation

National Organization for People of Color Against Suicide

Contributions to this monograph are from key diversity leaders who attended the National Science Foundation (NSF) Intersection of Diversity and Learning Conference in Athens, GA, May 2006 either as keynote speakers or section facilitators. The entire monograph can be downloaded, or you can choose a section that meets your needs. http://janette.myweb.uga.edu/diversity/ outcomes.html

The National Organization for People of Color Against Suicide (NOPCAS) was formed to stop the tragic epidemic of suicide in minority communities. The organization is developing innovative strategies to address this urgent national problem. For information on how to a part of the nation's leading effort to develop fresh ideas that instill hope, improve health and opportunity, and save lives in communities of color visit the website at: http://www.nopcas.com/.

Online Bookseller Targets Spanish-Only Market

Toolkit on Community Health

Lectorum, a Scholastic subsidiary and the largest and oldest distributor of Spanish-language books in the United States, opened a new consumer web site: http://www.librerialectorum.com/ on November 17, 2008. It is the largest U.S. online bookstore operating exclusively in Spanish.

This toolkit from the Association for Community Health Improvement provides detailed illustrations of how different communities and organizations have approached the toolkit's six steps to better understand, and ultimately improve, the health of their communities. The toolkit can also serve as a template to aid system of care communities in assessing behavioral health needs. http://www.assesstoolkit.org/assesstool kit_app/index.jsp.

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FOR YOUR INFORMATION… October 8th, 2008 is Health Cares about Domestic Violence Day!

http://hsc.unm.edu/chpdp/Assets/Projec ts/Assets/TRUST_Executive_Summary _May08.pdf, and the Report link is http://hsc.unm.edu/chpdp/Assets/Projec ts/Assets/TRUST_Report_May08.pdf.

The HCADV Day organizing packet will help you get started: http://www.endabuse.org/programs/dis play.php3?DocID=186.

McGruff in Indian Country Dating Violence

The Adventures of McGruff & Scruff in Indian Country: A Drug and Violence Prevention Comic-Activity Book. http://www.ncjrs.gov/App/shoppingcart /ShopCart.aspx?item=NCJ%20223595 &repro=0.

The National Center for Injury Prevention and Control reports that the Centers for Disease Control and Prevention now broadcasts public health videos through the web site, www.cdc.gov/CDCtv. The first, “Break the Silence: Stop the Violence,” addresses teen dating violence. For more information, visit www.cdc.gov/feat u res /cdctv/ or www.cdc.gov/CDCTV/.

U.S. DHHS Administration for Family and Children 2008 Tribal Resource Directory Administration for Native Americans 2008 Tribal Resource Directory http://www.acf.hhs.gov/programs/ana/r elevant/tribalresource2008.html#primar y.

Toolkit for Community Based Service Providers SAMHSA has released a new toolkit, “Sustaining Grassroots CommunityBased Programs: A Toolkit for Community- and Faith-Based Service Providers.” http://download.ncadi.samhsa.gov/prev line/pdfs/SMA08-4340.pdf.

State Ethnic/Racial Child Indicators New comprehensive state-level data on kids and families in the five largest racial and ethnic groups – African American, Hispanic/Latino, Asian and Pacific Islander, American Indian and Alaskan Native, and Non-Hispanic White – are now available online for 10 key indicators. http://www.kidscount.org/datacenter/

Research in Indian Country The Project Trust document contains a well-structured literature review and basic research in a Native Community with some important recommendations. The Executive Summary link is:

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OEMA COMMUNIQUÉ U.S. Department of Justice Tribal Youth Program Report: Building Brighter Futures

Broken Justice in Indian Country http://www.nytimes.com/2008/08/11/o pinion/11duthu.html?_r=1&oref=slogin.

Tribal Youth Focus Group Report Guides OJJDP http://ojjdp.ncjrs.gov/typ/download/22 3353.pdf.

Indian Country Drug Threat Assessment 2008 This report highlights the challenges of combating drug traffickers who target Native American Communities (July 21, 2008)

CDC Finds Alcohol Taking Deadly Toll on Native Americans This is the first national report of AADs and YPLLs among AI/ANs; the results demonstrate that excessive alcohol consumption is a leading cause of preventable death and years of lost life in this population. The report can be viewed at: http://www.cdc.gov/mmwr/preview/m mwrhtml/mm5734a3.htm.

http://www.jointogether.org/news/headl ines/inthenews/2008/report-highlightschallenges.html.

Intergenerational Trauma Resource The Way Home Tour is a national campaign planned for 2009 to support a collective healing of Native American peoples from the curse of “intergenerational trauma.” http://www.whitebison.org/TheWayHo meTourIndex.htm.

Corporal Punishment of American Indian Students Indian students are more than twice as likely to be paddled in school, according to a report being released on August 20, 2008. http://hrw.org/reports/2008/us0808/.

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