Advancing Research to Reduce Drug Abuse and HIV/AIDS Health Disparities: Methodological Considerations

United States

NIDA Organizer(s): Dionne Jones, Ph.D. and Aria Crump, Sc.D./DESPR

Purpose & Intent

The Division of Epidemiology, Services and Prevention Research (DESPR) hosted a meeting on June 21-22, 2004 to engage the scientific community in a dialog on how to encourage methodologically rigorous study of health disparities related to drug use and drug related-HIV/AIDS. The objectives of this scientific meeting were to: 1) identify methodological innovations and strategies that have strengthened the science of drug abuse epidemiology, services, and prevention research and drug-related HIV/AIDS research; and 2) engage health disparities scholars in discussion of critical directions for future research and methodological innovation on these topics. 

Meeting Outcome

Key themes emerging from this meeting are as follows:

• Scientists need to be explicit with definitions when focusing on health disparities research. A part of identifying what makes this field important is the focus on addressing inequality stemming presumably from injustice. In this context, an examination of the differential between who uses drugs and who suffers the most significant consequences, such as dependence and HIV/AIDS infection, highlights a need to better understand mechanisms that drive differential progression to adverse outcomes.
• Although evidence suggests that race/ethnicity alone do not drive racial/ethnic differences in drug use or consequences, our knowledge is significantly limited by the lack of variance in key explanatory variables, such as socioeconomic status, across many of our large data sets. Further, more research is needed to clarify which socioeconomic constructs are most meaningful, since education, neighborhood residence, income, wealth, and other variables are not equivalent in their relationship to race/ethnicity.
• Longitudinal, developmental research is needed to identify underlying mechanisms driving health disparities.
• Significant progress has been made in the articulation and measurement of some explanatory variables such as micro-aggressions and colonial trauma response, but significantly more work is needed in these areas.
• Scientists need to study HIV/AIDS and drug abuse across the lifespan with attention to gene/environment interactions and gene/environment correlations to understand the pathophysiology that manifests in disease. Interdisciplinary teams will be necessary to engage successfully in this work.
• Scientists need to engage in research on a structural level, examining ways in which neighborhoods, institutions, and access to resources impact on health disparities in HIV/AIDS and drug abuse.
• Greater care must be taken in drawing conclusions based on data from subgroups that are heterogeneous. Scientists must study key explanatory variables such as national origin and level of acculturation (among others) or risk masking key disparities and losing valuable information.
• Scientists need to address issues of data quality, particularly as related to measurement by ensuring that instruments are adequately designed to accurately measure key constructs in the population of interest. It is particularly important to recognize the role of idiom as well as language and the need for the translation process to be sensitive to the subtle complexities of usage and culture.
• Scientists need to address issues of data quality through studies of differences in reporting accuracy because of the sensitive nature of the questions asked. Further scientists should triangulate information from various sources, in part because of the culturally charged nature of some of the constructs measured in developmental and behavioral studies related to drug abuse and HIV/AIDS.
• It is necessary to ground prevention theory in an understanding of specific risk and protective factors and to understand the behavior of individuals within the cultural context.
• Prevention research must address issues of transportability and adaptation of interventions across racial/cultural contexts.
• In part because of distrust of the scientific community by members of many racial/ethnic groups, careful attention should be paid to the nature of the interactions with communities around research. Community participatory research, community oversight, culturally grounded techniques, and the use of community advisory or action boards are vehicles for accomplishing this. In the context of distrust, feedback to the community on both the process and outcomes of research is critical.

The following recommendations were made:

• Develop a repository of instruments that have been adapted for various populations so that scientists don't have to constantly replicate this work.
• Develop or identify a funding mechanism to facilitate developmental work with communities in special populations where measures may be inadequate or community collaborative work is being undertaken or issues of trust must be resolved prior to researcher collaboration.
• Develop or identify a funding source for providing feedback to the community on research findings and/or dissemination to allow communities to be full partners in the research and to benefit from the research.
• Develop or identify ways for scientists to share more of the information on the processes of conducting research with special populations. Journals are typically poor vehicles because of page limitations. Moreover, investigators could benefit from sharing information on processes such as interfacing with the community, developing measures for key constructs, and adapting interventions.

NIDA should consider increasing research on the role of structural factors in the emergence of health disparities, and the protective mechanisms that prevent individuals from engaging in risk behaviors related to drug abuse and HIV/AIDS.

Resulting Publications

Meeting participants are preparing articles based on presentations they made for publication in a special issue of the Journal of Urban Health . This journal reaches a broad multidisciplinary audience that shares a common interest in understanding dynamic patterns of disease and the social, environmental, biological, and behavioral factors that influence them. The articles in this special issue are based on research with diverse minority populations involved in drug abuse who are at risk for contracting HIV/AIDS. They highlight innovative methodological approaches undertaken by the researchers in implementing their work, and inform future research in drug abuse and HIV/AIDS.