NIH - Addressing Health Disparities through Effective Interventions among Immigrant Populations (R01, R21)

The following description is from the R01 version of this FOA:

The goal of the Immigrant health initiative is to support research to design and implement effective interventions to reduce the health disparities among immigrant populations (particularly migrant workers, recent and 1st generation immigrants) and address issues that promote health equity. For the purposes of this funding announcement, the term “1st generation” refers to people who were born in their native country and relocated to the U.S. The term “2nd generation” refers to the U.S. born children of 1st generation immigrants.

In 2015, the immigrant population in the U.S. was 44.9 million and the immigrant wave is expected to reach around 78 million people (18% of the population) by 2065. Approximately 30% of immigrant families have incomes below the federal poverty level and 23% of today’s new immigrants tend to be less educated and have not completed high school. Some immigrant populations suffer a significant burden of disease and healthcare systems face daunting challenges in addressing the health of these populations. Among immigrants, cardiovascular disease (CVD), stroke, hypertension diabetes and some types of cancers (particularly those associated with infectious agents) are often higher than their counterparts in the general U.S. born populations, although in some groups the rates of CVD and stroke are substantially lower. In addition, many immigrants come from areas of the world where exposures to toxic chemicals are common, such as pesticides long banned in the US at sensitive windows of development, that may increase risk for future health conditions/diseases. Importantly, risk factors and disease outcomes vary by subpopulations among immigrants based on the country of origin; however, many studies consider immigrants as one homogenous group. For example, U.S. immigrants from approximately 20 Latin American countries are treated as one group and not separated into nationality sub-groups, Asians (from more than 30 countries) or Africans are treated as one immigrant group when the health outcomes are often different among different sub-groups.

Factors associated with immigration processes can translate into higher risk for diseases. Moreover, immigrant populations face multiple challenges, such as low health literacy, lack of health insurance, limited English proficiency, barriers to effective patient-provider communication, other limitations in accessing health care as well as maintenance of traditional health practices. Singularly or interactively, these factors that may contribute to health disparities observed in these populations. Factors like the concentration of immigrants in low-income and segregated neighborhoods (ethnic enclaves) and low-wage occupations with exposure to toxic chemicals, poor or other unsafe working conditions may also contribute to worse health outcomes among immigrant populations.

Despite the numerous stressors faced by immigrants, published literature documents that recent immigrants report better health status (e.g., healthy immigrant effect) than U.S. born populations, a status that is thought to deteriorate with length of U.S. residence and in subsequent generations The role that ethnic enclaves, social networks, resilience and acculturation play in explaining some health advantages needs to be further explored. The effect might vary by gender and health outcome focus. Alcohol use among Latina women may drop but among Latino males appears to increase in the first generation in the U.S. How duration of stay in the U.S. coupled with acculturation pressures lead to changes in health behaviors and outcomes and how these factors interact with changes in socioeconomic status are some of the range of factors that need more research.

Therefore, to improve health outcomes in this vulnerable population, there is a need to build an evidence base for effective interventions that could reduce health disparities among U.S. immigrant populations.

Given current understanding of the determinants of immigrant health, (e.g. social, environmental, biological and behavioral) and the mechanisms that these determinants act on to influence health status, a well-developed intervention research framework and interdisciplinary approach is needed to address immigrant health disparities.

Research Objectives

Given the scientific literature documenting health inequities among immigrant populations, this announcement calls for research focusing on the design and implementation of effective interventions that will address immigrant-specific factors to reduce health disparities among immigrants, particularly among migrant workers, recent and 1st generation immigrants.

The intervention research under this FOA should be aimed at improving the health outcome among immigrant groups by targeting the causes or consequences of health disparities. Multi-level interventions that include a combination of individual, group (such as peers, family members, etc.), and/or community-level intervention components have been shown to be effective in improving health outcomes. Therefore, this FOA strongly encourages multi-level interventions (i.e., ranging from individuals to societies) in addressing immigrant health disparities.

A life-course perspective is encouraged with interventions focusing attention on transition points across the lifespan and associated risk and protective factors for immigrant populations. Such an approach emphasizes the fact that early life disadvantage need not lead to later negative health outcomes, provided there are compensating experiences in the intervening years. This would also allow consideration of the reasons and the conditions under which the individuals migrated to the U.S. Attention should be given to the positive aspects of lives of immigrants that may buffer the effects of adversity.

Projects should involve collaborations among relevant stakeholders in US immigrant population groups, such as researchers, community organizations, healthcare providers, public health organizations, consumer advocacy groups, and faith-based organizations. As appropriate for the research questions posed, inclusion of key immigrant community members in the conceptualization, planning and implementation of the research is encouraged (but not required) to generate better-informed hypotheses and enhance the translation of the research results into practice.

Interventions that are culturally sensitive and community based addressing population level factors to overcome barriers to improve overall health and reduce health disparities among immigrants are encouraged. Research projects are encouraged to utilize rigorous innovative multidisciplinary approaches including biological assessments (such as genomics, epigenomics, microbiome, telomere length, allostatic load, or other biomarkers) to show whether they may serve as measurable indicators for excess risk or health outcomes. Interventions that include health information technology applications (e.g. behavior monitoring tools, decision aids, health information portals, etc.) and/or social media elements to improve immigrant health are encouraged. Studies to conduct only needs assessments or interventions designed to increase knowledge as a sole outcome will not be supported under this FOA.

The focus of this FOA is specifically on immigrants who, once residing in the U.S., belong to one or more U.S. racial/ethnic minority populations (i.e. Blacks/African Americans, Hispanics/Latinos, Asians, or Pacific Islanders). Research is encouraged among distinct immigrant sub-populations based on the country of origin, rather than larger racial/minority populations when feasible (e.g., Koreans, Vietnamese, Cambodian, etc., rather than Asian Americans). For projects involving comparisons across populations, these comparisons should illuminate immigrant-specific phenomena rather than representing more global comparisons between immigrants with the non-Hispanic whites or the US general population. Examples of appropriate comparisons include:

immigrant subgroups within the same racial/ethnic minority group (e.g., Nicaraguan immigrants vs. Mexican immigrants)
immigrants across racial/ethnic minority groups that share similar experiences in the US (e.g. Asian immigrant garment workers vs. Latino immigrant garment workers)
immigrants with their US-born counterparts (Chinese immigrants vs. US-born Chinese Americans)

For this FOA, residents of U.S. territories (Guam, Puerto Rico, American Samoa, Commonwealth of the Northern Mariana Islands, and US Virgin Islands) who migrate to the U.S. mainland are also considered as immigrants. Research on refugees is not supported under this FOA.

Specific Areas of Research Interest

Research topics of specific interest on interventions may include but are not limited to:

Improve health care access and utilization among newly arrived immigrant populations or migrant workers and 1st generation immigrants;
Address stress related to stigma, discrimination, social isolation, other experiences faced by immigrants that affect health;
Address adversity and chronic stress that result in worsened health outcomes;
Address culture specific beliefs and practices for health promotion and disease prevention among various immigrant sub-populations, specifically where traditional health practices may be the preferred and/or used with western healthcare systems;
Develop culturally consistent ways of treating and/or preventing the spread of infectious diseases that increase health risks among recent immigrants or migrant workers or immigrants that travel back and forth between the US and the native country;
Utilize technology to address language and other barriers in accessing health care and health information among immigrant populations with limited English proficiency;
Design and implement culturally appropriate strategies to address immigrant specific risk factors to improve the health and quality of life of immigrant populations;
Examine patterns and quality of health care for immigrants who travel back and forth from the U.S. to the native country and receive care in both countries;
Address health care team or organizational-level factors (systems) that facilitate the treatment delivery and follow up care to medically underserved immigrants;
Address systematic barriers to care and accommodate cultural and individual diversity for multiple immigrant sub-populations;
Adapt evidence-based interventions to ensure cultural relevance for those with Limited-English proficiency and low health literacy in low-resource settings to improve quality of care and health outcomes among immigrants;
Develop and test health behavior interventions aiming at reducing illness risks, including interventions in tobacco control, diet and physical activity, and other health promotion efforts;
Develop tailored prevention strategies for different immigrant sub-populations to address screening disparities for preventable diseases or conditions;
Develop strategies focusing on key transition points across the lifespan and associated risk and protective factors for immigrant populations to improve overall health;
Examine how multilevel intervention components may address social determinants (such as housing, employment and educational systems) to increase reach/access to prevention and care in low-resource settings for immigrant (sub)populations;
Studies that test prevention and treatment interventions for excessive drinking, alcohol use disorders, other substance use other substance use and other common co-occurring mental health disorders (e.g., depression, PTSD, other anxiety disorders, etc.) among U.S. based immigrant populations.

Deadlines:

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Filed Under: Funding Opportunities

NIH – Addressing Health Disparities through Effective Interventions among Immigrant Populations (R01, R21)