FY 2001–FY 2003 Health Disparities Strategic Plan
I. Statement of the NIDCD Mission
The mission of the National Institute on Deafness and Other Communication Disorders (NIDCD) is to conduct and support basic and clinical research and research training in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. Basic and clinical research focused on understanding the normal processes and disorders of human communication are motivated both by intrinsic scientific interest and importance to the health of the Nation.
II. Background
The Director, NIH, has requested that each Institute and Center at NIH develop a Strategic Plan for Reducing Health Disparities. In preparation for developing a Strategic Plan on Reducing Health Disparities, the NIDCD sought broad input from the NDCD Advisory Council and Board of Scientific Counselors, as well as 170 of its constituent groups. Several research opportunities to understand the basis for health disparities within the purview of NIDCD were identified.
III. Goals
A. Research
- Advance understanding of the development and progression of disease that contributes to health disparities
Otitis Media
Otitis media (OM), or middle ear infection, is the most common cause for visits by children to physicians for acute illness, costing several billion dollars annually in the United States. In addition to the discomfort and risk of more serious infection such as meningitis, otitis media is also associated with disabilities such as hearing deficits, reading disorders, and language delays. The disorder is reported to occur at a disproportionately high rate among Native American children. A number of papers have been written about OM and Native Americans, some suggesting that there are anatomical differences between Native Americans and other Americans in the anatomy of the eustachian tube. It has also been reported that there are differences in the rate of OM among the various Native American tribes.
Goal 1: Research to Explore the Possibility of a Genetic Basis for Increased Susceptibility to Otitis Media in Native Americans
A recent scientific study reported a complex genetic basis for susceptibility to otitis media (Ehrlich GD, Post JC. Susceptibility to Otitis Media: Strong Evidence that Genetics Plays a Role. JAMA 282(22):2167-9, 1999).
Native Americans were not included in this study, leaving open the possibility that allelic variants of one or more genes may confer susceptibility to otitis media in Native Americans.
OM, particularly recurrent serous otitis media, deserves attention because of the particularly high prevalence of the disease and associated disabilities among Native Americans (Mendola, Buck and Starr, 1994, citing Zinkus, Gottlieb and Schapiro, 1978).
Potential New Initiative (A.1. New):
Studies to examine the hypothesis that allelic variants in one or more genes may underlie the increased susceptibility of Native Americans for otitis media.
2002 Funding Levels:
$500,000 (5%)
$600,000 (10%)
$700,000 (15%)
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Goal 2: Study the Epidemiology of Otitis Media in Native Americans (DC02963-03: Kathleen Daly, University of Minnesota) (A.1. Ongoing)
Although Native Americans have a high prevalence of chronic otitis media, prospective studies of OM among Native American infants and young children of this group are sparse. The goals of this study are to understand the epidemiology of otitis media and hearing loss among Native Americans from birth to age two, and define the relative importance of known and new risk factors in this population. A community program assessment of services has been conducted regarding breast feeding promotion and support, tobacco control, and nutrition for prenatal infants and mothers. The findings of this assessment indicate that intervention programs should focus on tobacco control, as this is a significant risk factor for OM in this population and there appears to be a gap in services addressing infant exposure to parental smoking.
2002 Commitment: $525,000
Potential New Initiatives:
(1) Intervention and outreach efforts to reduce the burden of otitis media in Native Americans caused by risk factors identified in the present study. (C.2. New)
2002 Funding Levels:
$50,000 (5%)
$60,000 (10%)
$70,000 (15%)
- Develop new or improved approaches for detecting or diagnosing the onset or progression of disease and disability
Hearing and Language Disorders
In this age of information, communication and technology skills are central to a successful life for all Americans, and the labor force of the 21st century will require intense use of these skills. However, for about 1 in 6 Americans with communication disabilities, and their families who support them, facing each day can be a challenge. The simple acts of speaking, listening, of making their wants and their needs understood are often impossible. Hearing and language disorders can exact a significant economic, social, and personal cost for many individuals. A more complete understanding of the scientific mechanisms underlying normal communication and the etiology of human communication disorders is needed.
Goal 1: Develop Language Tests for Non-Standard English (DC82104: Harry Seymour, "Children Who Speak Black English" and DC82100 Aquiles Iglesias, "Bilingual Hispanic Children") (A.2. Ongoing)
As the U.S. becomes more culturally, racially, and linguistically diverse, it is becoming increasingly difficult to discriminate between language disorders and language differences in children. Problems in language assessment arise because the majority of currently available measures are designed for identifying speech and language problems in Standard English speakers. Many children of multicultural populations are often misdiagnosed as language impaired because culturally appropriate language assessment instruments or procedures are unavailable. In addition, other children from multicultural populations who have genuine language disorders that are in need of remediation may go unrecognized. In response to this need, the NIDCD is supporting projects to develop language tests for non-standard English, specifically for children who speak Black English and for bilingual Hispanic children. Investigators are collecting cross-sectional data on language abilities in normally developing four- to six-year-old speakers of Black English and bilingual Hispanic children whose primary language is not English or is a non-standard form of English. These data are aimed at developing items for a language assessment instrument or procedure that could be used to differentiate between language impairment and normal language development in these two populations.
2002 Commitment: $1,120,000
Potential New Initiative:
Disseminate language assessment instruments and procedures that are verified to discriminate between language disorders and language differences in Hispanic and Black children.
Estimated funding for 2004: $50,000
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B. Support Research Training and Career Development
Goal 1: Recruit and Retain Individuals from Underrepresented Groups to Careers in Research in Human Communication Through In-depth Experiences in NIDCD Division of Intramural Research (B.1. Ongoing)
In collaboration with the Office of Research on Minority Health (ORMH), the NIDCD Partnership Program was implemented to provide comprehensive research and training opportunities for qualified underrepresented minorities in biomedical and behavioral research. This research and training demonstration program began in 1994 with four academic centers with large enrollments of minority persons: The Morehouse School of Medicine/Atlanta University Complex, the University of Alaska, the University of Puerto Rico, and Gallaudet University.
The program provides an opportunity for exchange of personnel between the NIH and the academic centers. Each center collaborates with the NIDCD in developing a plan for that center and for the students, faculty, or staff of the institution. This program not only provides research training opportunities for students in NIDCD laboratories, but also provides career development for faculty and administrators at the academic centers in the program.
2002 Funding Levels:
$600,000 (5%)
$700,000 (10%)
$800,000 (15%)
Goal 2: Provide Support for Minority Doctoral Dissertations (B.1. Expansion of Ongoing)
In February 2000, the NIDCD issued a Request for Applications (RFA) announcing the availability of small grants (R03) to support doctoral dissertation research in human communication for doctoral candidates who are members of racial and ethnic minority groups that are underrepresented in biomedical and behavioral research. The goals of this program are to aid the research of new minority investigators and to encourage minority individuals from a variety of academic disciplines and programs to conduct research in hearing, balance, smell, taste, voice, speech, and language.
This grant initiative is to provide students who are members of minority groups with grants-in-aid to perform their dissertation research on a topic related to human communication, and thereby increase the pool of minority researchers interested in hearing, balance, smell, taste, voice, speech, and language.
2002 Funding Levels:
$300,000 (5%)
$325,000 (10%)
$350,000 (15%)
Goal 3: Support the Minority Supplements Program (B.1. Expansion of Ongoing)
The Research Supplements for Underrepresented Minorities program is another mechanism used by NIDCD to recruit minority researchers. Expanding upon the support provided by currently funded research grants, the supplement provides a means by which promising minority research trainees can gain training to enhance their research careers. Principal Investigators (PIs) currently being funded by NIDCD who are interested in mentoring a minority student or junior faculty member are encouraged to consider developing a supplemental application to their existing grant.
2002 Funding Levels:
$1,000,000 (5%)
$1,100,000 (10%)
$1,200,000 (15%)
Potential New Initiative:
Proposal to Assess the Research Supplements for Underrepresented Minorities Program in the NIDCD (B.1. Expansion of Ongoing)
The NIDCD has had a very active minority supplements program over the past several years and plans, in collaboration with ORMH, to evaluate participant success in pursuing careers in biomedical research. We anticipate that the results of this assessment will help to better determine predictors for success.
2002 Funding Levels:
$150,000 (5%)
$150,000 (10%)
$150,000 (15%)
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C. Public Information/Outreach/Education
Noise-Induced Hearing Loss
Ten million Americans have already suffered irreversible damage from noise, and thirty million are exposed to dangerous levels of noise each day. Exposure to harmful sounds causes damage to the sensitive hair cells of the inner ear, eventually affecting hearing. These structures can be injured by noise in two different ways: from an intense brief impulse, such as an explosion from a firecracker, or from continuous exposure to noise, such as in a woodworking shop.
Goal 1: Increase Public Awareness and Prevention of Noise-Induced Hearing Loss (C.2. Expansion of Ongoing)
The WISE EARS!® campaign was initiated on July 4, 1999 and now includes more than 80 organizations of workers, employers, health and medical professionals, advocates for children and older Americans, teachers, parents, children, unions, industry, federal, regional and local government agencies and institutes, and the general public. The WISE EARS!® campaign has been published nationwide in over 1,000 newspapers with an estimated readership of 91 million. The campaign is designed to reach minority individuals as identified by specific occupational or recreational risk.
In addition, a special outreach effort is underway to reach Hispanic seasonal workers including materials, individuals in work environments with dangerous levels of noise, and a special effort to reach teenagers in vocational programs with work/study experiences. Many materials are available in Spanish. This is a collaborative effort with the NIH Office of Hispanic Communication.
2002 Funding Levels:
$25,000 (5%)
$30,000 (10%)
$35,000 (15%)
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