Leadership Development for Health Researchers at Historically Black Colleges and Universities

Abstract

Historically Black colleges and universities (HBCUs) have traditionally been a magnet for Black students at all levels nationwide and have been an exemplar of mentorship models for preparing leaders in many fields.

A research career development program for junior faculty scholars that leverages the unique strengths of HBCUs has the potential to promote diverse leadership in health research and advance practical understanding of how to address HIV/AIDS and related health challenges that ravage vulnerable communities. A program that creates institutional bonds between HBCUs and other academic institutions can create a groundbreaking framework for more-effective community-based participatory research.

We present a rationale for supporting an HBCU-led collaborative research program, one that both advances junior faculty and explores the interrelationship between HIV/AIDS, mental health, and substance abuse through research in correctional facilities.

HISTORICALLY BLACK colleges and universities (HBCUs), if adequately funded, can work to recruit and retain more Blacks in the medical research workforce, thereby alleviating their underrepresentation in this field. HBCUs give high priority to mentoring throughout the educational process. A greater appreciation for the value and role of HBCUs in reducing health disparities may be gained by reviewing their history and contributions to date. Furthermore, an examination of the roles that graduates of HBCUs play in research and service shows the wisdom of increased investment in these institutions.

The Higher Education Act of l965 defines HBCUs as those institutions of higher education established before 1964 whose principal mission was, and remains, the education of Blacks.¹ Many HBCUs were founded in the 19th century. They have a proud history of both educating generations of promising young people at a time of widespread racial discrimination and of serving their surrounding communities.

Today, the 105 institutions of higher education designated as HBCUs have a record of distinguished scholarship that continues to attract students and faculty members who reflect the Black communities they serve.¹ In addition, these institutions have impressive graduation rates for Black undergraduate and graduate students. Although HBCUs represent only 3% of America's 4084 institutions of higher education, they account for approximately 14% of all Black students and provide nearly one fourth of all undergraduate degrees received by Black students.²

HBCUs have a unique perspective on how to bring out a student's potential and groom future leaders.^2,3 These institutions have created a robust pipeline of students who are well qualified for further study at the predoctoral and postdoctoral level. Of Black holders of master's and professional degrees, 1 of 6 received their degrees at HBCUs.² A National Science Foundation report concluded that Blacks who graduate from HBCUs have a greater likelihood of pursuing graduate degrees.³ In science and engineering, the report noted, HBCUs awarded advanced degrees to 17% of all Black students enrolled in a graduate program.

Postgraduate enrollment data document how HBCUs have played a significant role in diversifying the racial/ethnic composition of the nation's health care and medical research workforce. In 2006, about 21% of all Blacks accepted to medical school had earned their undergraduate degrees from HBCUs. Similarly, during the period 2002 to 2006, 16% of all Black students who graduated from medical school received undergraduate degrees from HBCUs.⁴ As Table 1 indicates, HBCUs play a pivotal role in developing a more culturally competent medical workforce.

TABLE 1.

Number of Non-Hispanic Black Medical School Matriculants Who Graduated From Historically Black Colleges and Universities (HBCUs): United States, 2002–2006

Year and Gender	No. of Black Medical School Matriculants From HBCUs	% of All Medical School Matriculants Nationwide	No. of All Black Medical School Matriculants	No. of All Medical School Matriculants Nationwide
2002
Women	195	2.4	787	8 113
Men	100	1.2	419	8 375
Total	295	1.8	1 206	16 488
2003
Women	179	2.2	757	8 212
Men	83	1.0	389	8 329
Total	262	1.6	1 146	16 541
2004
Women	158	1.9	764	8 235
Men	70	0.8	401	8 413
Total	228	1.4	1 165	16 648
2005
Women	148	1.8	714	8 239
Men	71	0.8	431	8 764
Total	219	1.3	1 145	17 003
2006
Women	181	2.1	773	8 438
Men	72	0.8	417	8 923
Total	253	1.5	1 190	17 361

Note. Because students could choose more than 1 race, data are from those who described themselves solely as Black as well as those who also chose an additional racial identity.

Source. Association of American Medical Colleges.⁴

One worrisome trend apparent in Table 1 is a decline in the number of Black men with undergraduate degrees from HBCUs enrolling in medical school. Although enrollment in medical school by graduates from other institutions of higher learning has remained virtually unchanged, it dropped by nearly 30% from 2002 to 2006 among those who graduated from HBCUs. A scarcity of Blacks in the medical research workforce has implications for research in diseases that disproportionately affect them, and it can deepen their historic distrust in health care systems that has resulted from discrimination in access to care.^5,6

Black medical students can often encounter obstacles directly related to their underrepresentation. The men often feel isolated because of their small numbers and the scarcity of role models, and the women are more likely to be viewed as nurses rather than as medical students.⁷ Effective mentoring requires an understanding of the experience of students from various cultural backgrounds.^8,9 This type of social support is extremely important in academia, particularly for ethnically diverse students.⁷

HIV/AIDS, Mental Health, and Substance Abuse Treatment

It is well documented that the HIV/AIDS epidemic is a health crisis for Blacks.¹⁰ Almost one half (49%) of people in the United States with HIV or AIDS are Black, even though this group represents only 13% of the population.¹¹ Overall, Black adults and adolescents have a rate of AIDS diagnosis that is 10 times that of Whites and nearly 3 times that of Hispanics.¹² Many researchers conclude that the incidence and prevalence of HIV/AIDS in the Black community is related to the use of harmful substances, untreated mental health distress, and high levels of violence and incarceration.^13,14

The elevated incidence of HIV/AIDS in the Black community is compounded by the criminal justice system and nationally mandated sentencing laws that have fractured partner and familial relationships.¹⁵ In 2004, there were 23 659 people incarcerated in state and federal prisons who were known to be infected with HIV, of whom approximately 20 000 were men.¹⁶ The rate of confirmed AIDS among the prison population was 3 times that of the general population; for women in prison, the rate was 15 times that of women in the general population.¹⁷

The prognosis for Black prisoners with AIDS is poor. In 2003, Blacks accounted for two thirds of AIDS-related deaths in prisons. In state prisons, Blacks were at least 3 times more likely than were Whites to die of AIDS-related illnesses and more than twice as likely as Hispanics.¹⁶

To understand the spread of HIV/AIDS in the Black community, researchers must also understand the health behaviors of people entering and exiting correctional facilities. In a study of 244 HIV-positive Black men and women, researchers found that most had partners who had been incarcerated.¹⁸ It is estimated that at least one fourth of those with HIV will be detained in a correctional facility each year.¹⁹ Unfortunately, research also indicates that transmission often occurs while people are incarcerated and that there are no readily available barriers (e.g., condoms) or institutional protections to interdict transmission, despite the proven efficacy of these methods when used.²⁰ Self-reported data from newly incarcerated inmates suggests a high prevalence of chronic health conditions, including HIV/AIDS, and limited access to health care and other resources, in addition to notably high levels of motivation to change risky behaviors.²¹

Another major health concern in the Black community is alcohol and other drug dependency. This health crisis is complicated by a social context that includes the underground drug economy, which attracts individuals with few other options for employment.¹³ In communities devoid of resources, feelings of anger and hopelessness—and simply the need to survive—can affect behavior and mental health. A disproportionate number of Blacks are homeless, are incarcerated for long periods of time, are products of foster care (many as a result of the loss of caregivers to jail and prison), and are exposed to economic marginalization and violence, all of which are predictors of poor mental and physical health.¹⁴

Many inmates suffer from mental illnesses and have comorbid substance abuse conditions.²² One study indicated that state prison inmates with adverse mental health conditions were more likely to be incarcerated for a violent offense, under the influence of alcohol and drugs at the time of arrest, and homeless prior to arrest. Despite the prevalence of adverse mental health conditions among people behind bars, many do not receive the mental health services they need.²³ A history of untreated depression, or lack of mental health services to address previous trauma, may lie at the root of many substance abuse issues. A 2000 study examining the co-occurrence of substance abuse disorders with depression and antisocial personality among a sample of federal inmates found that 43% of drug-dependent female prisoners were diagnosed with antisocial personality.²⁴ A history of sexual or physical abuse is also common among drug-dependent women prisoners, and it is prevalent among those likely to engage in HIV/AIDS-related risk-taking behavior.^25–27 Overall, 1 in every 3 women prisoners suffer from chronic depression, compared with approximately 1 in 6 incarcerated men (17%).²⁸

These findings indicate the need for greater monitoring and assessment for inmates diagnosed with substance abuse and mental health disorders. Little attention is given to stress, anger, depression, feelings of hopelessness, or posttraumatic stress disorder among released inmates, and little new research or treatment is being integrated into a system of prison care or postrelease care—even though sexual practices that result in disease transmission may well be influenced by the psychological state of individuals returning to the community.²⁹

HBCUs are profoundly affected by the burgeoning HIV/AIDS crisis and its role in the dissolution of the behavior and social patterns that historically have made the Black community resilient, and by the eroding effect of high rates of incarceration on gender balance and family structure.³⁰ Additionally, the proximity of HBCUs to the Black community both geographically and in spirit gives them an advantageous position for conducting scientific research related to these health challenges. With their history as virtually the sole provider of educational opportunity and translator of health and social messages, these institutions are trusted both for their cultural ethos and scientific priorities. HBCU faculty are already adding to the recognition that social and environmental contexts contribute to illness, and they are imparting this understanding to their students. At the same time, the literature continues to show the value of researchers working with underrepresented populations and of scientific inquiry that resolves conflicts between academic institutions and communities.³¹ These conditions would seem to support a more prominent role for HBCUs in research, yet they continue to struggle for the research dollars that would allow them to undertake inquiry on a scale commensurate with their communities of interest.

Investing in Research at Black Colleges

Although the capacity to conduct research is largely based on federal grants, in 2001, HBCUs received only $240 million in federal research and development funding out of more than $19 billion awarded.³² Data received under the Freedom of Information Act for fiscal years 2001 through 2006 indicate that the overall acceptance rate of R01 proposals for HBCUs has remained roughly the same despite a slight increase in submissions (56 in 2001 vs 64 in 2006).³² (R01 grants, the most competitive offered by the National Institutes of Health, are typically funded for 3 to 5 years and generally do not have a specific funding limit.) Such a low level of funding constrains the ability of HBCUs to nurture future researchers, despite widespread acknowledgment of the importance of reducing health disparities and increasing diversity in the health workforce. At the undergraduate level, programs such as the National Institute of General Medical Sciences’ Bridges to the Baccalaureate Program (R25)³³ illustrate the benefits of investing in HBCUs while at the same time permitting and encouraging them to form alliances with other institutions. This type of program is an excellent example of the level of investment needed to reverse current trends in postgraduate research and education.

Currently, research capacity at HBCUs is not commensurate with these institutions’ vision, credibility, and track records in developing outstanding research scholars. Fully integrated, strategic alliances with faculty at majority institutions offer a way to significantly increase the research capacity of these institutions. These relationships may benefit from the proven capacity of HBCUs for leading culturally relevant and appropriate research and mentorship, making it possible for the community to become an integral component of any first-tier research paradigm. Indeed, the development of a new framework for community-based participatory research in Black communities offers the best way to address health disparities, given the inability of current strategies to dramatically reduce the spread of disease.

Research investments that identify HBCUs as lead collaborators can stimulate the formation of coalitions that not only build on the leadership attributes of HBCUs and their ability to selectively partner with other research institutions, but that over time increase the numbers of scholars from underrepresented minorities who are leading research teams. The Department of Psychiatry of Morehouse School of Medicine currently has such a partnership with the School of Medicine of the University of North Carolina for an R25 provided by the National Institute of Mental Health. Additionally, the National Institute on Drug Abuse has made an infrastructure and capacity development grant available to Morehouse School of Medicine through its Minority Institution Drug Abuse Research Program. Both of these federal institutes have acknowledged the role that Morehouse School of Medicine can play in the HIV/AIDS, mental health, and substance abuse research agenda in correctional settings (both juvenile and adult).

HIV/AIDS and its transmission, some mental health conditions, and substance abuse are to a large degree associated with a dysfunctional social context that includes poverty. Treatment approaches that ignore harmful practices and such conditions as poverty and limited educational options avoid confronting the forces that erode community health. In a leadership role, HBCUs can mobilize all available resources to address the perils threatening the Black community's integrity and stability. To effect change, socially insightful and culturally informed community-based engagement in research and translational activities are needed. The ability to assess and address real health care challenges, using culturally competent research, can be greatly enhanced with the availability of resources and the support of community partners.

A mentorship framework can produce researchers who have the battery of skills and professional attributes needed to define the direction of future research. This research needs to go far beyond the etiology of illness. It should include a conceptual framework for the prevention and treatment of illness and an understanding of the significance of community, culture, and context in treating the body and healing the spirit.

Preparing the Next Generation for Complex Public Health Challenges

We propose partnerships between HBCUs and other research institutions to redress the critical lack of minority physicians and of social and behavioral scientists engaged in and leading research programs. The training of scholars would require 2 important elements: the development of a special institute for collaborative and intensive instruction, and the establishment of a virtual (i.e., online) national network of senior mentors with a thematic emphasis on the nexus between HIV/AIDS, mental health, and correctional health disparities. All partners would jointly participate in mentored research projects fostering skills in the areas of grantsmanship, research ethics, and cultural competence (i.e., the ability to work cross-culturally). The envisioned training model would bring together the multiple research and cultural-competency strengths of the partner institutions, and would blend these into a network that capitalized on the institutions’ strengths and abilities.

Components for an initial summer immersion program should include seminars on mental health, substance abuse, correctional health and reentry (postrelease) health, HIV/AIDS, and community composition, culture, and context. The program would establish the intellectual repertoire for understanding and appropriately framing interventions. Program participants would have personal interaction with a primary mentor with expertise in at least 1 of the disciplinary areas already outlined.

During the summer immersion program, related activities should include time spent in the research laboratories of interest and networking with peers and faculty from participant institutions. Workshops would be structured around competitive grantsmanship, cultural competence, research ethics, effective corrections interface mechanisms (i.e., gaining access to correctional institutions and working with correctional populations), research methodology, and statistics. Participants would also conceptualize small grant proposals and present them to peers and advisors, who would sharpen both the concept and the research design.

For students living far from the partnering campus, there would be 48 virtual classrooms and webinars on topics such as women's health, HIV and correctional facilities, mental health and leadership, research on health and mental health disparities, correctional populations, career development, epidemiology, biostatistics, study design, and grant writing. During the second year, junior researchers and scholars, under the guidance of mentors, would develop grant proposals; this activity would be accompanied by a review of grant guidelines and of previously funded proposals, as well as discussions with the authors of those proposals. These grant proposals would address the kind of vexing health problems whose solutions require new scientific knowledge as well as an understanding of communities and their cultural context.

The program we propose would help give researchers from underrepresented minorities leadership roles in the research community. The program would add the dimension of cultural understanding to a rational new model that would be instructive to the larger research community. It would also build on the important historical value of the HBCU as leader in research areas critical to the very survival of the Black community. Ultimately, and most importantly, the program would make clear the ability of HBCUs to emerge as research leaders in reducing health disparities, rebuilding community resilience, and mentoring junior researchers.