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Minorities Not Visible in Clinical Trials, Medical Schools

— Much is misunderstood about Latino health, says NIH official

MedpageToday

NATIONAL HARBOR, Md. -- Latinos are greatly underrepresented in studies for prostate cancer screening, and this problem needs to be corrected, an NIH official said here Friday.

"There hasn't been a single screening trial including a significant number of Latinos or blacks ... yet it impacts our practice and we have no data to know if it works in this population," Eliseo Pérez-Stable, MD, director of the National Institute on Minority Health and Health Disparities, in Bethesda, Maryland, said at the National Hispanic Medical Association annual meeting.

Many facts about the U.S. Latino population are not well understood, according to Perez-Stable. For example, although Latinos are, as a group, poorer and less well-educated than their white counterparts, they have a longer life expectancy. It's a bit of an "epidemiologic paradox -- their outcomes are better than expected based on standard predictive risk factors," he said. "Just because you're poor doesn't mean you're always going to do worse ... We seem to have forgotten about that in thinking about disparities and adverse effects."

Smoking is another misunderstood issue in this group, he continued, noting that Latinos have lower rates of smoking than whites -- in 2015, 13.1% of Latino men and 7.1% of Latino women smoked, compared with 17.2% of white men and 16.0% of white women.

"About half of Latinos are very light or non-daily smokers. We've always approached cigarettes as a nicotine addiction problem, but if you don't smoke every day, you can't be addicted." Studies haven't been done on cessation in this population, except for one that is ongoing at Rutgers University, he said.

In fact, better data needs to be collected on minority populations overall, said Pérez-Stable. "We need to have standard measures [in the electronic health record] for demographic and social determinants of health." Health information technology can help minority groups in lots of other ways too. "Touch-screen technology helps ... Portal access to the clinician is really important. If you have an 80-year-old patient, they may not get on the internet and write a message, but their family will."

Interventions to improve minority health need to be done at multiple levels, said Pérez-Stable. "I'm a real big supporter of doing more research into the micro-environment of the clinical care setting between patients and clinicians, and patients and navigating the system." And behavior change can be accomplished through modifying the environment: "If you put in nice, big, easy-to-use stairs, people will use them more."

Sometimes those interventions come in unexpected forms, he said. For instance, one intervention done at a middle school found that the way to get students to drink fewer sugary drinks was to have lots of chilled water readily available; that worked better than more education on the issue. "It was giving an alternative in a structural way that made a difference," he said.

Health workforce diversity -- both for researchers and clinicians -- is an urgent issue among Latinos and other minorities, Pérez-Stable asserted. "Only about 7% of all NIH 'R01' grants are awarded to African-American or Latino primary investigators." Among medical school graduates in 2014, 5% were Latino, 5.5% were African American, and less than 0.002% were American Indian. "This is a crisis," especially since minority physicians are typically willing to see more uninsured and Medicaid patients, and minority medical students have a greater commitment to work in underserved areas, he added.