Promotion and Tenure for Community‐Engaged Research: An Examination of Promotion and Tenure Support for Community‐Engaged Research at Three Universities Collaborating through a Clinical and Translational Science Award

Introduction

Community‐engaged health research, an approach to research which includes the participation of communities, promotes the translation of research to address and improve social determinants of health. As a way to encourage community‐engaged research, the National Institutes of Health required applicants to the Clinical and Translational Science Award (CTSA) to include a community engagement component. Although grant‐funding may support an increase in community‐engaged research, faculties also respond to the rewards and demands of university promotion and tenure standards. This paper measures faculty perception of how three institutions funded by a CTSA support community‐engaged research in the promotion and tenure process.

Methods

At three institutions funded by a CTSA, tenure track and nontenure track faculty responded to a survey regarding perceptions of how promotion and tenure committees value community‐engaged research.

Results

Faculty view support for community‐engaged research with some reserve. Only 36% agree that community‐engaged research is valued in the promotion and tenure process.

Discussion

Encouraging community‐engaged scholarship requires changing the culture and values behind promotion and tenure decisions. Institutions will increase community‐engaged research and more faculty will adopt its principles, when it is rewarded by promotion and tenure committees.     

Survey of Community Engagement in NIH‐Funded Research

Community engagement is an innovative and required component for Clinical and Translational Science Awards (CTSAs) funded by the National Institutes of Health (NIH). However, the extent of community engagement in NIH‐funded research has not been previously examined. This study assessed baseline prevalence of community engagement activities among NIH‐funded studies at a large Midwestern university with a CTSA. An online survey was e‐mailed to principal investigators of recent NIH‐funded studies (N = 480). Investigators were asked to identify what types of community engagement activities had occurred for each study. Responses were received for 40.4% (194/480) of studies. Overall, 42.6% reported any community engagement activities. More collaborative types of engagement (e.g., community advisory board) were less common than activities requiring less engagement (e.g., sharing study results with community members). Studies with more collaborative community engagement were less likely to be described as basic or preclinical research compared to all other studies. Given NIH''s inclusive call for community engagement in research, relatively few NIH‐funded studies reported community engagement activities, although this study used a broad definition of community and a wide range of types of engagement. These findings may be used to inform the goals of CTSA community engagement programs. Clin Trans Sci 2010; Volume *: 1–4     

Engaging the Community in the Dissemination,Implementation, and Improvement of Health‐Related Research

To help maximize the real‐world applicability of available interventions in clinical and community healthcare practice, there has been greater emphasis over the past two decades on engaging local communities in health‐related research. While there have been numerous successful community–academic partnered collaborations, there continues to be a need to articulate the common barriers experienced during the evolution of these partnerships, and to provide a roadmap for best practices that engage healthcare providers, patients, families, caregivers, community leaders, healthcare systems, public agencies and academic medical centers. To this end, this paper presents a summary of a forum discussion from the 2014 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium, sponsored by the University of California Los Angeles (UCLA) Clinical Translational Science Institute (CTSI), University of Southern California (USC) CTSI, and Kaiser Permanente. During this forum, a diverse group of individuals representing multiple constituencies identified four key barriers to success in community‐partnered participatory research (CPPR) and discussed consensus recommendations to enhance the development, implementation, and dissemination of community health‐related research. In addition, this group identified several ways in which the over 60 NIH funded Clinical and Translational Science Institutes across the country could engage communities and researchers to advance DII science.     

Partnership‐Driven Resources to Improve and Enhance Research (PRIMER): A Survey of Community‐Engaged Researchers and Creation of an Online Toolkit

Objective: This project aimed to develop an open‐access website providing adaptable resources to facilitate best practices for multisite research from initiation to closeout. Methods: A web‐based assessment was sent to the leadership of the Clinical and Translational Science Award (CTSA) Community Engagement Key Functions Committee (n= 38) and the CTSA‐affiliated Primary Care Practice‐based Research Networks (PBRN, n= 55). Respondents rated the benefits and barriers of multisite research, the utility of available resources, and indicated their level of interest in unavailable resources. Then, existing research resources were evaluated for relevance to multisite research, adaptability to other projects, and source credibility. Results: Fifty‐five (59%) of invited participants completed the survey. Top perceived benefits of multisite research were the ability to conduct community‐relevant research through academic–community partnerships (34%) and accelerating translation of research into practice (31%). Top perceived barriers were lack of research infrastructure to support PBRNs and community partners (31%) and inadequate funding to support multisite collaborations (26%). Over 200 resources were evaluated, of which 120 unique resources were included in the website. Conclusion: The PRIMER Research Toolkit (http://www.researchtoolkit.org) provides an array of peer‐reviewed resources to facilitate translational research for the conduct of multisite studies within PBRNs and community‐based organizations. Clin Trans Sci 2011; Volume 4: 259–265     

Sharing of Grant Funds between Academic Institutions and -Community Partners in Community‐Based Participatory Research

Objectives

To determine how grant funds are shared between academic institutions and community partners in community‐based participatory research (CBPR).

Methods

Review of all 62 investigator‐initiated R01 CBPR grants funded by the National Institutes of Health from January 2005 to August 2012. Using prespecified criteria, two reviewers independently categorized each budget item as being for an academic institution or a community partner. A third reviewer helped resolve any discrepancies.

Results

Among 49 evaluable grants, 68% of all grant funds were for academic institutions and 30% were for community partners. For 2% of funds, it was unclear whether they were for academic institutions or for community partners. Community partners’ share of funds was highest in the categories of other direct costs (62%) and other personnel (48%) and lowest in the categories of equipment (1%) and indirect costs (7%).

Conclusions

A majority of CBPR grant funds are allocated to academic institutions. In order to enhance the share that community partners receive, funders may wish to specify a minimum proportion of grant funds that should be allocated to community partners in CBPR projects.     

Community Stakeholders’ Perceptions of the Role of Family in HIV Prevention in Iringa,Tanzania

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions.     

Community‐Based Participatory Research Skills and Training Needs in a Sample of Academic Researchers from a Clinical and Translational Science Center in the Northeast

Purpose: To determine the community‐based participatory research (CBPR) training interests and needs of researchers interested in CBPR to inform efforts to build infrastructure for conducting community‐engaged research. Method: A 20‐item survey was completed by 127 academic health researchers at Harvard Medical School, Harvard School of Public Health, and Harvard affiliated hospitals. Results: Slightly more than half of the participants reported current or prior experience with CBPR (58 %). Across all levels of academic involvement, approximately half of the participants with CBPR experience reported lacking skills in research methods and dissemination, with even fewer reporting skills in training of community partners. Regardless of prior CBPR experience, about half of the respondents reported having training needs in funding, partnership development, evaluation, and dissemination of CBPR projects. Among those with CBPR experience, more than one‐third of the participants wanted a mentor in CBPR; however only 19 % were willing to act as a mentor. Conclusions: Despite having experience with CBPR, many respondents did not have the comprehensive package of CBPR skills, reporting a need for training in a variety of CBPR skill sets. Further, the apparent mismatch between the need for mentors and availability in this sample suggests an important area for development. Clin Trans Sci 2012; Volume #: 1–5     

Standardization of Research‐Quality Anthropometric Measurement of Infants and Implementation in a Multicenter Study

Malnutrition is one of the earliest clinical manifestations of cystic fibrosis (CF) and is associated with poorer pulmonary and cognitive outcomes and survival later in life. Infant growth can be a responsive measure for clinical research in this age group if obtained and characterized accurately. We report here the methods to standardize and implement research‐quality anthropometric measurement of infants with cystic fibrosis in the Baby Observational Nutrition Study multicenter trial.     

Self‐Regulation of Sleep,Emotion, and Weight during Adolescence: Implications for Translational Research and Practice

Self‐regulation—the ability to manage motivations, emotions, physiological sensations, and behavior to meet internal and external demands of the environment—is critical to health and development. Adolescence represents a dynamic period of change in both the demand and capacity for self‐regulation. As teens mature and become more autonomous, they are confronted with decisions in determining where they spend their time, what they eat, when they go to bed, and how they prioritize and pursue various social, academic, and recreational goals. We highlight opportunities to improve self‐regulatory capacities and related health outcomes during this important developmental window. In particular, we focus on emotion regulation, sleep regulation, and weight regulation as three separate but synergistic self‐regulatory systems that may provide unique opportunities for intervention to optimize health outcomes. To this end, we begin by describing developmental changes that occur in emotion, sleep and weight regulatory systems during the transitional period of adolescence, as well as how these changes can lead to profound and enduring health consequences. Next, we describe emerging evidence that indicates complex and synergistic interactions among these regulatory systems during adolescence. Last, we end with possible prevention and intervention efforts that capitalize on the interactions among these three regulatory domains.     

The Design and Conduct of a Community‐Based Registry and Biorepository: A Focus on Cardiometabolic Health in Latinos

Background

Latinos are disproportionately impacted by obesity and type 2 diabetes but remain underrepresented in biomedical research. Therefore, the purpose of this project was to develop a research registry and biorepository to examine cardiometabolic disease risk in the Latino community of Phoenix, Arizona. The overarching goal was to establish the research infrastructure that would encourage transdisciplinary research regarding the biocultural mechanisms of obesity‐related health disparities and facilitate access to this research for the Latino community.

Methods

Prior to recruitment, key stakeholders from the local Latino community were engaged to develop a broad rapport within the community and seek advice regarding recruitment, enrollment, and follow‐up. Self‐identified community‐dwelling Latinos underwent a comprehensive cardiometabolic health assessment that included anthropometrics, a fasting laboratory panel, and a 2‐hour oral glucose tolerance test with measures of insulin and glucose to estimate insulin action and secretion. Separate consent was requested for future contact and banking of serum, DNA, and RNA. Research collaborations were sought out based on the cultural and metabolic profile of participants, faculty research agendas, and the potential for generating hypotheses.

Results

A total of 667 participants (20.4% children, and 79.6% adults) were enrolled with 97% consenting to the registry and 94% to banking of samples. The prevalence of overweight/obesity was 50% in children and 81% in adults. Nearly 20% of children and more than 45% of the adults exhibited some degree of hyperglycemia. To date, more than 15 research projects have been supported through this infrastructure and have included projects on the molecular biology of insulin resistance to the sociocultural determinants of health behaviors and outcomes.

Conclusions

The high prevalence of obesity and cardiometabolic disease risk factors coupled with the overwhelming majority of participants consenting to be re‐contacted, highlights the importance of supporting research infrastructure to generate hypotheses about obesity‐related health in Latinos. Future studies that stem from the initial project will likely advance the limited understanding regarding the biocultural determinants of health disparities in the Latino community.     

Different inflammatory mechanisms in lungs of severe and mild asthma: crosstalk of NF‐kappa‐B,TGFβ1, Bax,Bcl‐2, IL‐4 and IgE

Objective: To examine differences in the apoptotic, inflammatory, allergic and immunological features in the lungs of adults with asthma. Material and methods: Thirty‐six patients with mild asthma (MA), 16 with severe asthma (SA) and 20 healthy volunteers (HVs) were enrolled. Bronchoalveolar lavage fluid (BALF) was processed into cell‐free fluid for enzyme‐linked immunosorbent assay detecting soluble TGFβ1, IL‐4 and IgE and BALF lymphocytes for immunocytochemical staining of cellular Bax, Bcl‐2 and nuclear factor‐Kappa‐B (NFκB). Results: Cellular NFκB expression was higher in SA than in MA and HVs, while extracellular TGFβ1 was high in both the SA and MA groups but low in the HVs. Bcl‐2/Bax ratio was higher in SA than in MA and in MA than in HV groups and correlated significantly with NFκB level. Interestingly, the levels of IgE and, to a lesser extent, IL‐4 were higher in MA than in SA and both were much higher than in HVs, and were inversely correlated with NFκB level in the SA group and with TGFβ1 level in the MA group. Conclusions: NFκB has a central role in the perpetuation of persistent inflammation in SA and might induce apoptosis via Bcl‐2. The SA group appears not associated much with allergen‐based IgE and IL‐4 reactions as efficiently as in MA. This was supported by the lower levels of IgE and IL‐4 in SA compared to MA. TGFβ1 appears to be associated with asthma pathogenesis, especially allergen‐based MA.     

Platelet‐derived VEGF,Flt‐1, Angiopoietin‐1 and P‐selectin in breast and prostate cancer: further evidence for a role of platelets in tumour angiogenesis

BACKGROUND: Cancer is a complex multi‐factorial disorder that may commonly show abnormal angiogenesis in such patients. Recently, platelets have been postulated to have a major role in both these processes, suggesting that anti‐platelet strategies may be useful in cancer treatment.

MATERIALS AND METHODS: To further investigate the role of platelets in angiogenesis, we used a novel platelet lysate assay to analyse platelet contents in breast cancer (n?=?30) and prostate cancer (n?=?30) patients and age‐ and sex‐matched controls (n?=?60). Markers of angiogenesis (vascular endothelial growth factor (VEGF), angiopoietin‐1 and–2 (Ang‐1, ‐2), and their respective receptors (Flt‐1 and Tie‐2) plus a marker of platelet activation (P‐selectin (P‐sel)), were all measured in platelet lysate by enzyme‐linked immunsorbent assay.

RESULTS: Platelet lysate from breast cancer patients contained higher levels of VEGF (P?<?0.0001), Ang‐1 (P?=?0.0186) and P‐sel (P?=?0.0002), compared to healthy controls. Platelet lysate from prostate cancer patients had elevated VEGF (P?=?0.008) but not Ang‐1 or P‐sel. There were no significant differences between levels of Flt‐1 between patients and controls, and both Ang‐2 and Tie‐2 were undetectable in both patient groups and control platelet lysate.

CONCLUSION: We have shown that our previously developed platelet lysate technique could be used to measure indices of angiogenesis, and their respective receptors, and that this assay can be applied to patients with cancer. Our study also provides further evidence that platelets may influence angiogenic abnormalities in human cancer. The platelet may be a useful target in anti‐cancer strategies.     

Are Community Violence-Exposed Youth at Risk of Engaging in Delinquent Behavior? A Review and Implications for Residential Treatment Research and Practice

Numerous studies have documented a direct association between children’s exposure to community violence and subsequent delinquent behavior. Regrettably, an understanding of the community violence exposure-delinquent behavior link is incomplete because violence-exposed children rarely engage in delinquency immediately. Rather, there are complex, developmental pathways in which these children experience behavioral problems before subsequently exhibiting delinquent behavior. Despite the importance of understanding the mechanisms that illuminate how children exposed to violence in the community might engage in delinquency, relatively few studies have investigated potential mechanisms. This review proposes four potential mechanisms: depression, anxiety/PTSD, conduct disorder, and aggression. More specifically, we examine how certain internalizing and externalizing behaviors can potentially mediate the relationship between community violence exposure and delinquent behavior. We also discuss implications for residential treatment research and practice.     

Effects of long‐term whole‐body cold exposures on plasma concentrations of ACTH,beta‐endorphin,cortisol, catecholamines and cytokines in healthy females

Objective. Cold therapy is used to relieve pain and inflammatory symptoms. The present study was designed to determine the influence of long‐term regular exposure to acute cold temperature. Two types of exposure were studied: winter swimming in ice‐cold water and whole‐body cryotherapy. The outcome was investigated on humoral factors that may account for pain alleviation related to the exposures. Material and methods. During the course of 12 weeks, 3 times a week, a group of healthy females (n = 10) was exposed to winter swimming (water 0–2°C) for 20?s and another group (n = 10) to whole‐body cryotherapy (air ?110°C) for 2?min in a special chamber. Blood specimens were drawn in weeks 1, 2, 4, 8 and 12, on a day when no cold exposure occurred (control specimens) and on a day of cold exposures (cold specimens) before the exposures (0?min), and thereafter at 5 and 35?min. Results. Plasma ACTH and cortisol in weeks 4–12 on time‐points 35?min were significantly lower than in week 1, probably due to habituation, suggesting that neither winter swimming nor whole‐body cryotherapy stimulated the pituitary‐adrenal cortex axis. Plasma epinephrine was unchanged during both experiments, but norepinephrine showed significant 2‐fold to 3‐fold increases each time for 12 weeks after both cold exposures. Plasma IL‐1‐beta, IL‐6 or TNFα did not show any changes after cold exposure. Conclusions. The main finding was the sustained cold‐induced stimulation of norepinephrine, which was remarkably similar between exposures. The frequent increase in norepinephrine might have a role in pain alleviation in whole‐body cryotherapy and winter swimming.