Many dimensions of disparity exist in the United States, both in health and in the social and economic aspects of well-being. If a health, social, or economic outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve health and well-being. CDM projects address disparities related to disenfranchised populations that often have multiple health and social/economic problems further aggravated by poverty, homelessness, and lack of health insurance.

Women’s Health

Coordinating Center for the HHS Office of Women’s Health (OWH) project. This project was developed in response to a growing body of evidence that lesbian and bisexual (LB) women tend to have higher rates of obesity than heterosexual women, and little intervention research had been funded to address this issue and related health inequities. As a result, five OWH-funded contracts in communities across the United States involved LB women 40 years and older at risk for (or with) heart disease, cancer, diabetes, musculoskeletal problems, asthma, and other morbidities related to overweight and obesity. CDM conducted the cross-site evaluation of the five contracts to identify and test effective and innovative ways to reduce obesity in this population. The project included analysis of focus group data, core survey, and anthropometric measures; logistical support; creation and facilitation of Evaluation and Editorial Committee meetings; development of detailed protocol manual for the evaluation; identification and provision of analytical, technical assistance needs at each site; data analysis; production of four publications; and presentations at two national meetings.

Care Delivery for Special Populations

SAMHSA Knowledge Application Program (KAP). As part of this project, CDM produced a 300+ page Treatment Improvement Protocol (TIP; Number 59) titled Improving Cultural Competence(revised in 2015). This guide helps professional care providers and administrators understand the role of culture in the delivery of mental health and substance use services. It describes cultural competence and discusses racial, ethnic, and cultural considerations. The TIP targets specific racial, ethnic, and cultural concerns, and the core elements of cultural competence are highlighted in the model. These core elements include cultural awareness, general cultural knowledge, cultural knowledge of behavioral health, and cultural skill development. The primary objective of this TIP is to assist readers in understanding the role of culture in the delivery of behavioral health services (both generally and concerning specific cultural groups). Some of our most notable TIPs have focused on special populations:

  • Individuals who are Homeless (TIP 55)
  • Women (TIP 51)
  • Individuals Involved With the Criminal Justice System (TIP 44)
  • Individuals With Co-Occurring Disorders (TIP 42)
  • Individuals With HIV/AIDS (TIP 37)
  • Individuals With Child Abuse and Neglect Issues (TIP 36)
As an integral part of our work, CDM continues to support gender initiatives, racial/ethnic initiatives, and other programs that reach disenfranchised populations that often have multiple and overlapping health problems exacerbated by poverty, homelessness, and lack of health insurance.
Adolescent Health

Trajectory Outcomes of Teens that Ride with Impaired Drivers & Drive Impaired. In collaboration with Yale University, CDM is examining the life trajectories of adolescents who report impaired driving (DWI) and/or riding with an impaired driver (RWI). This project aims to characterize the development of these two behaviors during adolescence and determine their associations with health, employment, and education during emerging adulthood. Using NEXT survey data, longitudinal DWI and RWI patterns from high school through young adulthood (abstainers, escalators, decliners, and persisters, i.e., trajectory classes) are identified for all NEXT participants. Qualitative interviews of members of these trajectory classes are conducted to identify explanatory contextual variables and themes (individual and social-environmental) that affect the development of RWI/DWI trajectory class and their relationship to health, employment, and higher education in emerging adulthood. Relying on data from the longitudinal NEXT survey, the qualitative interviews, NIAAA’s APIS dataset, all relevant literature, and input from an expert panel, system dynamics modeling is used to construct an explanatory model of how multi-level factors influence the development of RWI/DWI trajectory classes and lead to different and disparate status in health, employment, and higher education enrollment.

For the NEXT Generation Health Study for the NIH Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD), CDM recruited and worked across cultures and races with children and youth and their parents and families to administer surveys and anthropometric measures, obtain dietary information, obtain driving information, and much more. CDM was involved in the NEXT study and its predecessor—the Health Behavior in School-Age Children (HBSC) survey—from 2008 to 2017.

For the Adolescent Bariatric Surgery: Psychosocial Health and Risk Across Ten Years study with the NIH / National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), CDM identified the benefits and risks to psychosocial health for young adults who underwent weight-loss surgery as an adolescent compared to young adults who have not had weight loss surgery. The study included questionnaires regarding risk behaviors and psychosocial health, a clinical interview on participants’ risk behaviors and psychosocial health, an interview evaluating comorbidity for other health problems, and a medical evaluation of health status, including anthropometrics and assays of urine and blood samples.