Introduction:
Alleviating sexual and reproductive health (SRH) disparities affecting racial and ethnic minorities, as well as other vulnerable populations (e.g., urban and rural poor living in mixed race communities), is one of the leading public health challenges facing the United States (Centers for Disease Control and Prevention, 2012; Prejean et al., 2011). Blacks are disproportionately affected by STIs, accounting for nearly 67% of gonorrhea cases and nearly half of reported cases of chlamydia and syphilis. Latinos experience nearly twice the rates of gonorrhea and chlamydia of Whites (Centers for Disease Control and Prevention, 2012). Racial and ethnic minority groups, particularly men who have sex with men (MSM), are also disproportionately affected by HIV/AIDS (Brewer et al., 2011; Millett et al., 2012). Blacks make up 14% of the general population yet are burdened with 52% of new HIV/AIDS diagnoses; Latinos make up 16% of the population but account for 20% of diagnoses; while Whites account for 72% of the population and only 28.1% of the diagnoses (Centers for Disease Control and Prevention, 2007; Finer & Henshaw, 2006; Mosher, Jones, & Abma, 2012). Surveillance data clearly indicate that race and ethnicity continue to play a role in determining sexual and reproductive health outcomes, highlighting the urgent need to better understand the context of sexual risk and preventive behaviors.
Despite shifts in the demographics of the U.S., where the latest Census shows the U.S. population has a growing percentage of people of color, there are limited numbers of people of color working in the fields of health care and health research, including HIV/STI disparities research. Blacks and Latinos represent 14% and 16% of the U.S. populace respectively; however, they make up less than 10% of the health care work force (The Sullivan Commission, 2004; United States Census Bureau, 2011a, 2011b). Given Census projections that by the year 2050 Latinos and African Americans will comprise 30% and 15% of the U.S. population, respectively, considerable efforts are needed to ensure that a culturally-competent health care work force, which includes researchers, is in place (The Sullivan Commission, 2004). In addition to expanding opportunities to increase Black and Latino enrollment in medical, dental, pharmacy, and public health schools, the appropriate scientific workforce must be trained to produce high quality research so that health care providers and workers can intervene effectively to promote health and disease prevention among an increasingly diverse U.S. populace. Racial and ethnic minority scientists have a unique understanding of the complex socio-structural as well as individual-level factors that continue to drive HIV/STI and SRH disparities. They are more likely to collaborate with communities of color, encourage their minority students to adopt research careers, and maintain their commitment over time to conducting research with vulnerable populations due to personal experiences as well as deep understandings of diverse cultural beliefs (Fitzpatrick, Sutton, & Greenberg, 2006; Marín & Díaz, 2002; Wyatt, Williams, Henderson, & Sumner, 2009). Therefore, racial and ethnic minority scientists who are committed to sustained programs of research are often best positioned to make innovative contributions that profoundly impact HIV/STI and SRH disparities research.
Racial and ethnic minority scientists face specific challenges in achieving research funding, securing appropriate mentoring, sustaining their programs of research, and continuing in the research pipeline. There are relatively few racial and ethnic minority investigators and they often face unique barriers in the development of independent research careers. Absence of mentoring and research collaboration has been identified as a critical barrier to research participation by minority investigators (Green, Rivers, & et al., 2006; Lewellen-Williams, Johnson, & et al., 2006; Marín & Díaz, 2002; Padilla, 1994; Waitzkin, Yager, Parker, & Duran, 2006). The most talented minority graduate students are often recruited directly to faculty positions. Once they are recruited by universities, these faculty are expected to assume heavy student advising loads, to become the first and often only points of contact on diversity matters within their departments, serve on affirmative action and related committees, serve as liaisons with minority communities, negotiate cultural differences between administration, staff, and students, and even to translate documents (Padilla, 1994). These activities take precious time away from scientific pursuits and are often not counted as contributions in tenure and promotion decisions. In addition, scientists who focus their research on minority and other vulnerable populations may find their research not valued by other faculty and that multidisciplinary studies with others on campus, or research collaboration with others knowledgeable about the group they wish to study, is difficult and sometimes impossible to find (Padilla, 1994). An additional hindrance facing scientists from institutions with limited extramural research funding experience is a lack of institutional knowledge regarding one or more of the multitude of steps necessary to successfully submit proposals to secure such funding.
Racial and ethnic minority investigators also may be aware of the lack of success of many investigators of color and as a result can feel that trying to obtain large-scale funding is futile. Historically, few racial or ethnic minority investigators have been funded by the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), or other federal agencies. Recent data from the NIH indicate that Black and Latino scientists are significantly less likely to receive R01 funding than their White counterparts (Ginther et al., 2011).
The CAPS Visiting Professor (VP) Program: To combat health disparities in HIV/AIDS, STIs, and reproductive health and to increase the diversity of the HIV and STI prevention scientific workforce, the CAPS VP program builds research capacity and supports early-career behavioral science researchers to develop their programs of research and their careers. More broadly, the program addresses the lack of PIs from underrepresented groups who are funded by the NIH, CDC, and other agencies by preparing investigators to compete successfully for NIH funds through research collaboration, development of programs of research, and the opportunity for ongoing support from and collaboration with mentors and peers working in the same areas of research. The CAPS VP program has the following four broad goals:
1) Build capacity among visiting professors (VPs) to conduct multidisciplinary social/behavioral HIV/STI and sexual and reproductive health (SRH) disparities research involving structural, social, cultural, and individual factors affecting HIV/STI-related disparities;
2) Provide funding and mentoring to VPs to design and conduct innovative pilot research that will be presented at conferences, lead to publications, and inform subsequent federal grant proposals;
3) Provide education, mentoring, and assistance to VPs in the writing, submitting, revising, and resubmitting of federal grants focused on social/behavioral HIV/STI disparities research; and
4) Provide peer review and consultations to VPs who have completed the program to help them continue their innovative programs of HIV/STI and SRH disparities research as independent investigators and mentors.
These goals are accomplished through a three-year intensive program, held at the UCSF Center for AIDS Prevention Studies (CAPS). With a nucleus of 23 principal investigators and 66 affiliated scientists spanning a wide array of academic disciplines and a rigorous internal peer review system for grant proposals, CAPS provides an ideal environment in which to hold the VP program. The program recruits early-career faculty members from around the U.S. who have not yet obtained multiyear federal funding at the R01 level and who are embarking on innovative programs of HIV/STI or SRH research targeting underserved, vulnerable U.S. populations (e.g., racial and ethnic minority populations). Each VP will visit CAPS for three summers, where VP program faculty mentors and other CAPS scientists will offer seminars on HIV/STI research topics, methods, and grant-writing to build VPs’ research capacity and grant-writing capacity.
The VP program borrows from Entrepreneurial Developmental Network Structures (EDNS) to frame its theoretical approach to mentoring. Research in organizational psychology highlights the benefits of Entrepreneurial Developmental Network Structures (EDNS), in which multiple mentors and trainees with similar interests but different disciplinary perspectives and experiences positively influence trainee development through strong ties to each mentor and fellow trainee (Higgins & Kram, 2001). The broad diversity of the mentor/trainee groups enhances problem-solving capacities and consideration of alternative courses of action by increasing the breadth of knowledge, skills, and available contacts. This is particularly true for tasks that involve acquiring new knowledge, such as designing and conducting pilot studies and drafting grant proposals (Hansen, Podolny, & Pfeffer, 2000).
For each interaction within the network, we employ an approach based on Social Cognitive Career Theory (SCCT), which demonstrates the importance of mentors and trainees establishing a systematic roadmap of the overall career development process, and, within it, a roadmap for each specific research project (Baaken, Byars-Winston, & Wang, 2006; Manson, 2009). At the outset of the summer program, VPs and their primary UCSF faculty mentors collaborate to identify and implement the steps by which broad, theoretically-driven research ideas supported by the literature are refined into feasible pilot study projects. An individual development plan (IDP) document, which lists short- and long-term career goals, anticipated barriers to realizing goals, possible solutions to overcoming barriers, and projected timelines to complete goals, provides a framework for these initial meetings and becomes a living document which VPs and their mentors refer to and update during the summer program and beyond. In the first summer, VPs, with input from their mentors, develop a protocol for a $20,000 pilot study to be completed during the academic year between the first and second summers. This pilot study protocol and an accompanying IRB protocol are peer-reviewed by another faculty mentor, a fellow VP program participant, and an outside faculty expert in the final week of the summer program. VPs and their mentors revise the pilot study protocol based on the peer review feedback and the VP receives $20,000 to carry out the pilot study between the second and third summer. In the second summer pilot data are analyzed to yield conference presentations, publications, and preliminary data for larger grant proposals, and proposals are drafted and submitted to NIH between the second and third summers. In the third summer, VPs revise and resubmit their NIH grant proposals. For each contact within the network, VPs are guided through these steps with rigorous yet self-affirming feedback based on studies showing that self-affirmation interventions designed to lessen the psychological threat of poor performance for scholars from underrepresented groups can have a large effect on improving intellectual achievement (Cohen, Garcia, Apfel, & Master, 2006). The VP program shares similarities with such interventions in reducing threat and affirming positive capabilities, setting the stage for VPs to achieve multiyear funding and embark upon significant programs of research in HIV/AIDS prevention. Figure 1 shows how this theory-based mentoring approach is applied in the context of the CAPS VP program. In one recent example, a VP, with input and peer review feedback from the program, created and submitted an NIH R24 application in 2012 to conduct a formative study involving HIV-prevention research with Black churches in the U.S. south. She received a very good but non-fundable priority score on her NIH application. At the outset of the 2013 summer program, the faculty mentors and VPs gathered to peer review the originally-submitted grant proposal along with the NIH reviewer comments and scores and gave the VP grant applicant various suggestions on next steps for how to improve the proposal. The VP then met with several VP program faculty mentors to receive additional specific ideas for how to implement suggestions from the VP program peer review. Lastly, she met with her primary faculty mentor to synthesize and integrate the feedback received from the other faculty mentors and her fellow VP colleagues and mapped out a plan of action for revising and resubmitting an altered version of the grant proposal to NIH.
During the academic years between the summer training programs, VPs communicate with VP program faculty mentors at least monthly, supplemented by webinars and the program’s new social-network-based web site. To fortify this three-year intensive research education experience, the program provides ongoing peer review and technical assistance after the third summer, which will help VPs to remain in the research pipeline and sustain and further extend their innovative programs of research.
The program's mentoring framework is explicitly designed to be horizontal in structure, with all program faculty mentors supplying valuable and unique input to VPs during the development of their pilot studies and grant proposal drafts and during peer review sessions. As well, a crucial element of the program is VPs spending a full six weeks together in San Francisco. The time VPs spend together in San Francisco at CAPS promotes close collaboration and networking among the VPs, and VPs serve as both formal (e.g., in seminars and peer reviews) and informal resources to each other as they advance their programs of research. While program faculty mentors bring years of experience and diverse disciplinary perspectives to the program that are irreplaceable, in many respects fellow VPs have the most expertise in the populations being studied and how to overcome practical problems VPs may encounter in the field when conducting their pilot studies. In this way the VP program unites the NIH funding experience and decades of research experience brought by the mentors with the current on-the-ground knowledge of the VPs to synergistically maximize the potential of each VP's research program. The role of the primary mentor within this horizontal structure is to help the VP synthesize disparate feedback received and integrate it into a feasible plan of action, as well as to be a trusted confidant and advisor regarding career goals and advancement concerns (Kahn & Greenblatt, 2009).
Core Summer Program Elements: The centerpiece of the VP program is the six-week intensive summer program described above. In the first week, first-year VPs present their programs of research and discuss how they envision the CAPS-supported pilot study fitting within their overall programs of research. Second- and third-year VPs present updates on their CAPS pilot study and other research findings and report on progress on their grant proposal drafts. Each presentation is attended by all VP program faculty mentors and fellow VPs to facilitate the mentors and VPs becoming familiar with everyone's programs of research. These interactive sessions lay the groundwork for VPs supporting each other to strengthen their research programs (Dolcini, Grinstead Reznick, & Marin, 2009).
Beginning in the second week of the program, VPs attend cohort-specific research planning seminars. For first-year VPs, this weekly two-hour seminar is designed to develop their long-term program of research and their specific pilot studies. VPs work with seminar leaders to develop the rationales and theoretical models for their overall programs of research, as well as the aims, data-collection instruments, budgets, and human subject’s protocols for their pilot studies. As faculty experts in their disciplines and research populations, VPs come to the program with varying levels of familiarity with theories and methods outside of their own disciplines. Thus, a critical element of the CAPS VP program’s multidisciplinary-research-capacity-building approach is for VPs to share ideas from different disciplinary viewpoints with each other. This aspect of the program helps VPs to broaden their knowledge of theories and methods from different disciplines. Rotating pairs of faculty mentors lead these seminars to provide unique disciplinary perspectives. Each week VPs draft a section of the pilot study protocol that follows the NIH R21 grant proposal format (i.e., specific aims, significance, innovation, approach, human subjects) and submit the draft two days before the seminar. Mentors and fellow VPs read the submitted materials and then discuss and refine materials at the seminar. By the final week of the summer program, each VP's seven-page pilot study protocol is ready for peer review. Second- and third-year VPs attend similarly-structured seminars where the focal product is an actual NIH or similar (e.g., CDC, non-federal) grant proposal.
CAPS has a well-developed system of peer review that we apply in the VP program. In the last week of the summer program, each VP's summer product is formally reviewed in a one-hour group session by a VP program faculty mentor, a qualitative methodologist or statistician unfamiliar with the project, another VP colleague, and an outside expert in the substantive area. Often the outside expert is a former VP program participant who has gone on to secure multiyear NIH funding. Seeing former VPs who have been successful is motivating and inspiring to current program participants. All program faculty mentors and current VPs attend each peer review. The peer review sessions are audio-recorded for the reviewees. Each peer reviewer shares seven minutes of verbal commentary and additional written comments with the reviewee. Following the formal portion of each review (30 minutes), mentors and other VPs use the remaining time to provide more comments and raise questions. Lively discussions among VPs and program mentors ensue. These discussions are invaluable because the VPs and mentoring faculty work together to offer useful suggestions to each VP for refining the quality of the proposed product. Moreover, VPs often find reviewing others' work catalyzes creative thinking about their own research projects and also that hearing solutions during peer reviews of others' work is helpful for their own projects. Following peer reviews, VPs meet with the primary mentors to synthesize the peer review feedback, plan next steps, and update their IDPs accordingly.
Additional Seminars: Augmenting the research planning seminars are specific seminars on research methods, human subjects protections (including the special human subjects protections considerations involved in conducting research involving stigmatized or illegal behaviors), effective pre-award budget and budget justification preparation, post-awards grants management, how to build and nurture collaborations with community-based organizations (CBOs), and the NIH public access policy for manuscripts. These seminars and the individual meetings described below typically consume two days per week, allowing the remaining three days to be used for meeting with mentors and other faculty experts and fellow VPs and to have writing time free of the inevitable distractions encountered at the VPs' home institutions.
Individual Meetings with VP Program Faculty Mentors and Other CAPS Faculty: During the summer program, VPs meet with VP program faculty mentors extensively, as well as with other CAPS and UCSF faculty experts with specialized expertise. Also, a critical component of the program is the social cohesion that VPs form by being in San Francisco for six weeks each summer. This intensive immersion experience catalyzes collaborations in which VPs share ideas and form research partnerships, some of which develop into lifelong research relationships. Prior to the start of each summer program, VPs complete the IDP form described above. When VPs and mentors meet, the IDP grounds their conversations. VPs and mentors revise the IDP at the end of each summer program during a Next Steps meeting, with mentor and VP action items clearly delineated and timelines clearly specified. Feedback from VPs regarding the IDP has been universally positive, and at least one VP has sought permission to adapt the IDP form to his own institution to improve the mentoring process there.
Program Faculty Mentors and Program Environment: The VP program faculty mentors represent an interdisciplinary group of nine social scientists, with training in social, health, and clinical psychology, sociology, statistics, and medical anthropology, with considerable experience in conducting multidisciplinary health disparities research. This broad spectrum of expertise and disciplinary training promotes synergy in group discussions during the summers and in online sessions because each faculty mentor brings a unique perspective to the VPs’ projects. Moreover, the diversity of faculty mentor backgrounds enables the VPs to integrate many disciplinary perspectives into their research. The program faculty mentors have extensive experience obtaining NIH and CDC funding. All have considerable experience in mentoring HIV/STI-prevention scientists, and all are competent in the cultural nuances of conducting prevention research in underserved communities by virtue of their extensive experience working with these communities and in conducting health disparities research (Marin & Diaz, 2002).
More broadly, CAPS provides a unique environment in which to conduct the VP program. Funded under the NIMH program for HIV/AIDS research centers (P30 MH062246; Morin, PI), CAPS features an extensive resource infrastructure through its six cores (administrative, developmental, methods, technology and information exchange, policy and ethics, and international), diverse expertise of 23 full-time faculty, and a collaborative culture that can help scholars surpass obstacles in their quest to conduct high-quality HIV/STI disparities research with underserved communities. CAPS faculty frequently supply in-kind consultations to VPs during the summer program and also serve as peer reviewers.
Accomplishments: Since the program's launch in 1996, VPs have obtained more than $166 million in research funding during and following their program participation, including 26 R01s, one NIH K award, seven CDC grants, and various grants from non-federal sources. During the past five years, VPs have received 14 NIH R01s, five R21s, three R34s, and three CDC grants, yielding over $45 million. Past and current VPs have over $39 million in active research funding. Of the 52 multiyear awards obtained by VPs, 31 (60%) were secured in the past five years, despite an increasingly challenging funding climate, including the Great Recession of 2008. VPs have produced 640 publications and technical reports, ranging from brief manuscripts to books and book-length monographs. VPs’ publications include empirical findings, literature reviews, research methods innovations, and best practices guidelines for conducting intervention research in vulnerable populations. VPs have published their findings in leading public health journals (e.g., American Journal of Public Health; Social Science and Medicine) and sexuality research outlets (e.g., Journal of Sex Research). VPs have also presented their work at national public and mental health meetings and conferences (e.g., American Public Health Association).
Future Directions: The CAPS intensive summer program is clearly successful and process evaluation results mirror the funding and publications outcome data reported above (e.g., VPs rate the vast majority of program activities as "very good" or "excellent" annually following the summer program). Faculty mentors and VPs have suggested that this already-excellent program can strengthened even further via adding quarterly distance education webinars and a social networking website to enable VPs and mentors to stay in closer touch during the academic years in between the summers and to enable past VPs to connect with each other and with current VPs to form collaborations. By implementing these additions, we anticipate the VP program will continue to benefit early-career faculty conducting HIV/STI prevention research in the underserved communities most disproportionately affected by those health disparities.
Acknowledgements
The CAPS Visiting Professor Program gratefully acknowledges funding from NIMH R25 MH067127, NICHD R25 HD045810, and NIDA R25 DA028567.
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