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Barrett, Nadine J

Overview:

As a Medical Sociologist with over 15 years of experience engaging diverse health systems and communities to improve community and population health, I have devoted my career to reducing health disparities among disadvantaged and vulnerable populations and effectively training health care and research professionals and trainees in community engagement, diversity and inclusion, and the principles of authentic and impactful stakeholder collaborations. My expertise can be defined broadly within the context of developing effective community and health system partnerships to improve health outcomes, and conducting community health assessments to inform strategic priority setting, and program development, implementation and evaluation. I serve as the inaugural director of the Office of Health Equity and Disparities at the Duke Cancer Institute, and the Director of the Community Connections and Collaborations Core within the Duke CTSA and the Center for Community and Population Health Improvement. I am also faculty in the Department of Community and Family Medicine, Division of Community Health. 
I have several funded project including Project PLACE (Population Level Approaches to Cancer Elimination), funded by the NCI is a three pronged research project designed to implement three robust mechanisms to inform the health equity strategic direction of the DCI over the next 5- 8 years. Project PLACE  is a highly intensive community engagement model and platform designed to shape robust scholarly productivity, partnered research and community programs to improve population health. I am also the Duke PI (subcontract) with Kevin Williams (lead-PI)of a national Susan G. Komen pipeline training grant on translational research in Inflammatory Breast Cancer, and community engaged research. I also co-direct the NCI funded Cancer Research and Education Program Core of the NCCU/DCI Translational Health Disparities Research Program which incorporates specified training in minority accrual in clinical research, a program I developed within the DCI entitled, Just Ask.  

Positions:

Assistant Professor in Family Medicine and Community Health

Family Medicine and Community Health, Community Health
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2005

Ph.D. — Texas Womans University

News:

Grants:

Reducing Disparities in the Quality of Palliative Care for Older African Americans Through Improved Advance Care Planning

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Patient Centered Outcomes Research Institute
Role
Co Investigator
Start Date
August 01, 2017
End Date
July 31, 2022

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2017
End Date
June 30, 2022

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2017
End Date
June 30, 2022

EMPOWER Study: Promoting BC Screening in Women Who Survived Childhood Cancer

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 23, 2009
End Date
March 31, 2022

Just Ask - Increasing Diversity in Oncology Clinical Research and Trials An Institutional and Stakeholder Engagement Approach

Administered By
Duke Cancer Institute
AwardedBy
V Foundation for Cancer Research
Role
Principal Investigator
Start Date
January 15, 2019
End Date
January 15, 2020

Lung Cancer Screening Initiative

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
July 01, 2018
End Date
December 31, 2019

Identification of Genetic Determinates for Disparities in African American Patients with Non-Small Cell Lung Cancer

Administered By
Medicine, Medical Oncology
AwardedBy
V Foundation for Cancer Research
Role
Co Investigator
Start Date
November 01, 2016
End Date
November 01, 2018

Duke CTSA (UL1)

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 26, 2013
End Date
July 31, 2018

Coping Skills for Colorectal Cancer Survivors with Pain and Distress

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Role
Co-Mentor
Start Date
July 01, 2015
End Date
June 30, 2018

Breast Cancer Awareness to Action Ambassador Program (BCAAAP)

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
April 01, 2013
End Date
June 15, 2014
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Publications:

Effect of Cultural, Folk, and Religious Beliefs and Practices on Delays in Diagnosis of Ovarian Cancer in African American Women.

BACKGROUND: Certain cultural, folk, and religious beliefs that are more common among African Americans (AAs) have been associated with later-stage breast cancer. It is unknown if these beliefs are similarly associated with delays in diagnosis of ovarian cancer. METHODS: Data from a multicenter case-control study of ovarian cancer in AA women were used to examine associations between cultural/folk beliefs and religious practices and stage at diagnosis and symptom duration before diagnosis. Associations between cultural/folk beliefs or religious practices and stage at diagnosis were assessed with logistic regression analyses, and associations with symptom duration with linear regression analyses. RESULTS: Agreement with several of the cultural/folk belief statements was high (e.g., 40% agreed that "if a person prays about cancer, God will heal it without medical treatments"), and ∼90% of women expressed moderate to high levels of religiosity/spirituality. Higher levels of religiosity/spirituality were associated with a twofold increase in the odds of stage III-IV ovarian cancer, whereas agreement with the cultural/folk belief statements was not associated with stage. Symptom duration before diagnosis was not consistently associated with cultural/folk beliefs or religiosity/spirituality. CONCLUSIONS: Women who reported stronger religious beliefs or practices had increased odds of higher stage ovarian cancer. Inaccurate cultural/folk beliefs about cancer treament were not associated with stage; however, these beliefs were highly prevalent in our population and could impact patient treatment decisions. Our findings suggest opportunities for health education interventions, especially working with churches, and improved doctor-patient communication.

Authors
Moorman, PG; Barrett, NJ; Wang, F; Alberg, JA; Bandera, EV; Barnholtz-Sloan, JB; Bondy, M; Cote, ML; Funkhouser, E; Kelemen, LE; Peres, LC; Peters, ES; Schwartz, AG; Terry, PD; Crankshaw, S; Abbott, SE; Schildkraut, JM
MLA Citation
Moorman, Patricia G., et al. “Effect of Cultural, Folk, and Religious Beliefs and Practices on Delays in Diagnosis of Ovarian Cancer in African American Women..” J Womens Health (Larchmt), vol. 28, no. 4, Apr. 2019, pp. 444–51. Pubmed, doi:10.1089/jwh.2018.7031.
PMID
30481095
Source
pubmed
Published In
J Womens Health (Larchmt)
Volume
28
Issue
4
Publish Date
2019
Start Page
444
End Page
451
DOI
10.1089/jwh.2018.7031

Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET).

Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N = 400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes. Trials registration: ClinicalTrials.gov, NCT02707471, registered 3/3/2016.

Authors
Shelby, RA; Dorfman, CS; Bosworth, HB; Keefe, F; Sutton, L; Owen, L; Corsino, L; Erkanli, A; Reed, SD; Arthur, SS; Somers, T; Barrett, N; Huettel, S; Gonzalez, JM; Kimmick, G
MLA Citation
Shelby, Rebecca A., et al. “Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET)..” Contemp Clin Trials, vol. 76, Jan. 2019, pp. 120–31. Pubmed, doi:10.1016/j.cct.2018.11.010.
PMID
30472215
Source
pubmed
Published In
Contemp Clin Trials
Volume
76
Publish Date
2019
Start Page
120
End Page
131
DOI
10.1016/j.cct.2018.11.010

Developing effective community and health system partnerships to advance health equity and health disparities research.

Authors
Barrett, N; Ingraham, K; Williams, K; Lin, P-H; Eisenson, H; Chirinos, M; Harvey, D; Patierno, S
MLA Citation
Barrett, Nadine, et al. “Developing effective community and health system partnerships to advance health equity and health disparities research..” Cancer Epidemiology Biomarkers & Prevention, vol. 27, no. 7, AMER ASSOC CANCER RESEARCH, 2018, pp. 34–34.
Source
wos
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
27
Issue
7
Publish Date
2018
Start Page
34
End Page
34

Attitudes, perceptions, and strategies toward increasing cancer screening, treatment, and participation in research among Latinos.

Authors
Barrett, NJ; Ingraham, KL; Boyce, X; Reyes, R
MLA Citation
Barrett, Nadine J., et al. “Attitudes, perceptions, and strategies toward increasing cancer screening, treatment, and participation in research among Latinos..” Cancer Epidemiology Biomarkers & Prevention, vol. 27, no. 7, AMER ASSOC CANCER RESEARCH, 2018, pp. 115–115.
Source
wos
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
27
Issue
7
Publish Date
2018
Start Page
115
End Page
115

Connecting Mentally Ill Detainees in Large Urban Jails with Community Care.

Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received community mental health services prior to jail detention in King County (Seattle), Washington over a 5-year time period using a unique linked administrative data source. Logistic regression was used to determine the probability that a detainee with severe mental illness received mental health services while in jail as a function of demographic and clinical characteristics. Overall, 70 % of persons with severe mental illness did receive in-jail mental health treatment. Small, but statistically significant sex and race differences were observed in who received treatment in the jail psychiatric unit or from the jail infirmary. Findings confirm the jail's central role in mental health treatment and emphasize the need for greater information sharing and collaboration with community mental health agencies to minimize jail use and to facilitate successful community reentry for detainees with severe mental illness.

Authors
Sayers, SK; Domino, ME; Cuddeback, GS; Barrett, NJ; Morrissey, JP
MLA Citation
Sayers, Sean K., et al. “Connecting Mentally Ill Detainees in Large Urban Jails with Community Care..” Psychiatr Q, vol. 88, no. 2, June 2017, pp. 323–33. Pubmed, doi:10.1007/s11126-016-9449-8.
Website
http://hdl.handle.net/10161/12944
PMID
27342104
Source
pubmed
Published In
Psychiatr Q
Volume
88
Issue
2
Publish Date
2017
Start Page
323
End Page
333
DOI
10.1007/s11126-016-9449-8

Engaging African Americans in Research: The Recruiter's Perspective.

Purpose: To examine barriers recruiters encounter when enrolling African American study participants, identify motivating factors to increase research participation, and provide recommendations to facilitate successful minority recruitment. Background: Recruiters are often the first point of contact between the research study and potential African American participants. While challenges in enrolling African Americans into clinical and epidemiologic research has been reported in numerous studies the non-physician recruiter's role as a determinant of overall participation rates has received minimal attention. Methods: We conducted four 90-minute teleconference focus groups with 18 recruiters experienced in enrolling African Americans for clinical and epidemiologic studies at five academic/medical institutions. Participants represented diverse racial and ethnic backgrounds and were asked to reflect on barriers preventing African Americans from participating in research studies, factors that motivated participation, and recommendations to increase participation of African Americans in research. Multi-coder and thematic data analysis was implemented using the Braun and Clarke method. Results: Prominent concerns in recruitment of African Americans in research include fear and mistrust and inflexible research protocols. The participants suggest that improved recruitment could be achieved through cross-cultural and skillset building training opportunities for recruiters, greater community engagement among researchers, and better engagement with clinic staff and research teams.

Authors
Barrett, NJ; Ingraham, KL; Vann Hawkins, T; Moorman, PG
MLA Citation
Barrett, Nadine J., et al. “Engaging African Americans in Research: The Recruiter's Perspective..” Ethn Dis, vol. 27, no. 4, 2017, pp. 453–62. Pubmed, doi:10.18865/ed.27.4.453.
Website
https://hdl.handle.net/10161/17605
PMID
29225447
Source
pubmed
Published In
Ethnicity & Disease
Volume
27
Issue
4
Publish Date
2017
Start Page
453
End Page
462
DOI
10.18865/ed.27.4.453

Implementing a Health Equity Agenda at the Duke Cancer Institute

Authors
Barrett, NJ; Vann, T; Wilder, J; ingraham, K; Worthy, V; Boyce, X; Reyes, R; Chirinios, M; Wigfall, P; Robinson, W; Patierno, S
MLA Citation
Barrett, N. J., et al. “Implementing a Health Equity Agenda at the Duke Cancer Institute.” Oncology Issues, vol. September-October 2016, Sept. 2016, pp. 48–57.
Website
http://hdl.handle.net/10161/12945
Source
manual
Published In
Oncology Issues
Volume
September -October 2016
Publish Date
2016
Start Page
48
End Page
57

2014 Durham County Health Assessment: Cancer”

This component of the Durham Health Assessment provides an overview of the cancer burden in Durham County. The report provides a comprehensive summary of primary and secondary data around the burden of cancer, areas of need, and potential opportunities to improve community and population health outcomes in the region.

Authors
Barrett, NJ; Bethea, K
MLA Citation
Barrett, N. J., and K. Bethea. “2014 Durham County Health Assessment: Cancer”.” Durham County Community Health Assessment, Jan. 2015, pp. 217–27.
Source
manual
Publish Date
2015
Start Page
217
End Page
227

Abstract A30: Using the principles of community-based participatory research to build an office of health equity within a nationally designated cancer institute

Authors
Barrett, NJ; Worthy, V; Boyce-Manon, X; Reyes, R; Banks, L; Patierno, S; Chu, C
MLA Citation
Barrett, Nadine Josann, et al. “Abstract A30: Using the principles of community-based participatory research to build an office of health equity within a nationally designated cancer institute.” Behavioral and Social Science, American Association for Cancer Research, Nov. 2014. Crossref, doi:10.1158/1538-7755.disp13-a30.
Website
http://hdl.handle.net/10161/12947
Source
crossref
Published In
Behavioral and Social Science
Publish Date
2014
DOI
10.1158/1538-7755.disp13-a30

Examining the Crack Epidemic and Subsequent Drug Policy through Identifying Trends in Outpatient Substance Abuse Treatment for Crack Use/Abuse: 1995-2005

Disparities in the crack/cocaine discourse have changed drastically since its inception over 30 years ago. Since the late 1980s, research examining this particular abuse has become more complex as both nationally and globally crack use/abuse has been examined within various contexts. Crack use has often been framed as an African American problem in part resulting from the high volume of African Americans seeking treatment for illnesses associated with their crack-cocaine use, and more African Americans dying from crack-cocaine overdose. This logical fallacy persists despite evidence showing African Americans have lower substance use/abuse compared to Caucasians. Given the impact of the crack epidemic as well as its related drug policies on African American communities and their families, further examination of crack use/abuse is necessary. This study will discuss the crack epidemic historically and examine crack use among clients of a large sample of outpatient substance abuse treatment units over a decade period between 1995 and 2005.

Authors
kim, M; Barrett, NJ; Gilbert, KL; Taylor, Y; Godley, P; Howard, D
MLA Citation
kim, M., et al. “Examining the Crack Epidemic and Subsequent Drug Policy through Identifying Trends in Outpatient Substance Abuse Treatment for Crack Use/Abuse: 1995-2005.” Journal of Equity in Health, vol. 3, no. 1, StarSpirit Press, Feb. 2014, pp. 124–38.
Website
http://hdl.handle.net/10161/12948
Source
manual
Published In
Journal of Equity in Health
Volume
3
Issue
1
Publish Date
2014
Start Page
124
End Page
138

Promoting community practitioners' use of evidence-based approaches to increase breast cancer screening.

Many women do not get mammography screenings at the intervals recommended for early detection and treatment of breast cancer. The Guide to Community Preventive Services (Community Guide) recommends a range of evidence-based strategies to improve mammography rates. However, nurses and others working in community-based settings make only limited use of these strategies. We report on a dissemination intervention that partnered the University of North Carolina with the Susan G. Komen Triangle Affiliate to disseminate Community Guide breast cancer screening strategies to community organizations. The intervention was guided by social marketing and diffusion of innovation theory and was designed to provide evidence and support via Komen's existing relationships with grantee organizations. The present study reports the findings from a formative evaluation of the intervention, which included a content analysis of 46 grant applications pre- and post intervention and focus groups with 20 grant recipients.

Authors
Leeman, J; Moore, A; Teal, R; Barrett, N; Leighton, A; Steckler, A
MLA Citation
Leeman, Jennifer, et al. “Promoting community practitioners' use of evidence-based approaches to increase breast cancer screening..” Public Health Nurs, vol. 30, no. 4, July 2013, pp. 323–31. Pubmed, doi:10.1111/phn.12021.
Website
http://hdl.handle.net/10161/12946
PMID
23808857
Source
pubmed
Published In
Public Health Nurs
Volume
30
Issue
4
Publish Date
2013
Start Page
323
End Page
331
DOI
10.1111/phn.12021

Can cultural competency speak to the race disparities in methadone dosage levels?

Although national methadone treatment trends have improved substantially from 1988 to 2001, current research has found that African Americans still receive lower dosages of methadone treatment than their white and Hispanic counterparts, which has significant public health concerns. We sought to empirically examine whether the degree of cultural competency within an outpatient substance abuse treatment (OSAT) organization has influence on the methadone dosage levels received by African Americans in 1995 and in 2005. The 1995 and 2005 National Drug Abuse Treatment System Survey (NDATSS) provided a nationally-representative, stratified sample of 618 and 566 OSAT organizations, respectively, of which 121 and 140 affiliated methadone maintenance treatment programs, respectively, were analyzed. The organizations' director and clinical supervisor were surveyed. Fixed-effects linear regression models were fitted with measures of cultural competency, client, and organizational characteristics to assess methadone dosage levels. Culturally-competent units have smaller numbers of methadone clients, greater percentages of clients who receive methadone dosages of less than 40 mg/d, smaller percentages of clients who receive methadone dosages of 80 mg/d or more, and provide a larger number of therapeutic and ancillary services during treatment than non-culturally-competent units. OSAT units with more African Americans are significantly more likely to have clients who receive dosages of less than 40 mg/d and are significantly less likely to have clients who receive dosages of 80 mg/d or more. There is no racial difference among culturally-competent unit clients who receive dosages of less than 40 mg/d, between 40 and 59 mg/d, between 60 and 79 mg/d, and 80 mg/d or more. However, among non-culturally-competent units, a racial difference exists among African Americans and other clients who receive these various dosage levels. Research indicating that African Americans receive lower dosages of methadone than their White and Hispanic counterparts may now be explained by whether these clients receive treatment in culturally competent organizations, rather than solely by arguments related to organizational differences in resources, experience and training of staff, staff bias and/or racism. Culturally competent organizations may seek a method of treatment that dissuades "replacing one drug for another," while simultaneously treating the root cause of the addiction through the provision of comprehensive therapeutic and ancillary support services. Further research is needed to determine if cultural competency results in better substance abuse treatment outcomes for African Americans. © Springer Science+Business Media, LLC 2009.

Authors
Howard, DL; Barrett, NJ; Holmes, DJN
MLA Citation
Howard, D. L., et al. “Can cultural competency speak to the race disparities in methadone dosage levels?.” Review of Black Political Economy, vol. 37, no. 1, Feb. 2010, pp. 7–23. Scopus, doi:10.1007/s12114-009-9052-4.
Source
scopus
Published In
The Review of Black Political Economy
Volume
37
Issue
1
Publish Date
2010
Start Page
7
End Page
23
DOI
10.1007/s12114-009-9052-4

Susan G. Komen for the Cure, NC Triangle Community Health Profile, 2009

This Community Health Assessment covers the 13 County Catchment Area of Susan G. Komen NC Triangle Affiliate and is designed to ensure strategic initiatives reach the most vulnerable populations in the Greater Triangle and eastern NC to increase breast cancer outreach, education, screening, and treatment for underserved populations in the region. The report is a comprehensive overview of primary and secondary data describing the current state of breast cancer incidence and mortality and the challenges associated with access to care in urban and rural counties in the Greater Triangle.

Authors
Barrett, NJ; Blondin, P; Steele, J
MLA Citation
Barrett, N. J., et al. “Susan G. Komen for the Cure, NC Triangle Community Health Profile, 2009.” Susan G. Komen for the Cure, NC Triangle Community Health Profile, 2009, Aug. 2009.
Source
manual
Publish Date
2009

Understanding public attitudes towards Social Security

There has been very little research on why individuals hold different attitudes toward Social Security. In this article we integrate social location theory and political predisposition theory to provide a framework of explanation and test these theories using a unique sample from the 1998 General Social Survey. Our multivariate results reveal that social structural positions along the lines of race, gender, class and age play a more important role than political predispositions in explain-ing individual differences in support for the current Social Security system against privatisation. Political party affiliation also partly contributes to variation in support for Social Security, but political ideology does not have a significant effect. Our results suggest that with regard to support for Social Security, primary consideration must rest on social structural positions. Racial minorities, women, the poor and the elderly tend to dislike a drastic change in the current Social Security system, and Social Security reform ought to pay attention to their concerns. Our robust finding of a positive relationship between age and support for Social Security also challenges much of the established knowledge, pointing to an intergenerational discord over Social Security. It is also important to differentiate among social welfare programmes in order to uncover the real determinants of public attitudes towards them. © 2006 The Author(s), Journal compilation © 2006 Blackwell Publishing Ltd and the International Journal of Social Welfare.

Authors
Yang, P; Barrett, N
MLA Citation
Yang, P., and N. Barrett. “Understanding public attitudes towards Social Security.” International Journal of Social Welfare, vol. 15, no. 2, Apr. 2006, pp. 95–109. Scopus, doi:10.1111/j.1468-2397.2006.00382.x.
Source
scopus
Published In
International Journal of Social Welfare
Volume
15
Issue
2
Publish Date
2006
Start Page
95
End Page
109
DOI
10.1111/j.1468-2397.2006.00382.x
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