Notably, the pilot awards also significantly contributed to mentee productivity in research on addictions, especially in underserved and minority populations (for more details, see Web site: http://hsc.unm.edu/som/fcm/mph/sarg/mentees.shtml):
- Tele-Counseling for Alcohol Problems: To test the effectiveness of motivational interviewing to reduce problem drinking using three formats—(1) telemedicine technology, (2) telephone counseling, and (3) in-person counseling.
- Alcohol Policies to Reduce Underage Drinking Among Border Youth: To review documents and interview stakeholders (e.g., city and county officials) about policy development and implementation along the border.
- Development of an Alcohol Intervention Model for Violence-Involved Emergency Department (ED) Patients: To establish baseline data for ED patients presenting with assault-related injuries and alcohol use and to develop an intervention targeting this population.
- Examining the Alcohol-Related Communications of Mexican Immigrant Parents and Their American-Born Youth: To interview parents and youth from single- and dual-parent families to assess the efficacy and challenges of their alcohol-related discussions and these discussions’ impact on youth drinking.
- Neurocognitive Deficits and Recovery in Thiamine Deficient Alcoholics: To examine the impact of thiamine replacement therapy on the neurocognitive functioning of older alcoholics.
- Adapting Motivational Interviewing to Native Americans: In partnership with community members and behavioral health providers, to use focus groups to create a Native American culturally based manual (see http://casaa.unm.edu/nami.html).
- Neurocognitive Impairment Due to a Past History of Alcohol in Older Ethnic Minorities: To use culture-fair methods (tests that do not evidence cultural bias in results) of information processing and psychophysiological assessment to advance understanding between chronic alcohol use, aging, and neurocognitive functioning.
As the authors analyzed the focus-group data, a CCMM emerged (Figure 2), with themes related to its community foundation, the institutional setting, SARG’s unique contributions, the mentorship core, and desired mentee and system outcomes.
In evolving the CCMM, mentees stated that issues of culture and community undergirded their career and research choices, with their primary motivation being maintaining a long-term connection to their communities and making a positive difference. Within this foundation, therefore, the flow of mentorship began with analyzing the setting, including both institutional barriers and SARG facilitating factors aimed at improving mentee and community outcomes. The mentorship core activities included (1) support, both culturally based psychosocial and technical support, (2) bidirectionality of knowledge, including CSIs and ESIs, and (3) community engagement, including training in CBPR and interaction with a CAB. The desired outcomes of the CCMM were mentee outcomes (i.e., research productivity and career advancement) and system outcomes (i.e., cultural community connections and benefits, institutional changes at the university, and a reduction in health disparities).
Setting: Institutional barriers in academia
While mentees expressed gratitude for the opportunities provided by SARG and belief that those opportunities were necessary in the presence of institutional barriers, they also expressed frustrations and impatience with the barriers. Group members expressed irritation at the lack of recognition for their accomplishments and stated that their accomplishments were sometimes attributed to minority status. One mentee stated, “It really frustrates me, angers me to hear people say, ‘you got into graduate school or you have this assistantship because you’re a minority,’… they just see your ethnic background and they don’t know that you are just as qualified or more qualified.” Mentees also stated that community-oriented work, which they valued, was generally discounted by the institution as reflected in one mentee’s query, “Why isn’t that something you can put toward promotion—community things—why doesn’t this count?”
Mentees lamented the lack of commitment from the university administration to recruit and maintain faculty of color. To illustrate, a well-respected Native American faculty member and SARG mentor was recruited by another university. Mentees perceived little effort from UNM to try to retain this valuable faculty member. Mentees also discussed the importance of adequate representation in academia to reflect the demographic composition of New Mexico. One mentee astutely observed, “And 55% of the state are racial/ethnic minorities and state tax dollars pay for this institution, so we should be represented.”
Mentees expressed a sense of isolation regarding their departments, especially when issues involving ethnicity were addressed, and more commonly, when these issues were ignored. One mentee made the following observation about efforts to make changes in the department: “It sure feels like it is a constant conscious effort to confront and be aware of how the status quo works …. It is very draining and I feel like I don’t have somebody to help me process this.” In addition, mentees discussed the considerable stress experienced when academicians make disparaging remarks about people of color. One mentee’s remark summarizes this stress well: “My problem is when people in an academic institution make derogatory remarks about poor and minority students or patients. Minority faculty are suddenly placed in a very difficult position. These comments add stress to minority faculty who usually feel compelled to address them, and this is usually not a problem for a person of the majority culture.”
Setting: SARG facilitating factors
The SARG infrastructure of culturally- based psychosocial support, and technical and financial resources, particularly for the CAB member stipends and costs, provided support for community participation. UNM, a minority-serving institution, provided the critical mass of ethnic minority mentees as well as access to the partnering minority communities. SARG mentees were appreciative of the scientific training they received including both exposure to the most recent, cutting-edge research designs and findings and the guidance in grant writing.
In addition to the technical training, mentees expressed gratitude that the SARG created a safe cultural space for minority faculty by emphasizing the value of cultural issues and community commitment. One mentee stated, “We constantly need to remind ourselves that we are here because a community that we come from is suffering considerably, and we need to keep those communities in mind and be more determined to serve them.” Equally important was the creation of a nurturing and safe environment that formed through the sense of community and camaraderie generated at the biweekly meetings. To counter the academic culture of competition, criticism, and little emotional involvement traditionally found in universities, these feelings of safety and support may be particularly important to junior academicians who are ethnic minorities, given their cultural values of contextualization, personal relationships, community, and respect.26
Despite the SARG’s facilitating factors and outcomes, there were a few inherent challenges.
Technical versus culturally-based psychosocial support.
The process of balancing how much mentored support should be technical—or psychosocial and cultural—resulted in some tension. In its conception, the SARG mentors planned a training program of intensive technical support and only minimal psychosocial support. The need for providing psychosocial support, as seen through a cultural lens, emerged over time. One mentee described this tension of having an environment from which the minority versus the majority/academic worldview is emphasized: “I thought when we got into SARG, I thought we were supposed to be developing different ways that were culturally appropriate to do research. I kept finding myself being shifted … it kept being moved to evidence-based. So we used the same models, but just a different color of people.”
While the mentees appreciated the opportunity to develop technical skills necessary for academic success, they expressed the challenge of developing such skills. One mentee observed, “It is like learning another language.” Both mentees and mentors noted the need for product-oriented formal training, but still within a supportive environment: “Competition is stiff, so it is good to practice in a safe environment.”
Issues related to psychosocial and cultural support were prominent in the discussions of both focus groups. As the mentees developed into a community, they were able to openly express their frustration at not receiving psychosocial support from the institution (i.e., the university, various departments, and professional colleagues), as well as the vital role SARG came to play in providing that support. The mentor group recognized that “The strengths [of the SARG] were that there was enough critical mass of minority faculty that we were able to come together,” and that the emotional support came through the association with the group: “Being with people of like mind is very empowering.”
Over time, the SARG began to focus on cultural issues more centrally vital to the mentoring model valued by mentees. One mentee commented that she “enjoyed cultural issues at the forefront,” as often in academia, cultural issues are secondary or simply not addressed.27,28 “For me I think of SARG as nurturing …. Knowing that you had community people involved was a sense of comfort to me. Because I knew it wasn’t just academia.”
A major source of culturally based psychosocial support, which resonated with the mentees, was a professional panel of senior faculty of color, organized by the mentors when they realized midway through the grant that the mentees could benefit from role models who had long years of academic experience. Through sharing their stories about and the challenges they encountered within their academic careers, these panelists of senior faculty not only created an intimate forum for mentees to reflect on cultural issues at a personal and professional level but also provided visible role models of successful faculty of color so that the mentees could better understand strategies for overcoming institutional barriers. Importantly, the SARG mentoring program also included a Native American faculty member who served as an ongoing role model. Having a successful, ethnic woman in a leadership role increased self-efficacy in a way that no other mentor could. One mentee expressed the value of this positive role model’s presence: “She is a good mirror to reflect on the possibilities of what could be.” In sum, a balance of technical and culturally-based psychosocial support with a critical mass of people of color was integral to the professional training of the mentorship core (Figure 2).
Bidirectionality of knowledge.
A foundational theme recognized by the SARG was to work with communities in sharing knowledge for the betterment of those communities. However, as is common to graduate training, mentees were predominantly trained to carry out ESIs, and they expected to learn more about developing CSIs in the SARG. Hence, they counted on being allowed more flexibility in their approaches to conducting research, but both mentors and mentees noted that priority was given to ESIs, especially with the priority given to technical (not cultural) training in the first year. A mentee described this tension: “I think for me it has been using paradigms that have been the old traditional paradigms and trying to fit in with those paradigms and just not being able to meet the grade as far as research and other questions go.”
The primary mentor was a leader in the field of substance treatment who carried out the initial training agenda, and many of the mentees, recruited from his department, shared his treatment perspective. One commentor reflected, “I think it was appropriate, because you know, with junior faculty they have to go with what they’re strongest in, and that’s what they were strongest in.” However, mentees, especially the few who had backgrounds different from that of the primary mentor, lamented the predominant early unidimensional focus in the SARG meetings. They felt they had to question and challenge the research process because they used a different set of theories and methods in the field of public health. A commentor affirmed this limitation and stated, “I felt the lack of attention to prevention, which from a public health point of view is where the action really should be.” In sum, the SARG participants realized that cultural and multidisciplinary approaches, including prevention, should have received greater attention earlier in the mentoring process if mentees were to incorporate community healing and knowledge into the scientific knowledge base.
Mentees expressed that they benefited from the focus on CBPR and from the CAB’s insistence on being accountable to community partners. The coinvestigator who oversaw the CAB reported of the mentees, “They want to know where the information goes, and if it is going to help the communities.” The CAB was also helpful in expanding the community focus and social networks in some of the mentees’ research projects. However, some tensions arose between the mentees and the CAB members about what knowledge was legitimate: academic or community-based wisdom. One mentee voiced this tension: “I think [more of the CAB] thought we would do research [with] them. I don’t think they felt respected.” Indeed, most mentees still conceptualized and carried out their pilot projects with less community input than expected from the CAB. This reflects one of the power differentials within research, as acknowledged in CBPR, with investigators often having more resources and time than their community counterparts.29
At the end of the SARG, mentees and CAB members shared a meal together to celebrate accomplishments and to dialogue about the challenging issues related to community input and community-driven approaches. One important outcome was that mentees realized that community engagement and using cultural knowledge require commitment, and they also gained an appreciation for the complexities of building authentic partnerships.
Despite the success of SARG for individual investigators, there was no immediate follow-up funding mechanism within NIAAA to continue intensive mentorship. A one-year, no-cost extension provided mentee opportunities for conference funding, periodic supportive meetings, and collaborative writing. Since the SARG program has ended, several programs and activities have sustained some elements of the SARG program. These include (1) CASAA’s seminars and other research support activities; (2) personal relationships between mentee and investigator/mentor, among mentees, and between mentees and the communities; and (3) several new UNM centers (i.e., the UNM Robert Wood Johnson Health Policy Center, a doctoral mentorship program for Latino, Native, and other underrepresented scholars; and the SOM Center for Participatory Research). In particular, investigators at the centers have expressed interest in continuing the scholarship developed from the CCMM. Attention to CBPR and its resonance with faculty of color has also been growing, as evidenced by a SOM task force, headed by two of the authors (T.P. and N.W.), to reexamine tenure and promotion guidelines to reflect special considerations for community engaged scholarship. Most important, the centers hope to support efforts to transform the UNM into a place that is more open to discussing and researching diversity issues, including retention of faculty of color, once recruited.
Discussion and Conclusions
Despite the tensions and, in fact, because the SARG provided a safe environment for dialogue about the tensions and about institutional issues, this CCMM is presented as a successful facilitator of advancement for ethnic minority faculty and students in academic health settings. In understanding the SARG tensions, we offer recommendations for institutional change aimed at creating an atmosphere more conducive to the success of all faculty including ethnic minorities. Together, the model and institutional recommendations are intended to support the recruitment, advancement, and retention of ethnic minority faculty who are more likely to study and serve ethnic populations3 in order to reduce ethnic minority health disparities. Because multidisciplinary AHC training projects are highly encouraged by federal funding institutions, this model would be of benefit to other health research programs.
One recommendation for those choosing to implement a model similar to the CCMM is to incorporate an analysis of institutional barriers and facilitating factors—both from the beginning and throughout the implementation—as part of the critical reflection important to the mentoring process. As evidenced in the focus-group discussions, the mentees encountered various institutional barriers. Responses to these barriers need to be both personal and structural. Junior faculty of color, for example, cannot carry the load alone for responding to racist comments. White senior faculty and administrator allies can counter comments on a personal level and can encourage peer support with other minority faculty. Structurally, the existence of the Centers on diversity and community-based participatory Research have proven to support minority faculty who might otherwise experience the detrimental effects of discriminatory practices and comments30; these centers provide a counterinfluence to the cultural conflict between the university’s norms of objectivity and the minority culture’s reliance on contextualization for learning.26,28 A recent study of diversity within three universities uncovered the link between diversity and excellence and posited that incorporating discourse on privilege represents the highest stage of a university’s capacity to create an environment conducive for minority faculty.27 As discussed by the SARG mentees, plans to diversify through recruitment are not sufficient. Efforts to support and retain underrepresented faculty are equally important. Culturally based mentoring can be one strategy.
Another barrier that the focus groups identified was the lack of recognition by the institution of the value that mentees placed on service to ethnic minority communities. Faculty of color tend to provide service out of a sense of concern and as a source of validation as such service provides a much needed connection to their communities.31 Junior faculty of color also tend to teach classes about diversity in the spirit of serving minority communities, but they are concerned when these courses are valued less than other department courses.32 Minority faculty should receive recognition for their expertise in minority culture, but recognizing the added burden of emotional stress related to defending that culture is also important. Policy should mandate that white senior faculty coteach diversity courses and that such courses include broader discussions on privilege, race, and racism. Not only does the entire institution benefit if diversity is a core value, but minority faculty are more likely to stay in an institution that honors diversity and cultural issues, including the role of service to diverse communities.
Culturally based mentorship can help build a solid networking infrastructure of minority faculty, providing access to mentors and role models of the same race/ethnicity or gender who are successful in academia.33 Despite the value of having mentors of the same race/ethnicity, ethnicity alone is not necessarily a crucial variable for a successful mentoring relationship. White mentors can effectively guide mentees from underrepresented backgrounds, especially when they provide access to important professional opportunities and when they cultivate an understanding of the minority experience in academia.34 If white mentors have limited expertise in culturally supported intervention research, finding cultural experts from other departments or from the community is important.
Ultimately, an infrastructure dedicated to supporting the research of mentors and mentees, whether through a department or through the university, is an important element of an academic environment. Senior mentors who take an active interest in helping advance junior faculty, especially faculty from underrepresented backgrounds, should be recognized for their efforts; for example, UNM SOM guidelines require evidence of mentorship for advancing to full professor.
The key to community service is the understanding that community knowledge is core to the research endeavor. The SARG’s emphasis on bidirectionality of knowledge contributed to the richness of the mentee research and enabled dialogue on the legitimacy of different knowledge bases. Despite the continued primacy of evidence-based approaches, new attention to the cultural dimensions of interventions and to external validity is needed to support improved translational and implementation research. The practice of conducting CBPR in conjunction with CABs can further this translational goal. A CAB enables researchers to bring communities into the study not as subjects but as partners directly involved in the research, including integrating knowledge of local culture into the intervention design, participating in data collection and analysis of outcomes, and discussing the use and dissemination of the data. CABs can ensure community benefits even before the research is completed; for example, they can request that the research team provide technical assistance or training to community members.
Tensions between academicians and community members are normal, given their different perspectives and agendas. In looking back on these tensions, we recommend holding meetings in the partner communities, clearly defining roles, and dialoguing throughout the research process. Researchers, moreover, must have institutional support and resources to undertake and sustain community partnerships in research; such support and legitimacy for engaging communities throughout the research process is growing within AHCs through the new Clinical Translational Science Centers awards.35 Similarly, new emphases on external validity and grounding interventions in local context and culture will promote the integration of CSIs and ESIs in translational research. A recent journal supplement on mentoring minority faculty mirrored the SARG findings, with recommendations for sustained institutional support, cross-disciplinary teams, peer monitoring and support, alternate community-based research paradigms, and cultural grounding and integration of indigenous values into the academy.36–38
Finally, in a reflection during the focus-group interview, one of the mentees voiced, “I need to remember the mentor in me and my ancestors. Sometimes that is better than an academic mentor.” This statement captured important issues that the SARG addressed: the cultural strengths of minority faculty and the connectedness to their communities. Ultimately, ethnic minority faculty need to have faith in themselves and their abilities despite the constant challenges encountered in academia. Mentorship programs can bolster this faith by supporting, in a safe, collegial space that honors cultural issues and values, the research agendas and skills of ethnic minority faculty. This includes honoring the scholarly knowledge and expertise of minority faculty, as well as the expertise of the communities with whom they are engaged in research, especially when conducting patient- and population-based research. In this manner, academicians take a first and most important step toward respecting the communities whom they serve and, in turn, earning the trust of the communities so that academicians and communities can work together toward the goal of reducing health disparities.
This research was funded in part by National Institute on Alcohol Abuse and Alcoholism grant 5 U01-AA014926. The authors wish to thank the Southeast Addictions Research Group mentors, William R. Miller and Bonnie Duran; the professional series speakers; and the Community Advisory Board.
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