Melvin Muhammad with community youth

Taking Risks in Pursuing a Dream

In rural Tarboro, North Carolina, Melvin Muhammad works tirelessly with at risk youths as part of a sophisticated research and intervention initiative called project GRACE (Growing, Reaching, Advocating for Change and Empowerment).

Mr. Muhammad says, “My job is to keep the community involved. We feel if we are going to be studied then we must be part of how the research is planned and executed.”

Project GRACE, which is funded by National Center on Minority Health and Health Disparities (NCMHD), is developing culturally sensitive and sustainable interventions to prevent HIV in rural African American communities. Most of the interventions are aimed at overcoming the stigma of HIV infection and the continued misinformation about the disease.

Project GRACE Steering Committee

Dr. Giselle Corbie-Smith

The initiative is the latest project in the remarkable research career of Dr. Giselle Corbie-Smith, an associate professor at the University of North Carolina Medical School.

“We are almost 30 years into the AIDS epidemic,” said Dr. Corbie-Smith, “but in this community many people still think you can spread HIV through kissing, hugging and on toilet seats. If we are to ever eliminate health disparities we have to discover ways to serve the needs of underserved populations.”

Dr. Giselle Corbie-Smith is a determined risk taker. Eliminating health disparities is both a passion and her career. She says it began with a series of anecdotal observations. “In 1995, when I was a resident at Yale, I was struck by the differing levels of care patients received in my hospital.”

She noted that the disparity seemed to be based on socio-economic class. When she became Chief Resident, she observed that many of the disparities seemed to occur because many of the doctors did not know how to communicate or relate to poor patients.

Trying to make sense of these early observations and her determination to test conventional scientific wisdom spurred Dr. Corbie-Smith’s career. 

“Most of the literature seemed to blame the victims with disparate health conditions,” she said. “The clear implication was that the major reason why more African Americans and other minorities were not in clinical trials was that they refused to participate. And the reason many had inferior outcomes was because they didn’t do what their doctors told them to do.”

In Brooklyn, New York, where Giselle Corbie-Smith grew up, more kids seemed to go to prison than to college. With a lot of support from her family and teachers, she ended up at Cornell University and later Yale’s School of Medicine. Her professors called her a rising star, but when she told them she wanted to do health disparities research many were not especially encouraging.

Dr. Giselle Corbie-Smith and volunteer

“She was a good doctor and effective teacher”, said Dr. Ralph Horowitz, her Chief of Medicine at the time, “but she was not prepared to pursue research. She didn’t have the background to be competitive but she was driven and persistent.”

Dr. Horowitz, who is now at Stanford University, took a chance on her and Dr. Corbie-Smith caught a break. The NIH had begun a program to diversify its cadre of funded researchers.  Dr. Horowitz told  Dr. Corbie-Smith to apply for the new diversity supplement grant and to study the recruitment patterns in a trial he was performing on how estrogen affects the stroke risk of menopausal women.

“The process helped her understand the rigor and creativity needed to be a good researcher,” said Dr. Horowitz, “in addition, it helped her understand how to distill information and frame a research question to capture the attention of reviewers.”

Project Connect ground rules

She got the grant and her research found that minority women in the estrogen trial participated at about the same rate as non-minority women. The reason was the researchers were imbedded in the community and had established a good rapport with local doctors.

“What the experience really did for me”, said Dr. Corbie-Smith, “was it enabled me to hone my research skills and broaden my relationships inside and outside medicine. I found my contacts in public health allowed me to think more broadly about health disparities.”

Project GRACE Intervention Design meeting

She began asking questions such as: can you measure the degree to which trust and distrust impact participation in research among minorities? What are the methodological and ethical issues involved in the inclusion of minorities in research? What approaches at alleviating health disparities work best in which communities? However, like so many minority scientists, answering these questions - pursuing her dream - became problematic.

“My medical training left me with so much debt,” said Dr. Corbie-Smith, “that I faced the possibility of having to moonlight in hospital clinics which would mean abandoning my research just as I was beginning to get answers to some vexing questions.” 

Two NIH programs kept her dream alive. The Loan Repayment Program (LRP) at NCMHD relieved the pressure from her crushing medical school debt and a ‘K’ grant from the National Heart, Lung, and Blood Institute allowed her to spend 75% of her time conducting research.

Project GRACE Intervention Design meeting

“In NIH supported research there is often a paradox, said Dr. Nathanial Stinson, acting director, Office of Scientific Programs, NCMHD. “In order to be most competitive to get a grant you have to have a history of obtaining such support. The LRP and K grants are great vehicles to begin that process.”

With those grants, Dr. Corbie-Smith moved to the University of North Carolina where her research efforts took off. New NCMHD grants helped her bring UNC and Shaw University, a small historically black university, together to create an NCMHD Center of Excellence (COE). Among other things, this COE is working with African American churches to develop effective academic - community research partnerships. In addition, the collaboration has helped Shaw build its research infrastructure by strengthening its Institute for Health, Social, and Community Research.

Project GRACE Intervention Design meeting

Project GRACE Connect Exhibitors

In 2003, Dr. Corbie-Smith achieved the NIH gold standard, a RO1 award and she got it on her first try. With the grant, she created Project LeARN, which examines the perceptions, mistrust and other concerns of African Americans about participating in genetic research. This is crucial information as the need for a large and diverse group of research participants becomes critical for the Human Genome Project’s next phase - developing tools for understanding genetic variation and disease expression.

As that project moved forward, Dr. Corbie-Smith received the NCMHD grant that funded Project GRACE, which is addressing the social and behavioral factors contributing to the spread of HIV among poor rural communities.

Building on this information, Dr. Corbie-Smith, in 2006, received her second RO1 award to support a project that increases access to HIV trials for rural minorities. One strategy uses a mobile van to bring prevention materials and the latest treatment options to this population. The utility of using a van in this context was a result of her earlier work that identified transportation as a serious barrier to care among the underserved in rural communities.

Her success has led to funding from numerous non-governmental sources; support that has allowed her to begin to define the barriers and facilitators to African American elders use of influenza vaccines and study the impact of cultural competency training on the clinical effectiveness of medical students and residents.

“From her very first grant, Giselle has created a pathway that she has marched down with increasing success,” said Dr. Horowitz. “It is an investment that continues to pay dividends.”

“The NIH can seem like an impenetrable colossus,” said Dr. Corbie-Smith, “but if my career shows anything, it demonstrates that the hurdles you face are not as high as they seem if you are well prepared, willing to take risks and are diligent in seeking out those who can help you the most.”

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