Early-career awards fast track studies on poverty and health

Rita Hamad of Austin, Texas, had just finished her third year as an undergraduate studying economics at Harvard University when she had a change of heart.

“I wanted less emphasis on corporate moneymaking and more on the economics of poverty alleviation,” said Hamad.

So she switched her major to chemistry and spent the next fall working in the HIV/AIDS department of the World Health Organization in Geneva. The internship propelled her career into a new direction.

“I saw how people with debilitating illnesses suffer in health-care systems globally, and I decided that I’d like to research ways to help these vulnerable populations,” said Hamad, who went on to earn a medical degree and master’s degree in public health from the UC Berkeley-UC San Francisco Joint Medical Program. Now, she’s working to build a research career that studies poverty as if it were a disease. Applying cutting-edge analytical techniques, she’s trying to better understand how the social, psychological, political, cultural and economic circumstances of those living in poverty influence their chances for a healthy life.

As she juggles her duties as a clinician and an instructor in family medicine at Stanford, she is closer than ever to her goal of a research career, with the help of an early-career program — the KL2 mentored career development award — and two pilot grants. Both the program and pilot grants are administered by Spectrum, the Stanford Center for Clinical and Translational Research and Education, which is funded by the National Center for Advancing Translational Sciences at the National Institutes of Health.

Springboards to NIH career grants

Hamad, 33, has chosen to enter research at a time when it is extremely difficult for young investigators to win career-sustaining grants from the NIH, the largest funder of biomedical research in the United States. More researchers than ever are competing for “10 years of essentially flat budgets eroded by the effects of inflation,” according to Sally Rockey, deputy director for extramural research at the NIH. What’s more, prestigious R01 grants tend to be given to older researchers with proven track records over young investigators with riskier, but more promising, ideas. 

“The average age of first-time, R01-funded investigators who have PhDs remains 42, even after seven years of policies at NIH to increase the numbers of new and early-stage investigators,” said Robin Barr, director of the NIH’s Division of Extramural Activities, in a recent editorial on the NIH website.

The KL2 program offers young physician-scientists like Hamad a competitive edge. First, it provides 75-percent salary support for a minimum of two years, enabling physicians to reduce their hours in the clinic and spend more time on their own research projects. KL2 awardees attend weekly sessions with clinical and methodological research mentors. In these sessions, they also receive advice on study design, grant-proposal writing, data collection and analytics, and on navigating the Stanford research environment. Second, the program offers participants full tuition support for advanced training in disciplines such as biostatistics, epidemiology, study design, genetics, bioinformatics and bioethics.

Being able to support the careers and see the growth in young investigators like Rita is one of the great pleasures of leading a program like this.

“I love the tuition support in the KL2 program,” said Hamad, who is using it to complete a PhD in epidemiology and learn advanced statistical techniques. These skills will help her in the extraction and interpretation of the many variables in large health, economic and insurance data sets, enabling her to better identify the cause-and-effect relationships between poverty and health.

“Being able to support the careers and see the growth in young investigators like Rita is one of the great pleasures of leading a program like this,” said Steven Goodman, MD, MHS, PhD, professor of medicine and of health research and policy, chief of the Division of Epidemiology and director of the Spectrum KL2 program. “And this year, trainees will start to see many more epidemiology course offerings and a much larger pool of research mentors.”

To help young investigators like Hamad, Spectrum also offers grants of up to $50,000 to interdisciplinary teams with novel ideas for improving human health. These one-year studies often generate proof-of-hypothesis data that may later be used in applications for larger NIH grants.

This year, Hamad is the lead investigator on two of these study grants. One is on the long-term effects of neighborhood environments on health outcomes using Denmark’s nationwide electronic health database. The other is exploring the impacts of education policy on population health in the United States.

Gathering evidence for policymakers

Hamad’s research career is also receiving a boost from the expansion of the Stanford Center for Population Health Sciences. The center, supported in part by Spectrum, is serving as a collaborative hub for population-based research such as hers, bringing together researchers from across the university.

The center soon will provide centralized access to a variety of U.S. and international health databases, as well as to several large insurance-claims data sets from public and private insurers. The center’s leadership plans to make these data sets available at a low cost to Stanford trainees and investigators. And center staff will provide technical support to help users get access to the data needed to answer their research questions.

Understanding the nuanced relationships between life experiences and health requires a new focus for research and a new breed of researcher.

Hamad collaborated with Mark Cullen, MD, the center’s director, on a study that examined the impacts of job insecurity on health-care utilization by a large cohort of employees of a manufacturing firm during the recession of 2007-09. Their findings will be published in Health Services Research this fall.

“Understanding the nuanced relationships between life experiences and health requires a new focus for research and a new breed of researcher who, like Dr. Hamad, brings skills from health and the social sciences,” Cullen said. “Answering these real-life questions lies at the very heart of the agenda for our population health sciences center.”

Another study of Hamad’s will be published this fall in the American Journal of Epidemiology. In this collaboration with David Rehkopf, ScD, MPH, assistant professor of medicine, she explored the impact of the earned-income tax credit on child health in the United States.  Such research is critical for informing policy on safety-net programs, especially during a time of strained state and federal budgets. For example, the California legislature decided this year to begin its own earned-income tax credit program because of research like Hamad’s.

With the help of these support programs, Hamad, in just two years, has produced actionable data that can be used by policymakers and by health-care providers to improve the overall health of populations.

“It has been so wonderful to be supported by Spectrum’s generous resources as I launch my career as a physician-researcher here at Stanford,” Hamad said.

Information on the KL2 and the pilot grant programs is available on Spectrum's website. Pilot grant proposals are due Sept. 30. Applications for KL2 career awards will become available in November and are due March 1.