NIH

Vence L. Bonham, Jr. J.D.

Associate Investigator, Social and Behavioral Research Branch
Head, Health Disparities Unit

Scientific Summary

Within the Social and Behavioral Research Branch, Mr. Bonham leads an independent research program and directs the Health Disparities Unit. The Unit's mission is to conduct research that evaluates approaches to integrating new genomic knowledge into clinical settings without exacerbating inequities in healthcare delivery.

Over the past nine years, with his interdisciplinary team of collaborators and trainees, Mr. Bonham has studied the translation of genetics and genomics research findings to clinical practice. His research group has demonstrated that application of new genomic-informed clinical tools likely will be influenced by clinicians' perceptions of their patients' race and ethnicity, and clinicians' approach to race will be influenced by their anxiety with uncertainty in clinical care.  The Bonham group is one of a small number of research teams working to bring empirical evidence to questions regarding genomics and health disparities in clinical service delivery. To this end, the Health Disparities Unit has focused its work on conceptual models that view the clinician-patient relationship as bi-directional, by looking at healthcare providers' knowledge, attitudes, and beliefs about human genetic variation and the constructs of race and ethnicity.  The Bonham group has shown that physicians use race as a heuristic tool to guide their utilization of genetic services and treatment decisions.

The Bonham group's research has found that scientists describe their research populations in compliance with NIH Inclusion Guidelines, but are often dissatisfied with these guidelines, as they may obfuscate associations of ancestry with genetic variation. The Bonham group has also studied patients' beliefs about their physicians' understanding of their race and ethnicity, and how the patients' believe it influences their clinical care.

Conceptual model
Conceptual model

Mr. Bonham's research program is iterative, using qualitative and quantitative methods to develop measurement tools grounded in race theory, social cognitive theory, public health policy, law, genomics and clinical decision-making.  His work has included a national representative survey of general internists to document the transition of genetics and genomics to clinical practice. This research and measurement development has resulted in the establishment of the first scale to assess health professionals' use of race and genetics in clinical practice - the Bonham and Sellers Race Attributes in Clinical Evaluation (RACE) scale and a new index designed to measure health professionals' knowledge of human genetic variation, and their beliefs and attitudes about its relationship to race. This research has led the Bonham group to a new experimental research study exploring how primary care physicians use precision medicine in clinical care.  It uses immersive virtual reality technology to study the clinical decision-making process and use of genomic information.

The Bonham group has expanded to study sickle cell trait and sickle cell disease, a condition with a significant health disparity impact both in the United States and globally. In 2014, Mr. Bonham established the interdisciplinary INSIGHTS study, conducted at the NIH Clinical Center, exploring the microbiome, genome, and physical and social environments of individuals living with sickle cell disease and sickle cell disease leg ulcers. The study brings together national and international health services research, microbiology, genomics, hematology, psychology and sociology experts to explore the variation of sickle cell disease, with the objective of identifying triggers that may be integral in leg ulcer onset and progression, and of enhancing our understanding of sickle cell disease phenotype variation. The central goal of this study is to develop a better understanding of the participants' leg ulcer microbiome, as well as the psychosocial and environmental factors that may increase one's likelihood of developing this complication. To achieve these goals, the study will characterize the leg skin microbiome of sickle cell disease patients in the United States, collect biomarker data, and use social science measures to assess the physical environment and psychosocial status (e.g., stress, discrimination, stigma and depression) of individuals with and without leg ulcers.

Health Disparities Unit Members

Nkeiruka Umeh,B.S., Predoctoral Fellow
Melissa Moss, B.S., Predoctoral Fellow
Khadijah Abdallah, M.P.H., Research Coordinator
Ashley Buscetta, R.N., B.S.N., C.W.O.C.N., Research Nurse

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Last Updated: July 31,  2015