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UMDNJ Faculty Survey

As part of the strategic plan for the SPH-Institute for the Elimination of Health Disparities, we are requesting your assistance in compiling an inventory of health disparities projects and activities. This information will be utilized for university wide partnerships and collaborations on research projects or health intervention initiatives.

SURVEY INSTRUCTIONS: Please complete a separate survey for each project or activity that you are involved in. Answer every question by checking the appropriate responses. If you are unsure about how to answer a question, please give the best answer you can. Thank you for your participation.

INVENTORY OF UMDNJ ACTIVITIES ON MINORITY HEALTH AND HEALTH DISPARITIES

HEALTH DISPARITIES RESEARCH

Health Disparities Research investigates, monitors, and evaluates population subgroups’ health differences that consist of either basic, clinical, or behavioral components. Health Disparities Research strives to achieve results that help to prevent, diagnose, and treat such conditions as diseases, disorders, and other conditions including mental health and substance abuse that are unique to, more serious, or more prevalent in racial and ethnic minorities or sub-populations that are economically disadvantaged and medically underserved.

For each activity, please provide a one-page (maximum) description that includes the following:

Faculty/Staff/Fellow/
Resident/Student Name:

Department:

Campus:

Phone Number:

Email:

Website:

 

 

Title of Activity or Project:

 

 

Type of Project :

research
service
clinical
education
other (please specify)
     

Timeframe:

Start Date

End Date

 

 

Funding Agency if applicable:

Funding Mechanism:

Grant
Contract
Cooperative agreement
other (please specify)
     

 

 

Name of Principal Investigator, title and department:

First Name:

Last Name:

Title:

Department:

Campus:

 

 

Target Population:

Age Group:

Seniors (65+)
Adults (18-65)
Adolescents (13-18)
Children ( 2-12)
Infants (0-2)
All of the above

   

Gender:

Male
Female
Both

   

Race:

African American or Black
Caucasian or White
Asian
Native Hawaiian or Other Pacific
      Islander
American Indian or Alaska Native
Other

   

Ethnic Group:

Latino or Hispanic
Non Latino or Hispanic

   

Disability:

Disability
Non-Disability

   

Geographic Region:

Urban
Suburban
Rural
   

Health Disparity Problem(s)/Issue(s) addressed:

 

Abstract or brief description of purpose of activity: