Food, Nutrition, Diet Loss of NIH funding jeopardizes landmark Puerto Rico nutrition, health studies Amy Roeder Hide caption Show caption A research assistant measures a participant’s blood pressure. / Courtesy of Jonathan Orozco

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Josiemer Mattei / Courtesy of Josiemer Mattei

Josiemer Mattei, Donald and Sue Pritzker Associate Professor of Nutrition at Harvard T.H. Chan School of Public Health, leads the most comprehensive study ever conducted on health determinants in Puerto Rico, and last year launched a clinical trial aimed at reducing diabetes risk in the island’s adult population. She works with local organizations to translate her research group’s findings into culturally relevant nutrition policies and programs. Mattei recently spoke about the future of PROSPECT (Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends) and PRECISION (Puerto Rico Evaluation of a Culturally Informed Sustainable Intervention for Optimal Nutrition) after funding was cut by the National Institutes of Health (NIH), part of the mass grant terminations affecting Harvard University.

Q: Tell us about your research. How important has federal funding been to it?

A: Federal funding has been absolutely essential. Most of my research group’s projects have had NIH funding, starting with training grants in my early career. Without NIH support for the past fifteen years, we wouldn’t be breaking new ground on nutrition and health now.

PROSPECT was funded by the National Heart, Lung, and Blood Institute [NHLBI]. Before we started it in 2018, there wasn’t a clear picture of chronic disease trends in Puerto Rico, and the behavioral and psychosocial risk factors people face. We launched PROSPECT after Hurricane Maria and were able to observe that in the storm’s aftermath chronic conditions and social needs were higher—but at the same time, people reported stronger social support and social connections. Storms and other natural disasters happen very often in Puerto Rico, so it has been important for us to see how food access and health are affected and how we need to respond first.

We were very successful during the initial funding cycle, as we generated key results such as those around the impact of Hurricane Maria, and seven ancillary studies. So, the NHLBI funded us to continue the study, with a focus on food insecurity. Half of the population of Puerto Rico receives federal food assistance, so we wanted to figure out the major needs for policy changes around food access.

Sample contents of PRECISION’s box of locally sourced produce. / Courtesy of Jonathan Orozco

Our other main project in Puerto Rico is the clinical trial PRECISION, funded by the National Institute of Minority Health and Health Dipartites. People received home deliveries of healthy, culturally tailored foods and nutritional counseling as part of the trial, which enabled us to look at both the impact of these strategies on diabetes risk and on household food insecurity. There was also a scientific arm of the study looking at biological mechanisms behind diabetes. We designed PRECISION as a pragmatic trial to help people overcome real-life challenges, and we were aiming to implement it as a standard prevention program through health insurances.

Q: What’s the status of these research projects now that their grants have been terminated?

A: We had to stop our follow-up with participants in PROSPECT before we were able to gather enough data to develop policy recommendations. Unfortunately, this is coming at a time when federal food assistance programs are facing cuts, and it will be important to understand how people are being affected. But we’re unable to do that if we can’t stay in regular communication with participants.

With PRECISION, we were in the second year of the trial. We had to pause recruitment, phase out food deliveries, and let go of some of the scientific questions we had hoped to answer. Since the study was recruiting on a rolling basis, we didn’t have preliminary results yet.

Losing the grants doesn’t just affect me and my science. There are communities and livelihoods being affected directly. Participants in both projects are now missing out on social and health benefits. For some of them, the evaluations they received through us were their only access to clinical or laboratory check-ups. And PRECISION participants are not getting boxes of healthy food that they’d been counting on receiving for the next two years. We also provided referrals to mental health services, food programs, and community activities that brought participants together.

Both projects were thriving because we spent 15 years working on the ground with community partners that were instrumental in building trust, making connections, and helping recruit participants. Weakening these connections now would set us back.

Losing team members has been the hardest thing for me. We’ve had to terminate or reduce the effort of staff in Boston and in Puerto Rico. There were almost 30 people on the team, including trainees and students.

We also had colleagues with ancillary grants at other institutions stemming off our primary grants that were depending on our research infrastructure and data collection for their own research. It’s like the game Jenga—when you pull out one block, it all comes crashing down.

PROSPECT team at FDI Clinical Research, San Juan, PR / Courtesy of Elena Martinez

Q: How are you keeping your work going?

A: I’m trying to keep the projects on life support for a year and maintain some essential research questions and basic services to keep our participants engaged. We already had a few foundation grants and thankfully received bridge funding, and we hope to receive private donations. I’m working with health insurance systems in Puerto Rico to see if they can help us continue the food deliveries. Nothing can truly replace NIH grants, however. The level of infrastructure, science, public health, and community outreach that we were doing was only possible through sustained federal funding.

Hopefully we can reapply for funding next year, if not have it restored, and then get our research back on track, close to the level it was at before.

Q: What do you wish people understood about your work as a researcher?

A: I wish people understood that the funding researchers receive is not a government handout. We put our brains, hearts, and souls into creating projects that will help people be healthier, even when they don’t see the research in action. Projects go through a rigorous process of evaluation, and only good science with a promising impact on public health gets funded. In addition, federal funding supports employees and trainees who are critical to the research.

The second I submit a grant, I start thinking about how I can keep moving the science forward. What if we use these data or hair samples that we collected to explore another crucial research question? Who do I need to connect with to make a policy change or a system change based on what I’m learning?

My research collaborators and I are committed to improving science and the health of all populations. Whatever happens going forward, the high quality and integrity of our research is not going to be affected.

About The Author Amy Roeder Senior Editor, Harvard Chan Magazine; Senior Writer in the Office of Communications

Featured in this article Josiemer Mattei Donald and Sue Pritzker Associate Professor of Nutrition