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The Center for Urban Epidemiologic Studies (CUES) is a research and evaluation group that provides key information on the health of East Harlem and, more broadly, New York City, using a variety of methodologies. This work reflects NYAM’s mission to address the health of vulnerable populations by reducing disparities of health while also achieving broader population health promotion. CUES has undertaken research and evaluation on a number of different areas including HIV and other infectious diseases, mental health and substance abuse, immunizations, violence, asthma, non-traditional public health provider models, the health of the elderly New York City residents, and disaster response. CUES’ mission and methods are transferable to a wider variety of health issues. CUES has in-house expertise and strong collaborations with academia, government and community partners to achieve goals.
African-Americans are disproportionately affected by HIV/AIDS in major urban areas of the United States, but there have been no prevention efforts targeted to heterosexual African-American men. To fill this gap, CUES investigators have joined forces with the New York Blood Center (NYBC) to research the prevention needs of African-American men at risk from heterosexual acquisition of HIV.
CUES is also working with NYBC to address the needs of African-American men who have sex with men (MSM) through Project DiSH – Dietary and Sexual Health. This novel intervention weaves proven information on cognitive-behavioral sexual risk reduction and skills building into cooking and sharing meals, to help participants create supportive communities of friends that value health, self-worth, self-identification as MSM, and social integration.
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Innovative CUES research is targeting easy-to-miss populations by examining their neighborhoods and patterns of drug use. IMPACT, a series of multi-level studies funded by the National Institute on Drug Abuse and the National Institute of Mental Health, is examining the association between features of the urban environment and negative health outcomes related to post-traumatic stress disorder (PTSD), sexual and drug use risk factors for HIV infection, HIV prevalence, and club drug use.
Drug use is a major risk factor for HIV infection and lower access to HIV medications. In one study, CUES is working with the Department of Epidemiology at Columbia University's Mailman School of Public Health to examine social factors associated with beginning to inject drugs, early high-risk behaviors following transition, and subsequent HIV and HCV infection among young adult drug users in the four New York City boroughs. Another study focuses on identifying factors that promote cessation of heroin use within economically disadvantaged, predominantly racial/ethnic minority neighborhoods in New York City. Both studies are funded by the National Institute on Drug Abuse.
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Harlem Community Academic Partnership. The Harlem Community & Academic Partnership (HCAP) is committed to identifying social determinants of health and implementing community-based interventions to improve the health and well being of urban residents using a community-based participatory research approach. The geographical communities of focus are East and Central Harlem, areas where a substantial proportion of the residents are poor people of color. The HCAP is composed of community-based organizations, partners from academia, the health department, and from CUES. The Board has developed an interim conceptual model for social determinants of health, which it then uses to review community-identified health problems and structure interventions to address social determinants. In the past year, HCAP activities have included a pilot intervention aimed at increasing physical activity among overweight women in Harlem; a policy review paper on prisoner reentry into communities; and ongoing supervision of CUES ongoing National Institutes of Health-funded research aimed at developing an intervention in East Harlem to increase the use of Expanded Syringe Access Legislation in New York City and for developing a rapid vaccination program for hard-to-reach populations in East and Central Harlem.
Immunizations. Low vaccination coverage is acute among hard-to-reach (HTR) populations such as drug users and elderly shut-ins. Project VIVA is designed to rapidly immunize HTR populations in disadvantaged minority communities using a multilevel community participatory intervention. With funding from the National Institute on Drug Abuse, it addresses factors including demographics, attitudes, health norms, barriers to access, and delivery methods. Begun in 2004, the project was conducted in eight disadvantaged neighborhoods within Harlem and the South Bronx. Its success led CUES to create Project VIVA-Harlem, aimed at improving vaccination rates among adults aged 50 and older living in East and Central Harlem. CUES also worked with the New York City Department of Health and Mental Hygiene and our community partners to address both seasonal and pandemic H1N1 vaccination needs, with funding from the National Center on Minority Health and Health Disparities. We are also targeting Human papillomavirus (HPV), studying potential barriers to and facilitators of HPV vaccine access and uptake among African American and Hispanic women and their children in economically disadvantaged neighborhoods.
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With evidence mounting on the influence of where people live on many aspects of their health, CUES launched a study of features in the urban environment that influence the risk of older people developing symptoms of depression, funded by the City of New York. Early findings of the New York City Neighborhood and Mental Health in the Elderly Study I (NYCNAMES I) suggest that where older people live does influence their risk of depression. Analysis continues, as researchers examine other neighborhood characteristics that may influence the risk of depression, levels of physical activity, and obesity. NYCNAMES II, exploring the relationship between levels of physical activity and subsequent risk of depression in the elderly, is now under way, with funding from the National Institute on Aging. Meanwhile, in conjunction with NYAM's Division of Health Policy, CUES is working on a blueprint for making New York City "a city for all ages" by guiding city agencies in assessing their capacity for increasing the age friendliness of NYC.
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