The Center for Urban Epidemiologic Studies (CUES) is a research and evaluation group which provides key information on the health of East Harlem and more broadly, New York City residents using a variety of methodologies. This reflects our mission to address the health of vulnerable populations to reduce disparities of health while also achieving broader population health promotion. Our approach is to use systematic literature reviews as well as qualitative and quantitative methods to obtain the broadest approach to assess the need, design interventions and then evaluate programs to improve the health of individuals and communities. The study designs have included: focus groups and in-depth interviews including stakeholder surveys to capture the viewpoints of individuals and communities about their needs, reactions to current approaches, and obtain input into strategies for solutions to problems; prevalence surveys to identify the magnitude and scope of a health problem or environmental risk; prospective studies to identify the onset of new conditions; retrospective case control studies to identify risk factors for disease or factors associated with health; social and behavioral intervention trials to test the efficacy of a novel approach to disease prevention and health promotion; a community randomized trial to test the effectiveness of a new approach to disease prevention; community based participatory research to build partnerships with civil society, academia and local government using quasi experimental designs to test effectiveness of jointly developed multi-component, multi-level interventions to improve the health of Harlem. For sampling of populations, we have used street intercept, venue based, respondent driven (chain referral) and random sampling of individuals (e.g., random digit dial). For data collection, we have used in-person face-to-face interviews, audio-computer assisted interviews, telephone assisted interviews, public administrative data with mapping using geographic information systems (GIS), neighborhood inventories, and biomedical assays. Our approaches to analysis are varied based on the question at hand, the design and methods used to address each topic. We have used qualitative and quantitative approaches including ecological, compositional and contextual analyses for cross-sectional and longitudinal data. We disseminate results through the academic peer reviewed literature, white paper reports and books. Our work has been sponsored by government, industry and foundations.
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. Our mission and methods are transferable to a wider variety of health issues. We have in-house expertise and strong collaborations with academia, government and community partners to achieve goals.
HIV Epidemiology and Prevention:
Preventing HIV Acquisition among Heterosexually Active African-American Men
Preventing HIV Acquisition among Heterosexually Active African-American Men African-Americans are disproportionately affected by HIV/AIDS in major urban areas of the United States. A number of HIV prevention interventions for heterosexual women exist, but there are fewer for heterosexual men, and none specifically for heterosexual African-American men. To fill this gap, the CDC funded three sites across the United States to conduct significant formative research and to develop a prevention interventions for these men. Together with the New York Blood Center, CUES investigators are conducting qualitative research to better understand the prevention needs of African-American men who are at risk from heterosexual acquisition of HIV. The data collected will lead directly to the development and testing of an innovative HIV prevention intervention. It is anticipated that approximately 100 men will participate in the formative research and that another 50 men will participate in a pilot study of the intervention developed. To date, half of the planned focus groups and in-depth interviews have been conducted and preliminary analyses have begun. Intervention development and piloting of the intervention will occur throughout the winter and spring of 2010.
Project MIX: a group intervention to reduce sexual risk of HIV associated with drug and alcohol use among African American, Latino and white men who have sex with men
This CDC-funded project, awarded to four cities (NYC, Chicago, San Francisco, and Los Angeles) is a multi-session group-level intervention targeted to gay and bisexual men who use non-injection drugs and/or alcohol and engage in unprotected sex. The target sample included a mix of 1/3 African American men, 1/3 Latino men and 1/3 white men, and included both HIV+ and HIV- serostatus. CUES collaborated with the New York Blood Center on this project. All intervention activities have been completed to compare the experimental intervention arm with an active control condition. The baseline and follow-up data are being analyzed. The CDC appended to this study a third arm – a non-attention control condition – to provide additional comparisons of outcomes. When the final interviews are completed of participants in this third arm, all data will be analyzed and reports prepared for publication. Analyses are being coordinated through the CDC.
Project DiSH – Dietary and Sexual Health: an HIV risk-reduction intervention for African American men who have sex with men
|
Epidemiology –Substance Abuse, Mental Health, Infectious Diseases – Hard to Reach Populations
IMPACT: Inner-City Mental Health Study Predicting HIV/AIDS, Club and Other Drug Transitions
IMPACT is a series of multi-level studies aimed at determining the association between features of the urban environment and three negative health outcomes: (1) club and other drug use, (2) HIV and other blood-borne pathogens, and (3) post-traumatic stress disorder (PTSD). Surprisingly little systematic research has explored the relation between features of the individual’s environment, her/his risk behavior, and disease morbidity (i.e. PTSD, HIV, and substance use) while controlling for relevant individual-level covariates. These studies were designed to examine the independent and interactive effect of key features of the urban social environment (residential segregation, income distribution, neighborhood disadvantage) and of the urban physical environment (population density, public transportation, the built environment) as they relate to PTSD, sexual and drug use risk factors for HIV infection, HIV prevalence, and club drug use. We enrolled 1,890 people using systematic recruitment techniques in 38 disadvantaged neighborhoods within four boroughs of NYC. Eligible and consenting participants completed structured interviews and provided blood and urine sample.
Two methodological papers have been published from this study. The first focused on the selection of neighborhoods. In research combining census or other publicly available data with surveys of residents and/or street-level observations, questions regarding neighborhood definition take on added significance. Neighborhoods must be identified and delineated in such a way as to optimize quality and availability of data from each of these sources. IMPACT utilized a multistep neighborhood definition process including development of census block group maps, review of land use and census tract data, and field visits and observation in each of the targeted communities. Field observations were guided by a preidentified list of environmental features focused on the potential for recruitment (e.g., pedestrian volume), characteristics commonly used to define neighborhood boundaries (e.g., obstructions to pedestrian traffic, changes in land use), and characteristics that have been associated in the literature with health behaviors and health outcomes (such as housing type and maintenance and use of open spaces). This process, implemented in February through July 2005, proved feasible and offered the opportunity to identify neighborhoods appropriate to study objectives and to collect descriptive information that can be used as a context for understanding study results.
The second methodologic paper provided the background and rationale for the sample selection. Studies seeking to identify neighborhood level determinants of drug use, particularly among marginalized urban populations need to overcome significant challenges, particularly in the area of sampling and recruitment. One key issue is defining functional neighborhoods which are relevant to local residents. Another arises from the need to sample a representative, or even a diverse, population when studying marginalized groups such as illicit drug users. These are common problems which raise particular challenges when both need to be addressed in the same study. For example, many sampling approaches for neighborhood-level studies have included some form of random sample of households, but this may systematically overlook marginalized populations. On the other hand, the sampling approaches commonly used in studies of hidden populations such as chain referral, snow ball and more recently, respondent driven sampling, typically expand beyond a geographic “neighborhood.” We describe the organization and rationale for the IMPACT Studies as a case illustration on how such issues may be addressed.
Social Ties Associated with Risk for Transition into Injection Drug Use (START Study)
In collaboration with the Department of Epidemiology at Columbia University, Mailman School of Public Health, we have set forth to investigate the effect of high-risk social networks on transition into injection drug use, early high-risk behaviors following transition, and subsequent HIV and HCV infection among young adult drug users in South Bronx, East/Central Harlem, Brooklyn, Queens, and the lower East Side of Manhattan neighborhoods of New York City (NYC). Since transmission of HIV/HCV occurs within the first 2-3 years of injection drug use, identifying critical social factors associated with the start of injection is important so that early prevention and intervention strategies can be designed. Given the persistent racial disparities in HIV, race/ethnicity will also be examined in relation to one’s social network and other social circumstances that predispose an individual to injection drug use. Typically, white drug users initiate injection drug using more often and at a younger age, while black drug users carry the burden of HIV. Therefore this study aims to understand the effect ones’ social network has on the start of injecting illicit drugs and the role that one’s race/ethnicity plays in this increase in severity of drug use. Additionally this study will determine the social characteristics associated with (1) adolescent transition into injection drug use, and (2) early post-transition drug-related socio-behavioral events among new IDUs using a four-year historical review. Finally, we will prospectively determine the incidence of transition into injection drug use, and the social network/support risk factors that predict transition into injection among non-IDUs. Participants will be recruited from selected high drug activity neighborhoods in NYC through use of ethnographic mapping and respondent-driven sampling. This study is funded by the National Institute on Drug Abuse, 2005-2010.
Heroin Cessation: A Case-Control Study
As a chronic relapsing condition, drug use is a major risk factor for HIV infection and lower access to HIV medications. An extensive literature on drug treatment entry, relapse and retention has been reported suggesting individual to neighborhood barriers to cessation and triggers to relapse, but recent data on spontaneous recovery and sustained cessation are sparse. Identifying factors associated with sustained cessation can contribute meaningfully to HIV prevention and treatment. The purpose of this case-control study is to characterize the individual and neighborhood-level determinants of initial and sustained cessation of heroin use among persons who report a history of chronic heroin use within economically disadvantaged, predominantly racial/ethnic minority neighborhoods in New York City (NYC). Groundbreaking studies in the 1960’s and 70’s provided mostly descriptive data on the natural history of drug abuse with samples drawn from drug abuse treatment and the criminal justice system. Considerable literature has continued to be devoted to short term cessation and relapse primarily as related to drug abuse treatment and incarceration although some dated information describes spontaneous recovery. Data are sparse on the prognostic indicators and course of sustained heroin cessation, particularly in street-recruited samples. Likewise, while cessation makes sense in terms of parenteral HIV prevention, heroin dulls libido, and little is known about levels of sexual risk following heroin cessation short or long term. This study seeks to isolate potentially modifiable factors to assist the overall goal of sustained abstinence if not risk reduction. Key to this study is our recognition of cessation as not only an outcome, but also a possible exposure associated with sexual risk behavior.
Methods for evaluating the physical and social environment of urban neighborhoods
The purpose of this study is to design and evaluate a comprehensive, systematic approach to characterizing urban neighborhoods through direct observation of neighborhood characteristics. Public health researchers and practitioners have begun to refocus on the context in which as individual lives as an important determinant of health. Neighborhood characteristics are typically measured through participant self-report, observation (often via video), or secondary databases like the US Census. Major limitations of these approaches include the inability to monitor changes over time, costs and significant staff. This has limited their inclusion in more than a few studies and resulted in neighborhoods being evaluated at a single point during a study. Yet, during a multi-year study, the urban neighborhood context may significantly change as a result of seasonality, gentrification, immigration, etc. We evaluated and revised a brief scale, aimed at measuring the social, physical and resource environment of urban neighborhoods through direct observation and examine the reliability and validity of the scale. To achieve these aims, we are working within a larger multi-level parent study (IMPACT, described above) aimed at examining the associations between features of the urban environment and mental health, drug use, and HIV risk in 38 NYC neighborhoods that have already been ethnographically defined. We will first define an additional 16 neighborhoods, as our current sampling frame is overrepresented by poorer . Next, we used our neighborhood evaluation scale and neighborhood mapping to measure the urban environment. Each of the target neighborhoods are rated by two independent observers twice a year for 2 years, providing 4 iterations for data collection, analysis and scale revision. In year 2, we also administered the scale in 50 randomly selected Detroit neighborhoods to evaluate the scale’s performance in another urban setting and assess the generalizability.
Asthma
Asthma Surveillance and Education in Preschool Settings
This research project was funded in April 2004 by the National Heart, Lung and Blood Institute of the NIH. It is a continuation of our research to improve asthma care for children in Head Start and subsidized preschool programs in disadvantaged communities heavily impacted by asthma. We built on our long collaborative partnership with Union Settlement Association, the largest provider of preschool childcare services in East Harlem. We also partnered with preschool childcare agencies in the Bronx and the Lower East Side. The intervention at the heart of this project built on lessons learned in earlier studies and used procedures and materials that were effective in improving the proportion of children identified with probable asthma and receiving appropriate medical management. There were three components to the intervention: surveillance, monitoring and education. Surveillance involved a case detection tool that we developed to identify children with probable asthma during the routine process of enrollment/re-enrollment, and a requirement that parents/guardians of all children identified as having probable asthma to get a written Asthma Action Plan from their doctor. Monitoring involved a "Health Trak” MS Excel-based system that aimed to improve staff compliance with administering the case detection tool and parental compliance with the Asthma Action Plan policy. Our asthma coach delivered one-to-one education to parents using a series of modules designed for families who haven’t bought into the idea that asthma is a disease that can be controlled with inhaled corticosteroids. We have published an article describing our education program. Now we are analyzing our data to access whether the surveillance and monitoring procedures increased the proportion of preschool children who had gotten written Asthma Action Plans from their doctors, and weather our education program increased adherence to inhaled corticosteroids. Our work has already had some impact on public health practices. The New York City Department of Health and Mental Hygiene disseminated of the surveillance and monitoring procedures to over 180 subsidized preschool and Head Start centers in East Harlem, the South Bronx, Central Brooklyn, and Queens, reaching over 18,000 children.
New York City Asthma Partnership (NYCAP)
One of our CUES researchers serves on the Steering Committee of the New York City Asthma Partnership (NYCAP), the umbrella group for all asthma coalitions in New York. One of NYCAP's responsibilities is to oversee the New York City Department of Health and Mental Hygiene's Day Care Asthma Program that disseminates the surveillance and monitoring system that CUES developed with NIH funding.
Violence
Changes in Homicide and Drug Overdose in New York City
Through a collaboration with investigators at Cornell University and with the New York City Office of the Chief Medical Examiner, we are exploring trends in homicide and fatal drug overdoses in New York City (NYC )between 1990-2006. The aims of the study are: (1) to determine the incidence, temporal trends, and correlates of homicide, accidental drug overdoses and other fatal accidents with a focus on identifying the emerging role of newer drugs such as ecstasy and oxycodone; (2) to determine neighborhood-level determinants of homicide (e.g., drug use, policing, concentrated disadvantages) and to assess how they are related to changes in the frequency of homicide over time and place; (3) to determine the association between individual drug use, age of decedents, neighborhood factors (e.g., economic disadvantage, level of illicit drug use), and the risk of becoming a homicide case using fatal accidents as controls; and (4) to determine neighborhood-level determinants of drug overdose and to assess how these are related to changes in fatal drug overdose over time and place. Early results show significant declines in homicide and that drug overdose deaths now exceed homicides in NYC; results have been shared with the NYC Department of Health and Mental Hygiene to develop overdose prevention interventions such as naloxone administration and distribution programs. Analyses are underway to identify factors that may explain the dramatic and continuing drop in homicides in NYC over the past 15 years; whether and to what extent this can be attributed to changes in demographics, improvement in medical care for those admitted for injuries, changes in policing (“quality of life” arrests), changes in illicit drug use (e.g., crack) are the subject of active inquiry.
The mortality study aimed to quantify the risk of mortality among this group of recently initiated injection drug users, to compare their risk to their peers in the general population, and to distinguish characteristics that were associated with premature death. Death was ascertained through the National Death Index through the end of 2002. Causes of death were determined by National Death Index-Plus and as a check of the NDI plus, supplemental death certificate and medical record review by the study’s endpoints committee. Analyses for this study are nearing completion with manuscripts due out in 2008.
Evaluation of a Parenting and Domestic Violence Curriculum for At-Risk Parents
Working in collaboration with Connect, Inc., a community-based non-profit dedicated to building communities’ capacity to respond to domestic violence and child abuse, this project is designed to evaluate the acceptability and feasibility of a parenting skills curriculum aimed at parents who are in on-going domestic violence situations. Growing research and practice evidence indicates that intimate partner violence and child abuse often co-occur in families; despite recent improvements in both policies and procedures, abusers often still live with their families, putting both women and children at risk. In addition, there are situations where, for a variety of reasons, women do not want their abusive partners to leave the family and therefore do not access legal protections. These realities catalyzed the creation of a parenting skills curriculum for parents who are experiencing or have experienced intimate partner violence and are also deemed to be at-risk for child abuse and/or neglect. Through a grant from the Department of Health and Human Services, researchers from CUES are working to evaluate the implementation of the training curriculum in four busy child abuse and neglect preventive agencies throughout New York City. In 2006, we completed the curriculum development process and the evaluation and the curriculum is currently being used in the Connect Clinical Training Institute.
The Social Ecology of Intimate Partner Violence against Women
This line of research encompasses two studies designed to further our understanding of what neighborhood factors are related to the distribution of intimate partner violence against women. Intimate partner violence against women is a major public health and social problem. Both the public health and safety system are working to reduce the prevalence of such violence. Developing primary and secondary prevention programs at the neighborhood level has been identified as an important way to do this. However, our understanding of what neighborhood factors are associated with intimate partner violence against women is limited. Thus, we designed two studies to explore how the “informal social control” of intimate partner violence against women works at the individual and neighborhood levels. The first study uses data from the “NYSES” and the “Changes in Homicide and drug Overdose” studies to examine what neighborhood factors, such as social cohesion and related social capital factors, predicted self-reported likelihood of intervening in an intimate partner violence situation. The results will provide an improved understanding of how the social environment influences an important form of social control of partner violence. The second study uses a qualitative method, concept mapping, to understand what neighborhood residents believe affect their likelihood of intervening in or offering assistance to women who experience partner violence. Both studies were funded in 2006 by NIDA via a five-year Career Development Award to Victoria Frye, DrPH, an adjunct research investigator at CUES.
Non-Traditional Public Health Providers
Pharmacists As Resources Making Links to Community Services (PhARM-Link / CBPR) – Harlem Community-based Participatory Research (CBPR) Evaluation Project
This community based participatory research (CBPR) study will evaluate the impact of the Expanded Syringe Access Program (ESAP) in Harlem pharmacies to reduce substance abuse-related health and social risks among injection drug users (IDUs) participating in ESAP, a program that allows the purchase of syringes at pharmacies without a prescription. Pharmacists participating in ESAP have become a first point of contact for IDUs and could feasibly help connect their IDU patients/customers with services focusing on drug treatment, primary care, mental health services, and benefits/entitlement services. Using pharmacies to link IDUs to medical/social services was the logical next step in addressing the multitude of consequences faced by those burdened and at risk of HIV and progressive drug-involvement. To enhance and help sustain the relationship between IDUs and pharmacy staff, this study will connect pharmacies to community-based organizations (CBO) so that pharmacy staff will have the necessary tools and support to provide these extended services. We will determine if this pharmacist – CBO partnership will have a positive impact in IDU health behaviors and pharmacy staff attitudes and opinions about ESAP. This project has the potential to create a stronger public health role for pharmacies, improve the lives of IDUs, and potentially reduce substance abuse — all lending to enhanced support of non-prescription syringe sales among NY State legislators. This study has been funded by the Robert Wood Johnson Foundation, 2007-2009.
Pharmacists As Resources Making Links to HIV Counseling and Testing (PhARM-Link / HIV) – A Structural Feasibility Study
The goal of this research project is to pilot test the feasibility of using ESAP-registered pharmacists as “linkages” to HIV counseling and testing. To achieve the specific aims of this study, the evaluation design will involve measurement of IDUs and pharmacy personnel. Twelve ESAP-registered pharmacies in Harlem, who have expressed interest in participating in a research study that helps link IDU-syringe customers to HIV testing services will be selected. Ten pharmacies will undergo training to provide HIV testing referrals to local testing sites and two pharmacies will undergo training in on-site HIV testing services. We will compare and contrast IDU syringe customers who patronize the PharmLink/HIV pharmacies with respect to uptake of HIV testing referrals and on-site HIV testing among IDU syringe customers. Additionally, we will examine the impact of HIV testing referral and on-site HIV testing on pharmacy staff with regards to customer base, business flow and attitudes and perceptions of HIV testing services linked to syringe sales. This study has been funded by the Centers for Disease Control, 2007-2011.
Pharmacists As Resources Making Links to Community Services (PhARM-Link): Community-Based Structural Intervention Trial
As the independent evaluator of ESAP since 2001 (a NY state public health program allowing non-prescription syringe sales in pharmacies), we found that a large number of pharmacies are enrolled in ESAP, early uptake of syringe purchases were made by IDUs, and no potential adverse effects (e.g. increased drug-related arrests, drug use, needle stick injuries, etc) were observed. However, there were racial disparities in pharmacy access. The Harlem Community & Academic Partnership (HCAP) board actively generated and implemented a community mobilization campaign involving IDUs, pharmacists and community residents for NYC, 2001-2003. By targeting both the individual and the social environment, our intervention increased pharmacy use among IDUs from 13% to 32% in Harlem, with significant increases among black IDUs. While the outcomes in this multilevel intervention were positive, room for improvement still existed. The purpose of this newly funded community-based intervention trial is to evaluate the effect of "enhanced" pharmacy services on the following outcomes among IDUs and pharmacy staff. This study will target pharmacies across the four boroughs (Manhattan, Bronx, Queens and Brooklyn) to enroll 110 pharmacies that will be randomized to three arms: (1) provision of expanded services in combination with syringe sales, referral of IDUs for a structured survey, and pharmacy staff survey; (2) standard syringe sales only, referral of IDUs for a structured survey, and pharmacy staff survey; and (3) standard syringe sales and pharmacy staff survey only. Among IDUs we will examine 1) increased repeated use of pharmacies for syringes, 2) increased safe syringe disposal practices, 3) increased frequency of HIV testing and use of other primary care services, 4) increased utilization of drug abuse treatment, and 5) increased health insurance coverage. Additionally, we will test the intervention effect among pharmacy staff with respect to attitudes towards IDUs and syringe sales, and pharmacy customer base. Specifically we will assess the following outcomes (1) increased support of ESAP; (2) increased support of enhanced pharmacy services for drug users; (3) increased new IDU customers / frequency of existing customers; and (4) increased prescription customer base. This study has been funded by the National Institute on Drug Abuse, 2007-2012.
Pharmacists As Resources Making Links to Comprehensive Screening Services (Pharm-Link / Screen) – A Structural Pilot Intervention
The goal of this research is to pilot test a pharmacy-based intervention that combines rapid HIV testing with other preventive screening services including blood pressure, glucose, and cholesterol screening targeted to injection drug users (IDUs) who purchase syringes from pharmacies via the New York State Expanded Syringe Access Program (ESAP) – a program that increases sterile syringe access to reduce HIV transmission. By combining HIV testing with less stigmatizing screening services and offering testing to all pharmacy patrons instead of singling out drug users, HIV testing and drug use-associated stigma will reduce. Although HIV testing is more accessible, HIV testing rates are low in the black and Hispanic community, especially among IDUs. Structural barriers (i.e. lack of health insurance) in the black and Hispanic community, especially among IDUs may limit access to regular health care/ preventive services. Access barriers are compounded by stigma associated with getting an HIV test that may identify an individual as a drug user and/or someone who engages in socially unacceptable behavior. Thus, this research will involves qualitatively evaluating HIV testing and chronic disease screening in pharmacies, 2) quantitatively compare/contrasting correlates of agreeing to a HIV test vs. not among IDU syringe customers and their peers, and 3) qualitatively compare/contrasting HIV testing with comprehensive screening services pharmacy (intervention) vs. HIV testing only pharmacy (control) among IDU syringe customers, their peers, and pharmacy personnel. This study has been funded by the National Institute on Drug Abuse, 2009 – 2011.
Community Based Interventions:
HCAP: 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 comprised 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 the following: (1) a pilot intervention aimed at increasing physical activity among overweight women in Harlem, (2) a policy review paper on prisoner reentry into communities, and (3) ongoing supervision of our ongoing National Institutes of Health funded research interventions 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
Rapid Vaccination of Hard-to-Reach Population: Project VIVA
|
With the success of Project VIVA, we applied for and received NIH funding to expand the scope of the intervention. Project VIVA –Harlem aims to improve vaccination rates among adults aged 50 and older living in East and Central Harlem through a community-based participatory research approach. Working with our community partners, Palladia, Inc., we are expanding and improving our original Project VIVA to create a sustainable intervention. We are currently working very closely with the New York City Department of Health and Mental Hygiene and our community partners to address both seasonal and pandemic H1Na vaccination needs.
B-VIVA: Venue Intensive Vaccines for Adults, Hepatitis B
The prevalence of hepatitis B among injection drug users (IDUs) is high, but vaccination coverage in this group remains low. Screening for exposure to hepatitis B virus prior to vaccination is generally recommended for adults in high risk groups, where the prevalence of hepatitis B is greater than 17% to 40%. In high risk populations such as injection drug users (IDUs), the prevalence of hepatitis B virus exposure is reported to be between 20% and 80%. This implies that IDUs should undergo prevaccination screening prior to being offered hepatitis B vaccination in most cases.
Prevaccination screening is recommended solely based on economic factors; hepatitis B vaccine is safe and there is no harm in administering it even if a person has completed the vaccination series or has been exposed to hepatitis B in the past. Whether to screen or not depends on the cost of screening tests, the cost of the hepatitis B vaccination series and their administration, and the seroprevalence; generally, other costs such as staff time invested in follow-up efforts have not been included in these analyses.
The purpose of this study is to evaluate and compare the acceptability of the first dose of HBV vaccine and completion of the vaccination series among IMPACT study participants in two settings: a community-based storefront and a mobile van. The study proposed is a natural experiment based on available resources to provide vaccines during the participants’ first visit to the storefront or mobile van. Due to limited resources, a clinician will not be available to administer HBV vaccines at the storefront and the van every day. Thus will we examine vaccine uptake among those offered HBV vaccine on their first study visit versus those who are referred to the next vaccination day.
UNITY: HIV Vaccine Efficacy Trials in Non-injecting Drug-using Women
Low- income women of color who reside in HIV epi-centers such as New York City are the fastest growing sector of the population at risk for HIV. However, women have been under-represented in studies testing potential HIV vaccine. We need to increase representation of women in HIV vaccine trials and learn how to more effectively teach high risk women -“vaccine concepts” -to improve their willingness to take part in such trials. Since no potential HIV vaccine is expected to be 100% effective, it is also necessary to find brief, yet powerful ways to motivate vaccine trial participants to minimize risky behavior that may put them at risk for HIV. In this study CUES collaborated with the New York Blood Center to develop and test a series of brief, individually-based counseling sessions to improve understanding of vaccine trial concepts and sexual risk reduction within a population of women at high risk for HIV. We began testing the intervention in 2005, and completed follow-up interviews in 2008. We found that the percent of women reporting sexual risk behavior declined significantly, but did not differ significantly by study arm. Knowledge of HIV vaccine trials concept also significantly increased but did not significantly differ by study arm. Concepts about HIV vaccine trials not adequately addressed by either condition included those related to testing a vaccine for both efficacy and safety, guarantees about participant in future vaccine trials, assurances of safety, medical care, and assumptions about any protective effort of a test vaccine. Further research in needed to boost educational efforts and strengthen risk reduction counseling among high-risk- non-injection drug using women. We have published two papers and third is under review.
Facilitators and barriers to HPV vaccine acceptance and uptake among minority women in economically disadvantaged communities
The purpose of this study was to examine knowledge, attitudes and beliefs towards HPV vaccine and patterns of health care seeking in the era of HPV vaccine among African American and Hispanic women who are either eligible for the HPV vaccine and/or the mothers/legal guardians of girls and young women eligible for HPV vaccine in economically disadvantaged communities. Human papillomavirus (HPV) infection is the primary etiologic agent for cervical neoplasia worldwide. Substantial racial/ethnic differences exist for cervical cancer; incidence and mortality rates are higher in African American and Hispanic than White women. Current recommendations include routine vaccination for women ages 11-12 and catch-up vaccination for women aged 13-26, with girls as young as 9 being eligible for vaccination. HPV vaccine presents an interesting challenge for delivery because it is a vaccine for a sexually transmitted disease that is aimed at children and may need parental consent in some settings. Racial/ethnic and socioeconomic disparities have been documented for other childhood vaccines and there is potential for similar disparities to develop as HPV vaccine comes into widespread use. This study will be important in providing information for designing interventions aimed at preventing or reducing disparities in HPV vaccine access and uptake which may then contribute to reducing or eliminating disparities in cervical cancer diagnosis, treatment and survival. Thus, this study sought to identify and understand potential barriers and facilitators of HPV vaccine access and uptake among African American and Hispanic women and their children in economically disadvantaged neighborhoods.
NYBC study
Screening for cardiovascular disease among blood donors In 2009, the New York Blood Center began offering a free cardiovascular disease risk screening for blood donors at locations in the Bronx and Brooklyn. The CVD risk screening program is enhanced by having a face to face counseling session by a health education specialist who provides the participant with their total cholesterol, HDL, blood pressure, BMI, and obtains a record of their familial CVD history and their current CVD high risk behaviors. This setting is unique in the sense that there is an interaction between a counselor and a participant in a non-traditional medical setting that was not spurred by an underlying medical reason which would provoke one to encounter a physician for an acute or chronic condition. The New York Academy of Medicine is following up participants who have undergone CVD screening via email or telephone. The analysis of the baseline and follow up data will provide the foundation for future full scale CVD assessment programs for blood donors in the tri state area.
Disaster Response
Sequels of the September 11thTerrorist Attacks in New York City
The September 11th terrorist attacks were the single largest human-made disaster in the United States. Nearly 3,000 people in NYC died as a result of the attacks, more than 100,000 jobs have been lost and billions of dollars in damage have been incurred. Early CUES work demonstrated the substantial mental health burden in NYC as a result of the attacks. CUES developed cross-sectional and longitudinal research projects investigating the psychological sequelae of the September 11th attacks on residents of New York City. We are currently in the process of following-up a cohort of more than 2,500 NYC metropolitan area residents 3 years after the disaster. The survey assessed rates of new onset posttraumatic stress disorder, depression, and other mental health outcomes, and identified subgroups with the highest rates, to target interventions. Data from our cross-sectional surveys and from this cohort have been provided to the New York City Department of Housing and the State Health Department of Mental Health to provide information for program planning. We continue to serve on the New York State Mental Health Consortium formed after September 11th. To date, we have published over 50 papers addressing issues surrounding the World Trade Center attacks, and this work is being extended to look at factors other than the attacks that are associated with mental health in city residents.
Health of the Elderly in New York City
New York City Neighborhood and Mental Health in the Elderly Study (NYCNAMES)
There is mounting evidence that where you live may be a powerful influence on many aspects of your health. This may be particularly true for older adults who are likely to spend more time in their neighborhood of residence, and may be more vulnerable to neighborhood features such as high crime rates or lack of disabled access. While many surveys have shown higher rates of depression in disadvantaged areas, there has been surprisingly little longitudinal research into the relationship between neighborhood characteristics and mental health. This is important since the previous survey findings may simply reflect a tendency for depressed individuals to become disadvantaged, or to live in disadvantaged neighborhoods. If the influence of neighborhood on risk of depression could be confirmed and the neighborhood characteristics that influence depression better defined, this would provide the opportunity for structural interventions to reduce the risk of depression, regardless of an individual’s socio-economic status. The New York City Neighborhood and Mental Health in the Elderly Study (NYCNAMES) is a longitudinal study funded by the City of New York that has been designed to identify features in the urban environment that influence the risk of an older person developing symptoms of depression. 808 older residents of all Boroughs of New York City were interviewed in 2005 and 2007 and asked about a range of health issues including symptoms of depression and physical activity. Early findings suggest that where an older person lives does, indeed, influence their risk of depression. Living in an affluent area appeared to protect against depression, regardless of an individual’s income, and living in an area with high “walkability” also had a positive effect. Analysis of NYCNAMES continues with the researchers looking to identify other neighborhood characteristics that may influence the risk of depression, levels of physical activity and obesity.
Age Friendly Cities New York
In conjunction with the Division of Policy, CUES is working
to provide a blueprint for making New York City “a city for
all ages”. This document will guide city agencies as they
assess their current and potential capacity for increasing
the age friendliness of NYC. CUES is working with partners
at the Built Environment and Health Project at Columbia
University to build a geospatial database of environmental
factors relevant to older people and map these in a form
that will be useful for Agencies and policy makers.
Mission | Staff | Publications | Partners | Donors | Training | J. of Urban Health | Resource Guides
