Research Examining Substance Use Issues, Access to Child Health Insurance in Latest Journal of Urban Health

NEW YORK CITY, June 22 ??? A series of studies examining substance use issues, including an analysis of the best locations for new syringe-exchange sites in New York City and an overview of government policies that deter Harlem drug users from getting the best treatment, are featured in the latest edition of the Journal of Urban Health: Bulletin of The New York Academy of Medicine. In addition, a revealing study by Academy staff outlines the roadblocks that poor New York City families face when enrolling children in government-funded health insurance programs.

Impact of Municipal Policies on Substance Users in Harlem: Drug and alcohol users in Harlem fail to get optimum care and become mired in a cycle of drug-dependency in part because of restrictive public policies regarding drug treatment, Medicaid and post-jail benefits, according to research conducted by Juliana van Olphen, Ph.D., an Assistant Professor at San Francisco State University, and Nicholas Freudenberg, Dr.P.H., Professor of Urban Public Health at Hunter College.

Eighty staff workers at Harlem-based drug treatment, health and social service agencies reported the following policies as particularly harmful to drug-using clients: long waiting period for a Medicaid card in order to receive health care, especially after release from jail (rated ???harmful??? by 86 percent of surveyed workers); release of inmates from jail without drug treatment planning (rated ???harmful??? by 75 percent); eviction of individuals and/or families from public housing if a household member is convicted of a drug crime (73 percent); failure of drug treatment programs to offer child care services (70 percent); and, failure of drug treatment programs to accept Medicaid (65 percent). These policies impede substance users??? attempts to get their lives on track, the authors said. Substance use contributes to the high rates of HIV, homicides and violence in low-income urban communities.

Optimal Placement of Syringe Exchange Programs: Central Harlem, East Harlem and Union Square are the best locations in Manhattan for new Syringe Exchange Programs because the largest number of injection-drug users (IDUs) live there, according to a statistical model developed by researchers from the University of Washington and Harvard University. A new syringe exchange program in any of these neighborhoods would serve 300 or more IDUs, the study found. The newly developed model, which can be used for any geographic area, is based upon the knowledge that Syringe Exchange Programs (SEPs) serve fewer IDUs when located further than a 10-minute walk from home. Previous research has shown that 81 percent of IDUs in New York City would use an SEP within a 10-minute walk; only 59 percent when the exchange site is further away.

Researchers plotted the number of known IDUs living in 20,000 imaginary ???cells??? (135- by 175-foot zones) in Manhattan and created a geographical model of where the SEPs would be most used. SEPs play a proven powerful role in slowing the spread of AIDS. Those who cannot get clean needles may instead share needles with another user, risking the spread of infectious disease. An estimated 200,000 IDUs live in New York City and while they comprise only 2 percent of the city???s population, they accounted for more than 50 percent of the city???s AIDS cases from 1994-97. Lead author Amy Welton, Caribbean Regional Program Coordinator of the International Training and Education Center on HIV at the University of Washington, and colleagues write that accurate knowledge about where IDUs live is quite limited and is sorely needed. ???SEPs will necessarily be placed in suboptimal locations and will consequently prevent fewer AIDS cases than they otherwise might until further research determines where IDUs live and how far they are willing to walk.???

HIV Rates Higher Among Injection Drug Users on East Coast: Injection drug users (IDUs) living on the East Coast are ten times more likely to be HIV-positive than IDUs on the West Coast, but the difference could not be linked to riskier sexual and injection habits, according to a new study co-authored by David Vlahov, Ph.D., Director of the Academy Center for Urban Epidemiologic Studies. Only 2 percent of the 1,149 West Coast study participants were HIV positive, compared to 22 percent of the 1,528 East Coast participants.

Researchers offer several possible explanations for the difference. One is that a ???critical mass??? of HIV infection among IDUs???the point at which enough people have the virus that it spreads rapidly???has not yet been reached on the West Coast. Another factor may be that drug preparation practices differ between the regions. For example, black tar heroin, which is commonly injected in the West, dissolves only after heating it to a point that may inactivate the HIV virus. Powdered heroin dissolves easily in water and is the form typically injected in the East.

Impediments to Enrolling Children in Public Health Insurance in New York City: Three out of four families who applied for child health insurance through Medicaid or Child Health Plus in New York City were successful at enrolling but on average, it took 60 days to get the insurance, longer than is considered optimal by both programs. Part of that time was lost on the confusing process of assembling needed documents to prove eligibility, according to the study, led by Gerry Fairbrother, Ph.D., Senior Scientist in the Academy Division of Health and Science Policy. Most applicants (76 percent) needed considerable assistance completing the application process, mostly to figure out what type of documentation was needed to prove things like age, income, residence and citizenship, ???Many states have implemented policies that make it easier for families to prove their eligibility,??? Fairbrother wrote. ???Our findings suggest that if New York were to adopt some of these simplification requirements, it could lead to higher success in enrollment.???

Researchers followed 419 families for six months through the enrollment process. Those who initially applied at a community-based ???facilitated enrollment??? site that helps families fill out applications and assemble needed documents, were more likely to successfully obtain insurance (80 percent did) than those applying through the somewhat different process at managed care organizations (60 percent got insurance). Over 60 percent of the 410,000 uninsured children in New York State are eligible for either Child Health Plus or Medicaid.

The Journal of Urban Health is published quarterly for The New York Academy of Medicine. The Academy is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on urban populations, especially the disadvantaged.

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Posted on June 22, 2004

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