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NYAM Approach: Innovative Research

NYAM addresses urgent health problems that disproportionately affect underserved urban communities through community-based participatory research and preventive interventions. Our research unit, the Center for Urban Epidemiologic Studies (CUES), conducts a wide range of studies geared toward disease prevention and educating communities on health risks including those described here.

HIV EPIDEMIOLOGY AND PREVENTION

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 Centers for Disease Control and Prevention (CDC) funded three sites across the United States to conduct significant formative research and to develop 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.

Project DiSH – Dietary and Sexual Health: An HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men

Although the disproportionate burden of HIV/AIDS among African American men who have sex with men (MSM) is stark and alarming, few interventions have been developed that address the complex intersections of economics, ethnicity, incarceration experiences, and ties to family and community that impact sexual behavior among African American MSM who are at high risk of HIV. To meet this need, CUES and the New York Blood Center secured funding from the CDC to develop a novel intervention that weaves proven cognitive-behavioral sexual risk-reduction information and skills building modules into cooking and meal sharing activities to engage participants in creating supportive caring communities of friends that value health, self-worth, self-identification as MSM, and social integration. Food provides a way to bring participants together in a context where the focus is on nourishment and health and building relationships that do not necessarily involve sex, in contrast to parks, or the bar and club scene where alcohol and drug use and an emphasis on casual and anonymous sex dominate.

SUBSTANCE USE

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 negative health outcomes. 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 post-traumatic stress disorder (PTSD), sexual and drug use risk factors for HIV infection, HIV prevalence, and club drug use. CUES enrolled 1,890 people using street recruitment techniques in 38 disadvantaged neighborhoods within four boroughs of New York City for interviews and specimen collection. These studies are funded by the National Institute on Drug Abuse and National Institute of Mental Health.

Social Ties Associated with Risk for Transition into Injection Drug Use (START Study)

In collaboration with the Department of Epidemiology at Columbia University and the Mailman School of Public Health, CUES has begun 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 the South Bronx, East/Central Harlem, Lower East Side, Brooklyn, and Queens. 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. This study aims to understand the effect one's social network has on the start of injecting illicit drugs and, given the persistent racial disparities in HIV, the role that 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, CUES 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 were from selected high drug activity neighborhoods in New York City through use of ethnographic mapping and respondent-driven sampling. This study is funded by the National Institute on Drug Abuse.

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. 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. 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. This study is funded by the National Institute on Drug Abuse.

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. CUES 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. This study is funded by the National Institute on Drug Abuse.

COMMUNITY-BASED INTERVENTIONS

Rapid Vaccination of Hard-to-Reach Population: Project VIVA

This is a quasi-experimental project involving a multilevel community participatory intervention that is designed to rapidly immunize hard-to-reach (HTR) populations in disadvantaged minority communities; this project was started at the end of 2004.

Low vaccination coverage among minorities and persons living in and near poverty is a persistent problem that is particularly acute among HTR populations (e.g. injection drug users, elderly shut-ins). Immunization rates are affected by multiple factors including demographics, attitudes about vaccination, health norms, barriers to access, and immunization delivery methods. Efforts to successfully vaccinate HTR populations must address these factors. A community-based program with rapid vaccination can serve as an initial model for emergency preparedness vaccination plans in the event of an influenza pandemic and for future efforts to widely introduce HIV vaccination in disadvantaged urban communities. This project has been conducted by a community-public health partnership in eight disadvantaged neighborhoods within Harlem and the South Bronx in three phases. Materials from the project are available at www.projectviva.org. This study was funded by the National Institute on Drug Abuse.

With the success of Project VIVA, we expanded 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 worked very closely with the New York City Department of Health and Mental Hygiene and our community partners to address both seasonal and pandemic H1N1 vaccination needs. This study was funded by the National Center on Minority Health and Health Disparities.

Facilitators and Barriers to Human Papillomavirus (HPV) Vaccine Acceptance and Uptake among Minority Women in Economically Disadvantaged Communities

The purpose of this study was 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. 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.

HEALTH OF OLDER NEW YORKERS

New York City Neighborhood and Mental Health in the Elderly Study I and II (NYCNAMES I and II)

The New York City Neighborhood and Mental Health in the Elderly Study I (NYCNAMES I) 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. Over 800 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.

Building on our findings from NYCNAMES I, CUES is now conducting NYCNAMES II. NYCNAMES II is a population-based longitudinal study aimed at characterizing the relationship between levels of physical activity and subsequent risk of depression in the elderly. The study will also determine the influence on these factors of the environment in which an older adult lives. This study is funded by the National Institute on Aging.

The Junior Fellows Philanthropy Project: An Exploration of Community Service through Targeted Health Research

This past fall, with the support of Bristol-Myers Squibb Foundation, NYAM’s Office of School Health Programs (OSHP) developed and launched a new component of The Junior Fellows Program, The Junior Fellows Philanthropy Project. This pilot is designed to teach students how to utilize health research as a tool in learning about philanthropy and community service. Read More >>

NYAM in the Media

The Next Step in Drug Treatment
The New York Times publishes an editorial on a public health approach to drug policy upon the release of NYAM and the Drug Policy Alliance’s Blueprint for a Public Health and Safety Approach to Drug Policy.

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