Clinical Epidemiology and Evaluative Sciences Research
The Division plays a leadership role in health disparities research to prevent and treat chronic disease. In partnership with minority communities with culturally tailored interventions, this research helps to address conditions that disproportionately impact underserved Blacks and Latinos in NYC including obesity, uncontrolled hypertension, diabetes, and cancer. Dr. Boutin Foster and Dr. Phillips-Caesar have conducted community-based participatory research with faith-based organizations, community organizations and safety net providers.
1. Nanette Laitman Scholars Award in Community Health (PI: Carla Boutin Foster, MD, MS, Department of Public Health, 2007-2010)
Carla Boutin-Foster, MD, MS was awarded the Nanette Laitman Scholars Award in Community Health. Dr. Boutin-Foster is engaged in research initiatives targeted at communities that are hardest to reach but that experience the highest burden of health disparities. The objective of these activities is to develop novel strategies of disseminating preventive and public health messages in the areas of cardiovascular disease, HIV/AIDS, and mental health. Communities that have limited health access, linguistic barriers, and limited economic resources are most likely to suffer the greatest impact. The long term goal of the activities that will be undertaken as part of the Laitman Award, is to reduce health disparities in these conditions by increasing knowledge and awareness at the community level and enhancing community capacity for change. Dr. Boutin-Foster is also engaged in community activities with the New York Academy of Medicine as part of the Harlem Community Academic Partnership to develop community-based programs in obesity prevention.
2. The newly funded Center for Excellence in Health Disparities Research and Community Engagement (PI: Carla Boutin-Foster, MD, MS, Mary Charlson MD, James Hollenberg, MD, Martin Wells, PhD, NCMHD, $ 7,973,286)
Dr. Carla Boutin Foster, as principal investigator, developed the Center for Excellence in Health Disparities Research and Community Engagement which involves Weill Cornell, Hunter, Lincoln Medical Center, Renaissance Health System and New York University. The Center has two randomized trials focused on reducing health disparities from hypertension and colorectal cancer in Central Harlem and South Bronx.
The first project randomizes Black men recruited through barbershops to either patient activation or patient navigation to increase screening for colon cancer and blood pressure control. The second trial focuses on blood pressure control among Black hypertensive patients who receive care at Renaissance, and evaluates an educational/behavioral contract vs. an affective intervention to achieve blood pressure control.
The project would train 10-15 new minority investigators, and forge new community partnerships. In addition to an Administrative Core, the Center has a Community Outreach and Engagement Core, a Research Training Core, and a Research Core, which provides methodological, statistical and informatics support. Dr. Charlson is the co-principal investigator. The total five year award from NIH is $ 7,973,286, with $4,830,550 in direct costs.
1. Preventive strategies of hard to reach populations (PI: Erica Phillips-Caesar, MD, MS, MIRS, NIDA, $324,027, 2004-2007)
The goal of this study was to better understand the barriers and facilitators of treating comorbid health conditions in drug abusers and to design, develop, and test new behavioral therapies for the reduction and prevention of drug abuse in this population. Substance abuse is one of several major barriers to the adoption and maintenance of healthy behaviors. By addressing the role of social networks and social cohesion and their association with drug dependence and its health consequences at the individual and community level, this project helped to define new prevention strategies.
2. Project VIVA: A community based intervention to increase influenza vaccination rates among hard to reach populations (Erica Phillips-Caesar MD, MS, Co investigator, NIDA $132,408)
This project was a multilevel intervention to increase uptake of influenza vaccination in hard to reach populations, including substance abusers, immigrants, elderly, sex workers and homeless people in East Harlem and the Bronx. The project targeted the individual community organization and neighborhood levels. It significantly increased interest in receiving vaccine and provided a model for future intervention efforts.
3. Eating Well and Exercising for a healthier Harlem: (PI: Erica Phillips-Caesar, MD, MS Robert Wood Johnson Foundation and Cornell Institute for Translational Research on Aging; $66,622)
This two phase study was aimed at increasing physical activity and healthy nutrition practices among Black and Latino women residing in East and Central Harlem. In collaboration with Harlem Community and Academic Partnership, Dr. Phillips-Caesar conducted focus groups. The groups identified four principal risk factors for obesity: genetic predisposition; aging; eating habits developed during childhood that are difficult to break and food insecurity. There were competing ideas regarding the definition of "physical activity" versus "exercise". The groups identified four main components of a healthy diet: portion size; food preparation; types of food; and timing of eating. They also identified four barriers to healthy nutrition and physical activity: costs; lack of accessibility to healthy food options; lack of willpower; and time constraints. Using the women's input, Dr. Phillips-Caesar created Eating Well and Exercising for a Healthier Harlem, a workbook to help overweight and obese women make lifestyle changes to improve their health. The workbook was then used as a teaching aid in an 8 week healthy nutrition and exercise training program.
4. Faith-based Health Challenge (PI: Erica Phillips-Caesar, MD, MS and Carla Boutin Foster, MD, MS)
A faith-based intervention, "the Health Challenge" was developed and piloted among 152 African-American participants building upon the natural social networks that occur in the faith-based settings. The goal of this program was to enhance weight loss through healthy eating and increased physical activity. The program was piloted during an 8 week period. The participants were regular members of the church who were divided into small teams of 8 to 10 members; each had a team captain whose role was to facilitate group activities. Each activity had a Biblical reference, for example, Gospel aerobics was incorporated as part of the physical activity. All of the participants were overweight and 65% were obese; 88% of the participants were women. 64% lost weight. Among participants who lost weight the average weight loss was 3.3 lbs ± 2.8 lbs. Overall, 36% had a net weight gain of 6.7 lbs. Participants who actually gained weight frequently cited life stressors as barriers to weight loss. Those who were most successful in losing weight cited factors such as the faith-based setting, social support, and having a supportive team captain as most helpful.
Division of Clinical Epidemiology and Evaluative Sciences Research
Mary E. Charlson, MD, Chief
Suzan Toro, Administrator
338 East 66th Street