Pilot Study # 1 funded for two years
IMPACT OF CORONARY HEART DISEASE (CHD) RISK PERCEPTION ON HEALTH BEHAVIORS
Assesses the effect of risk perception of coronary heart disease on health-promoting behaviors among a socio-economically and ethnically diverse population, such as African Americans and Hispanics in the Bronx by testing a recently developed risk perception instrument for potential wide-spread clinical application. Overall knowledge of coronary risk factors was found to be sub-optimal with a low-to-moderate perception of personal risk of Coronary Heart Disease. Paradoxically, persons at highest risk of coronary disease were aware of their risk, yet engaged in more unhealthy behaviors.
Janice Barnhart, M.D., M.S
Pilot Project #2 funded for two years
COMMUNITY HEALTH CENTER-BASED SCREENING PROGRAM FOR DIABETES MELLITUS
The prevalence of undiagnosed diabetes in patients attending a community health center is not known, nor has the feasibility of diabetes diagnosing screening methods been tested. The researchers obtained random capillary blood glucose that were done "on the spot" to screen for diabetes. The study found a median glucose of 96 mg/dl with 38% having a value 100 mg/dl. The prevalence of undiagnosed diabetes was very low (0.74%), and confirmatory testing among positive screenees was high. On the other hand acceptance of diabetes screening in this population was low with many individuals declining and often giving as a reason, "If I have diabetes, I don't want to know about it."
Pilot Project #3 funded for two years
A FAMILY-ORIENTED MODEL OF COMMUNITY OUTREACH TO REDUCE DISPARITIES IN CARDIOVASCULAR & DIABETES MORBIDITY & MORTALITY IN THE SOUTH BRONX
The long-term aim of this project was to conduct a randomized clinical trial of the use of peer educators to provide family group education and support for people with high risk profiles for cardiovascular disease and diabetes. The "Peer Educators," or Promotores de la Salud, were adults, predominantly African-Americans and Latinos recruited from the South Bronx and given an extensive course in cardiovascular and diabetes related risk reduction. Family discussion groups led by peer educators were found to be feasible psycho-educational techniques to improve multiple risk factor reduction behavioral change, and improve knowledge among both patients and family members, reducing weight, depression and improvement in glucose levels among a majority of participants.
Alvin H. Strelnick, MD
Pilot Project #4 funded for two years
RKERS IN OBESE MINORITY YOUTH
The relationships among obesity, blood pressure regulation and various biomarkers are not well defined in children. The hypothesis that adipocytokines (biomarkers of cardiovascular disease), in obese minority adolescents are associated with hypertension or early elimination of the normal nocturnal dip in BP, and alterations in glucose metabolism, and microalbuminuria will be studied by measuring levels of fat-derived peptides and cytokines (adiponectin, leptin, CRP, and PAI-1) in obese pubertal minority subjects and lean controls, speculating that those with abnormalities in blood pressure and/or glucose intolerance will have abnormalities in cardiovascular biomarkers.. Findings will be helpful in the development of pediatric criteria for the metabolic syndrome and will permit assessment of efficacy of therapeutic interventions. The study is targeted to involve 80 pubertal minority youth 10-18 years old predominantly female, African-American and or Hispanic.
Joan DiMartino-Nardi, MD
Joseph Flynn, MD
Katherine Freeman, DrPH
Pilot project #5 funded for one year
RACIAL AND ECONOMIC DISPARITIES IN ACCESS TO NICOTINE REPLACEMENT THERAPY IN NEW YORK CITY PHARMACIES
Race, ethnicity and socioeconomic status are predictors of tobacco use; a possible determinant of the different rates of smoking among minority groups is access to smoking cessation aids such as nicotine replacement therapy. Pharmacies in nonwhite neighborhoods are less likely to sell over-the-counter nicotine replacement products and may have more tobacco products displayed. The investigators will examine a random sample of New York City pharmacies including pharmacies located in supermarkets or affiliated with health care settings in order to assess the accessibility of nicotine replacement products in undeserved populations. The data will be used to improve future community-based interventions for lowering tobacco use.
Steven Bernstein, MD
Lisa Cabral, MD
Pilot project # 6 funded for one year
THE IMPACT OF PHARMACEUTICAL SAMPLING OF MEDICATIONS FOR HYPERTENSION, DIABETES, AND HYPERCHOLESTEROLEMIA ON RACIAL DISPARITIES IN THE TREATMENT OF THESE CONDITIONS
Long-term adherence to medications is important in the management of chronic diseases such as hypertension, diabetes and hypercholesterolemia. Distribution of medication samples by pharmaceutical representatives (drug detailing) may ease the economic barriers to treatment adherence, can improve relationships between physicians and patients, but can also lead to reliance on newer and more expensive medications. The investigators will examine the impact of distributing medication samples in primary care clinics and their impact on racial differences and adherence. They will survey clinic policies related to medication samples, obtain information of the number of medications provided, and assess physician and staff attitude towards the ability to accept and distribute samples. A secondary aim will be to study the impact of the availability of samples by assessing the number of brand vs. generic prescription generated, as well as the impact that samples have on chronic adherence.
Nancy Sohler, PhD, MPH
Diane McKee, MD
Pilot project # 7 funded for data analysis
GAY, LESBIAN, AND BISEXUAL YOUTH SPEAK OUT TO PROVIDERS: UNDERSTANDING YOUTH PERSPECTIVES ON HEALTH CARE PROVIDERS AND HEALTH CARE SETTINGS IN ORDER TO IMPROVE QUALITY AND ACCESS
This is a project to elicit perspectives and experiences of health care provided to gay, lesbian, bisexual, and transgender individuals. The study obtains information about health care providers' attitudes, the settings in which they receive health care, and health concerns and issues. Funding is being used to complete an analysis of previously obtained surveys. The data will be used in the future to prepare a training curriculum for primary care providers in order to improve health care and health care access for this sub-population of youth.
Neal Hoffman, MD
Kathy Freeman, DrPH