Website: The Bronx CREED website was completed and went live on March 23, 2005, and features our logo that also graces the cover of our new brochure. Besides comprehensive descriptive information about Bronx CREED and our calendar, links are provided to our archived webcasts, PowerPoint presentations of Key Personnel about our organization and research, other Project EXPORT Centers, NCMHD, NIH, and DHHS.
Evaluation: The Bronx CREED evaluation plan, using logic models for the overall Center and each of its cores, was presented by Dr. Strelnick at the Project EXPORT annual directors meeting in Bethesda, MD, on September 22, 2004.
During the past year under the leadership of Dr. Blank our evaluation has focused on three dominant areas: documenting the implementation of Bronx CREED; refining the logic models for each core; and articulating critical measurement variables with each of the six Bronx CREED cores.
Articulation and integration of the core logic models are being developed through an Executive Committee process of modifying an overall conceptual model for health inequalities and disparities first offered by Amy Schulz and Mary Northridge ("Social Determinants of Health: Implications for Environmental Health Promotion," Health Education & Behavior 2004;31(4):455-471) to reflect Bronx CREED's Specific Aims, activities, theoretical framework, and operating philosophy.
Additional Collaborations: Largely through their activity on the ICCH Community Advisory Board, several organizations have become more involved in Bronx CREED's Coordinating Council and activities, including Bronx-Lebanon Hospital Center; Casita Maria, a women's shelter; For a Better Bronx (FABB), a grassroots environmental justice group; Fordham University's Science & Technology Entrance and College Science & Technology Entrance Programs (STEP & C-STEP) for gifted minority students; Hostos Community College; Morris Heights Health Center; Mosholu Preservation Corporation; Planned Parenthood of New York City (Project Street Beat); Small Business Development Center of Lehman College; VIP Services, a drug treatment program; Visiting Nurse Service of New York City; and Women's Housing & Economic Development Corporation (WHEDCO). Several specific collaborations are described below.
Leveraged and Collaborating Funded Programs: Two proposals mentioned in last year's Progress Report were funded: the Bronx-Einstein Alliance for Tobacco-Free Health (Bronx BREATHES), funded by the New York State Department of Health for five years and the Bronx Science & Health Education Partnership (HP03987-01), funded by HRSA's Division of Health Professions Diversity and Development for three years. Both share office space with Bronx CREED. Bronx BREATHES promotes professional training in smoking cessation and other smoking cessation programs. BxSHOP supports the health professions "pipeline" for minority students beginning in 7th grade through post-baccalaureate programs in collaboration with Fordham STEP and C-STEP (among others).
Pending Funding Proposals: Our renewal proposal to NIEHS for the South Bronx Environmental Justice Partnership (ES11085-04) received a priority score of 160, and SBEJP still has two years remaining on its ethics grant (ES12103-03). Our renewal proposal to the NIH's National Center for Research Resources for the Bronx Science Education Partnership (RR15677-05) is pending review in October 2005. Bronx CREED organized a broad coalition, the Bronx Health Disparities Intervention Research Initiative, in response to the NCMHD's RFA-MD-05-002 on Community Participation in Health Disparities Intervention Research, which is also pending review, submitted with Dr. Strelnick as Principal Investigator through Montefiore Medical Center.
"LOS CAMINOS: DEVELOPING CULTURALLY-SENSITIVE PATHS TO DIABETES SELF-MANAGEMENT"
PUBLICATION: Data being analyzed for publication
IMPACT OF CORONARY HEART DISEASE (CHD) RISK PERCEPTION ON HEALTH BEHAVIORS
COMMUNITY HEALTH CENTER-BASED SCREENING PROGRAM FOR DIABETES MELLITUS
PUBLICATION: Abstract presented, data is being analyze for publication
A FAMILY-ORIENTED MODEL OF COMMUNITY OUTREACH TO REDUCE DISPARITIES IN CARDIOVASCULAR & DIABETES MORBIDITY & MORTALITY IN THE SOUTH BRONX
PUBLICATION: Data currently being analyzed for publication.
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
Research Training Core
Minority Student Summer Research Opportunity Program: Under the leadership of Assistant Dean for Minority Student Affairs Nilda I. Soto, M.S.Ed., the Minority Student Summer Research Opportunity Program (MSSROP) for undergraduate students was expanded from 7 to 10 students per summer.
Lehman College MPH Program: The full CUNY Board of Trustees voted to approve the proposed Lehman College MPH Program at their June 27, 2005 meeting.,after being passed unanimously by its Committee on Academic Policy, Program and Research on June 6th. The Lehman College MPH Program, which will focus on health disparities and offer specializations in epidemiology and policy/management has been developed to meet all the requirements for accreditation by the Council on Education for Public Health (CEPH) and will seek accreditation at the appropriate time. The MPH Program will admit its first class, spring 2006.
Health Disparities Faculty Development Fellowship: Associate Professor of Pediatrics, Iman Sharif, MD, MPH, and Dr. Marsha Guess,of the Department of Obstetrics, Gynecology, and Women's Health (Ob/Gyn) both successfully completed their second year of the Fellowship in coursework of the Clinical Research Training Program (CRTP}. They will graduate May 2006. Two new Fellows were selected and have begun the Fellowship and CRTP: Dr. Karen Warman, Associate Professor of Pediatrics at Montefiore Medical Center (MMC) and Dr. Rodney Wright, Assistant Professor of Ob/Gyn, completed his three year Maternal Fetal Medicine Fellowship and will focus his research on issues related to the management of HIV in pregnant women of color. Both Drs. Guess and Wright are African-American and members of Ob/Gyn's Division of Equity in Women's and Perinatal Health (DEW Point).
Community Outreach & Information Dissemination (COAID) Core
Strengthening Community Collaboration: COAID Core and other Bronx CREED key personnel participate in Reach Out and Read; the Bronx Health Link's monthly planning council meetings; Bronx REACH Coalition's monthly meetings and its Faith-Based Working Group's meetings; Bronx Borough President's Clergy Working Group, Task Force on Environmental Hazards in the South Bronx, and Healthy Bronx Campaign; and Bronx HIV Care Network (which also meets monthly).
Bronx Faith & Medicine Project:
In collaboration with the New York chapter of the American Heart Association's faith-based "Search Your Heart" program, which conducted a series of health education workshops hosted by Bronx and Brooklyn churches.
Reverend Jackson, Dr. Charles Nordin of Jacobi Medical Center, and Dr. Strelnick serve on the "Seqrch Your Heart" Steering Committee. A day-long symposium for the African-American community and clergy about end-of-life-care, called "Crossing Over Jordan," developed originally by Duke University was held at Riverside Church in Manhattan with over 400 clergy, lay, and health care providers attending on June 7, 2005.
The Visiting Nurse Serve of New York was the lead local planning agency with Bronx CREED co-sponsorship. Those attending asked that it become an annual event.
On June 22, 2005, Bronx Faith & Medicine Project hosted "Bring Ten: A Clergy Conference," which was an official event during Bronx Week and was attended by over 200 clergy, parish nurses, laity, and health care providers.
Health Disparities Education
Undergraduate Curriculum Development: As part of the general education curriculum for Lehman College and in conjunction with Dr. Barnhart, Bronx CREED's Core Director Research Training, respectively, a new upper-level course, LEH 301, was given in both the fall and spring semesters of 2004-05 with 25 and 22 students, respectively, entitled "Health Disparities in the United States" by Professor Jane Levitt, who will direct the MPH Program (see above).
Graduate and Professional Curriculum Development: The development of a Masters degree in Public Health at Lehman College was described above under the Research Training Core. Professor Levitt has also developed a graduate level course, "Health Disparities and Cultural Diversity," which is awaiting approval from the Lehman College Graduate Curriculum Committee. Dr. Neil Calman continues his annual lecture on "Health Disparities" for the health policy workshops in the required "Introduction to Clinical Medicine" for first year Einstein students; two 90 minute workshops have 20-25 students each. Dr. Strelnick also continues to give a monthly seminar on "Community Health and Health Disparities" to Albert Einstein College of Medicine students during their required Family Medicine clerkship, so over each academic year all 180 3rd year students participate.
Post-Graduate and Graduate Medical Education: Bronx CREED sponsored Ruth Zambrana, PhD, Professor of Women's Studies and Director of Research of the Consortium on Race, Gender, and Ethnicity at the University of Maryland and member of our EPAC, as a Visiting Professor from May 25-27th. After attending the EPAC meeting, she was a guest discussant at Grand Rounds in the Department of Family and Social Medicine (DFSM), where Professor Ruth Stein presented the IOM's "Children's Health, The Nation's Wealth" and then met with faculty on the Montefiore campus; in the afternoon she gave a seminar on the campus, entitled "Latino Women's and Children's Health." Robert G. Robinson, DrPH, Associate Director of Program Development in the CDC's Office of Tobacco and Health was a Visiting Professor on June 25th, presenting "Black-White Tobacco Use: Elimination of a Disparity in Prevalence" at DFSM Grand Rounds at Montefiore, met with Bronx BREATHES leadership, attended a lunch at the Faculty Club, and made the presentation again on the campus.
Faculty & Professional Development: After solving some technical difficulties, a total of 11 webcasts have been broadcast by the Clinical Directors Network (CDN) and archived both on the CDN ( http://www.cdnetwork.org/NewCDN/LibrarySearch.aspx ) and Bronx CREED websites. These include the four plenary speakers for the "Addressing Cross-Cultural Issues and Health Care Disparities" pre-conference, held in conjunction with the Northeast Regional meeting of the Society of Teachers of Family Medicine in Rye, NY (10/28/04), four speakers from Montefiore's "Advanced Diabetes" symposium (4/22/04), Dr. Neil Calman's )Overview of Health Disparities in the Bronx," (6/9/04) and two speakers from the Bronx CREED Coordinating Council Forums-Karla Damus, DrPH, Professor of Ob/Gyn, on "Perinatal Health Disparities" (10/22/04) and Jing Fang, MD, Assistant Professor of Epidemiology and Population Health on "Neighborhood Disparities and Cardiovascular Health in New York" (7/30/04). Monthly Coordinating Council Forums have included directors of both the Diabetes and Cardiovascular Prevention and Control Bureaus of the New York City Department of Health and Mental Hygiene, Drs. Diana Berger (3/18/05) and Sonia Angell (4/22/05), respectively, presenting their public health initiatives; a school-based fitness and nutrition initiative (10/1/04); a community health initiative of a local managed care organization (11/9/04); Bronx BREATHES (1/28/05); and peer- and community-based education (2/25/05).
Cultural Competency Curricula Needs Assessment & Assets Inventory: A Cultural Competency and Health Disparities Survey was developed and conducted by telephone of residency and clinical clerkship directors of the major clinical departments (i.e., Family Medicine, Geriatrics, Internal Medicine, Neurology, Ob/Gyn, Pediatrics, and Psychiatry) at Jacobi and Montefiore Medical Centers, Einstein's major clinical affiliates in the Bronx. Of 15 residency programs at the two hospitals, all but one (Cardiology) agreed to the interview. Seven of eight required clinical clerkship directors were interviewed (all but surgery). Open ended questions were asked regarding current training in cultural competency and health disparities, departmental faculty interested in these subjects, topics that would be of interest that are not currently taught, availability of curriculum materials to share (e.g., lists of seminars, etc.), methods of evaluation, and estimates of the current time devoted to this training. The qualitative data was gathered by Ms. Soshana Silberman, the Health Disparities Education Core's Coordinator, and her findings summarized in June 2005 (to be discussed by the Executive Committee at its July meeting). Among the highlights of her study were the following: a majority (54%) of residencies covered using interpreters and interpretive services, most (64%) were interested in health disparities in health care outcomes in specific diseases followed by interviewing across the cultural divide (57%) and socio-cultural determinants of health (54%) and addressing organizational and structural barriers to care (50%) and cultural issues at the end of life (46%). Clinical clerkships were more complicated as medical students were trained for much shorter periods (4-8 weeks) in many (6-12) different clinical sites. An "impressive" number of faculty who were particularly interested in these issues, who may form the basis of institution-wide curriculum development. Shared Resources Core
Quantitative Research Consultation: Kathy Freeman, DrPH, Shared Resources Core Director, has assisted the staff of Health People in their evaluation of the diabetes and heart disease peer educator program(1/10/05) and met with 15 potential investigators, including many applicants for the Bronx CREED pilot and feasibility grants, including three community-based applicants. Dr. Freeman assisted Ms. Silberman in the development of the cultural competency survey for the Health Disparities Education Core. Applicants for the Faculty Development Fellowship were also encouraged to seek her expertise. For example, Dr. Yvette Calderon, a Hispanic Center of Excellence (HCOE) Faculty Development Fellow, whose research focuses on overcoming language barriers in HIV testing, sought consultation with Dr. Freeman and submitted a mini-grant proposal. Dr. Freeman assisted in reviewing the mini-grant proposals.
Qualitatitve Research Consultation: Kate McCoy, PhD, has assisted ten investigators and both the South Bronx Environmental Justice Partnership and Bronx Science Education Partnership in conducting focus groups. She also assisted Dr. Calderon, who has a NIH Minority Research Supplemental Award, and Ms. Silberman in analyzing the qualitative data from her interviews. Three investigators consulted both Drs. Freeman and McCoy on their research projects, including Dr. Barnhart.