Section for Health Equity Applied Research & Evaluation Unit | NYU Langone Health

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Section for Health Equity Research Section for Health Equity Applied Research & Evaluation Unit

Section for Health Equity Applied Research & Evaluation Unit

In the Section for Health Equity’s Applied Research and Evaluation Unit, part of NYU Langone’s Division of Health and Behavior, we employ community-partnered, rigorous methodology as a cornerstone of our work.

The purpose of this unit, led by Stella S. Yi, PhD, MPH, is to accelerate the translation of research to policy and practice in diverse communities through the integration of systems science and implementation science, leveraging mixed methods data, and driven by community-based participatory research principles. These methods are applied across the five section tracks and toward serving various population subgroups, including immigrant and racial and ethnic minorities, older adults, and families.

Community-Driven Identification of Health Priorities

Our unit is conducting several projects surrounding the community-driven identification of health priorities.

Health Atlas

Through the Health Atlas report, Dr. Yi and Laura Wyatt, MPH, research data manager, are assessing prevalence estimates for risk factors, health behaviors, and lifestyle behaviors by race and ethnicity and detailed Asian American, Native Hawaiian, and Pacific Islander (AA and NH/PI) subgroups, both nationally and regionally.

Researchers are studying two national datasets, the National Health Interview Survey, 2012 to 2017, and the Behavioral Risk Factor Surveillance System, 2013 to 2017; five state-level datasets from the Arizona, Texas, Utah, and Hawaii Behavioral Risk Factor Surveillance System, 2013 to 2017, and the California Health Interview Survey, 2013 to 2017; and three city-level datasets from the New York City Community Health Survey, 2013 to 2017, Los Angeles County Health Survey, 2015 and 2018, and Healthy Chicago, 2015 to 2017. Regional datasets were chosen based on existing and emerging population sizes of the subgroups and by data availability. Frequencies are being run by racial and ethnic groups and population subgroups.

Asian American Community Health Resources and Needs Assessment

The Asian American Community Health Resources and Needs Assessment (CHRNA), led by Simona C. Kwon, DrPH, is a large-scale health project conducted in diverse, low-income Asian American communities in New York City. The project uses a community-engaged and community venue‒based approach to assess existing health issues, available resources, and best approaches to meet community needs in ethnic-specific Asian Americans.

A first round (wave 1) of CHRNAs was undertaken from 2004 to 2006 in Filipino, Cambodian, Chinese, Korean, South Asian, Vietnamese, and Japanese communities, with a second round (wave 2) conducted from 2013 to 2016 in communities including Arab, Bangladeshi, and Himalayan. Researchers assessed population changes, population health improvements, and changes in risk and protective factors. Researchers assessed population changes, population health improvements, and changes in risk and protective factors. Learn more about our CHRNA reports. Our data are available by application and request.

Arab American Community Health Resources and Needs Assessment

The purpose of the 2019 Arab American CHRNA in Brooklyn, overseen by Nadia S. Islam, PhD, and MD Taher, MPH, senior project coordinator, was to characterize health status, needs, priorities, and access to care barriers and facilitators of the local Arab American community. The needs assessment was initiated at the Arab Community Quarterly Meeting, hosted by NYU Langone Hospital—Brooklyn in September 2018, and was conducted with support from the Community Service Plan of NYU Langone’s Department of Population Health, Division of Health and Behavior. Needs assessment partners included the Arab American Association of New York, the Arab-American Family Support Center, the Moroccan American House Association, Salam Arabic Lutheran Church, the Yemeni American Merchant Association, and the Arab Health Initiative of Memorial Sloan Kettering Cancer Center.

Regional Community Health Resources and Needs Assessment

The Regional Community Health Resources and Needs Assessment (CHRNA) is an extension and continuation of the CHRNA conducted in New York City in two previous waves. NYU Center for the Study of Asian American Health (CSAAH)’s National Advisory Committee on Research (NAC) and Scientific Committee, who regularly offer insight and knowledge concerning local community needs and existing programs, emphasized a need for disaggregated demographic and health information on AA and NH/PI communities in their localities. Beginning in 2019, CSAAH partnered with NAC member community-based organizations in regions with new, emerging, or underrepresented AA and NH/PI populations to launch a regional round of CHRNA (wave 3), collaboratively identifying research support needs such as training, translation, and community outreach approaches, and developing a data analysis and support plan.

CSAAH is collaborating with Asian Pacific Community in Action, the Center for Pan Asian Community Services, and the National Tongan American Society on the regional CHRNA. Partners led translation of the survey tool to engage their local communities of interest, including Burmese-, Chinese-, Korean-, Nepali-, Samoan-, Tagalog-, Tongan-, and Vietnamese-speaking communities. The team is currently beginning data analysis and aims to gather a rich and nuanced collection of community-sourced health needs and resource data that may be used to improve community health.

Waves of CHRNA Surveys and Communities Impacted

Wave Location, Size, and Date Communities Impacted
1 Metro New York
(N* = 1,201; conducted 2004–06)
Cambodian, Chinese, Filipino, Korean, South Asian, Vietnamese, and Japanese communities
2 Metro New York
(N* = 1,802; conducted 2013–16)
Arab, Asian Indian, Bangladeshi, Himalayan, Indo-Caribbean, Indonesian, Nepali, and Pakistani communities
3 Salt Lake City, Phoenix, and Atlanta
Regional CHRNA (N* = 1,500; initiated March 2021)
Burmese, Chamorro, Chinese, Filipino, Korean, Native Hawaiian, Nepalese, Polynesian, Samoan, Tongan, Vietnamese, and other Pacific Islander communities
3 Metro New York
COVID-19 CHRNA (N* = 500; initiated March 2021)
Arab, Burmese, Cambodian, Chinese, Filipino, Japanese, Korean, Lao, South Asian, and Vietnamese communities
3 Metro New York
Older Adult CHRNA (N*= 900; initiated April 2021)
Arab, Bangladeshi, Chinese, Korean, Mexican, and Russian communities

Comments: N refers to the total number of individuals who participated in the survey.

COVID-19 Community Health Resources and Needs Assessment

CHRNA surveys are an integral part of the Centers for Disease Control and Prevention (CDC)‒funded National AA and NH/PI Forging Partnerships for Rapid Response to COVID-19. This project, titled the Asian American COVID-19 Experience and conducted from June 2020 to March 2021, aims to strengthen existing and expanding collaborations in COVID-19–related research with current partners and a network of Federally Qualified Health Centers serving AA and NH/PI populations.

In this unprecedented national, coordinated effort, our researchers led by Dr. Yi identified available disaggregated data on COVID-19 infection, hospitalization, and mortality among high-risk subgroups within AA and NH/PI communities for targeted health efforts. We also conducted a rapid assessment of access to care, language proficiencies, and cultural practices in various subgroups of AA and NH/PI communities, while aggregating existing efforts and implementing new collections informed by the PhenX Toolkit, the Census Household Pulse Survey, and the National Institutes of Health Public Health Emergency Disaster Research repository.

Other objectives are to develop patient-facing education materials and strategies describing COVID-19 contact tracing and testing access, processes, and follow-up for AA and NH/PI communities and to identify the development, adaptation, and dissemination of culturally appropriate and situation sensitive strategies to facilitate compliance with CDC recommendations.

This research can inform more precise targeting of population subgroups and tailoring of health communication and messaging for COVID-19 testing and contact tracing. The study can also provide baseline data of COVID-19 diagnostic testing and positivity rates among these communities; promote an understanding of facilitators and barriers to COVID-19 testing and care; and identify evidence-based practices for reporting, monitoring, and tracking COVID-19 data.

Community Participatory Systems Science

Researchers in the Applied Research and Evaluation Unit are also leading efforts to improve the public health data infrastructure for racial and ethnic minority communities.

Assessment of Policies Through Prediction of Long-Term Effects of Cardiovascular Disease Using Simulation

Through the Assessment of Policies through Prediction of Long-term Effects on Cardiovascular Disease Simulation (APPLE CDS) project, Dr. Yi and Yan Li, PhD, at the Icahn School of Medicine at Mount Sinai are comparing the effects of food policies on cardiovascular disease‒related outcomes and healthcare costs for adults. This research is being performed through our Cardiovascular Health and Diabetes Research Track.

Using agent-based modeling combined with an established health outcomes model, researchers are evaluating and comparing the effect of alternative food policies and programs on dietary behaviors, blood pressure, body mass index, and diabetes across different New York City neighborhoods. They are also linking the agent-based model with a well-established, validated New York City cardiovascular disease policy model to forecast the long-term impact of various food policies on cardiovascular disease outcomes, quality-adjusted life years, and healthcare costs. Community-level data on dietary behaviors collected by the New York City Department of Health and Mental Hygiene are helping to validate and parameterize the model. A broad range of multisector partners across the city are continually engaged to ensure relevance of simulation results toward implementation of the most cost-effective, neighborhood-specific food policies and programs to improve population health.

NYU COVID Closures Study

In the NYU COVID Closures (CoClo) Study, Dr. Yi is using a combination of online data scraping and in-person fieldwork so our researchers can estimate the changes in the retail food environment in New York City neighborhoods resulting from the COVID-19 pandemic. Scientists used the New York City Department of Health and Mental Hygiene restaurant inspections database to identify area restaurants, and the New York State Department of Agriculture’s markets retail stores list to locate local retail food stores. The primary data source to identify fruit and vegetable vendors was Google street view and prior data available on Manhattan’s Chinatown from a CoClo collaborator that was published in From Farm to Canal Street: Chinatown's Alternative Food Network in the Global Marketplace.

Our researchers checked for evidence that the identified fruit and vegetable vendors, restaurant, and retail food stores were open in 2019 and in present day. Stores undergoing temporary or permanent closure were noted. Our researchers hope these data inform future modeling efforts on how changes in the food environment, in particular closures of food outlets, affect dietary behavior and longer-term cardiovascular disease outcomes. Explore a Chinese language version of the study website, as well as in-language webinars in Mandarin and Cantonese dialects, for more project details and infographics.

Systems to Understand Nutrition, Diet, and Active Living Opportunities in Adults 50+ Years

Systems to Understand Nutrition, Diet, and Active Living Opportunities in Adults 50+ Years (SUNDIAL), is being conducted by Dr. Yi in collaboration with our Healthy Aging and Alzheimer’s Disease Research Track. The study aims to support new participatory systems science and implementation science research on Alzheimer’s disease and related dementias disparities within the NYU Center for the Study of Asian American Health, a longstanding National Institute on Minority Health and Health Disparities Center of Excellence.

Our researchers are identifying broad-scale and feasible ways to improve lifestyle behaviors such as diet and physical activity that prevent or slow cognitive decline in mid- to older-aged Chinese and Mexican adults in New York City.

SUNDIAL leverages longstanding community partnerships, expertise, and infrastructure of the NYU Center for the Study of Asian American Health, two prior Alzheimer’s disease and related dementias funding supplements, and additional National Institutes of Health‒funded projects focused on aging and systems science. We are conducting formative research to understand the current landscape of evidence-based approaches, policies and programs, and lifestyle behaviors in our patient populations and identifying the best community-based policies and programs for improving lifestyle behaviors using a group model.

As a part of our Cancer Research Track and in tandem with SUNDIAL, Dr. Yi is also conducting the Focus on Obesity Reduction and Tools in Immigrant Families and Youth (FORTIFY) Study, applying participatory systems science methods.

Building Access to Food Through Systems and Simulation

The Building Access to Food Through Systems and Simulation (BASIS) project is a partnership between the Section for Health Equity, Chinese American Planning Council, Glynwood, Brooklyn Grange, and The Table, part of the Family Health Centers at NYU Langone. The goal of BASIS is to develop and refine a subsidized community-supported agriculture (CSA) program for low-income, immigrant (Chinese, Mexican, and Arab) neighborhood residents in Brooklyn that is culturally appropriate and includes in-language health, cooking, and nutrition education.

In a traditional CSA model, an individual purchases a share from a farm before the growing season and then receives allotments of the harvest at set time points throughout the season. CSAs have been demonstrated to increase fruit and vegetable intake, diet quality, and in some cases improve food security, but have mostly been accessed by and evaluated in affluent, White populations. This groundbreaking work will lay the foundation for creation of self-sustaining, community-led food system model.

Improving Data Infrastructure

Unit researchers are also leading efforts to improve the public health data infrastructure for racial and ethnic minority communities.

Application of Implementation Science

The Applied Research and Evaluation Unit uses established frameworks such as Reach, Effectiveness, Adoption, Implementation, Maintenance and the Consolidated Framework for Implementation Research across multiple projects, including Implementing Million Hearts for Providers and Community Transformation, or Project IMPACT, Patient-Centered Stomach Cancer Prevention in Chinese Americans, and the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative.

Researchers also used implementation science adaptation frameworks as a foundation for the cultural adaptation of evidence- and practice-based interventions, such as the Kickstart-Assess-Evaluate-Refer Toolkit (KAER) Adaptation, Culturally and Cost-Appropriate Rapid Intergenerational Nutrition Guidance (CARING), and the Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) program.

NYU CSAAH Data Equity Project

Structural racism is inherent in the way data is collected, analyzed, and reported. Past and current data infrastructure in the United States for describing the health experiences of Asian Americans is stymied by both a tendency for Asian Americans to be classified as “other,” “unknown,” or “missing” in large administrative datasets and dropped from both analyses and reporting. This is further exacerbated by a lack of data that is disaggregated by Asian subgroup and long-held and inaccurate beliefs about the health of Asian American communities, such as model minority stereotype, healthy immigrant effect, and perpetual foreigner. The cumulative effect is the systematic erasure of the Asian American health experience.

Dr. Yi and Dr. Kwon are leading NYU Langone initiatives funded by New York State to advise on best practices for the collection of specific subgroup data for all racial and ethnic groups, including Asian Americans, to advance data equity. This work was prompted following decades of advocacy by community groups and scholars for the collection and reporting of disaggregated data for Asian Americans, efforts that accelerated due to the rising violence being observed against the Asian American community. In a historical win, our community partner, the Coalition for Asian American Children and Families, and our team at CSAAH were awarded a contract by New York State’s Governor’s Office and Department of Health in 2021. We have designed these collaborative projects to be multidisciplinary across academia, government, community, and healthcare systems—applying principles of epidemiology, quantitative and qualitative data analysis, algorithm development, and community-based participatory research—to inform our approach.

City Health Dashboard’s Demographic Maps and Tables

City Health Dashboard is a web-based visualization tool that allows users to view or compare a variety of health outcomes, social and economic factors, and health and clinical metrics across major U.S. cities. Members of the City Health Dashboard team reached out to CSAAH as they developed a demographic maps and tables feature to ensure the tool would be a useful and digestible resource. Released in October 2020, this feature allows users to view demographic distribution across major U.S. cities using high-resolution maps of U.S. Census tract-level race and ethnicity data to visually depict “where” communities are located, filtering data by age, race and ethnicity subgroups, and percent of Census respondents born outside of the United States.

Community-based organizational leaders and partners serving AA and NH/PI communities from CSAAH’s National Advisory Committee on Research (NAC) and Scientific Committee reviewed and provided critical feedback during development of the demographic maps and tables feature, to promote ease of use for diverse audiences and stakeholders. Our collaboration supports community research-related health and data equity efforts through disaggregation of available Census data to enable community and academic leaders or stakeholders to share and navigate granular demographic data. This effort is continually important as racial and ethnic population groups, particularly AA and NH/PI and Latinx subgroups, continue to grow swiftly.

Mixed Methods Research

We conduct qualitative and quantitative analyses of our community health worker interventions, including the Project on Asian American Partnership in Research and Empowerment (Project AsPIRE), Reaching Immigrants Through Community Empowerment (RICE) Project, and DREAM Project. Secondary data analysis of our own datasets, including the Racial and Ethnic Approaches to Community Health (REACH) U.S. Risk Factor Survey, CHRNA, and community health worker interventions, is another component of our work.

Additionally, our researchers assess and evaluate the implementation of several evidence-based interventions for the prevention of infection-related cancers among Asian American populations. We perform qualitative analysis of facilitators and barriers to colorectal cancer screening among South Asian communities in New York City and community needs and knowledge gaps related to the prevention, early identification, and treatment of Alzheimer’s disease and related dementias among AA and NH/PI populations.