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.
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 (AANHPI) 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 of CHRNAs was undertaken from 2004 to 2006 in Filipino, Cambodian, Chinese, Korean, South Asian, Vietnamese, and Japanese communities, with a second round conducted from 2013 to 2016 in Bangladeshi, Cambodian, Chinese Filipino, Himalayan English, Himalayan Nepali, and Indian communities. 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.
The purpose of the 2019 Arab American CHRNA in Brooklyn, overseen by Nadia S. Islam, PhD, and MD Taher, MPH, research 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.
CHRNAs are an integral part of the Centers for Disease Control and Prevention (CDC)‒funded National AANHPI Forging Partnerships for Rapid Response to the coronavirus disease (COVID-19) pandemic. 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 AANHPI 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 AANHPI communities for targeted health efforts. We also conducted a rapid assessment of access to care, language proficiencies, and cultural practices in various subgroups of AANHPI 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 education materials and strategies describing COVID-19 contact tracing and testing access, processes, and follow-up for AANHPI 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 also conduct community participatory systems science projects.
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 (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.
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.
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 AANHPI populations.