The epidemiology and services research team in NYU Langone’s Department of Psychiatry conducts large-scale, cross-sectional, and longitudinal cohort studies, including randomized clinical trials (RCTs) and implementation science that investigate physical (e.g., accelerated epigenetic aging) and behavioral health (i.e., mental health and psychological wellbeing, substance use). Our researchers investigate the social and structural determinants that perpetuate disparities in clinical, behavioral, social, and services outcomes across the life course.

Our research team uses innovative mixed-method epidemiological research approaches, integrating survey, in-depth qualitative, and biological data. These approaches are implemented in rural and urban community settings and inform the development of effective novel interventions.

Research Faculty

• Helen-Maria Lekas, PhD
• Crystal F. Lewis, PhD
• Kerstin E. Pahl, PhD

Clinical Studies

Clinical studies in epidemiology through NYU Langone’s Department of Psychiatry take a variety of approaches to achieve the goal of improving mental health outcomes.

The following research study, funded by the National Institute on Aging, is currently enrolling participants.

Life-Course Adversity and Other Determinants of Stress Regulation and Epigenetic Aging in Midlife Adults (5R01AG077945; PI: Kerstin E. Pahl)

Life-course structural adversity impacts health and life expectancy, especially for under-resourced communities. The proposed mixed-methods research will collect new data to complement the wealth of existing longitudinal data previously collected at key developmental stages over more than three decades from two geographically and socioeconomically heterogeneous cohorts, those in the Harlem Longitudinal Development Study and the Children in the Community Study.

The sample will consist of 450 rural, suburban, and urban midlife adults previously surveyed in childhood/early adolescence, emerging adulthood, young adulthood, and midlife.

The proposed research, informed by the Phenomenological Variant of Ecological Systems Theory, will quantify and contextualize the associations of exposure to structural adversity, namely, individual-level experiences of adversity within and across institutions and social contexts over the life course (e.g., socioeconomic disadvantage) and neighborhood-level socioeconomic inequality with stress regulation, epigenetic modifications (i.e., epigenetic age), and mental health (i.e., psychological distress, depression, anxiety, post-traumatic stress). This will be accomplished using four forms of data that will be triangulated to optimize results and interpretation: survey, biological, qualitative, and U.S. Census data.

The quantitative survey and biological data will facilitate comprehensive analysis of geographic differences in structural adversity and their associations with stress regulation, epigenetic aging, and mental health. These analyses will be further contextualized through in-depth interviews with a purposive sample selected from the study cohort. The qualitative data will innovatively provide deeper understanding and interpretation of structural adversity over the life course, including exclusion from opportunities, stress, resilience, and other salient experiences that are often missed by quantitative data, including intergenerational transmission of both disadvantage and resilience. This research will also identify protective factors that can mitigate the deleterious sequelae of adversity and thus highlight areas of resilience that can be leveraged in interventions.

In conclusion, identifying how social conditions that manifest at individual and neighborhood levels create structural adversity and examining their association with biological stress regulation, epigenetic aging, and mental health constitutes a crucial step toward changing policies and systems that stand in the way of realizing the attainment of the highest level of health for all people, an explicit goal of the Healthy People initiative.

For more information, please contact Maggie Ding at Xinyu.Ding@NYULangone.org.

The two following community-based opioid treatment access studies, all funded by the National Institute on Drug Abuse, are currently enrolling participants.

Addressing Racial Disparities in Opioid Overdose Deaths Using an Open Source Peer Recovery Coach Training and Multimodal Mobile Health Platform (1R34DA059770; PI: Helen-Maria Lekas)

People who use opioids (PWUO) who are Black or Latinx bear a disproportionate burden of opioid-related overdose deaths. Racial disparities among this community are exacerbated by persistent socioeconomic and structural barriers (e.g., stigma, lack of social support, housing instability) that may be partially addressed using scalable open-source solutions (e.g., peer recovery coaches, mobile health, telemedicine).

With NIH support, we have validated using a theory-based, artificial intelligence (AI)–driven texting using natural language processing in a publicly funded health system to provide real-time responses to patient queries combined with automated texts to enhance identification and address participant unmet social determinants of health (SDH) needs (e.g., access to peer support, healthcare), and linkages and retention in buprenorphine treatment per the medical management model (e.g., patient education, self-management).

We have also refined an evidence-supported cultural structural humility (CSH) training for peer recovery coaches that goes beyond an SDH framework to also include stigma reduction, health habitus, and patient navigation to improve clinical outcomes and social services use in this population. This proposal aims to adapt the evidence-supported CSH training to interactive video modules for peer recovery coaches (PRCs) and refine an AI-driven texting tool to reinforce core CSH principles.

The three-month pilot RCT will test AI-driven CSH-enhanced texting tool + CSH-trained PRC providing telephone-based services coordination (multimodal intervention arm-1) vs. AI-driven CSH-enhanced texting tool (intervention arm-2) vs. treatment as usual / informational pamphlets only (control arm) among emergency department–enrolled Black / Latinx PWUO (N=150) to estimate rates of contact, AI-driven texting use, and assess potential for pre-/post-intervention impact on reduction of felt or anticipated stigma, clinical outcomes (i.e., time to initial receipt of buprenorphine), and social services use, and estimate the associated cost of implementing and sustaining the multimodal intervention.

Feasibility of Pharmacy-Delivered Patient Navigation + Virtual Buprenorphine + HIV Services (5R34DA057191; PI: Crystal F. Lewis)

Pharmacies are emerging nationally as frontline public-health-practicing spaces due to their ubiquity, accessibility to medication and screening, and rapid scalability. Independent pharmacies in particular have successfully expanded services , including delivery of harm reduction services, with greater ease due to the absence of corporate restrictions. Today, linkage to and retention in buprenorphine treatment and HIV prevention and care remains suboptimal in many underserved, HIV-burdened communities.

The goal of this study is to further expand public health pharmacy practice by exploring on-demand harm reduction services delivered by pharmacy staff in two communities that experienced healthcare system and local community-based services disruptions during COVID-19 where services recovery were never fully realized: New York City’s Harlem and South Bronx. Building on two decades of disparities-focused pharmacy-based intervention research via Pharm-Link Studies (2001–21) and taking advantage of recent innovations, including telemedicine-based buprenorphine treatment, our team leveraged the NYC Health + Hospitals’ Virtual Buprenorphine Clinic (VBC) to investigate Pharm-Link/VBC+. This entails in-pharmacy delivery of opioid use disorder services (i.e., low-threshold access to telemedicine-based buprenorphine treatment initiation, naloxone dispensation/overdose prevention counseling) linked with HIV services access for PWUO recruited from community/hospital electronic health records (EHR). Pharm-Link/VBC+ will also include public health–minded pharmacy staff trained in harm reduction and social determinants of health-focused patient navigation.

The study has three aims:

• Develop Pharm-Link/VBC+ using in-depth interviews among three stakeholder groups, including frontline providers, administrators, and PWUO with a treatment history.
• Assess feasibility and usability of implementing Pharm-Link/VBC+ using semistructured surveys and administrative data collected from the study pharmacies and Lincoln Hospital EHR.
• Finalize Pharm-Link/VBC+ for R01 scale-up using focus groups. This study will be accomplished through existing partnerships with two minority-owned independent pharmacies with demonstrated research capacity in the study geographic area.

For more information about these two studies, please contact Zoe Bertone at Zoe.Bertone@NYULangone.org.

The following research study, funded by the Agency for Healthcare Research and Quality, is currently enrolling participants.

Leveraging Social Determinants Via Artificial Intelligence and Peer Coaching to Address Racial Disparities in Primary Care Among People Who Use Opioids (5R18HS029783; PI: Crystal F. Lewis)

People who use opioids (PWUO) who are Black and Latinx bear a disproportionate burden of opioid overdose deaths. The economic burden faced by the Black and Latinx community has also risen due to costs associated with excess mortality and utilization of high-cost healthcare services. Racial disparities among persons who use opioids in primary care are driven by social determinants of health (e.g., lack of peer support or health insurance) and may be partially addressed by adopting innovative mobile health and peer coaching strategies.

With NIH support, we have validated a theory-driven, artificial intelligence (AI)–driven texting tool using natural language processing to facilitate real-time text responses to patient queries, combined with automated texts facilitating receipt of buprenorphine in office-based opioid treatment and social services that address social determinants of health. This open-source texting tool offers passive reminders, informational content, and interactive two-way response algorithms without personal staff contact. In addition, we have adapted an efficacious cultural and structural humility training for peer-recovery coaches (PRC) that goes beyond social determinants to also address stigma reduction, health habitus, and patient navigation to enhance uptake of primary care and social services.

Using a three-arm comparative effectiveness trial design, we have these specific aims:

• Assess the efficacy of PRC-supported text-based care/services coordination with PWUO + AI-driven SDH-enhanced text messaging (intervention arm-1) vs. AI-driven SDH-enhanced text messaging only (intervention arm-2) vs. TAU or printed social/medical services referrals (control) to enhance the receipt of buprenorphine in office-based opioid treatment (OBOT) among ED-enrolled Black / Latinx PWUO.
• Evaluate the implementation of the multimodal intervention (arm-1) guided by the RE-AIM and CFIR frameworks using in-depth interviews among three stakeholder groups: frontline providers, administrators; and a subset of the Black and Latinx PWUO from the multimodal intervention arm.
• Identify the resources and estimate the associated cost of implementing and sustaining the multimodal intervention and incorporate this information into a customizable budget-impact tool and conduct a comprehensive economic evaluation to calculate the relative economic value.

For more information, please contact Zoe Bertone at Zoe.Bertone@NYULangone.org.

Contact Us

For more information about epidemiology research, please contact Maggie Ding, senior research coordinator, at Xinyu.Ding@NYULangone.org.

Publications