NYU-CUNY Prevention Research Center Completed Core Projects

The NYU-CUNY Prevention Research Center (NYU-CUNY PRC), a partnership between NYU Langone and the CUNY Graduate School of Public Health and Health Policy, has completed core research demonstrating its ability to combine innovative community- and clinic-based interventions to enhance preventive care and chronic disease prevention and management—particularly in populations experiencing health disparities.

Our completed core research projects include:

• Program Evaluation of the New York City Health Justice Network (HJN)
• Harlem Health Advocacy Partners Program (HHAP) Evaluation
• Implementing Million Hearts for Provider and Community Transformation ( IMPACT)
• Reaching Immigrants through Community Empowerment (RICE)

Program Evaluation of the New York City Health Justice Network

The program evaluation consisted of two parallel evaluation studies. In the first study, led by Maria R. Khan, PhD, MPH. Our team helped to evaluate a novel community health worker–facilitated, trauma-informed intervention, the New York City Health Justice Network (NYC HJN), to improve the health of justice-involved populations. In a second study, led by Terry Huang, PhD, MPH, MBA, and Dr. Khan, and with separate funding from the District Attorney of New York, our team examined the impact of NYC HJN on reduced criminal justice involvement. These collaborations built on our established partnership with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and new partnerships with city and state criminal justice agencies.

Health-Related Needs of People with a History of Justice Involvement

The United States has the largest correctional population in the world, with 2.1 million individuals held in jail or prison at any given time and 11 million jail incarcerations each year. Incarceration disproportionately impacts racial and ethnic minority groups, which has lasting effects on their families and communities.

Criminal justice involvement is a social determinant of health that intersects with racism, poverty, trauma, and psychiatric symptoms to perpetuate disproportionate health disparities and disease risk in minority communities. Given the complex role of social determinants, strategies that link primary care and social services using a trauma-informed framework by trusted sources, such as community health workers (CHWs), have the potential to reduce health disparities in people with a history of justice involvement (PWJI).

Evaluation of a Municipal Practice-Based Community-Clinical Linkage Model

In 2018, the NYC DOHMH introduced the NYC HJN, a new CHW-facilitated practice-based community–clinical linkage program that extends the agency’s growing portfolio of municipally funded CHW programs to address the health-related needs of PWJI. This multisector program involves a partnership with the NYC DOHMH, Federally Qualified Health Centers, and community-based organizations, including three primary care clinics—the Institute for Family Health, Community Healthcare Network, and NYC Health + Hospitals/Sydenham. We are also working with three re-entry support service organizations, The Fortune Society, Osborne Association, and the Center for Innovation’s Harlem Community Justice Center.

The NYC HJN expands on current national-level models to deeply integrate CHWs with a history of working with people who have been incarcerated into primary care clinics and community-based organizations and implement trauma-informed care in both settings.

Funding from the District Attorney of New York to NYC DOHMH supported the program’s implementation over three years beginning in 2019, with the long-term goal of scaling this public health practice across New York City. The NYU-CUNY PRC and the NYC DOHMH collaborated with a unique multisectoral network of organizations on the evaluation including NYU Langone’s Health Evaluation and Analytics Lab (HEAL), the NYC Department of Correction and the NYC Mayor’s Office of Criminal Justice. We also collaborated with the New York State Department of Corrections and Community Supervision on an additional study focused on criminal justice outcomes.

New York City Health Justice Network Health Evaluation Aims

Our specific health evaluation intended to achieve the following aims:

• determine program effectiveness in improving primary care engagement and medication adherence, using New York State Medicaid claims data housed by HEAL
• determine program effectiveness in reducing acute care utilization (emergency department visits) at 6 and 12 months post-enrollment
• assess barriers and facilitators to adoption, fidelity, and maintenance of NYC HJN and identify organizational factors influencing implementation
• evaluate the sustainability and scalability of NYC HJN within applied practice settings

New York City Health Justice Network Criminal Justice Evaluation Aims

Our justice evaluation specifically included the following three aims:

• investigate associations between NYC HJN program participation and risk of recidivism at 6- and 12-months post-enrollment, and whether associations vary by participant factors
• examine NYC HJN program factors, such as recruitment, CHW interactions, service linkage and participant goal factors, that most strongly protective against recidivism
• explore participant experiences in the NYC HJN in a qualitative study

Evaluating this public health program, sponsored as part of the ongoing effort in New York regarding criminal justice reform and spearheaded by one of the nation’s leading municipal health departments, was a unique opportunity to address an understudied root cause of health disparities and to improve health for vulnerable communities.

View findings on the implementation facilitators and challenges for the HJN program.

View the final report for the HJN Recidivism Evaluation Study.

Harlem Health Advocacy Partners Program Evaluation

Launched in 2014 through the New York City Mayor’s Office, the Harlem Health Advocacy Partnership (HHAP) is a place-based initiative that seeks to improve the health outcomes of New York City Housing Authority (NYCHA) residents in East and Central Harlem by connecting residents to CHWs and health advocates. The intervention, a partnership among the NYC DOHMH, NYCHA, community-based organizations, and the NYU-CUNY PRC, aims to reduce the proportion of residents with uncontrolled diabetes, hypertension, or asthma, while also activating the community to develop broad wellness and prevention capacity.

With Lorna E. Thorpe, PhD, MPH, serving as principal investigator, our center played a key role in evaluating and supporting this NYC DOHMH–led initiative. The HHAP evaluation included two parts: a community needs assessment conducted before the intervention to inform its design; and a longitudinal component to assess the impact of the intervention on individual behaviors, self-efficacy, and health outcomes.

The community needs assessment, “Launching a Neighborhood-Based Community Health Worker Initiative,” is publicly accessible as part of the HHAP’s Additional Resources. We also developed an original CHW toolkit for HHAP, which can be used to fit the needs of other CHW programs. Papers have been published on the HHAP model and evaluation approach, as well as on financial and feasibility outcomes.

Implementing Million Hearts for Provider and Community Transformation

Led by Nadia S. Islam, PhD, and launched in 2014, Project IMPACT aimed to improve blood pressure control and cardiovascular health among South Asian patients receiving care in primary care clinics across New York City. Building on the strategies of the Million Hearts® initiative, the study’s goal was to test the efficacy, adoption, and impact of integrating physician-directed training and technical assistance to optimize the use of electronic health record (EHR)–based tools combined with patient-directed CHW coaching and culturally tailored health education to improve hypertension control.

Project IMPACT was implemented in 15 small primary care practices serving large proportions of South Asian patients across the city. The initiative was a collaboration with Healthfirst, an insurance organization serving more than 35,000 South Asian members in New York City, as well as Improving Healthcare for the Common Good, a quality improvement organization for New York State. Our research demonstrated a 3-fold improvement in blood pressure control among participants that received the intervention compared to a comparison arm. View further results from this study.

Our study findings have informed replication and scale of project components to other initiatives, including the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, a five-year trial integrating CHW- and EHR-based interventions to support weight loss among South Asians at risk for type 2 diabetes living in New York City, and a subsequent DREAM initiative with partners at Emory University School of Medicine in Atlanta to address diabetes and hypertension disparities within the growing community of South Asians living in the Southeastern United States. The New York DECIPHeR Alliance (Actions to Decrease Disparities In Risk and Engage In Shared Support For Blood Pressure Control (ADDRESS-BP) In Blacks) study was also informed by this study.

Reaching Immigrants through Community Empowerment

Led by Nadia S. Islam, PhD, and launched in 2009, the Reaching Immigrants through Community Empowerment project, or Project RICE, tested the efficacy of a CHW-led intervention to promote diabetes prevention among Korean American and South Asian American immigrants in New York City. A community-based participatory research approach guided development of the intervention, which consisted of six workshops held by CHWs on diabetes prevention, nutrition, physical activity, diabetes complications, stress and family support, and access to healthcare.

Positive changes were seen after six months in participants’ weight, waist circumference, diastolic blood pressure, physical activity nutrition, diabetes knowledge, and mental health. The Project RICE study findings, published in 2013, are cited by the Centers for Disease Control and Prevention’s Community Guide recommending the use of CHWs to support diabetes prevention.