Carol R Horowitz
Mount Sinai School Of Medicine
Project start date: 2005-09-30
Project end date: 2013-01-31
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Collaborations For Health Improvement In East Harlem
Carol R Horowitz, Assistant Professor
Medicinemount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 5R24MD001691-03 from National Center On Minority Health And Health Disparities IRG: ZMD1
Abstract: East Harlem (EH) is a large minority community in northern Manhattan in New York City. Its residents are 50% Latino and 40% Black. They are poorer and experience more chronic disease and worse health outcomes than those living in almost any other community in the city. EH is located across the street (96th St.) from the Upper East Side, one of the city´s healthiest and wealthiest neighborhoods. These two communities separated by a single city street, exhibit some of the largest health disparities in the United States. On a variety of health and health care measures, differences of 8 to10 fold are not uncommon. Using traditional research funding mechanisms, our research team has collaborated continuously for nearly 10 years with a variety of community groups, organizations, and individuals in East Harlem. In each instance, the research team brought its ideas to the community, with little opportunity for true participation by the community in the design and execution of the research. We have completed a number of successful research projects, including some that developed and demonstrated effective health improvement interventions. We have created new models for sustaining health improvement interventions in our community. We have not, however, had the opportunity to include community participation from the very beginning of project conception, through research design, implementation and evaluation. In this application, we have created a close partnership with Union Settlement Association, a community-based provider of a wide variety of services to East Harlem for over 100 years, and with North General Hospital, the only private, not for profit, non-academic hospital in Harlem. We worked closely with these partners and a group of community representatives to plan the application. Together, we will convene an expanded Community Action Board comprised of community members who reflect important social networks and organizations in East Harlem, and who are committed to addressing health disparities. This Community Action Board will guide the conduct of a community needs assessment using the model, Mobilizing for Action through Planning and Partnerships, developed by local health agencies and the CDC. This model was evaluated and approved during our pre-application community-based planning process. During the first year, we will work together to complete the community assessment. The assessment process will guide the partners to identify the illness or condition we will develop our pilot intervention to address and the type of intervention our community partners and research team believes most likely to yield the greatest positive impact. In the second and third grant years, we will work with our community partners to develop and test all aspects of the pilot intervention and the research design by which we propose to assess its impact
Keywords: community, health Hispanic American, Yersinia pestis disease, base, chronic disease /disorder, conditioning, emotion, experience, experimental design, frustration, gait, health /scientific organization, health care, health disparity, hospital, lead, model, success, urban area clinical research
Project start date: 2005-09-30
Project end date: 2008-06-30
5R24MD001691-03 (2007): $510664
COLLABORATIONS FOR HEALTH IMPROVEMENT IN EAST HARLEM - PROJECT HEED
Carol R Horowitz, Assistant Professor
Mount Sinai School Of Medicine Of Nyu, Of New York University, New York, Ny 10029-6574
Grant 5R24MD001691-06 from National Center On Minority Health And Health Disparities
Keywords: 0-11 years old; 21+ years old; Address; Adult; Aged 65 and Over; Anniversary; Arm; Back; Bears; Behavior; Body Weight; Body Weight decreased; Child; Child Youth; Children (0-21); Chronic Disease; Chronic Illness; Collaborations; Communities; Community Actions; Community Networks; Consultations; Death Rate; Development; Diabetes Mellitus; Diabetes prevention; Disease; Disorder; Dorsum; Economics; Education; Educational aspects; Educational workshop; Effectiveness; Effectiveness of Interventions; Elderly; Elderly, over 65; Enrollment; Epidemic; Evaluation; Friends; Goals; Hand; Health; High Prevalence; Human, Adult; Human, Child; Intervention; Intervention Strategies; Investigators; Knowledge; Latino; Lead; Learning; Life Style; Lifestyle; Location; Low income; Measures; Mediator; Mediator of Activation; Mediator of activation protein; Methods; Minority; Neighborhoods; New York City; Nutrition; Nutritional Science; Obesity; Over weight; Overweight; Pb element; Phase; Physical activity; Plague; Policies; Prediabetes; Prediabetes syndrome; Prediabetic State; Preparation; Preventive; Preventive Intervention; Programs (PT); Programs [Publication Type]; Publishing; QOL; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Design; Research Personnel; Research Resources; Researchers; Resources; Science of nutrition; Screening procedure; Sight; Site; Sound; Sound - physical agent; Study Type; Testing; Time; TimeLine; Translating; Translatings; Travel; Uninsured; Upper arm; Ursidae; Ursidae Family; Vision; Voice; Walking; Weight; Weight Loss; Weight Reduction; Work; Workshop; Yersinia pestis disease; adiposity; adult human (21+); advanced age; base; body weight loss; children; chronic disease/disorder; chronic disorder; community based participatory research; community organizations; coping; corpulence; corpulency; corpulentia; cost; design; designing; diabetes; diabetic; disease/disorder; dissemination research; effect of intervention; effectiveness trial; efficacy research; elders; enroll; experience; geriatric; health disparities; health disparity; heavy metal Pb; heavy metal lead; improved; innovate; innovation; innovative; interventional strategy; language translation; late life; later life; meetings; novel; nutrition; obese; obese people; obese person; obese population; older adult; older person; outreach; peer; prevent; preventing; preventional intervention strategy; primary outcome; programs; randomisation; randomization; randomized controlled study; randomly assigned; recruit; screening; screenings; secondary outcome; senior citizen; skills; social; sound; study design; syndrome x; treatment as usual; wt-loss; youngster
Project start date: 2005-09-30
Project end date: 2013-01-31
Budget start date: 1-FEB-2010
Budget end date: 31-JAN-2011
PFA/PA: RFA-MD-07-003
5R24MD001691-06 (2010): $563199
Grants awarded to Carol R Horowitz
Core--Community Outreach And Information Dissemination
Carol R Horowitz, Assistant Professor
Mount Sinai School Of Medicine Of Nyu Of New York University New York, Ny 100296574
Grant 1P60MD000270-019002 from National Center On Minority Health And Health Disparities IRG: ZMD1
Abstract: The Community Outreach and Information Dissemination Core will building on existing community and academic assets in East and Central Harlem to foster meaningful community-research partnerships and mutual exchanges of information in the development of all aspects of the Center s studies, projects and operations. Core personnel will work with researchers to develop and implement peer support group interventions to improve the health status of persons in Harlem that communities can sustain over time. The core will also conduct pilot peer education programs that target hard-to-reach populations with brief sessions to inspire these community members to form relationships with health providers so they can receive effective care. Researchers that are connected with the EXPORT Center will have the opportunity to work with our community advisory steering committee to incorporate designs and methods that are sensitive to the sociocultural backgrounds of, and responsive to the specific needs of Harlem s predominantly non-White population in ongoing disparities research. Through the community core, EXPORT center faculty will provide technical assistance to, and engage community stakeholders in the skill building needed to independently develop, obtain funding for, and evaluate programs that improve health and reduce health disparities in Harlem. Over time, we expect these efforts to generate innovative programs and collaborations with clear results, and to inspire a new generation of community leaders and researchers who will be dedicated to eliminating health disparities, and trained to independently develop and sustain programs to do so.
Keywords: biomedical facility, community, information dissemination, medical outreach /case finding, medically underserved population, racial /ethnic difference, African American, Hispanic American, continuing education
Project start date: 2002-09-30
Project end date: 2007-08-31
Carol R Horowitz, Assistant Professor
Mount Sinai School Of Medicine Of Nyu, Of New York University, New York, Ny 10029-6574
Abstract: Over the past decade, Mount Sinai investigators have established collaborations with a variety of community groups and organizations in Harlem. Relationships between researchers and community leaders were initially tenuous, and characterized by community leaders doubting researchers´ understanding of, and commitment to improving health outside their hospitals, and researchers doubting the expertise of community leaders. As our partnerships matured, we shared in proposal development, research decisionmaking, authorship, financial responsibility and the selection of research agendas. The Mount Sinai EXPORT Center has become a center for building substantive collaborations through its very active Community Core. The Core´s Community Advisory Board members are now published authors, accomplished speakers and knowledgeable research critics. For example, board members guided the EXPORT stroke researchers to move their intervention into the community and to adopt more practical recruitment strategies. The Community Engagement Core is now prepared to use our experiences and expertise to work with investigators and together, conduct health disparities research. Core advisory board members will improve research designs so projects recognize and capitalize on existing community resources and are sensitive to the backgrounds of Harlem residents. We will also propose and implement novel strategies to recruit and retain Harlem residents in studies, help researchers pose relevant questions during data collection and analysis, devise ways to sustain and replicate successful programs, and educate the community and local change agents about our research and about health-disparities. This team will use Appreciative Inquiry, a solution-oriented, as opposed to a more traditional, problem-focused approach, to harness the creativity and energy of community leaders and researchers to work together to conduct effective research. Through the work of this Core, we aim to inspire a new generation of academic-community partners with skills and dedication to eliminate the health disparities that lead to a disproportionate burden of suffering among Harlem residents
Keywords: Accounting; Adopted; Analysis, Data; Apoplexy; Aspiration, Respiratory; Authorship; Blood Pressure, High; Breathing; Care, Health; Cerebral Stroke; Cerebrovascular Apoplexy; Cerebrovascular Stroke; Cerebrovascular accident; Collaborations; Communicating Junction; Communication; Communities; Creativeness; Creativenesses; Data; Data Analyses; Data Collection; Decision Making; Dedications; Development; Development and Research; Fostering; Funding; Gap Junctions; Generations; HOSP; Health; Healthcare; Helicopter; Hospitals; Hypertension; Improve Access; Inhalation; Inhaling; Inspiration, Respiratory; Intervention; Intervention Strategies; Intervention Studies; Investigators; Lead; Left; Low-resistance Junction; Modeling; Neighborhoods; Nexus; Nexus Junction; Operation; Operative Procedures; Operative Surgical Procedures; Pb element; Plague; Policy Maker; Preparation; Programs (PT); Programs [Publication Type]; Publishing; R & D; R&D; Recruitment Activity; Research; Research Design; Research Personnel; Research Resources; Researchers; Resource Sharing; Resources; Series; Solutions; Stroke; Study Type; Surgical; Surgical Interventions; Surgical Procedure; Uncertainty; Vascular Accident, Brain; Vascular Hypertensive Disease; Vascular Hypertensive Disorder; Voice; Work; Yersinia pestis disease; brain attack; burden of disease; burden of illness; cerebral vascular accident; creativity; design; designing; disease burden; doubt; experience; health disparities; health disparity; heavy metal Pb; heavy metal lead; hyperpiesia; hyperpiesis; hypertensive disease; improved; inspiration; interventional strategy; meetings; member; new approaches; novel approaches; novel strategies; novel strategy; programs; recruit; research and development; skills; stroke; study design; surgery; years of life lost to disability; years of life lost to disease
Budget start date: 1-MAY-2010
Budget end date: 30-APR-2011
5P60MD000270-09_9006 (2010): $18435
5P60MD000270-08_9006 (2009): $17646
PRAISE: PREVENTING RECURRENCE OF ALL INNER-CITY STROKES THROUGH EDUCATION;
Carol R Horowitz, Assistant Professor
Mount Sinai School Of Medicine Of Nyu, Of New York University, New York, Ny 10029-6574
Abstract: More than one fourth of the 700,000 strokes that occur annually in the US are among stroke survivors. Blacks, or African Americans, both nationally and in Harlem, NYC, have a twofold increase in recurrent strokes, and our data reveal that Latinos in Harlem, have a threefold increase in risk relative to Whites. The primary risk factors for recurrent stroke include hypertension, hyperlipidemia, and underuse of antithrombotic agents. Controlling these risk factors may be particularly challenging for low-income, minority populations who often lack the healthcare, financial and community support needed to adhere to necessary and lifelong therapies. In Harlem, 72% of adults studied six months post- stroke did not have these three risk factors treated adequately. Peer-led patient education initiatives may help stroke survivors better manage their risk factors. Such initiatives may prove to be effective, low cost, sustainable stroke prevention strategies within communities of color, whose residents bear a disproportionate burden of suffering due to strokes. Over the past decade, we have been conducting studies to understand and reduce the health disparities related to stroke and associated conditions in Harlem. We have also built strong relationships with community leaders in Harlem that help us develop culturally appropriate interventions. Our team adapted the Stanford Chronic Disease Self-Management Program, a peer-led course for adults with all chronic diseases, to help acute stroke survivors reduce their risks for recurrence. Early results of a randomized controlled trial to test its effectiveness demonstrate that 24% more intervention subjects had all three risk factors controlled, compared with those randomized to usual care. However, the sample size was limited, based on our inpatient recruitment approach. We aim to work with our community partners to employ a novel, community based recruitment strategy that they proposed. Through this strategy, we will identify 600 Black, Latino and White community-dwelling residents of Harlem who have had strokes or transient ischemic attacks the past within five years. We will then conduct and rigorously evaluate a randomized, controlled trial to determine if participation in this program improves the control of risk factors for stroke recurrence. Finally, if the trial is successful, we will work to sustain the program locally, disseminate the results nationally, and use the lessons learned to inform health policy
Keywords: 21+ years old; Active Follow-up; Address; Adherence; Adherence (attribute); Adult; African American; Afro American; Afroamerican; Antithrombic Drugs; Antithrombotic Agents; Apoplexy; Bears; Black Populations; Black or African American; Blood Pressure; Blood Pressure, High; Brain TIA; Care, Health; Cerebral Stroke; Cerebrovascular Accident, Acute; Cerebrovascular Apoplexy; Cerebrovascular Stroke; Cerebrovascular accident; Chronic; Chronic Disease; Chronic Illness; Church; Clinical; Color; Commit; Communities; Community Hospitals; Community Outreach; Data; Drugs, Nonproprietary; Education; Education for Intervention; Educational Intervention; Educational aspects; Effectiveness; Event; Feedback; Fibrinolytic Agents; Fibrinolytic Drugs; Funding; Generic Drugs; HOSP; Health; Health Policy; Healthcare; Hospitals; Hospitals, Community; Human, Adult; Hyperlipemia; Hyperlipidemia; Hypertension; Individual; Inpatients; Instruction Intervention; Intervention; Intervention Strategies; Investigators; Knowledge; LDL Cholesterol; LDL Cholesterol Lipoproteins; Latino; Learning; Link; Low Density Lipoprotein Cholesterol; Low income; Medical; Medical center; Medicine; Minority; Neighborhoods; Outreach, Community; Participant; Patient Education; Patient Instruction; Patient Training; Patients; Population; Prevalence; Prevention program; Prevention strategy; Preventive strategy; Programs (PT); Programs [Publication Type]; QOL; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Recurrence; Recurrent; Regimen; Relative Risks; Research; Research Personnel; Research Resources; Researchers; Resources; Risk; Risk Factors; Risks, Relative; SIS; Sample Size; Science of Medicine; Self Management; Sister; Site; Stroke; Stroke prevention; Strokes, Acute; Survey Instrument; Surveys; Survivors; Symptoms; Testing; Thrombolytic Agents; Thrombolytic Drugs; Time; Training Intervention; Transient Ischemic Attack; Trust; Ursidae; Ursidae Family; Vascular Accident, Brain; Vascular Hypertensive Disease; Vascular Hypertensive Disorder; Work; acute stroke; adult human (21+); base; beta-Lipoprotein Cholesterol; black American; brain attack; cerebral vascular accident; chronic disease/disorder; chronic disorder; community setting; cost; design; designing; disease prevention; disorder prevention; experience; follow-up; generic; health care policy; health disparities; health disparity; hyperpiesia; hyperpiesis; hypertension control; hypertensive disease; improved; inner city; instructional intervention; interventional strategy; meetings; member; novel; peer; post stroke; poststroke; prevent; prevent stroke; preventing; programs; randomisation; randomization; randomized controlled study; randomized trial; randomly assigned; recruit; skills; stroke; treatment as usual; treatment strategy
Budget start date: 1-MAY-2010
Budget end date: 30-APR-2011
5P60MD000270-09_0004 (2010): $790946
5P60MD000270-08_0004 (2009): $713484
Carol R Horowitz, Assistant Professor
Mount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 5P60MD000270-079006 from National Center On Minority Health And Health Disparities IRG: ZMD1
COMMUNITIES IMPACT (INSPIRED AND MOTIVATED TO PREVENT AND CONTROL) DIABETES
Carol R Horowitz, Assistant Professor
Health Policymount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 1U58DP001010-01 from National Center For Chronic Disease Prev And Health Promo IRG: ZDP1
Project start date: 2007-09-30
Project end date: 2012-08-31