Asthma in Head Start Centers
This research project, funded from 1999 through 2003 by the CDC, implemented and evaluated a program of early asthma detection and intervention based in 10 Head Start centers (2 pilot centers and 8 study centers) serving predominantly low income, minority (Latino and African-American) families in East and Central Harlem. Project staff helped the Union Settlement Association in East Harlem make three programmatic adjustments: 1) Institute a procedure for “screening” families for asthma or probable asthma as a routine part of the enrollment/re-enrollment process, 2) Require parents/guardians of all children identified as having asthma or probable asthma to get a written Asthma Action Plan from their doctor, 3) Develop "HealthTrak” to monitor staff compliance with administering the “screener” and parental compliance to the Asthma Action Plan policy. The results have been very positive. Approximately 98% of families are “screened" and over 70% of children who are positive for asthma have written Asthma Action Plans – half of these children have appropriate medications.

During 2003, a series of educational modules was developed and tested at Union Settlement as well as a “case tracking form" to track efforts made with the family, and the family’s report on the child’s recent symptomatology and adherence to medications. In addition, the HealthTrak system was disseminated to Grand Street Settlement, a preschool on the Lower East Side, to generate pilot data on how well it can be institutionalized by an agency with which we haven’t yet developed a relationship. With funding from the New York City Department of Health and Mental Hygiene, a technical manual and PowerPoint presentation was developed for dissemination of the HealthTrak system to other preschool providers.

In addition, a study at Union Settlement that examined the association between asthma and preschool attendance was completed. Data were abstracted from over 1000 attendance records for the last 4 years from Union Settlement, as well as information from medical records to: a) assess the association between asthma and attendance, and b) assess how much agreement there is among the several medical forms that subsidized preschool agencies are required to collect from parents. These data will be analyzed in 2004.

Adolescent Trials Network (ATN): A Social Network Safer-sex Intervention for Teens
Adolescents account for a disproportionate number of STD cases; HIV incidence among teens is alarmingly high and growing. This study was newly funded in 2003 and is one of three prevention interventions selected nationally that will be conducted within the NICHD-funded Adolescent Trials Network. This study will recruit teens and their close friends to take part in a six-session, small-group safer-sex program. As part of the intervention, teens will develop and ‘test market’ safer-sex messages with their peers, which we hypothesize will enable them to more effectively talk and interact with their peers about sex, and will help to shift safer-sex norms. This is a phase two, feasibility trial, with pre- and post-test measures at three and six months. If the data are promising, these findings can be used to develop full-scale effectiveness trial, and ultimately, if effective, be widely disseminated in the community.

Changes in Homicide and Drug Overdose in New York City
Through collaboration with investigators at Cornell University and with the New York City Office of the Chief Medical Examiner we are exploring trends in homicide and fatal drug overdoses in NYC. The aims of the project are: (i) To determine the incidence, temporal trends, and correlates of homicide, accidental drug overdoses and other fatal accidents with a focus on identifying the emerging role of newer drugs such as ecstasy and oxycodone; (ii) To determine neighborhood-level determinants of homicide (e.g., drug use, policing, concentrated disadvantages) and to assess how they are related to changes in the frequency of homicide over time and place; (iii) To determine the association between individual drug use, age of decedents, neighborhood factors (e.g., economic disadvantage, level of illicit drug use), and the risk of becoming a homicide case using fatal accidents as controls; and (iv) To determine neighborhood-level determinants of drug overdose and to assess how these are related to changes in fatal drug overdose over time and place.

Determinants of Participation in ESAP: a Multilevel Analysis of IDUs, Pharmacies, and Community-level Factors
A more comprehensive approach is needed to identify the barriers drug users may face when considering participation in the Expanded Syringe Access Program (ESAP). The purpose of this study is to examine the social determinants that influence participation in ESAP among injection drug users (IDUs) in three high risk communities in New York City (East Harlem, South Bronx, and Bedford-Stuyvesant) using a multilevel investigation at the individual drug user, pharmacist, and community-level.

Disaster Research Education and Mentoring Center (DREM)
Through a collaboration between CUES and the Medical University of South Carolina (MUSC), DREM seeks to act as a source of practical education, mentoring and technical assistance for researchers and government and non-government agencies across the nation involved in post-disaster research. The principle aim of the DREM Center is to increase the amount of informed post-disaster research in order to assist disaster-response agencies identify which disaster victims are at greatest risk for developing specific disaster-related mental health problems and which mental health interventions are most appropriate for victims with different levels of exposure to the disaster.
The DREM Center has three primary functions: (i) to mentor local researchers involved in post-disaster research; (ii) to house a website that offers a wide-range of information regarding post-disaster research- www.disasterresearch.org ; and (iii) to disseminate evidence-based information about post-disaster research to researchers and relevant agencies.

Drug User Intervention Trial—Drug and Sexual Risk Behavior Reduction for New, Young IDUs (DUIT)
DUIT is a two-arm randomized trial to evaluate the effectiveness of a peer-educator intervention in reducing sexual and injection risks associated with HIV and HCV infection among young or recently initiated injection drug users (IDUs). Participants will receive either a 6-session, small group intervention that includes peer-educator skills-building and a placement at a local outreach organization to practice those skills, or a 6-session small-group video-and-discussion session on issues of health relevant to drug users. This effort is part of a national, multi-site study, and will provide information on the effectiveness of an innovative intervention strategy to reduce risky sexual and drug use behavior in order to prevent HIV and HCV in this high-risk population.

Evaluation of a Parenting and Domestic Violence Curriculum for At-Risk Parents
Working in collaboration with Connect, Inc., a community-based non-profit dedicated to building communities’ capacity to respond to domestic violence and child abuse, this project is designed to evaluate the acceptability and feasibility of a parenting skills curriculum aimed at parents who are in on-going domestic violence situations. Growing research and practice evidence indicates that intimate partner violence and child abuse often co-occur in families; despite recent improvements in both policies and procedures, abusers often still live with their families, putting both women and children at risk. In addition, there are situations where, for a variety of reasons, women do not want their abusive partners to leave the family and therefore do not access legal protections. These realities catalyzed the creation of a parenting skills curriculum for parents who are experiencing or have experienced intimate partner violence and are also deemed to be at-risk for child abuse and/or neglect. Through a grant from the Department of Health and Human Services, researchers from CUES are working to evaluate the implementation of the training curriculum in four busy child abuse and neglect preventive agencies throughout New York City.

Evaluation of Supervised HAART in Late-Stage HIV Infection
The purpose of this study is to determine for late stage HIV infected people factors associated with treatment failure, given optimum access, decision making, (with resistance testing), and adherence (nurses give all doses). By 2001, 104 residents of the seven participating residential facilities in New York City were enrolled in the Supervised HAART Study, a prospective evaluation of response to highly active antiretroviral therapy. Progress is evaluated by resident interviews to elicit subjective assessments of health, substance abuse patterns, and reported adherence to medication regimens. A review of the medical record gives information about clinical progress including HIV-related opportunistic infections and co-morbidities as well as clinical laboratory values and treatments. The medical record also documents the residents’ adherence to the prescribed medication regimen. Blood samples drawn at the first visit are sent for HIV resistance testing to help in the design appropriate medication regimens. Additional blood samples are banked for various assays including titers of Hepatitis C in those residents co-infected with HIV and HCV. Blood samples for host genetics are sent to at the National Cancer Institute to evaluate residents’ response to treatment in varying genetic subsets. In the near future, the implementation of Therapeutic Drug Monitoring is planned.

In the year 2003, data collection was completed.

Harlem Community and Academic Partnership (HCAP)
The Harlem Community & Academic Partnership (HCAP) (formerly the Harlem Urban Research Center) is a diverse partnership of community residents, community based organizations and service providers, academia, and public health institutions. HCAP’s mission is to identify social determinants of health and implement interventions to improve the health and wellbeing of urban residents using a community-based participatory research approach. The geographical communities of focus are East and Central Harlem, areas where a substantial proportion of the residents are poor people of color. HCAP is housed at the Center for Urban Epidemiologic Studies at The New York Academy of Medicine. This community-academic environment provides an opportunity to access the resources of a research institution and the expertise of community members and providers.

Community Based Participatory Research (CBPR) is a collaborative approach to research that equitably involves all partners (community and academic) in all aspects of the research process and recognizes the unique strengths that each partner brings to the process. The purpose of any project or research conducted by or involving HCAP is to benefit the community either through increased knowledge or by promoting better health.

HCAP projects and studies are organized as Intervention Work Groups (IWG), sub-committees comprised of HCAP members and non-HCAP members (as necessary) which conduct the community-based participatory research (CBPR) process around a specific health issue of relevance to the Harlem community. IWGs are primarily born out of a strong interest among individuals who are concerned about a particular health topic. Current IWGs include:

Policy Work Group: focuses on identifying policy barriers to substance use treatment in East and Central Harlem, and more recently have focused their inquiries on examining barriers to community reintegration and housing upon release from jail. In June 2007 PWG published a report of their findings: Housing and Reintegration in East and Central Harlem: Coming Home and No Place to Live.

HCAP Guides: The Guides IWG develops and promotes the web-based Harlem Resource Guide; an online search engine for social, medical and other service organizations, which serves as a timely source of referral information for community service providers; and the Survival Guide, an educational booklet created for and by substance users to provide information on health and social services and other useful and life-saving information.

Big Girls (Obesity Among Women of Color): The ‘Big Girls’ IWG is working to identify environmental barriers to healthy nutrition practices among overweight African-American and Hispanic women in low-income a community. A 2-phase pilot study has been conducted in East and Central Harlem in which focus groups and a six session workshop was implemented.

Cervical Health/HPV: This IWG proposes a multi-component, multi-level community intervention to increase cervical cancer and HPV screening and improve cervical health. A study looking at the attitudes and beliefs about HPV vaccination among African-American and Hispanic mothers and women, funded by Merck (makers of Gardasil) has recently begun. The IWG has also recently begun a pilot study evaluating cervical self swabs.

Asthma: The Asthma IWG works to improve pediatric asthma outcomes in communities with high prevalence through multi-level efforts to change community norms that perpetuate medical mismanagement of asthma.

PAT-Link (Pharmacists Linkages to Community Services): Members of HCAP and other HIV and harm reduction providers from the Bronx, Brooklyn and Queens serve on this IWG for the PATLink Study, a community-based participatory intervention study to increase injection drug users’ (IDUs) access to medical and social services and safe injection and syringe disposal information (see above).

Project VIVA (Venue Intensive Vaccinations for All): This IWG uses the resources and expertise of its members to develop a rigorous method to account for and vaccinate hard-to-reach populations in Harlem and the Bronx.

Community Capacity Center (CCC): The CCC serves as a point of resource and education for community members, focusing on research, grant writing and using and collecting data. Through the Seminar series, service providers and interested communities attend workshops on conducting research and seeking funding led by HCAP community and academic members.

HCAP meets monthly on the 2nd Tuesday from 12 – 2pm at NYAM. For more information contact HCAP Chair Ann-Gel Palermo by email at apalermo21@gmail.com.

Harlem ESAP Intervention Study
The purpose of this study is to design and implement a community-based participatory intervention trial in the East & Central Harlem neighborhoods of New York City to increase injection drug users’ (IDUs) legal access to sterile syringes and, in turn, to decrease HIV transmission in this group. This community trial is an attempt to create a more receptive social environment to the Expanded Syringe Access Demonstration Program (ESAP). Although the number of pharmacies registering in the program is encouraging, early data on the implementation of ESAP suggests that pharmacy syringe purchases by IDUs is low. We propose an intervention to address the features of the social environment that may be obstructing drug users’ access to ESAP. In doing so we hope to make it easier for drug users to access sterile syringes than it is for them to reuse potentially contaminated syringes.

Hepatitis C in New IDUs: Implications for HIV Prevention
The Hepatitis C study is a cohort study to determine the incidence and risk factors of hepatitis C (HCV) among recent initiates to injection drug use and among drug users who sniff drugs. This study will also define host/viral factors that are associated with HCV clearance. This study is important because it is not known whether indirect sharing is a source of HCV infection and why so few people with HCV clear the virus. Additionally, it has been suggested, but not proven, that HCV transmission can occur through sharing of snorting devices. Because HCV infection usually precedes Hepatitis B (HBV) and HIV infection in IDUs, studying risk of infection among IDUs when they first begin to inject will provide crucial information for community workers to target this vulnerable population early. The specific aims of this study are: (i) to identify discrete drug injection and non-injection indirect sharing behaviors that are risk factors HCV infection; (ii) to develop a risk profile scale of drug user practices that provides an efficient means to ascertain a composite risk score for this population; (iii) to identify host and viral factors that are associated with clearance of HCV viremia in newly infected individuals following documented seroconversion, and in prevalent cases.

High-Risk Social Networks and Transition into Injection Drug Use in Young Drug Users in New York City
In collaboration with the Department of Epidemiology at Columbia University, Mailman School of Public Health, we have set forth to investigate the effect of high-risk social networks on transition into injection drug use and subsequent HIV and HCV infection among young drug users in South Bronx, East and Central Harlem neighborhoods of New York City. Since transmission of HIV/HCV occurs within the first 2-3 years of injection drug use, identifying factors associated with the start of an injection career is important so that early prevention and intervention strategies can be designed. Thus, determining the role that ones’ social network plays on the start of an injecting career would allow a means of disseminating vital harm and risk-reduction information early on through drug-using networks.

HIV Vaccine Efficacy Trials in Non-injecting Drug-using Women
Low income women of color who reside in HIV epi-centers such as New York City are the fastest growing sector of the population at risk for HIV. However, women have been under-represented in studies testing potential HIV vaccine. We need to increase representation of women in HIV vaccine trials and learn how to more effectively teach high risk women “vaccine concepts” to improve their willingness to take part in such trials. Further, since no potential HIV vaccine is expected to be 100% effective, it is also necessary to find brief, yet powerful ways to motivate vaccine trial participants to minimize risky behavior that may put them at risk for HIV. This study is another newly-funded study in year 2003 in which we are collaborating with the New York Blood Center to develop and test a series of brief, individually-based counseling sessions to improve understanding of vaccine trial concepts and sexual risk reduction within a population of women at high risk for HIV.

HOPE: Harlem Outreach Prevention and Education
HOPE is cohort study to determine the prevalence and incidence of HIV among young non-injection drug users and to identify correlates and risk factors for HIV infection and for transition to IDU. This study will provide new information to develop strategies to prevent blood-borne infections and transition to injection drug use. The aims of the study are; (i) to determine the prevalence and incidence of HIV in recently initiated IDUs, referred to as new injectors or initiates; (ii) to identify correlates and risk factors of HIV infection among new injectors and non-injectors, including demographics, circumstances of initiation, sex practices, injection practices, physical/sexual abuse, psychiatric condition, and social networks/social support; (iii) to compare and contrast the above correlates on HIV seroprevalence between initiates and non-IDUs; (iv) to examine interaction between high risk sex practices and circumstances of initiation, high risk sex practices and psychiatric condition, high risk sex practices and social network/social support, and psychiatric condition and social network/social support as it relates to HIV seroprevalence; (v) to identify factors associated with transition from non injection to injection drug use considering the above covariates including sociodemographics, drug use, sex practices, physical/sexual abuse, psychiatric condition, and social networks/support but especially the role of pattern, type and frequency of non injection drugs including inhalants.

Inner-City Mental Health Study Predicting HIV/AIDS, Club and Other Drug Transitions (IMPACT)
IMPACT is a multi-level study is aimed at determining the association between features of the urban environment and three negative health outcomes: (i) post-traumatic stress disorder (PTSD), (ii) HIV and other blood-borne pathogens, and (iii) substance use. Surprisingly little systematic research has explored the relation between features of the individual’s environment, her/his risk behavior, and disease morbidity (i.e. PTSD, HIV, and substance use) while controlling for relevant individual-level covariates. This study will examine the independent and interactive effect of key features of the urban social environment (residential segregation, income distribution, neighborhood disadvantage) and of the urban physical environment (population density, public transportation, the built environment) as they relate to PTSD, sexual and drug use risk factors for HIV infection, HIV prevalence, and club drug use.

International Society for Urban Health (ISUH)
The International Society for Urban Health (ISUH) was started by CUES as a forum to encourage collaboration between researchers and practitioners interested in urban health. ISUH is an association of researchers, scholars, and professionals from various disciplines and areas of the world who study the health effects of urban environments and urbanization. The goals of ISUH are to encourage research, interventions, and program evaluations that lead to healthier cities in the twenty-first century. The principal aims of the society are to (i) facilitate the exchange of perspectives, research methods, and data on the study of diseases in urban areas, (ii) study the effects of urbanization on health, and (iii) evaluate and help develop programs that lessen urban health risks and promote well-being of people living in urban areas. In October 2007 ISUH organized the Sixth International Conference on Urban Health, bringing approximately 500 people from 20 countries together in Baltimore, MD to discuss different issues relevant to urban health. The Seventh International Conference on Urban Health (www.icuh2008.com) will take place this October in Vancouver, BC. The eighth conference is currently being planned and will take place in October 2009 in Nairobi, Kenya. More information is available at the ISUH web-site www.isuh.org.

Intervention Research Addressing the Primary and Secondary Prevention Needs of HIV-seropositive IDUs (INSPIRE)
As HIV prevalence and incidence is declining in the US, it is ever more important to target HIV prevention efforts more efficiently. The INSPIRE study is designed to help HIV positive drug users limit the spread of HIV to others. INSPIRE is a two-arm randomized trial to evaluate the effectiveness of peer-mentoring intervention in promoting utilization of HIV care, adherence to HIV medication and sustained reduction in sexual and illicit drug use behaviors among HIV-positive drug users. The interventions are either ten week, 10 two-hour sessions of empowerment-based intervention involving cognitive-behavioral, skills building training followed by placement as peer educators at local agencies, or a 10 week, 8-session video-and-discussion group on health issues relevant to HIV positive drug users. This project is part of a multi-center study, and the New York City research team is collaborating with research teams in Baltimore, Miami, and San Francisco. The goal of this study is to determine whether this intervention can lead to improved access, adherence to primary HIV care and to sustained risk reduction in HIV-positive IDUs.

During year 2003, study enrollment was completed in November. In New York, 288 people completed the baseline assessment and 219 entered the trial.

Pre-Hospital Evaluation of New York City Cardiac Arrest (PHENYCS)
PHENYCS is a prospective observational study to assess out-of-hospital cardiac arrest (OOHCA) survival in New York City (NYC). This project is a collaboration between the Fire Department City of New York (FDNY), and the New York Academy of Medicine (NYAM). Between October 1, 1990 and April 1, 1991, New York City Emergency Medical Services (EMS) participated in a study which evaluated all OOHCA dispatched by the NYC 911 system. The PHASE study found that overall survival following OOHCA was 1.4%. This survival rate was similar to that reported in Chicago, but compared unfavorably to OOHCA survival in Seattle. The PHASE investigators attributed the poor observed survival in NYC to lengthy elapsed time intervals at every step in the chain of survival, and suggested that other features e.g., race and socioeconomic status, might predispose residents of NYC to higher cardiac arrest mortality than individuals living in midsize urban/suburban and suburban/rural settings. Since the original PHASE was conducted, there has been a restructuring of Emergency Medical Services (EMS) in NYC following the study recommendations. The PHENYCS study is replicating the original PHASE methodology, and allowing both reevaluation of OOHCA survival in NYC, as well as further examination of some of the questions raised in PHASE. There are five specific aims of this project: (i) to estimate overall post-arrest survival rates in New York City, for comparison with PHASE and other studies, (ii) to identify factors associated with post-arrest survival (e.g., location of cardiac arrest) that could suggest opportunities for improvement in the current chain of survival, (iii) to estimate variability in time to key events, and assess factors associated with variability in overall response (e.g., 911 operator and vertical response times) that could suggest opportunities for improvement in current practice, (iv) to assess the success of paramedic out-of-hospital endotracheal intubation (ETI), and (v) to provide data for a parallel pediatric study that will evaluate OOHCA survival in children under eighteen years of age. During 2001 the PHENYCS study infrastructure was developed and the study pilot was started. Early data collection shows that the study is fully integrated into functioning of the NYC EMS and that we have cooperation from both FDNY and voluntary paramedic services. Data collection has been completed and data analysis has started.

Preschool Respiratory Health Study
In the aftermath of the terrorist attack on the World Trade Center, CUES was awarded a contract by the New York City Department of Health and Mental Hygiene to conduct a respiratory health survey of children enrolled in childcare programs below 14th Street. Our sample is parents of 3-5 year olds enrolled in subsidized and private preschool programs south of 14th Street. There are three phases to this study: 1) parents self-administer a simple “screener” with which we assess asthma prevalence and morbidity, 2) we conduct phone interviews of parents of children reporting breathing difficulties to get more detailed information on their home environment, symptoms, and medical management, 3) we conduct follow-up phone interviews one year later with 256 families to see if respiratory health has changed as time has passed since the WTC. Interesting features of this study include ethnic diversity (African-American, Latino, white, Chinese), interviews and instruments in 3 languages (English, Spanish, Chinese – with interviews in two dialects: Mandarin and Cantonese), and income diversity (within ethnic groups). During 2003 we finalized phase 3 and began analyzing data from the first 2 phases. In 2004, we will finish analyzing data from all phases and publish results from the study.

Prevention of Tuberculosis in Drug Users in East and Central Harlem and the Bronx
A significant portion of the cases of active tuberculosis infection occurs among HIV infected drug users. In an attempt to prevent active tuberculosis infection, CUES, in collaboration with the New York City Department of Health, offers tuberculosis skin tests to all drug users in all of our cohort studies. The rationale is that these drug users are at high risk of acquiring HIV infection and once infected, are at risk of developing active tuberculosis infection. Those drug users who are found to have a positive tuberculosis skin test are referred to the New York City Department of Health Chest Clinics where they are further evaluated.

During year 2003, continued enrollment and follow up of the full-scale trial occurred.

Project MIX
This CDC-funded project, awarded to four cities (NYC, Chicago, San Francisco, & Los Angeles) is a multi-session group-level intervention targeted to gay men who use non-injection drugs and/or alcohol and engage in unprotected sex. The target sample will be 1/3 white, 1/3 Latino and 1/3 African-American men, with HIV+ and HIV- serostatus. CUES is collaborating with the New York Blood Center on this project. The intervention outcomes are 1) to decrease sexual risk in the context of alcohol and drug use and 2) to decrease the number of unprotected anal sex partners. During 2003, both the intervention and control groups were developed and focus groups were conducted. During the beginning of 2004, the project will be piloted in all 4 sites with the goal of beginning the first cohort in the summer of 2004.

Project VIVA: Rapid Vaccination of Hard-to-Reach Populations
Low vaccination coverage among minorities and persons living in and near poverty is a persistent problem, particularly for hard-to-reach populations (e.g. injection drug users, elderly shut-ins, and undocumented immigrants). Efforts to successfully vaccinate HTR populations must address demographics, attitudes about vaccination, health norms, barriers to access, and immunization delivery methods. Project VIVA (Venue-Intensive Vaccines for Adults) is a quasi-experimental, multilevel community participatory intervention designed to quickly immunize HTR populations in disadvantaged urban communities. The project began in Fall, 2004, and aims to reach HTR populations in sections of East Harlem and the Bronx by bringing free vaccines door-to-door. Project VIVA is a community-based participatory research program whose goal, in addition to distributing free vaccines to those in need, serves as an initial model for emergency preparedness vaccination plans and for future efforts to introduce other door-to-door health services in disadvantaged urban communities.

Project VIVA is led by four enumeration phases. In Phase 1 (2004) we implemented a brief survey assessment to residents in designated neighborhoods to identify current key barriers to immunization faced by the target HTR populations in these neighborhoods. Using several estimation methods, we approximated the size of the target populations in the study neighborhoods to assess the need for vaccine and to estimate denominators for vaccination rates. In Phase 2, we will implement two waves of a multilevel community intervention trial, developed with input from the survey and community partners. In the first wave (Fall 2004 – Winter 2005), four randomly selected neighborhoods received the intervention (i.e., community education, community-organization engagement, and door-to-door influenza vaccination program for eligible groups etc). In the four control communities, target populations were invited receive vaccination at specified locations as part of usual public health efforts. In the second vaccination wave (Fall 2005 – Winter 2006), after updating and revising the approach based on experience from Wave 1, we will use a crossover design to implement Project VIVA in the four control communities. This vaccination wave will be conducted over two weeks to test the feasibility of rapid vaccination of these populations. Phase 3 of this project will identify the promising and generalizable elements of the program to other urban areas and distribution possibilities of other vaccines (e.g., HIV, HBV, etc).

Quality of Health Care Relating to Barriers for Hepatitis C Virus Infection Treatment
Approximately 3.9 million Americans are infected with the hepatitis C virus, which corresponds to a prevalence rate of 1.8%, according to estimates from the Third National Health and Nutrition Examination Study (NHANES III). The prevalence of HCV is approximately 65% to 90% among IDUs. Injection drug use accounts for more than 60% of all HCV infections nationwide. Rates of HCV infection among IDUs in New York City have ranged between 42% and 52%. CUES has identified hepatitis C virus (HCV) infection among injection drug users (IDUs) as an area for further research in terms of quality of, and access to care. Until recently, active injection drug use has been a contradiction for treatment of HCV injection. In June 2002, the National Institutes of Health (NIH) released a consensus statement on the management of HCV. The NIH now recommends that treatment of active IDUs be considered on an individual basis. Furthermore, active injection drug use in and of itself is no longer an exclusion criteria for antiviral therapy. CUES researchers are engaged in a research initiative aimed at understanding and addressing the shortcomings in quality of medical care that patients receive through funding from the New York State Office of Science, Technology and Academic Research (NYSTAR). In particular the CUES research team aim to describe the level of knowledge surrounding HCV infection and treatment among active IDUs; evaluate readiness for treatment and describe correlates for treatment readiness among active IDUs; evaluate active injection drug users access to HCV treatment, and identify potential barriers to treatment; and describe knowledge, attitudes and practices of health care providers surrounding treatment of HCV infection among active IDUs.

Sequelae of the September 11th Terrorist Attacks in New York City
The September 11th terrorist attacks were the single largest human-made disaster in the United States. Nearly 3,000 people in NYC died as a result of the attacks, more than 100,000 jobs have been lost and billions of dollars in damage have been incurred. Early CUES work demonstrated the substantial mental health burden in NYC as a result of the attacks. CUES has developed cross-sectional and longitudinal research projects investigating the psychological sequelae of the September 11th attacks on residents of New York City. We are currently in the process of following-up a cohort of more than 2,500 NYC metropolitan area residents for 2 years after the disaster. The survey assessed rates of new onset posttraumatic stress disorder, depression, and other mental health outcomes, and identified subgroups with the highest rates, to target interventions. Data from our cross-sectional surveys and from this cohort have been provided to the New York City Department of Housing and the State Health Department of Mental Health to provide information for program planning. We continue to serve on the New York State Mental Health Consortium formed after September 11th.

STRIVE:Drug and Alcohol Risk Behavior Reduction for New, Young IDUs
STRIVE is a two-arm randomized trial to evaluate the effectiveness of a peer-educator intervention among young IDUs who carry the Hepatitis C virus (HCV) in reducing the transmission of HCV to others, and to reduce their harmful risk behaviors such as alcohol consumption. An additional component of this study will be to identify the proportion of these individuals who would be eligible and willing to undergo treatment to eradicate HCV infection. Participants will receive either a 6-session, small group intervention that includes peer-educator skills-building and a placement at a local outreach organization to practice those skills, or a 6-session small-group video-and-discussion group on health issues relevant to young drug users. This effort is part of a multi-site study involving New York and two other cities in the US (Baltimore and Seattle). This study will provide information on the effectiveness of an innovative intervention strategy to reduce risky drug use behavior in order to limit the spread of HCV in this highly vulnerable population.

Enrollment in this trial was completed in May of 2004, and follow up will be completed in the spring of 2005. Nationally 632 were enrolled into the trial and 419 were randomized to receive one of the interventions. Analysis of the baseline data is underway.

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