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COE in Environmental Health Disparities

 

In September of 2011, NOCEMHD obtained funding to establish one of the 10 NIMHD/EPA Centers of Excellence in the country with the goal of adding a comprehensive battery of Social Determinants of Health (SDOH) to three community-based clinical trials1-3 and one cohort study4 conducted under NOCEMHD auspices.  Overall, we have collected cross-sectional SDOH data on over 1,000 minority individuals across all studies. Drs. Luchsinger, Link, and March hosted a symposium describing our work in the 2012 Summit on the Science of Eliminating Health Disparities (12/17-19/2012, National Harbor, MD) and participated as grantees in the EPA workshop held on 12/19/12 during that meeting. We also presented our work on social determinants as moderators of intervention response at the 2014 International Symposium on Minority Health and Health Disparities, which brought together NIMHD grantees from 12/01/14 to 12/03/2014.


The EPA Center team has forged an important and novel area of work on whether and how SDOH modify health outcomes. A forthcoming systematic review of randomized controlled trials (RCTs) demonstrates that SDOH moderate response to interventions.5 We have collected extensive data on SDOH in the EPA center. Preliminary analyses of data from 2 RCTs demonstrate that SDOH modify RCT outcomes. For example, in the Northern Manhattan Diabetes Community Outreach Project (NOCHOP), of a community-based intervention to improve diabetes control for Hispanics with poorly controlled diabetes, those with low social support, regardless of treatment assignment, had greater reductions in HbA1C levels; those who had experienced discrimination in health care in the enhanced usual care group experienced significant reductions in HbA1C.6 In the Northern Manhattan Caregiver Intervention Project (NOCIP), a RCT of a community-based intervention to reduce depression among Hispanic caregivers of persons with dementia, participants who deployed fewer coping behaviors for general stress showed more improvement in their depressive symptoms over time.7


The EPA Center team has forged an important and novel area of work on whether and how SDOH modify health outcomes. As part of our conceptual work to define this area, we demonstrate in our forthcoming systematic review of randomized controlled trials (RCTs) that SDOH moderate response to interventions.5 We argue that there is a need for a harmonized approach that informs how SDOH affect how particular interventions are successful, have no effect, or are harmful, in order to improve health disparities. We propose measuring SDOH as potential modifiers in clinical trials with a priori planned analyses driven by the particular type of intervention and context.

Publications

1. Palmas W, Teresi JA, Findley S, et al. Protocol for the Northern Manhattan Diabetes Community Outreach Project. A randomised trial of a community health worker intervention to improve diabetes care in Hispanic adults. BMJ open. 2012;2(2):e001051.

2. Luchsinger J, Mittelman M, Mejia M, et al. The Northern Manhattan Caregiver Intervention Project: a randomised trial testing the effectiveness of a dementia caregiver intervention in Hispanics in New York City. BMJ open. 2012;2(5).

3. Allen JK, Dennison-Himmelfarb CR, Szanton SL, et al. Community Outreach and Cardiovascular Health (COACH) Trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. Circulation. Cardiovascular quality and outcomes. Nov 1 2011;4(6):595-602.

4. Luchsinger JA, Cabral R, Matias J, Eimicke JP, Manly JJ, Teresi JA. Pre-diabetes and diabetes are related to lower cognitive performance in middle aged Hispanics. Psychosomatic medicine. in press.

5. March D, Link BG, Luchsinger JA. Social determinants of health as moderators of intervention response in randomized controlled trials. American journal of public health. Accepted with revisions.

6. March D, Darakjy S, Eimicke JP, et al. Social Determinants of Health Moderate Response to a Community-based Diabetes Control Intervention in Urban Hispanics (03.01.02.043). International Symposium on Minority Health and Health Disparities. National Harbor, MD2014.

7. Luchsinger JA, Darakjy S, March D, Eimicke JP, Teresi JA, Mittelman M. Social Determinants of Health Moderate Response to a Community-based Intervention to Reduce Depression among Hispanic Caregivers of Persons with Dementia. International Symposium on Minority Health and Health Disparities. National Harbor, MD2014.

 
 
NOCHOP, COACH and address
link to NOCHOP link to COACH email link rc2415@cumc.columbia.edu