Public Health Magazine: Spring 1996, Vol.4, No.1
Short Takes

National Head Start Conference in June

Head Start's third national research conference, "Making a Difference for Children, Families and Communities: Partnerships among Researchers, Practitioners and Policymakers," will be held June 20-23, 1996 at the Hyatt Regency on Capitol Hill. It is a joint effort by the Administration of Children, Youth and Families Administration for Children and Families (Department of Health and Human Services), CSPH's Center for Population and Family Health, and the Society for Research in Child Development. The conference has limited space and a postmark deadline for registration on Saturday, May 25, 1996.

"Our aim is two-fold," says CSPH's Faith Lamb-Parker, Ph.D., director of the Head Start conference. "We hope to help practitioners and policymakers gain a fuller understanding of the applications of early childhood and family research to facilitate effective programming and policies for low-income, ethnically diverse families. And we want to help researchers further understand the current critical problems facing families in poverty as well as the research needs of the early intervention and family support systems that serve them."

Among the presenters will be Lawrence Aber, Ph.D., director of CSPH's National Center for Children in Poverty.

For further information call the Columbia School of Public Health at (212)304-5251.

Picture Clears in Kaposi's Research

Patrick Moore, Ph.D. and his wife Yuan Chang, M.D. have extended their initial discovery of a new human herpesvirus found in Kaposi's sarcoma, called Kaposi's sarcoma-associated herpesvirus. Using classical epidemiologic criteria, they have shown that the virus is the likely infectious cause of Kaposi's sarcoma in patients both with and without AIDS, and have published a definitive description of the agent establishing it as a new herpesvirus. They also found that it contains several cancer-related genes and have developed a serologic test that will allow extended epidemiologic study of the virus.

Patrick Moore (center), his wife and professional colleague Yuan Chang and student Preston Perry discuss a research project.

New Leadership at Harlem Center

"The Harlem Center is privileged to have long-standing community involvement with its churches as well as a history of political activism for political power," says Mary Bassett, M.D., M.P.H., the new director of the Harlem Center for Health Promotion and Disease Prevention. "The Center has an unusual opportunity for community links that will have real meaning for improving public health," she says. "These links aren't simply 'paper' coalitions, but coalitions in practice."

Bassett's interest in hands-on community-based epidemiology is not new. She has extensive experience in public health, international health and health promotion and disease prevention. She has been a consultant for UNICEF on water- and sanitation-related diseases, and on the Village Community Worker program in Zimbabwe, completing several grant-funded research projects on women and AIDS, and AIDS prevention. At the request of the Zimbabwe Ministry of Health, Bassett authored a training manual for mid-level health workers in community health and epidemiology. She has also served as the secretary of the Zimbabwe National Cancer Registry Advisory Committee, and has lectured internationally on topics ranging from the epidemiology of AIDS in Africa to the socioeconomic determinants of vulnerability to HIV infection and the evaluation of asbestos-related research.

Until last year, Bassett was a senior lecturer at the University of Zimbabwe, in Harare. Prior to her work in Africa, she had extensive experience working in the Harlem community, completing her medical residency at Harlem Hospital in 1979. She was chief resident and attending physician in the Department of Medicine at Harlem Hospital; during her public health studies at the University of Washington she was a Robert Wood Johnson Scholar.

Fears of Violent Mentally Ill Outstrip Reality

Mental illness is no stronger a predictor of violent behavior than is gender, education or age. Despite this fact, the fear of violence from people with mental illness far outstrips the reality. Now, CSPH researchers have demonstrated that the association between violence and mental illness is largely restricted to people who have psychotic symptoms that lead them to perceive a threat from others or to experience a weakening of personal control. Building on past work, the researchers have shown that threat and control symptoms were related to violence in markedly different social contexts, as different as Washington Heights and Israel.

Bruce Link, Ph.D. and Ann Stueve, Ph.D, psychiatric epidemiologists at CSPH and the New York State Psychiatric Institute, found that specific psychotic symptoms put people at risk. In comparable studies of mental illness and violence in Washington Heights and Israel, they showed that people whose psychotic experiences made them feel threatened by others were more likely to behave in a hostile fashion, regardless of the disparate degrees of violence in their cultures. In Israel, where citizen-to-citizen violence is rare and substance abuse minimal, the same specific set of psychotic symptoms predicted violence as in the urban Washington Heights community where rates of crime and drug use are high.

"Most people with mental illness do not exhibit violent behavior and are not more dangerous than the average person," Link said at the annual meeting of the American Association for the Advancement of Science, in February.

He explained that even among those who experience the psychotic symptoms in question, effective treatment interventions are possible. In fact, with significant improvements in the delivery of mental health services, people with mental illness may someday pose no more of a crime threat than other members of the general population, Link said.

Mental Health Needs of Gay Men Unmet

AIDS educators should pay more attention to the mental health of gay men, not just to risky sexual behavior, a Columbia School of Public Health study has found.

Young gay men most likely to enter AIDS prevention programs suffer symptoms of anxiety and depression that are not necessarily related to AIDS, say Laura Dean, Ed.M., and Ilan H. Meyer, Ph.D., both of the Sociomedical Sciences Division's AIDS Research Unit. At the same time, those who reported very high-risk sexual behavior rarely sought help or advice from safer sex programs. "What we frequently see is that those most in need of services are those least likely to seek them," Dean said.

The researchers found that only about ten percent of young New York City gay men believe that they can benefit from education or support to help them practice safer sex. About half that number actively sought such help. AIDS educators must address both safer sex education and mental health problems, say the authors, if they are to be effective.

The study also found that young gay men who engaged in very high-risk sex, which the investigators defined as unprotected receptive anal intercourse with multiple partners, were more likely to suffer from mental health problems. Men who reported substance abuse problems and internalized homophobia were eight times as likely to engage in high-risk sex, and to conceal unsafe sex practices even from gay friends. Such men are not likely to seek help, say the researchers, and AIDS program planners must devise ways to attract them to safer sex programs.

The work is reported in "The Impact of AIDS in New York City's Gay Community," a special supplement to AIDS Education and Prevention, an academic journal. Dean served as guest editor for the winter 1995 issue. The study was supported by the National Institute of Mental Health, the New York Community Trust and the Aaron Diamond Foundation.

HIV Home Test: to sell or not to sell

In the next few months, the Food and Drug Administration will consider whether to approve home diagnostic tests for HIV. As the FDA deliberates the decision to allow marketing of the controversial test, Ronald Bayer, Ph.D., professor of public health at CSPH and an AIDS ethicist, asserts that the potential individual and public health benefits of a home test outweigh the evidence of potential serious psychological risk to some of the product's users.

"Barring the licensure of home testing would be an act of unwarranted paternalistic intrusion and unwise public policy," Bayer wrote last year in the May 11 issue of the New England Journal of Medicine.

CSPH Accreditation Renewed

The Council for Education on Public Health has unconditionally extended the accreditation of CSPH for six years and, pending the satisfactory completion of a mid-term progress report, will extend accreditation for a seventh year. Because seven years is the maximum period of accreditation that can be granted, their decision represents strong support for the mission and activities of the School.

The Council and the site visit team conducted a thorough review, rating the School on a variety of criteria. The highest ratings were achieved on most criteria: mission and goals; faculty; research; service; instructional requirements for the M.P.H. program; resources; student advising and placement counseling; student recruitment and admissions; self- study process for the reaccreditation review; organizational setting supportive of teaching, research and service; and, school governance and academic policies. Also noted was CSPH's progress in the areas of: learning objectives for curriculum planning and student evaluation; continual self examination and monitoring; and, prerogatives accorded the School by the University.

"The successful reaccreditation effort required a great deal of work over a sustained period by many faculty members, administrators, students and alumni which is greatly appreciated," said Andrew Davidson, associate dean of academic affairs, who oversaw the accreditation process.

Utilization Review: Does It Work?

Although utilization review is widely used to control health care costs, its effect on patterns of health care had been unclear until CSPH health policy and management researchers, led by Stephen Rosenberg, M.D., M.P.H., compared the health service of 3702 enrollees whose requests received sham review and were automatically ap-proved for insurance coverage.

The researchers found that the utilization review program had little effect except for reducing the number of diagnostic and surgical procedures for which second opinions were required. The enrollees, physicians and hospitals were all unaware of the group assignments. Both actual review and sham review may have decreased the use of hospital services, with patients or their physicians choosing more efficient treatment when they believed that care would be reviewed.

"The Effect of Utilization Review in a Fee-For-Service Health Insurance Plan," a special article on the efficacy of utilization review in a fee-for-service health insurance plan, appeared in the November 16, 1995 issue of the New England Journal of Medicine.

Green Light For Environmental Health Ph.D.

Environmental health encompasses a broad range of activities related to the detection, analysis, evaluation, regulation and control of human exposure to chemical and physical agents in the environment. Due in part to a growing national, regional and local demand for doctoral-level environmental health professionals, the executive committee of Columbia's Graduate School of Arts and Sciences has unanimously approved a proposed Ph.D. program in Environmental Health Sciences.

The program will revolve around laboratory-based investigations that address the toxicologic mechanisms of environmental agents. The M.A./ Ph.D. program is expected to require five to six years to complete, and four new students will be admitted annually. The first class will matriculate this fall.

Developing Nations Need Maternity Care

"Most serious obstetric complications are neither preventable nor predictable, but they are eminently treatable," says Division of Population and Family Health (PFH) Research Scientist Deborah Maine, director of the Prevention of Maternal Mortality Program, funded by the Carnegie, Mellon and MacArthur foundations.

Responding to earlier approaches to maternal mortality in developing countries, which have focused exclusively upon risk assessment and prenatal care, Maine asserts that emergency services must be more readily available in developing countries. United Nations agencies such as UNICEF, WHO and UNFPA are revising their policies on maternal mortality based on this new understanding. According to the World Bank, emergency obstetric care is not only affordable by the poorest nations, but also cost-effective.

Maine was featured in the article, "New Push to Reduce Maternal Mortality in Poor Countries," in the August 11, 1995 issue of Science. She and Angela Kamara, R.N., PFH assistant clinical professor, were also quoted in, "Women's Health Research Blossoms," in the same issue.

Angela Juaka Kamara (far left), CSPH faculty member and deputy director of the Prevention of Maternal Mortality Program, leads a project team visit to a hospital in Calabar, Nigeria.

The hospital has been upgraded by the Program's efforts.

Dominicans Praise Parent Ed Program

In recognition of its service to and support of the Dominican people in Washington Heights, the Center for Population and Family Health's Adult Parent Education Program was recently honored by the Duartenian Society. Aurea Martinez,

coordinator of the program, received the award from the society at a special gala commemorating Dominican independence and the Dominican Republic's first president, Juan Pablo Duarte. Nearly 400 men and women have graduated from the Parent Education

Program.

The Adult Parent Education Program focuses on improving communication between children and their parents. Although the program places a heavy emphasis on teen sexuality issues, it also addresses a range of other areas that may have an impact on the relationship between parent and child, including cultural and generational differences.

NCCP Maps State-by-State Approaches to Supporting Young Children and Families

The report, "Map and Track: State Initiatives for Young Children and Families," addresses a very important question: What initiatives are states undertaking to promote the healthy development of the next generation of American citizens? "A growing body of research emphasizes the effectiveness of intervening during the early years to promote children's healthy development and growth," said Larry Aber, Ph.D., new director of the National Center for Children in Poverty (NCCP).

"'Map and Track' examines what states are doing to support young children and their families during this important period."

According to June Knitzer, deputy director of NCCP and co-author of the report with Stephen Page, "'Map and Track' highlights what a difference a state can make for young children and families. The supports that are available to a child can vary tremendously depending upon the state where he or she happens to be born."

The report shows that eight states have developed comprehensive, linked, goal driven efforts for young children and their families. Ten more have program and planning initiatives that are not explicitly linked, and 23 states have either program development or planning strategies targeted to young children and families. Five states have developed program or system reform initiatives only for young children facing special risks (e.g., out-of-home placement, evidence of emotional difficulties, etc.). Four states have no special initiatives beyond what is required by the federal government.

• Strategic Approach 1: States with comprehensive, interconnected sets of initiatives focused on young children and families-Colorado, Georgia, Minnesota, North Carolina, Ohio, Oregon, Vermont, and West Virginia.

• Strategic Approach 2: States with parallel program initiatives that specifically target young children and families, and planning initiatives that may or may not target young children and families-Alaska, Arkansas, Delaware, Florida, Kansas, Kentucky, Missouri, Pennsylvania, Rhode Island, Washington.

•  Strategic Approach 3: States with only program initiatives or only planning initiatives for young children and families-Arizona, California, Connecticut, Hawaii, Iowa, Illinois, Indiana, Louisiana, Maine, Maryland, Massachusetts, Michigan, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oklahoma, South Carolina, Tennessee, Texas, Virginia, Wisconsin.

• Strategic Approach 4: States with system reform or cross-cutting, multiservice initiatives for subgroups of children - Alabama, Mississippi, Montana, Nevada, Utah.

• Strategic Approach 5: States with very limited, if any, cross-system, multiservice program or planning initiatives beyond those mandated or supported by federal programs - Idaho, North Dakota, South Dakota, Wyoming.

Copies of "Map and Track: State Initiatives for Young Children and Families," are available for $19.95 from the National Center for Children in Poverty, Columbia School of Public Health, 154 Haven Avenue, New York, NY 10032. E-mail: ejs22@columbia.edu.

Violence Research Center Looks Ahead

In the past decade, public health professionals began to speak of violence as a public health problem. Now, Columbia School of Public Health has launched the Center for Violence Research and Prevention under the direction of CSPH Sociomedical Sciences faculty member Jeffrey Fagan.

The Center expects to work with communities and begin to develop channels for intervention models that address the risk factors and causes of violence at the local level. Working with state and city health departments and their data, the Center will concentrate on primary and secondary prevention. "We will analyze the neighborhood locations of injuries from violence and the dynamics of those neighborhoods that make them unsafe. It is absolutely critical that research inform prevention efforts and that we carefully evaluate those efforts," said Fagan, indicating that many intervention and prevention programs exist but are not tailored to a specific neighborhood's violence problems.

Currently, the Center is researching interpersonal violence among adolescents and in the home.

"The latest research looks at violence not as a dependent variable in sociomedical science but as an independent variable with an effect on health outcomes," said Fagan, explaining the relationship between violence and public health. "Consider that from 1980 to 1992, the prison population of violent offenders tripled but homicide trends still increased most in the youngest groups of people. The continued growth of violence suggests that violence prevention has not been served by good thinking and that current remedies are not working well," he said.

Michael S. Sparer, Ph.D., assistant professor, Health Policy and Management, takes a critical look at state-dominated health care in his book, Medicaid and the Limits of State Health Reform, to be published in June by Temple University Press.

Young Men's Clinic: Winner and Champion

Young Men's Clinic founder and director Bruce Armstrong (lower left), and clinic physician Alwyn Cohall (left), have received the New York Urban League's Building Brick Award (above). At the award ceremony were, left to right: Herman H. Martin, Jr., general chairman; LaQuita Henry, chairperson of the Manhattan advisory board, New York Urban League; Glenda McNeal, vice president of American Express Company, honorary benefit chairwoman; Armstrong; Cohall; Paula Sneed, senior vice president of Kraft Foods, honorary benefit chairwoman; Michelle Morris, general chairperson.

Champions of young men's reproductive health needs for more than a decade, the leaders of the Young Men's Clinic won recognition from the Urban League this winter. The neighborhood health clinic, co-sponsored by CSPH's Center for Population and Family Health and the Presbyterian Hospital Ambulatory Care Network Corporation, was honored at the 29th New York Urban League Annual New Year's Reception. The league's Building Brick Award was bestowed on Bruce Armstrong, D.S.W., the clinic's founder and director, and Alwyn Cohall, M.D., the clinic physician.

In 1985, when CSPH faculty visited the streets and playgrounds of Washington Heights to learn how adolescent males defined "health" and about the kind of services they needed, New York City's only reproductive health clinic for young men was imagined. Funded by a small federal grant, the Young Men's Clinic opened its doors in 1986.

Today, the free clinic is staffed each Monday evening by physicians, social workers, health educators, support staff and over 30 volunteer medical and public health students. Physical exams for sports, employment, and school; diagnosis and treatment of sexually transmitted diseases; HIV counseling and testing; individual and group health education; condom distribution and social work services are all provided. Over 1,000 adolescent and young men visited the clinic last year.

The Young Men's Clinic has been widely recognized as one of the country's most innovative health programs. Its creative outreach strategies, utilization of volunteers and graduate students, and unique counseling and condom distribution interventions have been cited by many organizations and publications, including the Children's Defense Fund, the Center for Population Options, the Vera Institute of Justice/Ford Foundation, the Planned Parenthood Federation of America and The New York Times.

Armstrong and Cohall have published articles, chaired task forces and trained professionals concerned with health issues of adolescent and young adult males.

HRAs Improve Health Behavior

Donald Gemson advocates the use of computer technology for assessing health risks and improving health behavior.

Computerized health risk appraisals (HRAs) are an effective component of periodic health exams at the worksite, according to associate clinical professor Donald Gemson, M.D., M.P.H., co-author of "Efficacy of Computerized Health Risk Appraisal as Part of a Periodic Health Examination at the Worksite," in the July/August, 1995 issue of American Journal of Health Promotion.

Combined with other research, Gemson's study appears to confirm that HRA is an effective tool for improving health behaviors. If this assertion holds true, practitioners may be expected to incorporate HRA into a greater variety of health promotion settings. This will create a greater need for research examining the factors associated with successful implementation of HRA in a variety of settings and populations.

A further note: Gemson's achievements have earned him a three-year term on the board of the American College of Preventive Medicine, region three.

School-City Epidemiology Collaborations

Communicable disease epidemiology has established a more prominent status in the Division of Epidemiology in the areas of teaching, research supervision and research production. Patrick Moore, Ph.D., in collaboration with Dr. Isaac Weisfuse, now present a systematic overview of communicable diseases worldwide, including some potential new threats. Videoconferenced from CSPH, this course is open to both CSPH students and New York City Department of Health employees.

School-city collaboration also is reflected in the Epidemiology of Tuberculosis course, taught by Dr. Tom Frieden, who works for the Centers for Disease Control and Prevention as well as NYCDOH, and Dr. Moise Desvarieux, newly appointed to the faculty to develop this field of inquiry. In addition, NYCDOH's Dr. Mary Ann Chiasson co-teaches a course on the epidemiology of HIV/AIDS with Zena Stein, M.B., professor emeritus of public health in psychiatry.

This summer, Dr. Salim Abdool Karim will lead a course in methods of communicable disease epidemiology. Research supervision is available through NYCDOH, the Public Health Research Institute, and the AIDS International Training Program.