Director of Educational Advancement and Assessment
Clinical Associate Professor of Community Health Science and Practice
Dr. Cheryl Merzel has over 25 years of experience in public health researcher, evaluation, program development, advocacy, and education. Her work focuses on design and evaluation of community-based health promotion interventions and development of community capacity to engage in public health efforts. Her work also involves developing approaches to support communities in translating research to relevant, evidence-based public health practice. She has decades of involvement with Health Start, a federally-funded community-based program for improving the health of pregnant and parenting women and their infants.
Dr. Merzel co-directs the College of Global Public Health’s Community Health Initiative with Dr. Andy Goodman. As the Director of Educational Advancement and Assessment for the College, Dr. Merzel is committed to improving public health pedagogy through scholarship and innovative teaching practice. She has served on the public health faculty at a number of institutions including Columbia University Mailman School of Public Health, the City University of New York, and Albert Einstein College of Medicine. She is a past president of the Public Health Association of New York City.
BA, Biology, Yeshiva University, New York, NYMS, Jewish Education, Yeshiva University, New York, NYMPH, Sociomedical Sciences, Columbia University, New York, NYDrPH, Sociomedical Sciences/Political Science, Columbia University, New York, NY
Delta Omega Honorary Society in Public Health, Delta Beta Chapter (2016)Calderone Award for Junior Faculty Development, Columbia University (2000)Marissa de Castro Benton Dissertation Prize, Columbia University (1988)Alumni Scholarship, Columbia University (1987)
Community DevelopmentCommunity HealthCommunity InterventionsDissemination and Implementation of Evidence-based ProgramsPublic Health PedagogyTobacco Control
Pedagogical Scholarship in Public Health: A Call for Cultivating Learning Communities to Support Evidence-Based EducationMerzel, C., Halkitis, P., & Healton, C.
Journal titlePublic health reports (Washington, D.C. : 1974)
Page(s)679-683Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.
Becoming a Professional: Online Discussion Boards as a Tool for Developing Professionalism among MPH StudentsMerzel, C., & Goodman, A.
Journal titlePedagogy in Health Promotion
Smoking cessation among U.S. Hispanic/Latino adults: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)Merzel, C. R., Isasi, C. R., Strizich, G., Castañeda, S. F., Gellman, M., Maisonet Giachello, A. L., Lee, D. J., Penedo, F. J., Perreira, K. M., & Kaplan, R. C.
Journal titlePreventive Medicine
Page(s)412-419This paper examines patterns of smoking cessation among Hispanics/Latinos with particular attention to gender, acculturation, and national background. Data are from the Hispanic Community Health Study/Study of Latinos, a population-based study of 16,415 non-institutionalized Hispanics/Latinos ages 18-74 from a stratified random sample of households in Chicago, Miami, the Bronx, and San Diego. Face-to-face interviews, in English or Spanish, were conducted from 2008 to 2011. Findings are based on 6398 participants who reported smoking at least 100 cigarettes in their lifetime. Associations with smoking cessation outcomes were assessed in bivariate and multivariable analyses. Findings indicate that approximately equal proportions of men and women were former smokers. There was little difference by gender in socioeconomic characteristics associated with smoking cessation. Both men and women who lived in households with smokers were less likely to be abstinent. Multivariable analysis indicated that the likelihood of quitting varied by national background primarily among men, however, Puerto Rican and Cuban smokers of both genders were the least likely to successfully quit smoking. Among women, but not men, younger and more socially acculturated individuals had lower odds of sustaining cessation. Over 90% of female and male former smokers reported quitting on their own without cessation aids or therapy. The results suggest that many Hispanics/Latinos are self-motivated to quit and are able to do so without clinical assistance. Heterogeneity in smoking behaviors among Hispanics/Latinos should be taken into account when developing and delivering smoking cessation interventions and public health campaigns.
Using the Interactive Systems Framework to Support a Quality Improvement Approach to Dissemination of Evidence-Based Strategies to Promote Early Detection of Breast Cancer: Planning a Comprehensive Dynamic TrialRapkin, B. D., Weiss, E. S., Lounsbury, D. W., Thompson, H. S., Goodman, R. M., Schechter, C. B., Merzel, C., Shelton, R. C., Blank, A. E., Erb-Downward, J., Williams, A., Valera, P., & Padgett, D. K.
Journal titleAmerican Journal of Community Psychology
Page(s)497-517Dissemination efforts must optimize interventions for new settings and populations. As such, dissemination research should incorporate principles of quality improvement. Comprehensive Dynamic Trial (CDT) designs examine how information gained during dissemination may be used to modify interventions and improve performance. Although CDT may offer distinct advantages over static designs, organizing the many necessary roles and activities is a significant challenge. In this article, we discuss use of the Interactive Systems Framework for Dissemination and Implementation to systematically implement a CDT. Specifically, we describe "Bronx ACCESS", a program designed to disseminate evidence-based strategies to promote adherence to mammography guidelines. In Bronx ACCESS, the Intervention Delivery System will elicit information needed to adapt strategies to specific settings and circumstances. The Intervention Synthesis and Translation System will use this information to test changes to strategies through "embedded experiments". The Intervention Support System will build local capacities found to be necessary for intervention institutionalization. Simulation modeling will be used to integrate findings across systems. Results will inform on-going policy debate about interventions needed to promote population-level screening. More generally, this project is intended to advance understanding of research paradigms necessary to study dissemination.
Identifying women at-risk for smoking resumption after pregnancyMerzel, C., English, K., & Moon-Howard, J.
Journal titleMaternal and Child Health Journal
Page(s)600-611While prevalence of smoking during pregnancy has declined over the past two decades, maintenance of cessation after pregnancy remains an important public health challenge, particularly for women of color. This article reports on methods for improving detection of women at risk for smoking resumption after pregnancy through the use of an evidence-based smoking assessment instrument. The instrument was adapted for use by lay health workers in a community-based maternal and infant health program. A total of 276 primarily low-income Black and Hispanic pregnant and postnatal women enrolled in the program were screened for tobacco use in an initial assessment. Of these, 190 were reassessed an average of 2.7 months later. Assessments included measures of current and past smoking and risk factors associated with relapse. Bivariate differences by smoking status were analyzed. Seventeen percent of participants who would be classified as non-smokers using less sensitive screening questions were identified as former smokers and at-risk for resuming smoking. Twenty-two percent of former smokers resumed smoking by reassessment. Smoking resumption among former smokers was associated with having a partner and household members who smoked. Identification of former smokers is critical in order to prevent resumption of smoking after pregnancy and promote long-term maternal smoking cessation. Brief assessment instruments administered at multiple points in time during the prenatal and postnatal periods are an effective means of improving detection of women at risk for smoking resumption. Former smokers should be included in prenatal and postnatal tobacco education and counseling services.
Translating public health knowledge into practice: Development of a lay health advisor perinatal tobacco cessation programEnglish, K. C., Merzel, C., & Moon-Howard, J.
Journal titleJournal of Public Health Management and Practice
Issue3The value of lay health advisor (LHA) interventions as an effective approach toward ameliorating racial, ethnic and/socioeconomic health disparities has been noted by researchers and policy makers. Translating scientific knowledge to bring state-of-the-art health promotion/disease prevention innovation to underserved populations is critical for addressing these health disparities. This article examines the experiences of a community-academic partnership in designing, developing, and implementing an evidence-based, LHA-driven perinatal tobacco cessation program for low-income, predominately African American and Hispanic women. A multimethod process evaluation was conducted to analyze three essential domains of program implementation: (1) fit of the tobacco cessation program into the broader project context, (2) feasibility of program implementation, and (3) fidelity to program implementation protocols. Findings indicate that project partners have largely succeeded in integrating an evidence-based tobacco cessation program into a community-based maternal and infant health project. The successful implementation of this intervention appears to be attributable to the following two predominant factors: (1) the utilization of a scientifically validated tobacco cessation intervention model and (2) the emphasis on continuous LHA training and capacity development.
Adherence to antiretroviral therapy among older children and adolescents with HIV: A qualitative study of psychosocial contextsMerzel, C., VanDevanter, N., & Irvine, M.
Journal titleAIDS Patient Care and STDs
Page(s)977-987Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.
Check out that body: A community awareness campaign in New York CityBleakley, A., Merzel, C., Messeri, P., Gift, T., Kevin Malotte, C., Middlestadt, S., & VanDevanter, N.
Journal titleThe Journal of Primary Prevention
Page(s)331-339The authors evaluate the effectiveness of the small media campaign in raising community awareness about the importance of going for a health check up. Data were collected over time from 535 respondents ages 15-30 years using cross-sectional surveys in two low-income, predominantly African-American communities in New York city. Regression analyses indicated campaign material recognition at 15 months was significantly higher in the intervention community relative to the comparison community. There were no significant changes in social norms, attitudes, or beliefs. Media campaigns aimed at adolescents and young adults on a community-wide level are an effective means of gaining material recognition. Editors' Strategic Implications: This research illustrates the effect of a public health media campaign on awareness, but it also serves as a reminder to public health officials that awareness is not necessarily sufficient to promote attitudinal or behavioral health changes.
Making the connections: Community capacity for tobacco control in an Urban African American CommunityMerzel, C., Moon-Howard, J., Dickerson, D., Ramjohn, D., & VanDevanter, N.
Journal titleAmerican Journal of Community Psychology
Page(s)74-88Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.
Developing and sustaining community-academic partnerships: lessons from Downstate New York Healthy Start.Merzel, C., Burrus, G., Davis, J., Moses, N., Rumley, S., & Walters, D.
Journal titleHealth Promotion Practice
Page(s)375-383Partnering with communities is a critical aspect of contemporary health promotion. Linkages between universities and communities are particularly significant, given the prominence of academic institutions in channeling grants. This article describes the collaboration between a school of public health and several community-based organizations on a maternal and infant health grant project. The partnership serves as a model for ways in which a university and community organizations can interrelate and interact. Central lessons include the significance of sharing values and goals, the benefit of drawing on the different strengths of each partner, the gap created by the university's institutional focus on research rather than service and advocacy, and the strains created by power inequities and distribution of funds. A key element of the partnership's success is the emphasis on capacity building and colearning. The project demonstrates the potential of employing community-academic partnerships as a valuable mechanism for implementing community-based health promotion programs.
A community-based intervention designed to increase preventive health care seeking among adolescents: The gonorrhea community action projectVanDevanter, N. L., Messeri, P., Middlestadt, S. E., Bleakley, A., Merzel, C. R., Hogben, M., Ledsky, R., Malotte, C. K., Cohall, R. M., Gift, T. L., & St. Lawrence, J. S.
Journal titleAmerican Journal of Public Health
Page(s)331-337Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.
A cost-effectiveness analysis of interventions to increase repeat testing in patients treated for gonorrhea or chlamydia at public sexually transmitted disease clinicsGift, T. L., Malotte, C. K., Ledsky, R., Hogben, M., Middlestadt, S., Vandevanter, N. L., St. Lawrence, J. S., Laro, M., Paxton, K., Smith, L. V., Settlage, R. H., Davis, R., Richwald, G. A., Penniman, T., Gaines, J., Olthoff, G., Zenilman, J., Vanblerk, G., Ukairo, C., Fulmer, K., Mattson, S., Johnson, V., Merzel, C., Messeri, P., Bleakley, A., Weisfuse, I., Cohall, A., Blank, S., Cohall, R. M., Levine, D., Peake, M., & Pequegnat, W.
Journal titleSexually Transmitted Diseases
Page(s)542-549Background: Persons who have been infected with chlamydia or gonorrhea (CT/GC) are at elevated risk for reinfection. The cost-effectiveness of interventions designed to encourage public sexually transmitted disease (STD) clinic patients to return for rescreening has not been well-evaluated. Goal: The goal of this study was to conduct a program- and societal-perspective cost-effectiveness analysis of five interventions designed to encourage public STD clinic patients infected with CT/GC to return for rescreening 3 months after initial treatment. Study: Researchers at two STD clinics collected cost data for the five interventions. These were combined with study data on return rates and CT/GC positivity rates among returning patients to compare the cost-effectiveness of the interventions. Results: The cost per patient counseled with a brief recommendation to return, followed by a telephone reminder after 3 months, was higher than two interventions: a brief recommendation to return with no reminder and a $20 incentive, received on return. However, the brief recommendation with a telephone reminder yielded the highest return rate (33%) and was the least costly in terms of cost per infection treated ($622 program, $813 societal). In-depth motivational counseling that helped clients identify risk factors and provided reasons for returning was more costly than a phone reminder alone and was not more effective. Conclusions: Phone reminders are more cost-effective than motivational counseling and improve return rates over a brief recommendation given at the time of initial treatment.
Psychological mediating factors in an intervention to promote adolescent health care-seekingHogben, M., Ledsky, R., Middlestadt, S., Vandevanter, N., Messeri, P., Merzel, C., Bleakley, A., Malotte, C. K., Sionean, C. K., & St. Lawrence, J. S.
Journal titlePsychology, Health and Medicine
Page(s)64-77Some of the highest rates of curable sexually transmitted diseases in the USA are found among adolescents. Routine, comprehensive health care that includes a sexual history may contribute to alleviating this problem. We designed and ran a three-session small-group workshop for adolescents, using local community organizations as intervention sites, with peers (typically 2-3 years older) helping facilitate the interactive sessions. Outcomes are summarized elsewhere: in this paper, we present an examination of theoretically based psychological mediating factors that we sought to influence during the intervention, Adolescents' health care-seeking beliefs, general attitudes to seeking care, and intentions to do so all changed such that they held more positive beliefs, evaluated health care more favorably, and developed stronger intentions to seek care. Furthermore, relationships among these constructs were strengthened according to theoretical precepts. Adolescents' self-efficacy and their perceptions of social norms pertaining to health care-seeking, however, were unaffected by the intervention. We explored gender differences in mediating factors, finding no interaction, although females did score higher on post-intervention attitude and intention measures.
Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visitsMerzel, C. R., Vandevanter, N. L., Middlestadt, S., Bleakley, A., Ledsky, R., & Messeri, P. A.
Journal titleJournal of Adolescent Health
Page(s)108-115Purpose To examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits. Methods A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression. Results Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing. Conclusions Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues.
Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinicsMalotte, C. K., Ledsky, R., Hogben, M., Larro, M., Middlestadt, S., St. Lawrence, J. S., Olthoff, G., Settlage, R. H., Van Devanter, N. L., Paxton, K., Smith, L. V., Davis, R., Richwald, G. A., Penniman, T. V., Gaines, J., Merzel, C., Messeri, P., Bleakley, A., Weifuse, I., Cohall, A., Blank, S., Cohall, R. M., Levine, D., Peake, M., Zenilman, J., VanBlerk, G., Ukairo, C., Gift, T. L., & Pequegnat, W.
Journal titleSexually Transmitted Diseases
Page(s)637-642Background: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended. Goal: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea. Study: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1,5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder. Results: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0). Conclusions: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.
Computer Access and Internet Use among Urban YouthsBleakley, A., Merzel, C. R., VanDevanter, N. L., & Messeri, P.
Journal titleAmerican Journal of Public Health
Page(s)744-746This report presents data on computer access, Internet use, and factors associated with health information seeking on the Internet among a sample of youths aged 15 to 30 years in New York City. Findings from street intercept surveys indicate substantial computer access at home (62%) and frequent (everyday or a few times a week) Internet use (66%). Fifty-five percent of the sample reported seeking health information on the Internet, which was associated with positive beliefs about getting a health checkup and frequent Internet use.
On reconsidering community-based health promotion  (multiple letters)Kuller, L. H., & Merzel, C. R.
Journal titleAmerican Journal of Public Health
Reconsidering community-based health promotion: Promise, performance, and potentialMerzel, C., & D’Afflitti, J.
Journal titleAmerican Journal of Public Health
Page(s)557-574Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.
Access to health services in an urban community: Does source of care make a difference?Merzel, C., & Moon-Howard, J.
Journal titleJournal of Urban Health
Page(s)186-199The importance of having a usual source of medical care is well established. Few studies, however, examine whether there are differences in health care utilization associated with the type of site used and whether having a primary clinician is more important than site in influencing utilization. The aim of this study was to examine these issues and assess the relative importance of usual source of care characteristics in determining access to a variety of health services. The study was based on a cross-sectional survey of a household probability sample of 695 adults from Central Harlem in New York City. Outcomes examined included use of hospitals as the regular source of care compared with other types of providers, having a usual clinician, receipt of various preventive health services, and illness-related utilization. Multiple logistic regression analysis indicated that men and people of lower socioeconomic status were significantly (P ≤ .05) more likely to rely on hospitals alone as the usual source of care. People who exclusively used hospitals for ambulatory services were 72% less likely to have a primary clinician compared with those using other types of medical care sources. Having a usual source of care of any type was a significant predictor of receipt of five of eight health care services examined; having a main clinician was associated with four of the services. However, type of site used was unrelated to utilization. The impact of having a usual source of care appears to be independent of the effect of having a primary clinical provider, suggesting that having an initial portal into the health care system is as important as possessing an ongoing relationship with a clinician in ensuring access to services. Socioeconomic factors remain important influences on gaining entry into the health care system.
Effect of an STD/HIV behavioral intervention on women's use of the female condomVan Devanter, N., Gonzales, V., Merzel, C., Parikh, N. S., Celantano, D., & Greenberg, J.
Journal titleAmerican Journal of Public Health
Page(s)109-115Objectives. This study assessed the effectiveness of a sexually transmitted disease (STD)/HIV behavior change intervention in increasing women's use of the female condom. Methods. A total of 604 women at high risk for STDs and HIV in New York City, Baltimore, Md, and Seattle, Wash, enrolled in a randomized controlled trial of a small-group, skills-training intervention that included information and skills training in the use of the female condom. Results. In a logistic regression, the strongest predictors of use were exposure to the intervention (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.8, 10.7), intention to use the female condom in the future (OR= 4.5; 95% CI = 2.4, 8.5), having asked a partner to use a condom in the past 30 days (OR= 2.3; 95% CI = 1.3, 3.9), and confidence in asking a partner to use a condom (OR = 1.9; 95% CI= 1.1, 3.5). Conclusions. Clinicians counseling women in the use of the female condom need to provide information, demonstrate its correct use with their clients, and provide an opportunity for their clients to practice skills themselves.
Tailoring interventions to the local context and working with community partners: Lessons learned from a multi-site, multi-component intervention studyMiddlestadt, S. E., St. Lawrence, J., Merzel, C., Hogben, M., & Bleakley, A.
Journal titleSocial Marketing Quarterly
Gender differences in health care access indicators in an urban, low- income communityMerzel, C.
Journal titleAmerican Journal of Public Health
Page(s)909-916Objectives. This study examined factors associated with gender differences in health insurance coverage and having a usual source of medical care. Methods. In-person interviews were conducted with a community sample of 695 residents of Central Harlem, New York City. Predictors of the 2 outcome variables and the interaction of key variables with gender were analyzed via logistic regression. Results. No strong patterns emerged to explain gender differentials in having insurance coverage and having a usual provider. However, women employed full time had increased odds of insurance coverage, whereas employment had no similar effect among men. Public assistance evidenced a strong relationship with insurance coverage among both men and women. Socioeconomic factors and health insurance were important independent predictors of having a usual source of health care for men but had little effect among women. Conclusions. Expanding the availability of both public insurance and affordable private coverage for men living in low-income communities is an important means of reducing gender disparities in access to health care. Public assistance is an important means of enabling access to health care for men as well as women.
The adolescent years: An academic-community partnership in Harlem comes of age.Northridge, M. E., Vallone, D., Merzel, C., Greene, D., Shepard, P., Cohall, A. T., & Healton, C. G.
Journal titleJournal of Public Health Management and Practice
Page(s)53-60Much has been written about the potential benefits in health promotion that are possible through partnerships between academic institutions and community-based organizations, but little practical advice has been provided on how to sustain these relationships when the original grant funds have been exhausted. Here we document our experiences in Harlem, New York City, a community with grave social, structural, and physical environmental inequities, and describe the successes and failings of a partnership now in its "adolescence" between researchers at the Joseph L. Mailman School of Public Health of Columbia University and community activists at West Harlem Environmental Action (WE ACT).
Factors influencing participation in weekly support groups among women completing an HIV/STD intervention programVandevanter, N., Parikh, N. S., Cohall, R. M., Merzel, C., Faber, N., Litwak, E., Gonzales, V., Kahn-Krieger, S., Messeri, P., Weinberg, G., & Greenberg, J.
Journal titleWomen and Health
Page(s)15-34Over the past three decades, the influence and importance of social support has been well documented and the findings have suggested a beneficial effect on stress-related situations, mental and physical health, and social functioning. More recently, small group/skills training behavioral interventions have demonstrated success in changing behaviors which affect the transmission of sexually transmitted diseases, including HIV among populations at risk for these diseases. Studies of support groups to date have been conducted exclusively in research settings where women are offered financial incentives for participation. Little is known about the willingness of women to participate in ongoing support groups after successfully completing a skills training intervention. The present study examines the factors that may influence participation among women in a weekly support group after completing a structured, six session HIV/ STD intervention. Both quantitative and qualitative data are collected from 265 women in the intervention arm of a multi-site randomized controlled behavioral intervention trial. Results reveal that less than a quarter (22%) of women participated in at least one support group. Participation varied significantly by site, ranging from 34% to 15% (p = .008). Participation was also strongly linked to recent use of domestic violence services. Qualitative data indicated that although monetary incentives play some role in the woman's decision to participate, other factors are also important. These include program outreach, support group size, salience of the group content, consistency of group leadership from the intervention to the support group, and use of peer leaders along with professional facilitators. Implications for design of post-intervention support groups programs are discussed.
The diffusion of innovation in AIDS treatment: Zidovudine use in two New Jersey cohortsCrystal, S., Sambamoorthi, U., & Merzel, C.
Journal titleHealth Services Research
Page(s)593-614Objective. This study investigates patterns of utilization of zidovudine (ZDV) by gender, race, risk group, and other respondent characteristics following approval of this treatment. Study Population. Longitudinal observational data were used on a demographically diverse population participating in New Jersey's Medicaid waiver program for persons with symptomatic HIV disease. Data Extraction Methods. Claims data were merged with administrative data on demographic characteristics, risk group, and functional status. Periods of ZDV utilization were determined by analysis of pharmacy claims. Design. The proportion of respondents ever using ZDV (treatment incidence) and the proportion of time on ZDV among users (treatment persistence) were analyzed for a cohort enrolling in 1987 and 1988, and for a cohort enrolling in 1989 and 1990, with follow-up of utilization through August 1992. For each cohort, bivariate analyses were used to compare incidence and persistence by patient subgroup; logistic regression was used to investigate the predictors of incidence in a multivariate model; and OLS regression was used to analyze proportion of time on ZDV among those with any ZDV use. Principal Findings. For the 1987-1988 cohort, substantial race, gender, and risk group differences in utilization were observed, even though all participants in this Medicaid population had financial coverage for ZDV treatment. Treatment incidence was significantly lower for blacks than for others in bivariate comparison (45 percent versus 63 percent had any use of ZDV) and in a logistic regression controlling for a variety of demographic and health status indicators (relative risk .46, CI .31 to .69). Treatment persistence differences were also substantial in the 1987-1988 cohort: among ZDV users, women, blacks, and injection drug users (IDUs) had significantly less persistence in use, and the gender and risk group differences were significant in a multivariate model. In the 1989-1990 cohort, however, both incidence and persistence of treatment converged: no significant differences were observed across demographic groups. Conclusions. Less-advantaged subgroups lagged in access to this new therapy, suggesting the presence of nonfinancial barriers to care. However, these initial differences subsequently converged. Relevance/Impact. Socioeconomic differences have been observed in access to newly introduced treatments for a variety of diseases, reflecting nonfinancial as well as financial barriers to care. Such differences may or may not disappear as use of therapies becomes institutionalized. Monitoring patterns of treatment initiation as well as persistence of treatment over time, using merged data from claims and administrative files, can provide important information on the diffusion of treatments and the extent to which initial disparities are or are not reduced over time.