Joyce Moon Howard
Joyce Moon Howard
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Clinical Associate Professor of Social and Behavioral Sciences, Community Health Science and Practice
Interim Director of Community Health Science and Practice
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Professional overview
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Dr. Joyce Moon Howard’s work and career is rooted in the community healthcare movement, where she witnessed the transformative power and positive impact of neighborhood and community action on healthcare.
Through community-based participatory research (CBPR), she facilitates cooperation between researchers and community members to understand community needs and concerns, create lasting bonds that build trust, and empower communities to take action. While working in rural Tanzania on needs assessment, she engaged community members and employed qualitative strategies, such as photovoice (a research technique where community members photograph scenes to describe a particular problem and/or research theme) and focus groups, to create a space for open dialogue among community members and researchers to effectively address health needs. Further, she has served as Principal Investigator in several research studies: a Health Resources and Services Administration study on eliminating disparities among pregnant women in low-income areas in New York City; a National Institute of Child Health and Infant Development study focusing on HIV/AIDS prevention strategies in African American communities; and an National Institute on Aging study examining facilitators and barriers to CBPR at the Columbia University Medical Center.
As a professor, Dr. Moon Howard shares her research experiences with students in Community Assessment and Evaluation courses and in an undergraduate course, Health, Society, and the Global Context.
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Education
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BA, University of California at Berkeley, Berkeley, CAMPH, Columbia University, New York, NYDrPH, Columbia University, New York, NY
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Areas of research and study
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Community EngagementCommunity HealthCommunity-based Participatory ResearchQualitative Research
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Publications
Publications
A balancing act : The tension between case-finding and primary prevention strategies in New York State's voluntary HIV counseling and testing program in women's health care settings
AbstractMoon Howard, J., Healton, C., Howard, J., Messeri, P., Sorin, M. D., Abramson, D., & Bayer, R. (n.d.).Publication year
1996Journal title
American journal of preventive medicineVolume
12Issue
4 SUPPL.Page(s)
53-60AbstractThis study sought (1) to identify factors that influence women's willingness to accept voluntary HIV counseling and testing at New York State Family Planning Programs (FPPs) and Prenatal Care Assistance Programs (PCAPs) and (2) to evaluate the effectiveness of such a voluntary counseling and testing program. Telephone interviews elicited organizational-level data from 136 agencies; a combination of telephone and face-to-face interviews was used to gather provider data from 98 HIV counselors; and client data were gathered from 354 women in face-to-face interviews at counseling sites. Slightly fewer than 60% of women agreed to be counseled, and, of those, under half consented to an HIV test at the counseling site. Approximately two thirds of the women who were tested returned for their results and posttest counseling. Clients' recall of pretest counseling content was relatively poor. Bivariate and regression analyses suggest that client, provider, and organizational factors are all associated with rates of pretest counseling and testing. The current voluntary counseling and testing program is achieving only moderate success. Although a substantial number of clients accept HIV counseling, many women remain reluctant to consent to HIV testing, and many who accept testing do not return for their results. Moreover, among those who receive pretest counseling, many do not recall important informational content, which suggests variation may exist in the quality of counseling or that one-time HIV counseling interventions are insufficient to communicate complex information. Medical Subject Headings (MeH): AIDS, HIV serodiagnosis, women's health, patient education.A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh
AbstractMoon Howard, J., George, C. M., Van Geen, A., Slavkovich, V., Singha, A., Levy, D., Islam, T., Ahmed, K. M., Moon-Howard, J., Tarozzi, A., Liu, X., Factor-Litvak, P., & Graziano, J. (n.d.).Publication year
2012Journal title
Environmental Health: A Global Access Science SourceVolume
11Issue
1AbstractObjective. To reduce arsenic (As) exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs) testing and provide As education compared to sending representatives from outside communities to conduct these tasks. Methods. We conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks. Results: Overall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50g/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source. Switching was more common in the outside-tester (63%) versus community-tester villages (44%). However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77). At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased. Conclusion: The overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost approach to reduce As exposure in many As-affected areas of Bangladesh.A Community Services Program Case Management for HIV Clients: An Analysis of its Function, Cost and Effectiveness
AbstractMoon Howard, J., Moon-Howard, J., Messeri, P., Glied, S., & Kennedy, G. (n.d.).Publication year
1993Abstract~A Dental Needs Assessment of NY City Head Start Children: Report to US Public Health Service.
AbstractMoon Howard, J., Moon-Howard, J., & Josey, L. E. (n.d.).Publication year
1989Abstract~A New York State Community Services Programs: Past Accomplishments and Future Directions
AbstractMoon Howard, J., Moon-Howard, J., Healton, C., Messeri, P., & Jefferson, L. (n.d.).Publication year
1992Abstract~A Pipeline to Increase Public Health Diversity : Describing the Academic Enrichment Components of the Summer Public Health Scholars Program
AbstractJoyner, D. M., Faris, E., Hernández, D., Moon Howard, J., Fullilove, R. E., Cohn, E. G., Odlum, M., Mitchell, D., & Hutcherson, H. (n.d.).Publication year
2021Journal title
Pedagogy in Health PromotionVolume
7Issue
1_supplPage(s)
44S-50SAbstractA public health workforce that reflects the increasing diversity of the U.S. population is critical for health promotion and to eliminate persistent health disparities. Academic institutions must provide appropriate education and training to increase diversity in public health professions to improve efforts to provide culturally competent care and programs in the most vulnerable communities. Reaching into the existing talent pool of diverse candidates at the undergraduate level is a promising avenue for building a pipeline to advanced training and professional careers in the field of public health. The Summer Public Health Scholars Program (SPHSP) at the Columbia University Irving Medical Center (CUIMC) is a 10-week summer internship program with a mission to increase knowledge and interest in public health and biomedical sciences. Funded by the Centers for Disease Control and Prevention’s (CDC) Undergraduate Public Health Summer Programs, sponsored by the CDC’s Office of Minority Health and Health Equity, SPHSP aims to pipeline underrepresented students into public health graduate programs and careers by providing mentorship, academic enrichment, professional development, and field-based placements. The SPHSP is uniquely positioned to offer scholars a program that exposes them to core public health training components through the joint effort of all four CUIMC schools: public health, dentistry, nursing, and medicine. Here, we describe the program’s academic enrichment components, which provide advanced and multifaceted public health training opportunities. We discuss the impacts of the program on student outcomes and lessons learned in developing and refining the program model.A stroke preparedness RCT in a multi-ethnic cohort : Design and methods
AbstractMoon Howard, J., Boden-Albala, B. M., Stillman, J., Perez, T., Evensen, L., Moats, H., Wright, C., Moon-Howard, J., Doyle, M., & Paik, M. C. (n.d.).Publication year
2010Journal title
Contemporary Clinical TrialsVolume
31Issue
3Page(s)
235-241AbstractBackground: Tissue plasminogen activator (tPA), the only approved treatment for acute ischemic stroke (IS), is significantly underutilized likely due to poor lay information about stroke as an emergency. In order to improve outcomes in acute IS, it is critical to raise awareness and recognition of stroke symptoms particularly among minority populations. This manuscript describes the application of a stroke preparedness behavioral intervention and includes baseline information in a multi-ethnic population of stroke and transient ischemic attack (TIA) survivors. Methods: In the Stroke Warning Information and Faster Treatment Study (SWIFT), we prospectively identified, and randomized IS and TIA patients to determine efficacy of a culturally tailored interactive stroke preparedness strategy. Data collected at baseline included acute stroke parameters, stroke knowledge, severity, social resources and vascular risk assessment. Results: Of the 736 enrolled to date, 76% were IS and 24% TIA events. The cohort was 51% female: 45% Hispanic, 26% White and 25% Black. Over 75% reported hypertension, 36% diabetes, and 16% cardiac disease. Mean time from onset to emergency department (ED) arrival was 46 h (median 13 h) differing significantly between Whites (mean 52 h, median 11 h) and Blacks (mean 52 h, median 17 h) versus Hispanics (mean 39 h, median 11 h). Knowledge that a stroke occurs in the brain differed significantly by between Whites (85%), Blacks (64%), Hispanics (66%, p < 0.000). Conclusions: Disparities remain in both action and knowledge surrounding acute stroke. Use of written information has not proven an effective means of changing health behaviors. We propose an interactive culturally tailored intervention to address behavioral change in acute stroke.A Systematic Approach to the Clinical Management of Dental Services : A Program Training Manual
AbstractMoon Howard, J., Moon-Howard, J., Svarchergs, J., Demby, N., & Josey, L. E. (n.d.).Publication year
1985Abstract~Access to health services in an urban community : Does source of care make a difference?
AbstractMoon Howard, J., Merzel, C., & Moon-Howard, J. (n.d.).Publication year
2002Journal title
Journal of Urban HealthVolume
79Issue
2Page(s)
186-199AbstractThe 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.African American women and smoking : Starting later
AbstractMoon Howard, J., & Moon-Howard, J. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
3Page(s)
418-420AbstractIt is commonly accepted that adolescence is the period for initiation into smoking and other tobacco use behaviors. However, evidence is increasing that the set of presumptions about adolescent onset of tobacco use may not be true for all cultural or sub-population groups. Secondary analysis of data from the 2000 National Health Interview Survey (NHIS) was used to examine ethnic differences in smoking patterns among African American and White women. Results showed a striking racial/ ethnic difference in age of onset; African American women initiate smoking later than White women at each age group. Prevention interventions need to continue beyond adolescence well into the adult years, especially for African American women. Late onset for these women represents an often missed window of opportunity for prevention.An HIV Counseling and Testing in New York State Family Planning and Prenatal Care Assistance Programs
AbstractMoon Howard, J., Healton, C., Moon-Howard, J., Abramson, D., & Bayer, R. (n.d.).Publication year
1993Abstract~Approaches to Increase Arsenic Awareness in Bangladesh : An Evaluation of an Arsenic Education Program
AbstractMoon Howard, J., George, C. M., Factor-Litvak, P., Khan, K., Islam, T., Singha, A., Moon-Howard, J., van Geen, A., & Graziano, J. H. (n.d.).Publication year
2013Journal title
Health Education and BehaviorVolume
40Issue
3Page(s)
331-338AbstractThe objective of this study was to design and evaluate a household-level arsenic education and well water arsenic testing intervention to increase arsenic awareness in Bangladesh. The authors randomly selected 1,000 study respondents located in 20 villages in Singair, Bangladesh. The main outcome was the change in knowledge of arsenic from baseline to follow-up 4 to 6 months after the household received the intervention. This was assessed through a pre- and postintervention quiz concerning knowledge of arsenic. Respondents were between 18 and 102 years of age, with an average age of 37 years; 99.9% were female. The knowledge of arsenic quiz scores for study participants were significantly higher at follow-up compared with baseline. The intervention was effective in increasing awareness of the safe uses of arsenic-contaminated water and dispelling the misconception that boiling water removes arsenic. At follow-up, nearly all respondents were able to correctly identify the meaning of a red (contaminated) and green (arsenic safe) well relative to arsenic (99%). The educational program also significantly increased the proportion of respondents who were able to correctly identify the health implications of arsenic exposure. However, the intervention was not effective in dispelling the misconceptions in the population that arsenicosis is contagious and that illnesses such as cholera, diarrhea, and vomiting could be caused by arsenic. Further research is needed to develop effective communication strategies to dispel these misconceptions. This study demonstrates that a household-level arsenic educational program can be used to significantly increase arsenic awareness in Bangladesh.Assessing the Public's Health
AbstractMoon Howard, J., Younger, D. S., & Moon-Howard, J. (n.d.).Publication year
2016Journal title
Neurologic ClinicsVolume
34Issue
4Page(s)
1057-1070AbstractMetrics are an important part of the assessment of public health. They include traditional measures of mortality and newly described summary measures to describe the disability engendered by diseases. Epidemiology has transformed the understanding of risk factors for disease; however, a holistic approach includes recognition of social determinants and the neighborhood and communities where the people most at risk reside.Building a Dental Constituency : a Survival Strategy for Public Health Dentistry
AbstractMoon Howard, J., Jorey, L. E., & Howard, J. M. (n.d.).Publication year
1983Journal title
Journal of public health dentistryVolume
43Issue
4Page(s)
313-316Abstract~Building the Capacity of Faith Organizations to Address HIV/AIDS in Five African Nations : A Three-Pronged, Multi-Tiered Approach
AbstractMoon Howard, J., Moon-Howard, J., Steele, P., Mugarura, E., Belton, E., Brown, V., Karugu, N., Perry, T., & Bashir, A. (n.d.).Publication year
2004Page(s)
137Abstract~Community Services Program: Seven Years of Community Response to AIDS
AbstractMoon Howard, J., Healton, C., Messeri, P., Moon-Howard, J., & Nsiah-Jefferson, L. (n.d.).Publication year
1990Abstract~Computer use, internet access, and online health searching among Harlem adults
AbstractMoon Howard, J., Cohall, A. T., Nye, A., Moon-Howard, J., Kukafka, R., Dye, B., Vaughan, R. D., & Northridge, M. E. (n.d.).Publication year
2011Journal title
American Journal of Health PromotionVolume
25Issue
5Page(s)
325-333AbstractPurpose. Computer use, Internet access, and online searching for health information were assessed toward enhancing Internet use for health promotion. Design. Cross-sectional random digit dial landline phone survey. Setting. Eight zip codes that comprised Central Harlem/Hamilton Heights and East Harlem in New York City. Subjects. Adults 18 years and older (N = 646). Measures. Demographic characteristics, computer use, Internet access, and online searching for health information. Analysis. Frequencies for categorical variables and means and standard deviations for continuous variables were calculated and compared with analogous findings reported in national surveys from similar time periods. Results. Among Harlem adults, ever computer use and current Internet use were 77% and 52%, respectively. High-speed home Internet connections were somewhat lower for Harlem adults than for U.S. adults overall (43% vs. 68%). Current Internet users in Harlem were more likely to be younger, white vs. black or Hispanic, better educated, and in better self-reported health than non-current users (p < .01). Of those who reported searching online for health information, 74% sought information on medical problems and thought that information found on the Internet affected the way they eat (47%) or exercise (44%). Conclusions. Many Harlem adults currently use the Internet to search for health information. High-speed connections and culturally relevant materials may facilitate health information searching for underserved groups.Cultural competency training for public health students : Integrating self, social, and global awareness into a master of public health curriculum
AbstractMoon Howard, J., Cushman, L. F., Delva, M., Franks, C. L., Jimenez-Bautista, A., Moon-Howard, J., Glover, J., & Begg, M. D. (n.d.).Publication year
2015Journal title
American journal of public healthVolume
105Page(s)
S132-S140AbstractCultural competency training in public health, medicine, social work, nursing, dental medicine, and other health professions has been a topic of increasing interest and significance. Despite the now burgeoning literature that describes specific knowledge, attitudes, and skills that promote cultural "competence," fully defining this complex, multidimensional term and implementing activities to enhance it remain a challenge. We describe our experiences in introducing a mandatory, full-day workshop to incoming Master of Public Health students, called "Self, Social, and Global Awareness: Personal Capacity Building for Professional Education and Practice." The purpose of the program is to provide a meaningful, structured environment to explore issues of culture, power, privilege, and social justice, emphasizing the centrality of these issues in effective public health education and practice.Developing a collaborative community, academic, health department partnership for std prevention : The gonorrhea community action project in harlem
AbstractMoon Howard, J., VanDevanter, N., Hennessy, M., Howard, J. M., Bleakley, A., Peake, M., Millet, S., Cohall, A., Levine, D., Weisfuse, I., & Fullilove, R. (n.d.).Publication year
2002Journal title
Journal of Public Health Management and PracticeVolume
8Issue
6Page(s)
62-68AbstractCommunity interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating communities. Key to conducting the formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.Electronic cigarette advertising at the point-of-sale : A gap in tobacco control research
AbstractMoon Howard, J., Ganz, O., Cantrell, J., Moon-Howard, J., Aidala, A., Kirchner, T. R., & Vallone, D. (n.d.).Publication year
2015Journal title
Tobacco controlVolume
24Issue
E1Page(s)
e110-e112Abstract~Emergency response and public health in Hurricane Katrina : What does it mean to be a public health emergency responder?
AbstractMoon Howard, J., Van Devanter, N. L., Leviss, P., Abramson, D., Howard, J. M., & Honoré, P. A. (n.d.).Publication year
2010Journal title
Journal of Public Health Management and PracticeVolume
16Issue
6Page(s)
E16-E25AbstractSince 9/11, federal funds directed toward public health departments for training in disaster preparedness have dramatically increased, resulting in changing expectations of public health workers' roles in emergency response. This article explores the public health emergency responder role through data collected as part of an oral history conducted with the 3 health departments that responded to Hurricane Katrina in Mississippi and Louisiana. The data reveals a significant change in public health emergency response capacity as a result of federal funding. The role is still evolving, and many challenges remain, in particular, a clear articulation of the public health role in emergency response, the integration of the public health and emergency responder cultures, identification of the scope of training needs and strategies to maintain new public health emergency response skills, and closer collaboration with emergency response agencies.Experiences of Public health workers in responding to Hurricane Katrina : Voices from the storm
AbstractMoon Howard, J., Moon-Howard, J., VanDevanter, N., Abramson, D., Leviss, P., & Honoré, P. A. (n.d.).Publication year
2010Journal title
Journal of Public Health Management and PracticeAbstract~HIV-1 seroprevalence and risk behaviors in an urban African-American community cohort
AbstractMoon Howard, J., Brunswick, A. F., Aidala, A., Dobkin, J., Howard, J., Titus, S. P., & Banaszak-Holl, J. (n.d.).Publication year
1993Journal title
American journal of public healthVolume
83Issue
10Page(s)
1390-1394AbstractObjectives. Previous attempts at obtaining population estimates of human immunodeficiency virus type 1 (HIV-1) seroprevalence have been beset by problems of cooperation bias. As part of the fourth round of study with an urban African-American community cohort, the following investigation was aimed at assessing HIV-1 prevalence and the relative importance of sex and drug injection as risk factors in infection. Methods. Personal interviews were conducted in the home with 364 respondents, followed by voluntary blood sample collection from 287 of these individuals. Results. Blood assays showed a point prevalence of 8.4% HIV-1 seropositivity in this community cross section, with a higher female-to-male ratio than appears among acquired immunodeficiency syndrome (AIDS) case reports. Most infected persons were unaware and unsuspecting of their infection. Conclusions. First, findings underscore the need to focus on risk behaviors rather than on risk groups. Second, the smaller than 2:1 ratio of infected men to women suggests that current AIDS case reports seriously underestimate HIV-1 infection among certain cohorts of African-American women. Finally, wide spread ignorance of own infected status and inaccurate risk assessment signal the substantial task for community health educators in reaching inner-city African-American men and women at risk.HIV-positive men sexually active with women : Sexual behaviors and sexual risks
AbstractMoon Howard, J., Aidala, A. A., Lee, G., Howard, J. M., Caban, M., Abramson, D., & Messeri, P. (n.d.).Publication year
2006Journal title
Journal of Urban HealthVolume
83Issue
4Page(s)
637-655AbstractThis study examines patterns of sexual behavior, sexual relating, and sexual risk among HIV-positive men sexually active with women. A total of 278 HIV-positive men were interviewed every 6-12 months between 1994 and 2002 and reported considerable variability in sexual behaviors over time. Many were not sexually active at all for months at a time; many continued to have multiple female and at times male partners. Over one-third of the cohort had one or more periods when they had engaged in unprotected sex with a female partner who was HIV-negative or status unknown (unsafe sex). Periods of unsafe sex alternated with periods of safer sex. Contextual factors such as partner relations, housing status, active drug use, and recently exchanging sex showed the strongest association with increased odds of unsafe sex. A number of predictors of unsafe sex among African American men were not significant among the Latino sub-population, suggesting race/ethnic differences in factors contributing to heterosexual transmission. Implications for prevention interventions are discussed.Identifying women at-risk for smoking resumption after pregnancy
AbstractMoon Howard, J., Merzel, C., English, K., & Moon-Howard, J. (n.d.).Publication year
2010Journal title
Maternal and Child Health JournalVolume
14Issue
4Page(s)
600-611AbstractWhile 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.