Nina S Parikh
Clinical Associate Professor of Social and Behavioral Sciences
Dr. Nina S. Parikh has years of public health research experience, methodological expertise, and academic training in health services research and medical sociology. A continuing theme of Dr. Parikh’s research involves the examination of social, psychosocial, and cultural factors related to the health needs of ethnic-racial populations and developing evidence-based strategies that address and mitigate health inequities for these and other underserved groups, in particular immigrants, the uninsured, those with inadequate health literacy, and the elderly.
At NYU GPH, Dr. Parikh collaborates with scholars examining the social determinants of health, particularly social network mechanisms and how they relate to primary and secondary prevention of vascular diseases. This work builds on her previous research experience that has been community-based, grant-funded studies in partnership with local agencies and organizations that explore the well-being of older adults and their families, including social cohesion/social support, access to and utilization of health care services of immigrant populations, health disparities, community-based palliative care for chronically ill elders, and the promotion of healthy aging with a particular emphasis on developing and implementing behavioral strategies to combat some of the most prevalent chronic conditions for this group. In addition, Dr. Parikh developed and teaches the two-semester thesis course to MPH candidates.
Prior to coming to NYU, Dr. Parikh served as the Director of Research (Interim) at the Brookdale Center for Healthy Aging of Hunter College where she provided oversight and guidance on all research and evaluation studies conducted by the Center. Her work has received grant support from the Robert Wood Johnson Foundation, the Commonwealth Fund, Agency for Healthcare Research and Quality, and the NYC Department for the Aging.
BS, Biology and minor in Sociology, John Carroll University, Cleveland, OHMPH, Health Policy and Management, Emory University, Atlanta, GAPhD, Sociomedical Sciences, Columbia University, New York, NY
Aging and the Life CourseCultural Determinants of HealthImmigrationRacial/Ethnic DisparitiesSocial Determinants of Health
Positive health beliefs and blood pressure reduction in the deserve studyGoldmann, E., Jacoby, R., Finfer, E., Appleton, N., Parikh, N. S., Roberts, E. T., & Boden-Albala, B.
Journal titleJournal of the American Heart Association
Issue9AbstractBACKGROUND: There is growing recognition that positive health beliefs may promote blood pressure (BP) reduction, which is critical to stroke prevention but remains a persistent challenge. Yet, studies that examine the association between positive health beliefs and BP among stroke survivors are lacking. METHODS AND RESULTS: Data came from the DESERVE (Discharge Educational Strategies for Reduction of Vascular Events) study, a randomized controlled trial of a skills-based behavioral intervention to reduce vascular risk in a multiethnic cohort of 552 transient ischemic attack and mild/moderate stroke patients in New York City. The exposure was perception that people can protect themselves from having a stroke (ie, prevention self-efficacy) at baseline. The association between systolic BP (SBP) reduction at 12-month follow-up and self-efficacy was examined using linear regression adjusted for key confounders, overall and stratified by age, sex, race/ethnicity, and intervention trial arm. Approximately three quarters endorsed self-efficacy. These participants had, on average, 5.6 mm Hg greater SBP reduction compared with those who did not endorse it (95% CI, 0.5–10.7 mm Hg; P=0.032). Self-efficacy was significantly associated with greater SBP reduction, particularly among female versus male, younger versus older, and Hispanic versus non-Hispanic white patients. Sensitivity analysis adjusting for baseline SBP instead of elevated BP yielded no association between self-efficacy and SBP reduction, but showed sex differences in this association (women: β=5.3; 95% CI, −0.2 to 10.8; P=0.057; men: β=−3.3; 95% CI, −9.4 to 2.9; P=0.300; interaction P=0.064). CONCLUSIONS: Self-efficacy was linked with greater SBP reduction among female stroke survivors. Targeted strategies to improve health beliefs after stroke may be important for risk factor management.
Assessing the palliative care needs and service use of diverse older adults in an urban medically-underserved communityGardner, D. S., Parikh, N. S., Villanueva, C. H., Ghesquiere, A., Kenien, C., Callahan, J., & Reid, M. C.
Journal titleAnnals of Palliative Medicine
Page(s)769-774AbstractAlthough palliative care (PC) has become increasingly familiar, considerable gaps persist in access to and use of services. Community-based programs remain rare, and low-income, minority communities significantly under-utilize hospice and palliative services. We used community-based participatory research (CBPR) methods to conduct a mixed-methods community needs assessment of seriously-ill older adults (n=100) and providers from community-based programs and churches (n=41) in an urban medically-underserved community in the U.S. to explore: (I) the prevalence and severity of illness-related symptoms and psychosocial-spiritual concerns; (II) the scope and quality of community supports helping older adults manage their symptoms; and (III) the perceptions and utilization of palliative and supportive care services among older adults and community-based service providers. Participants reported high rates of chronic illness-related symptoms (i.e., pain, fatigue, sleeping difficulties, depression, and anxiety), and many described unmet needs around symptom management. Few had ever utilized PC or pain management services, and most relied primarily on family, friends, and faith communities to help them manage burdensome symptoms. Barriers included lack of familiarity with PC, limited access and financial concerns. Older adults were largely unfamiliar with PC, and many described unmet needs and desire for help with symptom burden. Findings support the need to further explore community-level and cultural barriers to PC among diverse, underserved older adults. Development of innovative community partnerships may help raise awareness of PC and address the physical and psychosocial-spiritual challenges facing chronically-ill minority older adults and their families.
Efficacy of a Discharge Educational Strategy vs Standard Discharge Care on Reduction of Vascular Risk in Patients with Stroke and Transient Ischemic Attack: The DESERVE Randomized Clinical TrialBoden-Albala, B., Goldmann, E., Parikh, N. S., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeier, J., Parides, M., & Quarles, L.
Journal titleJAMA Neurology
Page(s)20-27AbstractImportance: Despite secondary prevention strategies with proven efficacy, recurrent stroke rates remain high, particularly in racial/ethnic minority populations who are disproportionately affected by stroke. Objective: To determine the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack. Design, Setting, and Participants: Randomized clinical trial with 1-year follow-up. Participants were white, black, and Hispanic patients with mild/moderate stroke/transient ischemic attack prospectively enrolled from 4 New York City, New York, medical centers during hospitalization or emergency department visit between August 2012 and May 2016. Through screening of stroke admissions and emergency department notifications, 1083 eligible patients were identified, of whom 256 declined to participate and 275 were excluded for other reasons. Analyses were intention to treat. Interventions: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention is a skills-based, culturally tailored discharge program with follow-up calls delivered by a community health coordinator. This intervention was developed using a community engagement approach. Main Outcomes and Measures: The primary outcome was systolic blood pressure reduction at 12 months postdischarge. Results: A total of 552 participants were randomized to receive intervention or usual care (281 women [51%]; mean [SD] age, 64.61 [2.9] years; 180 Hispanic [33%], 151 non-Hispanic white [27%], and 183 non-Hispanic black [33%]). At 1-year follow-up, no significant difference in systolic blood pressure reduction was observed between intervention and usual care groups (β = 2.5 mm Hg; 95% CI, -1.9 to 6.9). Although not powered for subgroup analysis, we found that among Hispanic individuals, the intervention arm had a clinically and statically significant 9.9 mm Hg-greater mean systolic blood pressure reduction compared with usual care (95% CI, 1.8-18.0). There were no significant differences between arms among non-Hispanic white (β = 3.3; 95% CI, -4.1 to 10.7) and non-Hispanic black participants (β = -1.6; 95% CI, -10.1 to 6.8). Conclusions and Relevance: Few behavioral intervention studies in individuals who have had stroke have reported clinically meaningful reductions in blood pressure at 12 months, and fewer have focused on a skills-based approach. Results of secondary analyses suggest that culturally tailored, skills-based strategies may be an important alternative to knowledge-focused approaches in achieving sustained vascular risk reduction and addressing racial/ethnic stroke disparities; however, these findings should be tested in future studies. Trial Registration: ClinicalTrials.gov identifier: NCT01836354.
Immigration Status, Visa Types, and Body Weight Among New Immigrants in the United States
The experiences of providing caregiving for patients with schizophrenia in the Ghanaian contextGloria, O., Osafo, J., Goldmann, E., Parikh, N. S., Nonvignon, J., & Kretchy, I. M.
Journal titleArchives of Psychiatric Nursing
Age-related differences in antihypertensive medication adherence in hispanics: A cross-sectional community-based survey in New York City, 2011-2012Bandi, P., Goldmann, E., Parikh, N. S., Farsi, P., & Boden-Albala, B.
Journal titlePreventing Chronic Disease
Issue7AbstractIntroduction US Hispanics, particularly younger adults in this population, have a higher prevalence of uncontrolled hypertension than do people of other racial/ethnic groups. Little is known about the prevalence and predictors of antihypertensive medication adherence, a major determinant of hypertension control and cardiovascular disease, and differences between age groups in this fast-growing population. Methods The cross-sectional study included 1,043 community-dwelling Hispanic adults with hypertension living in 3 northern Manhattan neighborhoods from 2011 through 2012. Age-stratified analyses assessed the prevalence and predictors of high medication adherence (score of 8 on the Morisky Medication Adherence Scale [MMAS-8]) among younger (< 60 y) and older (≥60 y) Hispanic adults. Results Prevalence of high adherence was significantly lower in younger versus older adults (24.5% vs 34.0%, P = .001). In younger adults, heavy alcohol consumption, a longer duration of hypertension, and recent poor physical health were negatively associated with high adherence, but poor self-rated general health was positively associated with high adherence. In older adults, advancing age, higher education level, high knowledge of hypertension control, and private insurance or Medicare versus Medicaid were positively associated with high adherence, whereas recent poor physical health and health-related activity limitations were negatively associated with high adherence. Conclusion Equitable achievement of national hypertension control goals will require attention to suboptimal antihypertensive medication adherence found in this study and other samples of US Hispanics, particularly in younger adults. Age differences in predictors of high adherence highlight the need to tailor efforts to the life stage of people with hypertension.
Barriers and Strategies for Recruitment of Racial and Ethnic Minorities: Perspectives from Neurological Clinical Research Coordinators
Chronic Physical Illness Burden and Suicidal Ideation Among Dominicans in New York CityGoldmann, E., Roberts, E. T., Parikh, N. S., & Boden-Albala, B.
Journal titleJournal of Immigrant and Minority Health
Page(s)616-622AbstractLittle is known about the association between chronic illness and suicidal ideation (SI) among Dominicans living in the United States. This study used data from a community survey of 2753 Dominican adults in New York City. SI included thoughts of self-harm or being better off dead in the past month. Chronic physical illness burden was categorized as having 0, 1, or 2+ diagnosed conditions. Adjusted logistic regressions evaluated the association between number of conditions and SI, overall and stratified by sex and age. Adjusted models yielded a strong association between chronic illness burden and SI among men [odds ratio (OR) 5.57, 95 % confidence interval (CI) 2.19–14.18] but not women (OR 0.80, 95 % CI 0.50–1.29; interaction p = 0.011). The association of interest did not differ significantly between younger and older adults. Screening for SI in health care practice, particularly among Dominican men with multiple chronic health conditions, may be warranted.
Gender, Social Networks, and Stroke Preparedness in the Stroke Warning Information and Faster Treatment StudyMadsen, T. E., Roberts, E. T., Kuczynski, H., Goldmann, E., Parikh, N. S., & Boden-Albala, B.
Journal titleJournal of Stroke and Cerebrovascular Diseases
Page(s)2734-2741AbstractBackground and Purpose The study aimed to investigate the effect of gender on the association between social networks and stroke preparedness as measured by emergency department (ED) arrival within 3 hours of symptom onset. Methods As part of the Stroke Warning Information and Faster Treatment study, baseline data on demographics, social networks, and time to ED arrival were collected from 1193 prospectively enrolled stroke/transient ischemic attack (TIA) patients at Columbia University Medical Center. Logistic regression was conducted with arrival to the ED ≤3 hours as the outcome, social network characteristics as explanatory variables, and gender as a potential effect modifier. Results Men who lived alone or were divorced were significantly less likely to arrive ≤3 hours than men who lived with a spouse (adjusted odds ratio [aOR]:.31, 95% confidence interval [CI]:.15-0.64) or were married (aOR:.45, 95% CI:.23-0.86). Among women, those who lived alone or were divorced had similar odds of arriving ≤3 hours compared with those who lived with a spouse (aOR: 1.25, 95% CI:.63-2.49) or were married (aOR:.73, 95% CI:.4-1.35). Conclusions In patients with stroke/TIA, living with someone or being married improved time to arrival in men only. Behavioral interventions to improve stroke preparedness should incorporate gender differences in how social networks affect arrival times.
Race/ethnic differences in post-stroke depr ession (PSD): Findings from the stroke warning information and faster treatment (SWIFT ) studyGoldmann, E., Roberts, E. T., Parikh, N. S., Lord, A. S., & Boden-Albala, B.
Journal titleEthnicity and Disease
Page(s)1-8AbstractObjectives: Post-stroke depression (PSD) is common and associated with poor stroke outcomes, but few studies have examined race/ethnic disparities in PSD. Given the paucity of work and inconsistent findings in this important area of research, our study aimed to examine race/ethnic differences in depression in a multi-ethnic cohort of stroke patients. Design: Longitudinal. Setting: Prospective trial of a post-stroke educational intervention. Patients or Participants: 1,193 mild/moderate ischemic stroke/transient ischemic attack (TIA) patients. Main Outcome Measures: We used the Center for Epidemiologic Studies Depression (CES-D) Scale to assess subthreshold (CES-D score 8-15) and full (CES-D score ≥ 16) depression at one month ("early") and 12 months ("late") following stroke. Multinomial logistic regression analyses examined the association between race/ethnicity and early and late PSD separately. Results: The prevalence of subthreshold and full PSD was 22.5% and 32.6% in the early period and 22.0% and 27.4% in the late period, respectively. Hispanics had 60% lower odds of early full PSD compared with non-Hispanic Whites after adjusting for other covariates (OR=.4, 95% CI: .2, .8). Race/ ethnicity was not significantly associated with late PSD. Conclusions: Hispanic stroke patients had half the odds of PSD in early period compared with Whites, but no difference was found in the later period. Further studies comparing trajectories of PSD between race/ ethnic groups may further our understanding of race/ethnic disparities in PSD and help identify effective interventions.
Examining Barriers and Practices to Recruitment and Retention in Stroke Clinical Trials
Restaurant management views on the views on the new national menu labeling laws
Mind-body techniques, race-ethnicity, and depression among urban senior center participants
Linking neighborhood characteristics to food insecurity in older adults: The role of perceived safety, social cohesion, and walkability
Racial and Ethnic Diversity in Senior Centers: Comparing Participant Characteristics in More and Less Multicultural SettingsGiunta, N., Morano, C., Parikh, N. S., Friedman, D., Fahs, M. C., & Gallo, W. T.
Journal titleJournal of Gerontological Social Work
Page(s)467-483AbstractThe 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants. Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization. Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics. Implications and future directions for research, practice and policy are discussed.
The association between neighbourhood social cohesion and hypertension management strategies in older adults
The influence of neighborhood factors on the quality of life of older adults attending New York City senior centers: Results from the Health Indicators Project
Ethnic disparities in self-reported oral health status and access to care among older adults in NYC
Body weight and length of residence in the US among Chinese Americans
Health behaviors of older Chinese adults living in New York City
Immigrants and urban planning: Towards a policy frameowrk
Patients' shame and attitudes toward discussing the results of literacy screeningWolf, M. S., Williams, M. V., Parker, R. M., Parikh, N. S., Nowlan, A. W., & Baker, D. W.
Journal titleJournal of Health Communication
Page(s)721-732AbstractWe investigated patients' willingness to have their reading ability documented in their medical records and the degree of shame and embarrassment associated with such disclosure. Structured interviews were conducted among a consecutive sample of 283 primary care patients at an urban public hospital. Patients' literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Self-report of degree of shame and embarrassment related to literacy skills was measured using an orally administered questionnaire. Fifty-one percent of patients had low literacy skills (≤sixth grade) and 27.9% were assessed as having marginal literacy (seventh-eighth grade). Half (47.6%) of patients reading at or below the third-grade level admitted feeling ashamed or embarrassed about their difficulties reading, compared with 19.2% of those reading at the fourth-sixth-grade level and 6.5% of those reading at the seventh-eighth-grade level (p<0.001). More than 90% of patients with low or marginal literacy reported it would be helpful for the doctor or nurse to know they did not understand some medical words. Patients with limited literacy were more likely to report feelings of shame as a result of disclosure (p<0.05). Health care providers must recognize the potential shame patients might experience as a result of literacy screening.
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)109-115AbstractObjectives. 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.
Emergency department use in New York City: a substitute for primary care?
Emergency department use in New York City: a survey of Bronx patients.Billings, J., Parikh, N., & Mijanovich, T.
Journal titleIssue brief (Commonwealth Fund)