Taeko Frost prepares to test a man for Hepatitis C (Photo by Yumna Mohamed)

A middle-aged man hesitantly enters the CORNER Project syringe exchange program’s office on 176th Street and Wadsworth Avenue in Washington Heights.

“How are you doing today?,” asks Taeko Frost, program director at the CORNER Project, who is in charge of hepatitis C testing. “You OK?” She will be testing him for hepatitis C, a chronic disease affecting the liver.

A lot of information is crammed into these close quarters. The walls are plastered with posters and flyers about hepatitis C: testing, treatment and prevention.

The man, who asked for anonymity, takes a seat and rolls up his sleeve. Taeko explains the risks of sharing needles and cotton when using injected drugs with others and emphasizes the importance of a healthy diet and safe sex, regardless of this blood test’s results.

She gently taps his large, muscular arm for a vein, laughing as he jokes about having none left. She fastens a blue elastic band around his arm; he winces as she inserts the needle.

With a government estimate of 4 million Americans infected, viral hepatitis C infections are three to five times more common than HIV, according to a 2010 study by the National Institute of Medicine. The study adds that in the next 10 years, about 150,000 people in the United States will die from liver cancer and end-stage liver disease associated with chronic hepatitis B and hepatitis C.  

And more people are infected with Hepatitis C in New York City than anywhere else in the country, says Dawn Kalmar, spokesperson for Vertex Pharmaceuticals, which makes the Hepatitis C medication INCIVEK. She cites the Hepatitis C Index by the National Minority Quality Forum, an organization that studies health care issues among ethnic communities in the United States, which says 150,000 New Yorkers are infected.

Yet many health workers argue that the disease hasn’t gotten the attention necessary to make people more aware of preventing infection. And since it is symptomless, those  infected can spread the virus without realizing it.

Uptown, health professionals also worry that the disease is rising. “Drug use is increasing in Harlem with the increase in poverty,” says Jeffrey Day, a mental health nurse practitioner at Citicare, a Harlem family health clinic.  “More people are turning to drugs – as both dealers and users – when they give up hope of finding jobs and houses, and they are unaware of how easily they can contract and transmit Hepatitis C.”

Many of the people Frost’s organization helps are homeless and disconnected from health care. The Corner Project guides them through the first three steps of Hepatitis C testing: pre-test counseling and a full blood draw sent to a lab, with results in 48 hours.

If patients test negative, they’re told how to prevent infection by using sterile needles, not sharing cotton or cookers or straws (the disease can also be contracted nasally), avoiding unlicensed tattoo and piercing parlors and practicing safe sex. If patients test positive, they are referred to treatment programs.

But routine physical exams don’t usually test for hepatitis C, Kalmar says.

Vertex recently underwrote a guerilla marketing campaign called the “Find HepC” campaign, which consisted of posters, fliers and volunteers talking to people on the streets across the city; its enigmatic blue and yellow slogans featured a large yellow “C” and the words “4 million have it, 3 million don’t know.”

African-Americans and baby boomers are disproportionately impacted. “One in seven African-Americans over 55 are infected,” according to the National Minority Quality Forum’s report.  And
Americans born between 1945 and 1965 are at risk of infection because they grew up in an era of less emphasis on safe sex and the importance of clean needles when injecting drugs or  getting tattoos.

“Approximately 15 percent of people clear hepatitis C on their own during the first few months of infection without treatment,” said Nihar Johnson, project specialist at the city health department’s Office of Viral Hepatitis. “They ‘cure’ themselves.”

After six months of active infection, a person is considered chronically infected, according to Johnson, who added that people can be treated during the chronic phase.  If the viral load drops to undetectable levels and remains undetectable for six months after medical treatments has stopped, that’s called a ‘cure.’

“Certain types of Hepatitis C are easier to ‘cure’ than others,” Johnson said.  People with HIV, African-Americans, Latinos and those with certain other health problems are less easily cured, she added, but with new medications, the cure rate has risen for everyone.

“However, there are many factors involved in treatment success and every case is different,” Johnson said.

Kalmar added that INCIVEK, approved by the FDA in May, could increase cure rates among black Americans.

Despite the Big Yellow C, there aren’t enough awareness campaigns uptown, to reach the people most at risk of contracting and spreading the disease, Frost says.

“The Department of Health just put out a new TV ad to spread awareness, but our participants are not necessarily watching TV,” she said. “It’s not applicable to our population.”

Frost says the health department needs more staff working with community groups to reach people on the streets, actively seeking out drug users and encouraging them to visit testing centers.

“These people feel isolated and stigmatized,” Frost says. “Even if they think they’re at risk, they might not know where to go.”

The invasive nature of testing and treatment for Hepatitis C, involving medications that may have difficult side effects, also deters people, Frost says.

“We are a small program, and do our best to do outreach in Inwood and Hamilton Heights, as do other small drug treatment programs,” she said. “But it’s about being creative, thinking about who is actually at risk and the best way of reaching them.”

Charlie,  who’s 65, is a frequent visitor to the CORNER Project. Tall even when sitting down, he taps his black cane and recounts the dietary concerns his hepatitis C infection raises. Because of the disease’s harsh effects on the liver, patients have to avoid oily and sugary foods, as well as alcohol.

“See, I’m black and I like my fried chicken,” Charlie chuckles. “But because of the oils, it hurts when I eat it.  So I have to have everything broiled and baked, even though fried chicken tastes damn good.” Since his 2001 diagnosis, Charlie, who asked that his last name not be used, has had to make a lot of changes.

”The counselor taught me a lot about eating healthy,” says Charlie. “He told me that once a month he’d splurge on fried chicken, but mostly he advised us to stay away from it.”

For Charlie, the worst thing about living with the disease has been the medication. The treatment affects his mental state, prompting doctors to prescribe an array of additional drugs to deal with its side effects.

“Six pills a day, two shots a week, and then the sleep medication, eating medication and anxiety medication,” Charlie says with a resigned smile.  “I’m walking around with so much medication. I started a pill factory at one time.”

He has discontinued medication, but says, “I’m looking for new meds, something I’d be really interested in if it’s going to cure me.”

While Frost believes that New York has been a leader in HIV prevention and testing, as well as providing special services for those with HIV, the city has not responded as urgently to Hepatitis C.

“I think most people in New York can tell you what HIV is because there is so much education around it and a great emphasis on testing and services,” she says, pointing to the fact that the people most at risk for hepatitis C are drug users, not always considered a priority for health services.

One improvement would be to introduce rapid testing for Hepatitis C, she says, something that appears more likely since last month when OraQuick became the first rapid test to win FDA approval.

“We have a long way to go but I think rapid testing is very important because we’ll be able to use it on the site where people are,” says Frost. It’s less invasive than a blood test and won’t require refrigeration or laboratories. But will take time for free rapid testing to become broadly available.

For now, Charlie is happy to watch what he eats and avoid alcohol. He eventually hopes to give up his other damaging habits too.

“The more I think about me and my liver, the more I think about how much life I have left,” he muses.

“I’ve been doing drugs for over 30 years and I’m not getting anything from it anymore. So I think it’s best to go back away from it all, and go ahead and live my life the best way I can.”

East Harlem's McDonald's received a C grade by the city's health inspectors (Photo by Lucy Pawle)

Holding a half-eaten Happy Meal in his hand, Mike Serrano, 45, walked out of McDonald’s in East Harlem looking satisfied. He had picked up some fries and a McRib for his daughter, but couldn’t resist buying supper for himself. What he didn’t know was that the restaurant was rated C, the lowest grade the New York City Health Department can give without closing an establishment.

Serrano’s smile swiftly turned to a disgusted expression as he digested the news. He hadn’t noticed the C posted in the window – “They always have posters in the window, it just blends in,” he said. According to the Health Department’s website, this McDonald’s on East 110^th Street was found to have mice and flies at its latest inspection in October.

“I need to pay more attention to these things,” Serrano said.

East Harlem’s restaurants rank the lowest uptown and in Manhattan overall, according to the Health Department’s grades. Its most recent statistics show that in Central and West Harlem, 66 percent of restaurants have an A rating and 1.6 percent a C. In East Harlem, 58.7 percent of food establishments have an A rating, while 3.5 percent have a C.

Introduced just over a year ago, the restaurant grading system has caused controversy. The Health Department insists it helps maintain hygiene standards and forces restaurants to improve their game. But  New York State Restaurants Association Executive Vice President Andrew Rigie disagrees.

“The current system is subjective and very complex, leading to confusion and unfair grading,” he said. “It is a snapshot in time, but the sign hangs in the window for many months.” The association represents 5,000 eateries.

It’s rare to find a C-graded restaurant in East Harlem displaying the sign. Most have “grade pending” signs – which they are legally entitled to display if they’re challenging the decision – or no sign at all.

Bigger and older buildings are more likely to get lower grades because of difficulties in keeping them clean, Rigie said. East Harlem restaurant owners agree.

“I have a large building and it’s very old so there’s more to inspect,” said Erik Mayor, 36, owner of Milk Burger on Third Avenue. “The probability of something being there is much greater, and we also have a lot of pests in the area – just look at the asthma rates.”

At Restaurant Cuchifritos nearby, Maria Testal, 27, was preparing for this weekend’s opening. Her family owns numerous local restaurants and she agreed that the building plays a huge role in hygiene. “The buildings are old and the construction is old which makes it much easier for rats to come,” she said. But with her years of experience, she was confident her place would rate an A, “no problem at all.”

Open for nine months, Milk Burger, until last week, had a “grade pending” sign in its window because Mayor was contesting his C rating. It won an A, but if Mayor hadn’t prevailed, he insisted, his restaurant would have been short-lived. “People just won’t go there,” he said. “It plays a critical role.”

Mayor said he spent a lot of time in court fighting about $1,500 in fines from his C-graded inspection. Both the grade and fines cause immense anxiety, he said, because inspectors keep returning regularly. But he is delighted with his new A, which means inspections will be fewer. “It’s a year that I can conduct my business without having to look over my shoulder,” he said.

Mayor argued that East Harlem was challenging for businesses. “If you can make it in the industry here you can make it anywhere because it’s so brutal here,” he said. Poverty is a big factor, he explained. Employing enough staff and finding hours in the day to focus on health and hygiene can cost money that some restaurateurs feel they can’t afford to lose.

Serrano agreed. “You get what you pay for in East Harlem,” he said. And people don’t want to pay very much. “If people stopped going to restaurants with low grades, then things would change.”

Mayor seems right to be worried. “If I saw a C, I wouldn’t go in and I don’t think anyone else I know would,” said Carlos Baez, 48. But Baez was sitting in McDonald’s and like Serrano, had failed to notice the C-rating sign. “It needs to be more visible,” he said. “You just can’t see it.”

Up Third Avenue on 116^th Street, Adrian Sanchez, manager of Kahlua’s Café, ensures his team works hard to maintain its A grade. “I talk to my people, my workers, and remind them how important it is,” he said. “If we go down to a B we have less customers and less money.”

But even for restaurants graded A, health violations can bring large fines that many will struggle to pay. Sanchez thinks many restaurants will simply close. “The department needs to give us a break because they ask for ridiculous things,” he said. “Business is tough for everyone, so they should be more understanding and not fine us for things like leaving a door open.”

Rigie said that levying additional fines was “unfair and creates unnecessary anxiety.” How can an A-graded restaurant receive thousands of dollars in fines? he wondered. “Either it’s clean or not.”

Things might change if Rosemary Cruz, 47, is any indication. The East Harlem native and taxi driver regularly eats in the area, but her habits have changed since the grading system’s debut. “I think it’s great they’re grading restaurants,” she said. “I would never eat at a C-grade restaurant, and I’ve stopped going to some places.”

The Health Department insists its inspectors grade East Harlem restaurants as they do any other area of the city. “Every restaurant in New York City is inspected on an individual basis and the neighborhood in which it is located in does not impact its grade,” it said in an emailed statement.

Mayor admitted that he couldn’t entirely blame the inspector for his previous C grade. “Negligence is about 20 percent of the problem, I have to admit,” he said. Having owned restaurants for four years, he said the grading system had made him change his habits. “It does force you to improve an work on your restaurant,” he said.

Obesity data for East and Central Harlem. (Chart by Lina Zeldovich. Data provided by the New York City Department of Health )

Eating carrot cake is not the same as eating carrots, Malika Harrison told a group of Harlem children at the recent Fit for Life Obesity Program’s workshop at the James Varick Community Center. “Carrot cake would have added sugar in it so you’d have to be careful,” she said while her workshop partner held up a laptop showing a heap of vegetables on its screen.

The children discussed the importance of eating veggies of every color. They played a detective game to understand how media influences their food choices. They learned who sponsors advertisements, what messages ads deliver and how to spot information they hide.

While the kids learned about fat and sugar data on products’ labels in the gym, their parents received similar training upstairs. They learned how to find reduced-fat substitutes for cheeses and to balance calories by reducing TV and computer use and exercising more. They also shared lean recipes that use soy substitutes.

“Kids talk more when their parents are not around,” said program coordinator Sara Dennis  of the National Council of Negro Women’s Manhattan Section, which implemented the program with the National Institute of Child Health. Dennis explained that both groups learn the same concepts to understand how to stay fit and healthy as a family.

Uzo Ejogu came to the Fit for Life obesity workshop because her overweight daughter, Malika, gets tired after they take a 30-minute walk together. “We don’t eat fast food at home and we don’t have a TV,” said Ejogu, who wanted to know what else she could do to help Malika lose weight. “I told her she’s big, but she says, ‘No, I’m beautiful.’ But then all her friends are like that. And my husband says we shouldn’t tell her she’s fat because it would hurt her self-esteem.”

Ejogu didn’t bring her daughter to the workshop, but she left with a plan to sign up both of them for Zumba classes.  “It will help me lose weight, too,” she said. “I’m very glad I came. I learned a great deal.”

Cheryl Moody did bring her children, Anthony and Brianna Hatchett. “My doctor told me that my 5-year-old daughter was the same weight as my 6-year-old son,” she said.  “He said he didn’t want her to gain any more weight.” Moody heard about the event from her father who learned about it at his church.

Some parents dropped their children off but didn’t participate. Throughout the afternoon more people trickled in, but the turnout was lower than the organizers expected.

“It’s not an easy subject for many people,” said Dennis. “It means a commitment to making a lifestyle change.”  The National Council of Negro Women had reached out to community centers and churches to spread the word and will continue doing workshops, she said.

Cheryl Moody with her children, Anthony and Brianna Hatchett, at the Fit for Life workshop in Harlem. (Photo by Lina Zeldovich)

The program was motivated, in part, by Michelle Obama’s initiative to reduce obesity in children. Kim Hernandez, a workshop organizer, said that 12.6 million children over 6 are overweight, according to federal data. “Two million of them are African-American,” she said.

According to the National Institute of Child Health, 16 percent of American children are overweight, but the proportion in Harlem is higher. According to a recent neighborhood report from the East and Central Harlem District Public Health Office, 27 percent of public school students are obese and an additional 19 percent are overweight. Nearly 1 in 3 high school students has a weight problem – 14 percent are obese and an additional 18 percent are overweight. So are 6 of 10 adults. Obesity rates are higher in adolescents and adults in Harlem than in the rest of the city, the report says.

More Fit for Life workshops will take place next year, said Dennis.

Campaigners for marriage equality at the SAGE Harlem Health Fair and Pride 2011. (Photo: Christina Da Costa/SAGE)

Rosita Libre de Marulanda shifts in her chair for a few minutes before comfortably folding her hands in her lap. Apart from her long string of pearls and the tiny red flower in her graying hair, she is dressed casually with a large black fanny pack strapped across her T-shirt.

At 65, she struggles with loneliness after losing her partner seven years ago and with the challenges of juggling many identities: a lesbian, Latina, mother, grandmother and sister.

“But wait, there’s another very important piece of my identity that I’m forgetting and that is that I’m becoming an elder,” she says. “This is a whole new set of issues.”

An estimated 12,000 to 24,000 elderly people who are gay, lesbian, bisexual or transgendered live in poverty in New York, says Allison Auldridge, a policy associate at SAGE, a non-profit organization that tackles health and other issues in the elderly LGBT community.

“Their health issues are poverty related,” she says. “1 in 5 elderly LGBT in New York don’t have the basic income to meet their needs and are either under-insured or not insured at all.”

Accessing affordable insurance is one of the things the Affordable Care Act, signed by President Barack Obama last year, will address as it rolls out through 2014. In the past, same-sex partners couldn’t benefit from each other’s insurance without paying extra income tax but the new reforms, coupled with the legalization of same-sex marriage in New York, will likely bring change, Auldridge says.

A report released earlier this month by SAGE and the National Academy on an Aging Society highlighted the specific health problems facing the aging LGBT population. The report says lesbian, gay, bisexual and transgender adults over 50 are more susceptible to disability and mental stress, made worse by the fact that they are more likely than their heterosexual counterparts to drink heavily and smoke.

The report adds that lesbian, gay, bisexual and transgender seniors are less likely to see doctors because of the cost and their reluctance to disclose their sexual orientation, which prevents their learning about specific issues that concern them.

“When I go to my health care professional, I’m still a little uncomfortable even though I told her years ago what my sexuality is,” says 67-year-old Carole Robinson. “If I had to change health care providers, I would be in a world of hurt.”

Robinson lives in SAGE’s Naturally Occurring Retirement Community, or NORC, an area whose residents have “aged in place,” thereby forming a neighborhood with a large concentration of elderly gay people.  Spanning from 100^th Street to 150^th Street, it is the largest NORC in Harlem, says Bryan Pacheco, outreach coordinator at SAGE Harlem. SAGE established this branch last year to provide social activities, support groups and education for LGBT seniors of color.

“Harlem is different than other communities such as, say, openly gay Chelsea,” Pecheco says, adding that it’s harder for people to come out in Harlem. “There aren’t many LGBT organizations in Harlem, the older people here are not as open and don’t identify with the terminology.”

Many of these people feel isolated, Pacheco believes, after losing loved ones to AIDS; they grew up in a time when there was less awareness about HIV treatment and prevention.

The Department of Health and Human Services is confident that the Affordable Care Act is a step toward providing better health care and preventative care to the older LGBT population.

“The Affordable Care Act is helping millions of LGBT Americans gain access to preventative care and screenings for free, including for diseases that affect LGBT populations at rates higher than other populations,” says regional director Jaime Torres. “This includes cancer screenings, blood pressure and cholesterol screenings, HIV testing and contraceptives.”

While Auldridge agrees that the Affordable Care Act reflects progress, she says work remains to be done. She feels that data about the LGBT elderly needs to improve and the Department of Health and Human Services must ensure that information about the act reaches the people it affects most.

“I think it does amazing things for the LGBT community, but it could be more explicit in mentioning the LGBT and addressing LGBT definitions of family,” she says.

Torres points out that the elderly LGBT community is no longer governmentally invisible.

“Where once we failed to study LGBT health at all, today researchers engage LGBT populations and are looking to collect data we need to ground our work in science and shape our vision for the future,” he says.

Alex Sanchez cleaned toxic dust from buildings at ground zero for six months, and now suffers from a long list of physical and emotional ailments. (Photo by Sarah McNaughton)

As Alex Sanchez leaves his Washington Heights apartment with his young son and walks up the block to Broadway, he stops twice to catch his breath. When he starts walking again, he’s slower than before. His labored breathing sounds like that of an elderly man. He’s 44.

He says he is not feeling well today, and his exhaustion shows. His eyelids droop over swollen, bloodshot eyes and his words come out slowly. He looks dapper in slacks and a collared shirt, but his clothes drape loosely over his thin body.

Sanchez says his deteriorating health is a result of his job cleaning debris from buildings near ground zero after 9/11.

A recent study on long-term health problems related to 9/11 found that emergency responders and cleanup workers, like Sanchez, suffer from increasing physical and mental health problems over time. Published in The Lancet a week before the 10^th anniversary of the attacks, the study used data collected over nine years by the World Trade Center Monitoring and Treatment Program at Mount Sinai Medical Center in East Harlem.

Just 10 years ago, Sanchez was an athletic new dad. His son, Jack, was 6 months old when the twin towers fell and Sanchez, who normally worked the night shift buffing floors at New York University, was called in to clean the ubiquitous gray dust out of air vents and air conditioners in buildings surrounding the wreckage. He was proud to be working at ground zero.

“I was so caught up with the tragedy, being a New Yorker, witnessing my city come to its knees, that my main priority was to get this city up from its knees once again,” Sanchez says.

But the gray dust Sanchez cleaned and inhaled for six months, which the Environmental Protection Agency initially called harmless, turned out to be a toxic mix of asbestos, lead, glass fibers, hydrochloric acid and other harmful and carcinogenic chemicals. Sanchez says he was given a proper respirator mask for only two of the 10 buildings he worked on. In the others, he wore what he calls  “coffee filter masks, the ones that cost a dollar.”

Sanchez  now suffers from a long list of health problems, including chronic asthma, rhinitis, sinusitis, gastroesophageal reflux disease, pulmonary fibrosis, musculoskeletal syndrome and post-traumatic stress disorder.

“I’ve also developed nodules in my lungs,” Sanchez adds. “The toxins have left my body, but the damage has been overwhelming.”

The new study reviewed the 9/11-related ailments of more than 27,000 patients who, like Sanchez, have received free treatment through the World Trade Center Health Program at a consortium of five city medical centers, including Mount Sinai, since mid-2002. Sanchez’s ailments are common: the study reported widespread respiratory problems, with abnormal lung tests in 42 percent of patients. It also highlighted the extreme emotional damage of 9/11; out of all the recovery workers with no previous emergency training, nearly a third suffer from post-traumatic stress disorder, and 28 percent show symptoms of depression and panic disorders.

Sanchez was an active man before 9/11. His father, a professional wrestler, passed on his passion for athleticism. Sanchez was constantly at the gym and loved to play tennis, swim, bike and run. Now he says the one-block walk uphill to Broadway will probably send him to bed for days. Dr. Michael Crane, director of the Monitoring and Treatment Program at Mount Sinai, says this is a common problem among 9/11 responders.

“It’s a lot of an adjustment to go from a healthy worker where you can do what you want physically to where you have to take a lot of medications regularly.” Dr. Crane says.

Sanchez takes 14 every day. He’s adjusted to his new life, but says it has been 10 challenging years.

“I’m out of work, I have no medical insurance, I don’t know where to turn, I’m being pressured by my family to go out and work while my body and mind are saying something else,” he says. “I lost it all.”

The free treatment at Mount Sinai eased some of the financial burden, and Sanchez is one of the few responders who was able to get permanent disability compensation, qualifying him for Medicaid. But he’s working harder than ever as a vocal leader in the movement for improved, long-term health care for 9/11 workers. He’s visited Washington many times, pushing to get full health coverage for all 9/11-related ailments.

Crane agrees with the idea of a long-term treatment and monitoring program. Although the Mount Sinai study is an indicator of what responders and their doctors are dealing with now, he says that nine years still do not provide enough information.

“That’s not a long time,” he says. “When you look at occupational exposures, you start to see more findings in the second decade.”

In January, President Barack Obama enacted the Zadroga 9/11 Health and Compensation Act, named after a detective whose death from respiratory illness was attributed to 9/11 toxins. The act, which took effect on Oct. 3, gives $4.3 million to the September 11^th Victim Compensation Fund  to address health concerns associated with 9/11. Although most agree the act is a step toward providing medical monitoring, treatment and compensation to affected responders, it will expire in 2016 and covers only a specific list of health problems. Cancer is notably absent from the list, something that frustrates 9/11 workers.

Sanchez says he has lost many friends to cancers and illnesses associated with 9/11, and his family is worried.

“Cancer is always lingering in the backs of our minds – constantly,” he says.

Crane hopes that studies linking cancer and 9/11 will lead to an expanded Zadroga Act. Until then, he sees firsthand the sadness of thousands of first responders and recovery workers.

“The very human pain and suffering of having our patients have cancer and not being able to do everything we can for them is a source of frustration for us,” Crane says. “But I’m hoping to have more guidance about the cancer question in the near future.”

Jack, now 10 years old, runs circles around his dad as they walk along Broadway. When Sanchez talks about lobbying Congress for better health care, he looks 10 years younger. His swollen eyelids soften; his breathing slows. Even though each trip to Washington puts him to bed for three weeks afterward, he says he won’t stop until he and his fellow 9/11 responders receive recognition and care.

“You need to strive for the better even though you’re facing the worst,” he says, watching Jack speed ahead.

Maciel Lopez, 43, waits for the bleach in her hair to take

Two interns at the corner of 150^th Street and Amsterdam Avenue scan passersby for receptive-looking faces.  One tentatively walks up to a young woman playing with her phone.

“Excuse me, miss,” he says. “I’m with the organization WE ACT for Environmental Justice and I was wondering if you have a minute to answer some questions about your beauty regimen?” He hands her a two-page questionnaire.

The environmental activist group is surveying women of color uptown about their use of hair products and cosmetics that could endanger their health.

“We noticed that groups conducting surveys around this have focused on middle-class white women,” says Ogonnaya Dotson-Newman, campaign director for WE ACT in Harlem. “But there is a whole area of hair products that you wouldn’t know about unless you live in certain urban areas.”

The survey, which targets African, African-American and Hispanic women, asks how often they visit hair salons, what treatments they get and what hair products they use at the salon and at home. It also asks if they’re aware of the risks of certain chemicals and concerned about exposing themselves and their families to them.

Since launching the survey in August, WE ACT has gotten responses from 80 women. Although they have printed and distributed questionnaires in Spanish and English, they have had trouble reaching Hispanic women, Dotson-Newman says, unsure of the reason. She hopes to release findings by January. While the results will not be statistically valid, the group will use them to shape future awareness campaigns.

The products it’s concerned about include skin lighteners, perms, relaxers, texturizers, dyes and glues – all particularly used by women of color. They contain chemicals and hormones linked to early puberty and cancer, Dotson-Newman says, including parabens, placenta and formaldehyde.

The main problem, she says, is that the Food and Drug Administration and the Environmental Protection Agency have little authority or resources to monitor cosmetic companies and enforce environmental regulations.

Since the Safe Cosmetics Act of 2011 was reintroduced into the U.S. House of Representatives in June for the second year, environmental groups have been urging the Food and Drug Administration to better regulate cosmetic companies’ use  of chemicals and their products’ labels.

“It’s up to the government and the people to prove that certain products are harmful,” Dotson-Newman says. “That’s why we are conducting the survey, to get a better understanding of how people are using these products and what is their possible exposure to toxicity.”

While hair dyes, bleaches and relaxers have already been linked to skin problems (including rashes, burns, itching and hair loss), a number of national studies are being conducted to determine whether women of color face higher risks of breast and lung cancer from beauty product exposure.

Dr. Mary Beth Terry, a Columbia University epidemiologist, published a study in May in the Journal of Immigration and Minority Health showing that African-American and African-Caribbean women were more likely to be exposed to hormonally-active chemicals in hair products than white women, and used them more often.

“These products are often used daily and over the course of many years,” Terry says. “A number of these commonly-used products contain endocrine disruptors and placenta, and exposure to these could cause women to be more susceptible to hormone-sensitive diseases such as aggressive breast cancer.”

Some companies offer so-called natural alternatives in hair products. Carol’s Daughter, for instance, produces products that originated 20 years ago with founder Lisa Price making beauty remedies in her kitchen. But the products are marketed as “natural inspired” because even many of those contain chemicals.

“To have a product with natural ingredients, it has to have preservatives or it will go bad after some time,” says Shonitria Anthony, a supervisor at the Harlem branch of Carol’s Daughter. Although its products don’t contain the worst offenders like parabens, sulphates or mineral oils, the company steers clear of hair dyes and relaxers. “You can’t get a hair dye or relaxer without some sort of chemical, it just won’t last long,” says Anthony.

Dotson-Newman agrees, calling “organic perms” an oxymoron. A lot of products marketed as “organic” contain chemicals, she argues, but current laws leave lots of loopholes that companies can use to deceptively label products.

The Model Hair Care beauty salon on West 146^th Street and Amsterdam Avenue is a modest establishment run by 28-year old Senegalese immigrant May Seye. A small room with little ventilation, the salon has room for only one chair and a couch.

Seye averages 12 customers a day, students and fellow immigrants who appreciate her inexpensive prices.

“I also get a lot of African-American women bringing in their young daughters,” Seye says. “If the girls get their hair relaxed, it’s easier for the mothers to manage it in the mornings before school.”

As two young women sit on the couch with warm towels on their heads, tucking into chicken and rice as they wait for their treatments, Seye prepares for her next client.  She puts on latex gloves and begins mixing the relaxer with the activator. The smell is unmistakable, somewhat like chlorine.

Seye says she’s concerned about her health working with harsh chemicals, but asserts there are no truly organic alternatives on the market. She tries to check labels and take precautions, she says, wearing a mask when doing her clients’ hair treatments, washing her hands constantly and visiting her doctor regularly.

“I feel it affecting my lungs mostly,” she says.

“But I try to watch my health, eat right and drink lots of milk, especially after using certain products,” she says, adding that her mother taught her that whole milk strengthens the body’s resistance to disease.

Dotson-Newman says salon workers and owners are clearly more at risk because of their prolonged and frequent exposure to harsh chemicals, and more needs to be done to educate salon owners.

While Seye adjusts her white plastic mask, her client, Dana Williamson, explains that she comes in twice a month for a wash and set, and gets her hair relaxed twice a year.

“I am aware of the danger of some of these chemicals, and I think about it a little, but it’s not a concern,” she says. “I never go to places where I would be exposed to the harsher stuff, like the Brazilian keratin blow-out or formaldehyde.”

As a student, she can’t afford to buy “organic” beauty products, Williamson adds. She shops at Walmart instead.

But Dotson-Newman believes money is not the chief concern for women of color, saying she knows women who spend $1,500 on hairpieces. Their primary aim, in her opinion, is effective hair treatment, regardless of the risks or expense.

“Women spend $50 to $100 every eight weeks to get their hair done, plus all the products in between,” she said. “I think it’s a broader question about what beauty is.”

Ethnic women were never encouraged to embrace their natural features and were instead taught to emulate Caucasians, Dotson-Newman thinks, although it has become more acceptable, even trendy, to go natural.

“Before, you couldn’t even get a job without straight hair,” she says. “Now it’s in to be natural.”

Once the surveys indicate how often women are exposed to particular products, she says, the group can begin lobbying the cosmetics industry and advising women in Harlem about seeking beauty safely.

Proportion of residents with diabetes in U.S., New York City and uptown neighborhoods. (By Medina Roshan).

Half a dozen diabetes patients gathered in a classroom uptown one recent morning to discuss why keeping blood sugar levels between 70 and 150 is so vital.

The Naomi Berrie Diabetes Center at Columbia University Medical Center offers diabetes education classes, along with nutrition counseling and other programs, for a community beset with diabetes. “We are here like a GPS,” educator Martin Ovalles told the class. “We guide you where to go.”

Some who attended were among the estimated 10.7 percent of residents in Harlem, East Harlem, Washington Heights and Inwood with diabetes, compared to the city’s average of 9.7 percent, according to the city health department.  A health department survey released last year shows that diabetes disproportionately affects low-income neighborhoods, as well as black and Hispanic populations, all characteristic of uptown neighborhoods.

Uptown residents also face several additional risk factors for the disease, which some public health experts are calling a nationwide epidemic: poor diet, obesity, heredity and sedentary lifestyles.

Vanessa Castillo, a patient at the center, was shocked when her doctor diagnosed her, at 14,  with Type 2 diabetes.  “I was like me? Diabetes?,”recalled Castillo, now 22,. “For me, it was an old people’s disease.”

Her disease was discovered when she consulted a doctor about darkened skin around her neck, a condition known as acanthosis nigricans that is an indicator of diabetes.

Education is at the core of the problem, said nurse Patricia Kringas,  also a research coordinator and certified diabetes educator at the Berrie Center.

“Diabetes is a disease of management,” she said.

Type 1 diabetes occurs when the pancreas produces an insufficient amount of the insulin hormone, which regulates blood sugar in the body. Insulin resistance occurs with Type 2 diabetes, whereby the body is unable to process glucose to be metabolized for energy, Kringas explained.

With childhood obesity rates rising, Type 2 is no longer seen only in older adults. “Now more and more, you are finding it with younger people,” Kringas said.

Genetics also plays a role, she added. In Castillo’s family, her mother and several of her aunts have the disease, and two  grandparents died from complications of diabetes.

Poor diet choices are another major contributing factor.

About 60 percent of the patients that nutritionist Ericka Arrecis sees at the Berrie Center are uptown residents. Many are of  Dominican background and eat high-carbohydrate diets, she said, including starchy cassava, a traditional mainstay of Dominican cuisine. That makes healthy eating challenging.

But misperceptions about the disease and its management, and about which foods contain the right types of carbohydrates for diabetics, are widespread, Berrie staff members said, particularly among immigrant populations.  Some patients mistakenly believe that diabetes results from eating a lot of sugar or that being heavier means being healthy.

In fact, Ovalles said that his own mother, who lives in the Dominican Republic, complains that his sons, 9 and 11, are too thin; she asks him to send them to her for the summer so she can help them gain weight.

But even when patients understand how to manage the disease, Arrecis says, they complain about the cost of healthier foods, and about being unable to afford fresh vegetables or whole grains. “The diabetic diet is more expensive,” she acknowledged.

Castillo and her family frequently deal with this issue. “You just take whatever is cheaper,” she said of her family’s shopping habits. “Usually the cheaper stuff is the fattier food.”

Experts agree that socioeconomic factors contribute to the problem. “Diabetes to me is to me one more manifestation of social and economic inequity,” said Marilyn Aguirre-Molina, a professor of public health at the City University of New York..

Some families find it more convenient and economical to pick up dinner from the McDonald’s dollar menu rather than locate a grocery store that provides nutritious and affordable choices, she said. Uptown, “The food sources are atrocious,” Aguirre-Molina added. “They have lots of fast food, which I called fields of fat.”

According to a report from the East and Central Harlem District Public Health Office, two in three food stores in those neighborhoods are bodegas, many of which don’t offer healthy foods. For example, leafy green vegetables are available in just three percent of bodegas there, compared to 20 percent on the Upper East Side. “There has to be ways of bringing in supermarkets and other stores,” Aguirre-Molina said.

Furthermore, uptown neighborhoods are not conducive to physical activity, she added, especially when parents are concerned for their children’s safety.“Playgrounds in some of these areas are a disaster,”she said.

One uptown neighborhood responding to the growing problem is East Harlem, which Mt. Sinai School of Medicine researcher Euny Lee calls the epicenter of diabetes and obesity in the city.

Lee is the project manager of a study called the East Harlem Partnership for Diabetes Prevention, started to help pre-diabetic adults from developing full blown diabetes. Pre-diabetes occurs when people have higher than normal blood glucose levels that aren’t high enough to be classified as diabetes.

A participatory research program, the project involves several uptown community organizations in organizing workshops designed to help participants lose weight. “We’re trying to see if the workshops are a successful way of preventing diabetes,” Lee said.

While she said she can’t provide conclusive data from the study, still in progress, Lee has noticed a trend in participants’ ages. “Participants that we screen are a younger cohort,” she said.  “It’s not like they are senior citizens.”

Other city programs include the Healthy Bodegas Initiative, which encourages shopkeepers to provide healthier foods like fruits, vegetables and low-fat milk in exchange for help with advertising and permits to sell on sidewalks.

Castillo, learning about her disease, still struggles to eat well and remain active, she said.

Her blood sugar is higher than it should be and she also suffers from high blood pressure. Her doctor recently prescribed insulin injections, a prospect she is nervous about because she is afraid of needles.

“I don’t like pain,” she said.

Still, Castillo said she can’t complain because she has not felt ill since being diagnosed. Her goal, she said, is to get her diabetes under control.

Twenty-four laps around the P.S. 102 gym in East Harlem add up to a mile. Physical education teacher Steven Sloan makes his fifth graders run 25 laps.

“You tell ‘em to jog,” Sloan says, “and they just want to run, fast. They like to run all out.”

His regimen, which he admits is tough, has led P.S. 102 to the top ranks of New York Road Runners’ Mighty Milers youth program. Its 300-plus students together ran more than 50,000 miles last year.

“Here at P.S. 102, the kids really very quickly build up to where they are running a mile and sometimes more than a mile a day,” says Cliff Sperber, executive director of youth programs at New York Road Runners, at a recent event honoring the students. “It’s very impressive.”

In class, Sloan, 55, calls his students by pet names, like “Puff Cheeks,” “Muhammad Ali,” “Vanilla Smoothie” and “Hot Salsa.” He has his stars, the natural athletes who have come to love running under his tutelage. But just as important to him are the ones who come along when it’s not so easy.

Gloria Cruz, “Puff Cheeks,” counts herself among the latter; like many youth in East Harlem, she has asthma. In 2008, the disease sent 11 of every 1,000 neighborhood children to hospitals; in August, the city health department opened a youth asthma center aimed at halving that number.

The demands of gym class helped Gloria get healthier and more fit. Her homework, like her classmates’, is to run a mile a day, seven days a week. Regular instruction from Sloan has also helped Gloria and her mother manage her condition better, leading to fewer hospital visits.

For Gloria and her mother, Maria Santana, weekend walks from their Manhattan Avenue apartment to the school on Second Avenue used to take an hour and a half.

“Now it only takes us 40 or 45 minutes,” says Santana.

Steven "Superstar" Sloan, physical education teacher at P.S. 102 in East Harlem, chats with 5th-grade students Stephanie Azalo (center) and Darlene Salas (right), before a warm-up jog. (Photo by Jason Alcorn)

Sloan also must combat child obesity, another major issue facing Harlem youth. More than 46 percent of children between kindergarten and eighth-grade in East Harlem are obese or overweight, compared to 40 percent citywide, according to Department of Education statistics. The school serves a predominantly Hispanic student body; 96 percent have low enough household income to qualify for free lunches.

Sloan teaches his students to eat more healthily. Pizza, McDonald’s and Burger King have turned into “chicken, rice and healthy stuff,” as fifth-grader Darlene Salas puts it.

“Before I was here I used to eat a lot of junk food,” says Mohamed Yusef, a fifth-grader. “But now that I’m here I eat more healthy food and less junk food and I jog around the Jefferson Park track” across the street from the school.

Fifth-grader Melissa Lopez puts it more bluntly. “I know no one wants to be fat,” she says. “When you’re fat you can’t run anymore.”

In order to reach the students, Sloan takes a hard-line approach–one that, in the past, discomfited school administrators and teachers because he aggressively held parents accountable for students’ performance, he says.

Because of budget cuts, New York City’s public schools are producing fewer high-caliber athletes, Sloan says, and his old-school approach is meant to overcome those reductions. In class, his demeanor vacillates from playful to stern–if he feels the students are cutting corners.

“You’re out of breath because you didn’t do nothing this weekend,” Sloan shouts during a recent Monday morning gym class, as students slow their pace, doubling over, hands creeping toward their knees. “Unbelievable! It’s called that l-a-z-y word again. L-a-z-y: spells lazy.” The pace quickly picks up.

Since P.S. 102 principal Sandra Gittens approached Sloan seven years ago with the opportunity to join Mighty Milers, he’s had, as he puts it, “a happy marriage” with the school.

Last school year, over 10,000 students at 57 schools north of 96th Street in Manhattan participated in Mighty Milers or Young Runners, another New York Road Runners program.

“It’s great to teach kids a sport for life, very inexpensive, very accessible,” says Sperber, of New York Road Runners. “Running is that sport.”

Promoting her 'Let's Move' campaign, Michelle Obama played games with students. (Photo by Krishn Kaushik)

Michelle Obama visited the Police Athletic League on Manhattan Avenue in West Harlem today as part of her “Let’s Move” campaign, encouraging children to exercise daily and eat right.

“You guys are learning a lot and you’re moving,” said the First Lady. “Kids like you need this. You’ve got to eat healthy, you’ve got to eat nutritious foods and you have to get exercise. It’s just as important as learning to read and do math.”

About 60 kids got to listen to and play with the First Lady as she praised institutions like the PAL and urged that young people keep active at least 60 minutes a day.

“You were on the Disney Channel,” screamed one participant.

Obama encouraged the children to shout out answers to questions about what to eat and what sports to play. Resounding “yay”s were the most common response, until she asked them to switch off their game consoles at home.

“No!” the boys groaned, but the girls managed to outscream their male counterparts.

Michelle Obama played with Harlem children Thursday. (Photo by Krishn Kaushik)

The First Lady then joined in the activities, including jumping jacks, push-ups and general running around.

Nine-year-old Alex Rodriguez got a hug from Obama and spent a couple of minutes with her. “It was a very exciting day and it was very good to meet her,” he said afterwards.

Harlem PAL director Kobla Moats said he learned less than a week ago that Obama wanted to drop by. Police commissioner Ray Kelly, former Manhattan D.A. Robert Morgenthau, New York State First Lady Michelle Paterson and State Sen. Bill Perkins showed up today as well. Moats hopes the exposure will bring his organization more money for expanded programs.

“It’s a big day for Harlem,” he said. “Only good can come out of this.”

More than 50,000 New York kids participate in the Police Athletic League program.

According to the American Diabetes Association, more than 23 million children have diabetes, a disease linked to obesity and a sedentary lifestyle.

Tiffany Denise, facilitator of Hip Hop H.E.A.L.S., leads a health session at Thurgood Marshall Academy in Harlem. (Photo by Dewi Cooke)

They know the ingredients of a bottle of Coke and can describe the difference between empty calories and nourishing ones. But it’s Chris Brown who really speaks to them.

When MC Easy AD plays Brown’s bass-heavy “Transform Ya”, the fourth graders of Thurgood Marshall Academy Lower School on West 151^st street can’t contain themselves.

That’s just what AD – Adrian Harris, half of the pioneering hip-hop duo the Cold Crush Brothers – and his partner Tiffany Denise hope for. “Do you know dancing is great exercise?” Denise tells the group of 50 wriggling students seated on the floor of their school’s cafeteria. “When we dance, we burn calories.”

Hip-hop is the key to engaging students, she says. “They love the latest stuff, as long as it’s hot and fly and they can move to it.”

It’s a routine the pair run in schools around New York every week. Since starting in Harlem 18 months ago, the city-funded Hip Hop H.E.A.L.S (Healthy Eating and Living in Schools) project has taught 12,000 local schoolchildren about nutrition and health.

But it’s more than another anti-obesity program for kids. The brainchild of Harlem Hospital’s Dr. Olajide Williams, the project’s lesser-known aim is to use children as a way to funnel information on nutrition, diabetes and heart disease to at-risk parents.

And its sister program – Hip Hop Stroke, which laid the ground work for Hip Hop H.E.A.L.S. when it started in 2007 – just landed a $3.7 million grant from the National Institute of Neurological Disorders and Stroke to test that strategy. The five-year project,  led by Williams, will look at how well parents and grandparents grasp the messages children and grandchildren bring home, about stroke awareness and prevention.

“I call it child-mediated health communication,” Williams says. “It’s an approach that I think is innovative and I think it’s a potential vehicle for additional health communication in disadvantaged communities.

“It’s very hard to penetrate the home fabric of individuals in disadvantaged communities because there’s so many competing interests,” he continues. Survival is the primary objective for many of the families the program serves, mostly at public schools in low-income neighborhoods.

During each two-day Hip Hop H.E.A.L.S. session, children watch cartoons and hear songs created especially for the project. They go home with DVDs, comic books and t-shirts. The program covers different themes, including fitness, but the growing interest in child obesity makes nutrition the most requested, Denise says. Students use “beat boxes”, electronic remote controls allowing them to answer on-screen quizzes such as “Where do calories come from?” and “Do you have a grown up at home who looks after you who smokes cigarettes?”.

At Thurgood Marshall this month, one student raises her hand to respond to the cigarette question. She tells the group that her aunt smokes, and “sometimes I tell her not to, and she throws the cigarettes away and now she stopped”. The class cheered. Then they danced to Aretha Franklin’s “Respect”.

“See, that’s the power of children I’m telling you about,” Williams says.