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An editorial is presented in which the author discusses the management of the reporting of death data in New York City (NYC) amid the COVID-19 pandemic in spring 2020. The article examines the significance of death registration and analysis in public health, the NYC electronic death registration system known as eVital, and the importance of mortality data in the public health response to the COVID-19 pandemic.

Following the end of the Great Depression of the 1930s, the sectarian system of foster care services in New York City practiced open discrimination, African-American children were generally segregated in a small number of overcrowded and understaffed all-Black institutions. As the African-American migration to the city accelerated in the years following the outbreak of World War II, a small group of psychologists, jurists, philanthropists, and social workers began a systematic challenge to this system. This paper explores the role of racism in shaping New York's foster care system and the experience of African-American children who were forced to depend on services originally organized to serve Whites, It also looks at the ways race affected the way children were typed-as mentally ill, delinquent, or even criminal-in response to the structural realities of a system that sorted children into separate types of institutions according to race. The paper also provides the background for understanding the landmark challenge to segregation of children in sectarian and public institutions represented by Wilder v Sugarman. [ABSTRACT FROM AUTHOR]

This paper describes the present position of family health workers who were trained and worked at a neighborhood health center during the past five years. Problems initially anticipated for such workers did not materialize but others have emerged: lack of self-esteem, lack of upward and lateral mobility, inadequate evaluation of the validity of their training and role, and to some extent paternalism. These are discussed. [ABSTRACT FROM AUTHOR]

Soon after its founding in the politically tumultuous late 1960s, the Health Policy Advisory Center (Health/PAC) and its Health/ PAC Bulletin became the strategic hub of an intense urban social movement around health care equality in New York City. I discuss its early formation, its intellectual influences, and the analytical framework that it devised to interpret power relations in municipal health care. I also describe Health/PAC's interpretation of health activism, focusing in particular on a protracted struggle regarding Lincoln Hospital in the South Bronx. Over the years, the organization's stance toward community-oriented health politics evolved considerably, from enthusiastically promoting its potential to later confronting its limits. I conclude with a discussion of Health/PAC's major theoretical contributions, often taken for granted today, and its book American Health Empire. [ABSTRACT FROM AUTHOR]

Drawing on the case files of a major charitable agency, this paper explores how poor people experienced New York City's pioneering program of tuberculosis control. Although the program provided enormous benefits, poor New Yorkers often had pressing concerns that took priority over eradicating tuberculosis. Moreover, the program imposed extreme hardships even as it promised liberation from a terrible scourge. Poor people did not protest collectively, but many individually resisted. They delayed seeking diagnosis, disobeyed the advice promulgated by the Department of Health, attended clinics irregularly, and either refused to enroll in hospitals, sanatoria, and preventoria or fled soon after arrival. [ABSTRACT FROM AUTHOR]

Objectives. This paper describes the sexual risk behaviors of Puerto Rican men who have sex with men and their perceived obstacles to condom use. Methods. Interviews were conducted with 182 Puerto Rican men living in New York, NY. Results. Condoms were used inconsistently or not at all by half of the men who had anal sex with other men, by two thirds of the men who had vaginal sex, and be three fifths of those who had anal sex with women. Most of the men had unprotected oral sex and more than one sexual partner in the previous year. Three of 10 were positive for the human immunodeficiency virus (HIV). Dislike of condoms was the most frequently cited obstacle, followed by perception of low risk, trust in and emotional connection with partner, unavailability and inconvenience of condom use, lack of control and indifference. Conclusions. Barrier methods other than condoms, such as a microbicidal gel, need to be developed. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the authors' views about improving the efficiency and accuracy of geographic mobile data collection in relation to public health research in America. The U.S. Centers for Disease Control and Prevention's 500 Cities Project involving health indicators for American cities is examined, along with geographic differences in health. Public health research-related mobile technologies and tobacco marketing in New York, New York are assessed.

Abstract: This paper uses monthly time-series data from 1968 through 1988 to test whether the observed increase in the incidence of low birthweight in New York City represents a reversal of the downward trend that existed prior to 1984. We find that the trend has shifted for both Whites and Blacks. We estimate that between July 1984 and December 1988 there were 3,110 additional low-birthweight births to Blacks and 1,385 additional low-birthweight births to Whites above what would have been expected had the rate of low birthweight not shifted upwards. The incremental costs of treating these infants in their first year of life is estimated at over $22,000,000 in 1986 dollars. (Am J Public Health 1990; 80:682-684.) [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the use of New York City's (NYC's) electronic death registration system (EDRS) to conduct mortality surveillance during and after Hurricane Sandy. Methods. We used Centers for Disease Control and Prevention guidelines for surveillance system evaluation to gather evidence on usefulness, flexibility, stability, timeliness, and quality. We assessed system components, interviewed NYC Health Department staff, and analyzed 2010 to 2012 death records. Results. Despite widespread disruptions, NYC's EDRS was stable and collected timely mortality data that were adapted to provide storm surveillance with minimal additional resources. Direct-injury fatalities and trends in excess all-cause mortality were rapidly identified, providing useful information for response; however, the time and burden of establishing reports, adapting the system, and identifying indirect deaths limited surveillance. Conclusions. The NYC Health Department successfully adapted its EDRS for near real-time disaster-related mortality surveillance. Retrospective assessment of deaths, advanced methods for case identification and analysis, standardized reports, and system enhancements will further improve surveillance. Local, state, and federal partners would benefit from partnering with vital records to develop EDRSs for surveillance and to promote ongoing evaluation. [ABSTRACT FROM AUTHOR]

Electronic medical records can house patient information gathered over time and at multiple sites, thus they have the potential to increase continuity of care and improve service delivery in a multiclinic system. The New York City Department of Health and Mental Hygiene implemented an electronic medical record system in its 10 sexually transmitted disease clinics during 2004 and 2005. We examine the use of real-time electronic medical record data analyses to evaluate clinical services or program activities and present 3 examples of such analyses that have led to program improvements. Analyses of electronic medical record data have produced changes in clinical practice that in turn have resulted in more effective staff use, increased disease detection, and increased clinic capacity. (Am J Public Health. 2010;1 00:586590. doi: 10.2105/AJPH. 2009. 175349) [ABSTRACT FROM AUTHOR]

The New York City (NYC) Department of Health and Mental Hygiene ("Health Department") conducts routine surveys to describe the health of NYC residents. During the COVID-19 pandemic, the Health Department adjusted existing surveys and developed new ones to improve our understanding of the impact of the pandemic on physical health, mental health, and social determinants of health and to incorporate more explicit measures of racial inequities. The longstanding Community Health Survey was adapted in 2020 to ask questions about COVID-19 and recruit respondents for a population-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey. A new survey panel, Healthy NYC, was launched in June 2020 and is being used to collect data on COVID-19, mental health, and social determinants of health. In addition, 7 Health Opinion Polls were conducted from March 2020 through March 2021 to learn about COVID-19–related knowledge, attitudes, and opinions, including vaccine intentions. We describe the contributions that survey data have made to the emergency response in NYC in ways that address COVID-19 and the profound inequities of the pandemic. (Am J Public Health. 2021;111(12):2176–2185. https://doi.org/10.2105/AJPH.2021.306515) [ABSTRACT FROM AUTHOR]

Objectives. We compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not. Methods. We recruited Puerto Rican IDUs in New York City (n=561) and in Puerto Rico (n=312). Of the former, 39% were "newcomers," having previously injected in Puerto Rico; of the latter, 14% were "returnees," having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location. Results. Newcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR]=1.62) and homelessness (adjusted OR=2.52) were significant predictors of "shooting gallery" use; newcomer status also predicted paraphernalia sharing (adjusted OR=1.67). Returnee status was not related to these variables. Conclusions. Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior. (Am J Public Health. 2003:93:812-816) [ABSTRACT FROM AUTHOR]

Making public health data easier to access, understand, and use makes it more likely that the data will be influential. Throughout the COVID-19 pandemic, the New York City (NYC) Department of Health and Mental Hygiene's Web-based data communication became a cornerstone of NYC's response and allowed the public, journalists, and researchers to access and understand the data in a way that supported the pandemic response and brought attention to the deeply unequal patterns of COVID-19's morbidity and mortality in NYC. (Am J Public Health. 2021;111(S3):S193–S196. https://doi.org/10.2105/AJPH.2021.306446) [ABSTRACT FROM AUTHOR]

Objectives. The prevalence of Chlamydia trachomatis cervical infection in incarcerated adult women had not been reported. To develop a policy for testing and treatment, we determined the prevalence of and risk factors for chlamydial infection in women in a New York City jail. Methods. Interviews and cervical cultures for C trachomatis were obtained from 101 consenting female inmates. Results. Positive cultures for C trachomatis were found in 27% of the participants. Mucopurulent cervical discharge and education of 8 years or less were two independent risk factors for infection, but only 63% of the infected women had one or both of these factors. If pelvic tenderness were considered as a third factor, an additional 7% of the infected women would have been identified. Conclusions. The prevalence of chlamydial infection in this population was as high as that in populations for which presumptive treatment is recommended. Although the optimal policy for detection and treatment of chlamydial infection my vary depending on practical considerations, we suggest that women entering correctional facilities should be screened or offered presumptive therapy for C trachomatis infection. [ABSTRACT FROM AUTHOR]

A sample of 745 gay men, ages 20 to 65, were interviewed in 1985 as part of an effort to determine the impact of the AIDS (acquired immunodeficiency syndrome) epidemic on the non-ill but at-risk community. Measured in terms of the number of different sexual partners, sexual activity was reported to flare declined by 78 per cent since hearing about AIDS. The frequency of sexual episodes involving the exchange of body fluids and mucous membrane contact declined by 70 per cent, and condom use during anal intercourse increased from 1.5 to 20 per cent. Abstinence from gay sex did not change over time. (Am J Public Health 1987: 77:578-581.) [ABSTRACT FROM AUTHOR]

In the course of the screening program for gonorrhea in New York City, a total of 964 N. meningitidis strains were recovered from the genitourinary tract and/or anal canal over a four-year period (April 1975-April 1979), the rate of such recoveries having tripled during this time. The majority of strains were isolated from anal canal cultures of male patients most of whom were seen in a clinic treating homosexuals. N. meningitidis and N. gonorrhoeae were cultured together from 41 patients: in 24 cases from different sites and in 17 instances from the same specimen. Evidence of clinically significant N. meningitidis involvement of genitourinary sites was obtained in a number of cases of urethritis and proctitis as well as in three instances of epidemiologically linked cases. The rising frequency of N. meningitidis isolations from these sites, with its potential clinical implications, should alert microbiologists, clinicians, and epidemiologists to the need for careful distinction of meningococcal from gonorrheal infection, particularly among homosexual men. [ABSTRACT FROM AUTHOR]

Objectives. Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. Methods. A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. Results. Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%).The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). Conclusions. There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism. (Am J Public Health. 2002; 92:49-52) [ABSTRACT FROM AUTHOR]

Objectives. This study examined reported level of education and current reading ability as predictors of cognitive among older Africans in central Harlem, New York City. Methods. A probability sample of 164 noninstitutionalized older African Americans was assessed. Mini-Mental State Examination (MMSE) scores were regressed on education and reading ability measures. Results. Reading ability and educational attainment were significant, independent predictors of MMSE performance. Within any level of education, subjects whose grade-equivalent reading ability exceeded reported level of education scored significantly higher on the MMSE. Conclusions. Reading ability may be useful in interpreting the results of cognitive screening among low-educated and minority groups. [ABSTRACT FROM AUTHOR]

For New York City from 1978 to 1990, plotting the 3-year running averages of citywide new tuberculosis cases against the middle year yielded and S-shaped curve, with the inflection point at 1983 between early slow and late rapid rise. The inflection in the S curve appears to be associated with hierarchical establishment of secondary epicenters, and the phase of rapid rise in new cases seems to be associated with spatial diffusion from both the primary and secondary epicenters. [ABSTRACT FROM AUTHOR]

The article examines the different studies conducted concerning the occupational health of citizens living in New York City in 1870. The responsibilities of the Board of Health involved the inspection of tenement houses, factories, and regulation of occupations harmful to health. It explored the working conditions and health problems of several occupational groups that physician and assistant health inspector Allan McLane Hamilton described. Some of these manufacturing establishments included tobacco factories, foundries, lead smelting, shot and lead pipe plants. Hamilton's evaluation also comprised dusty atmospheres, ventilation, hours of work and workers' habit. He proposed the enforcement of regulation that would improve the work environment and living conditions of ordinary workers.

Objectives. To assess the impact of New York City's (NYC's) 2014 increase of the minimum legal purchase age (MLPA) for tobacco and e-cigarettes from 18 to 21 years. Methods. We performed a difference-in-differences analysis comparing NYC to the rest of New York State by using repeated cross-sections of the New York Youth Tobacco Survey (2008-2016) and to 4 Florida cities by using the Youth Risk Behavior Surveys (2007-2015). Results. Adolescent tobacco use declined slightly in NYC after the policy change. However, this rate of change was even larger in control locations. In NYC, e-cigarette use increased and reported purchases of loose cigarettes remained unchanged, suggesting uneven policy implementation, enforcement, or compliance. Results. Increasing the MLPA to 21 years in NYC did not accelerate reductions in youth tobacco use any more rapidly than declines observed in comparison sites. Public Health Implications. Other cities and states currently raising their MLPA for tobacco may need to pay close attention to policy enforcement and conduct enhancedmonitoring of retailer compliance to achieve the full benefits of the policy. [ABSTRACT FROM AUTHOR]

Objectives. To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. Methods. We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressure, and have a working telephone. We randomized participants to 1 of 3 groups: (1) patient navigation by a community health worker for CRC screening (PN), (2) motivational interviewing for blood pressure control by a trained counselor (MINT), or (3) both interventions (PLUS). We assessed CRC screening completion at 6-month follow-up. Results. Intent-to-treat analysis revealed that participants in the navigation interventions were significantly more likely than those in the MINT-only group to be screened for CRC during the 6-month study period (17.5% of participants in PN, 17.8% in PLUS, 8.4% in MINT; P < .01). Conclusions. Telephone-based preclinical patient navigation has the potential to be effective for older Black men. Our results indicate the importance of community-based health interventions forimprovinghealth among minoritymen. [ABSTRACT FROM AUTHOR]

We employed the research-to-practice consensus workshop (RTP; workshops held in New York City and Tompkins County, New York, in 2013) model to merge researcher and practitioner views of translational research priorities in palliative care. In the RTP approach, a diverse group of frontline providers generates a research agenda for palliative care in collaboration with researchers. We have presented the major workshop recommendations and contrasted the practice-based research priorities with those of previous consensus efforts. We uncovered notable differences and found that the RTP model can produce unique insights into research priorities. Integrating practitioner-identified needs into research priorities for palliative care can contribute to addressing palliative care more effectively as a public health issue. [ABSTRACT FROM AUTHOR]

Objectives. We examined loose cigarette (loosie) purchasing behavior among young adult (aged 18-26 years) smokers at bars in New York City and factors associated with purchase and use. Methods. Between June and December 2013, we conducted cross-sectional surveys (n = 1916) in randomly selected bars and nightclubs. Using multivariable logistic regression models, we examined associations of loose cigarette purchasing and use with smoking frequency, price, social norms, cessation behaviors, and demographics. Results. Forty-five percent (n = 621) of nondaily smokers and 57% (n = 133) of daily smokers had ever purchased a loosie; 15% of nondaily smokers and 4% of daily smokers reported that their last cigarette was a loosie. Nondaily smokers who never smoked daily were more likely than were daily smokers to have last smoked a loosie (odds ratio = 7.27; 95% confidence interval = 2.35, 22.48). Quitting behaviors and perceived approval of smoking were associated with ever purchasing and recently smoking loosies. Conclusions. Loosie purchase and use is common among young adults, especially nondaily smokers. Smoking patterns and attitudes should be considered to reduce loose cigarette purchasing among young adults in New York City. [ABSTRACT FROM AUTHOR]

Abstract: As a result of New York State's Newborn Screening Program 4,565 neonates with trait hemoglobinopathies were identified and 3,200 families were notified of the results of testing their infants in New York City in 1982. Of the 1,531 families (2,190 parents) tested and counseled, 22 parents were diagnosed with sickle cell disease and 39 couples were found to be at-risk for having a child with sickle cell disease. Amniocentesis was performed in 14 of the 28 at-risk pregnant women and three of the four affected pregnancies were terminated. [ABSTRACT FROM AUTHOR]

Objectives. We assessed consumer awareness of menu calorie information at fast-food chains after the introduction of New York City's health code regulation requiring these chains to display food-item calories on menus and menu boards. Methods. At 45 restaurants representing the 15 largest fast-food chains in the city, we conducted cross-sectional surveys 3 months before and 3 months after enforcement began. At both time points, customers were asked if they had seen calorie information and, if so, whether it had affected their purchase. Data were weighted to the number of city locations for each chain. Results. We collected 1188 surveys pre-enforcement and 1229 surveys postenforcement. Before enforcement, 25% of customers reported seeing calorie information; postenforcement, this figure rose to 64% (P<.001; 38% and 72%, weighted). Among customers who saw calorie information postenforcement, 27% said they used the information, which represents a 2-fold increase in the percentage of customers making calorie-informed choices (10% vs 20%, weighted; P<.001). Conclusions. Posting calorie information on menu boards increases the number of people who see and use this information. Since enforcement of New York's calorie labeling regulation began, approximately 1 million New York adults have seen calorie information each day. [ABSTRACT FROM AUTHOR]

We calculated population-based tuberculosis (TB) rates among HIV-infected persons in New York City from 2001 through 2005 using data from the city's TB and HIV/AIDS surveillance registries, and we examined those rates using linear trend tests and incidence rate ratios (IRRs). HIV-infected individuals had 16 times the TB rate of a "non-HIV" population (HIV status negative or unknown; IRR=16.0; 95% confidence interval=14.9, 17.2). TB rates declined significantly among the US-born HIV-infected population (P[sub trend] >.001) but not among the foreign-born HIV-infected population (P[sub trend] =.355). Such disparities must be addressed if further declines are to be achieved. (Am J Public Health. 2010;100:1031-1034. doi:10.2105/AJPH.2009.177725) [ABSTRACT FROM AUTHOR]

Objectives. We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. Methods. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n=1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-ex-change), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange). Results. There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR]=3.46, 95% confidence interval [CI]=2.41, 4.96 and AOR=4.02, 95% CI=1.67, 9.69, respectively) and Hispanics vs Whites (AOR=1.76, 95% CI=1.49, 2.09 and AOR=1.49, 95% CI=1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. Conclusions. New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ ethnic disparities in HIV infection. (Am J Public Health. 2009;99:S445-S451. doi: 10.2105/AJPH.2008.159327) [ABSTRACT FROM AUTHOR]

Objectives. We measured noise levels associated with various forms of mass transit and compared them to exposure guidelines designed to protect against noise-induced hearing loss. Methods. We used noise dosimetry to measure time-integrated noise levels in a representative sample of New York City mass transit systems (subways, buses, ferries, tramway; and commuter railways) aboard transit vehicles and at vehicle boarding platforms or terminals during June and July 2007. Results. Of the transit types evaluated, subway cars and platforms had the highest associated equivalent continuous average (L[sub eq]) and maximum noise levels. All transit types had L[[sub eq] levels appreciably above 70 A-weighted decibels, the threshold at which noise-induced hearing loss is considered possible. Conclusions. Mass transit noise exposure has the potential to exceed limits recommended by the World Health Organization and the US Environmental Protection Agency and thus cause noise-induced hearing loss among riders of ail forms of mass transit given sufficient exposure durations. Environmental noise-control efforts in mass transit and, in cases in which controls are infeasible, the use of personal hearing protection would benefit the ridership's hearing health. (Am J Public Health. 2009;99:1393-1399. doi:10.2105/AJPH.2008.138297) [ABSTRACT FROM AUTHOR]

Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation's largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration. (Am J Public Health. 2009;99:988-995. doi:10.2105/ AJPH.2007.123265. [ABSTRACT FROM AUTHOR]

We used a retrospective, matching, birth cohort design to evaluate a comprehensive, coalition-led childhood immunization program of outreach, education, and reminders in a Latino, urban community. After we controlled for Latino ethnicity and Medicaid, we found that children enrolled in the program were 53% more likely to be up-to-date (adjusted odds ratio=1.53; 95% confidence interval = 1.33, 1.75) and to receive timely immunizations than were children in the control group (t=3.91). The coalition-led, community-based immunization program was effective in improving on-time childhood immunization coverage. [Am J Public Health. 2008;98:1959-1962. doi:10.2105/AJPH.2007.121046) [ABSTRACT FROM AUTHOR]

Objectives. We measured HIV seroprevalence and associated risk factors among persons in New York City's house ball community. Methods. In 2004 we conducted a venue-based risk-behavior survey and HIV testing in the house ball community. Results. Of the 504 study participants, 67% were male, 14% female, and 18% transgender. Mean age was 24 years (range = 15-52 years); 55% were Black, and 40% were Latino. More than 85% of participants had previously been tested for HIV, although only 60% had been tested in the previous 12 months. Of the 84 (17%) persons who tested positive for HIV in our study, 61 (73%) were unaware of their HIV status. A logistic regression analysis on data from 371 participants who had had a male sexual partner in the previous 12 months showed that HIV-infected participants were more likely than were HIV-negative participants to be Black, to be older than 29 years, and not to have been tested for HIV in the previous 12 months. Conclusions. Culturally specific community-level prevention efforts are warranted to reduce risk behaviors and increase the frequency of HIV testing in New York City's house ball community. (Am J Public Health. 2008;98:1074-1080. doi:10.2105/AJPH.2006.108936) [ABSTRACT FROM AUTHOR]

Objectives. We sought to project future impacts of climate change on summer heat-related premature deaths in the New York City metropolitan region. Methods. Current and future climates were simulated over the northeastern United States with a global-to-regional climate modeling system. Summer heat-related premature deaths in the 1990s and 2050s were estimated by using a range of scenarios and approaches to modeling acclimatization (e.g., increased use of air conditioning, gradual physiological adaptation). Results. Projected regional increases in heat-related premature mortality by the 2050s ranged from 47% to 95%, with a mean 70% increase compared with the 1990s. Acclimatization effects reduced regional increases in summer heat-related premature mortality by about 25%. Local impacts varied considerably across the region, with urban counties showing greater numbers of deaths and smaller percentage increases than less-urbanized counties. Conclusions. Although considerable uncertainty exists in climate forecasts and future health vulnerability, the range of projections we developed suggests that by midcentury, acclimatization may not completely mitigate the effects of climate change in the New York City metropolitan region, which would result in an overall net increase in heat-related premature mortality. (Am J Public Health. 2007;97:2028-2034. doi:10.2105/AJPH.2006.102947) [ABSTRACT FROM AUTHOR]

Objectives. We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003. Methods. The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case-control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients. Results. Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR] = 2.7, 95% confidence interval [CI]= 1.2, 6.1) and seafood (OR = 4.8; 95% CI = 1.6, 14) between the power outage and symptom onset was associated with diarrheal illness. Conclusions. Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected. (Am J Public Health. 2005;95:547-553.) [ABSTRACT FROM AUTHOR]

Objectives. We assessed the relationship between distribution of education and health indicators in a large urban area to determine if distribution of education may be a determinant of population health. Methods. We studied the association between distribution of education, measured with the education Gini coefficient, and rates of 8 health indicators in 59 neighborhoods in New York City. Results. In separate adjusted ecological models, neighborhoods with more poorly distributed education had better population health indicators that might plausibly be associated with short-term changes in the social environment (e.g., homicide and infant mortality rate); there was no association between education distribution and health indicators more likely to be associated with long-term accumulation of social and behavioral stressors (e.g., cardiovascular disease and chronic lung disease mortality rates). These findings were robust to measures of income and to adjustment for several potential confounders (e.g., gender and race/ethnicity). Conclusions. The presence in a neighborhood of highly educated people may be salutary for all residents, independent of the potentially deleterious consequences of income maldistribution. (Am J Public Health. 2005;95:2198-2205.) [ABSTRACT FROM AUTHOR]

Objectives. We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250000 to 3000000 syringes exchanged annually. Methods. Serum samples were obtained from serial cross-sectional surveys of 3651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS. Results. HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990-1992, to 2.63/100 PYAR from 1993-1995, to 1.05/100 PYAR from 1996-1998, and to 0.77/100 PYAR from 1999-2002 (P<.001). There was a very strong negative linear relationship (r=-.99, P<.005) between the annual numbers of syringes exchanged and estimated HIV incidence. These results were highly consistent with a large number of shorter incidence studies among IDUs conducted during the time period. Conclusions. STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention. [ABSTRACT FROM AUTHOR]

Objectives. Recently, New York City and New York State increased cigarette excise taxes and New York City implemented a smoke-free workplace law. To assess the impact of these policies on smoking cessation in New York City, we examined over-the-counter sales of nicotine replacement therapy (NRT) products. Methods. Pharmacy sales data were collected in real time as part of nontraditional surveillance activities. We used Poisson generalized estimating equations to analyze the effect of smoking-related policies on pharmacy-specific weekly sales of nicotine patches and gum. We assessed effect modification by pharmacy location. Results. We observed increases in NRT product sales during the weeks of the cigarette tax increases and the smoke-free workplace law. Pharmacies in low-income areas generally had larger and more persistent increases in response to tax increases than those in higher-income areas. Conclusions. Real-time monitoring of existing nontraditional surveillance data, such as pharmacy sales of NRT products, can help assess the effects of public policies on cessation attempts. Cigarette tax increases and smoke-free workplace regulations were associated with increased smoking cessation attempts in New York City, particularly in low-income areas. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the impact of comprehensive tobacco control measures in New York City. Methods. In 2002, New York City implemented a tobacco control strategy of| (1) increased cigarette excise taxes; (2) legal action that made virtually all workplaces, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking. Results. From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140 000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US-born and foreign-born persons; and in all 5 boroughs. Increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third. Conclusions. Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing. [ABSTRACT FROM AUTHOR]

Objectives. We estimated the prevalence of overweight in a population of young children enrolled in a New York City Special Supplemental Nutrition Program for Women, Infants, and Children. Methods. Administrative and survey data were collected from a sample of enrolled families. Body mass index (BMI) of 557 children aged 2, 3, and 4 years was compared by sociodemographic and nutrition characteristics. Results. Forty percent of the children were overweight or at risk for overweight (BMI≥85th percentile). Compared with other racial/ethnic groups combined, Hispanic children were more than twice as likely (odds ratio=2.6; 95% confidence interval= 1.8, 3.8) to be overweight or at risk for overweight. Two-year-olds were less likely to be overweight than 3- and 4-year-olds. Conclusions. Interventions to address childhood overweight should be culturally specific and target very young children. (Am J Public Health. 2004;94:458-462) [ABSTRACT FROM AUTHOR]

In 1996 we launched a community-provider partnership to raise immunization coverage for children aged younger than 3 years in Northern Manhattan, New York City. The partnership was aimed at fostering provider knowledge and accountability, practice improvements, and community outreach. By 1999 the partnership included 26 practices and 20 community groups. Between 1996 and 1999, immunization coverage rates increased in Northern Manhattan 5 times faster than in New York City and 8 times faster than in the United States (respectively, 3.4% vs 0.4% [t=6.05, p<0.001] and vs 0.6% [t=5.65, p<0.001]). The coverage rate for Northern Manhattan stayed constant through 2000, although it declined during this period for the United States and New York City. We attribute the success at reducing the gap to the effectiveness of our partnership. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the association between a residential area's socioeconomic status (SES), race, and advanced-stage breast cancer in New York City. Methods. The cross-sectional study design used breast cancer information for 37 921 cases diagnosed in New York City from 1986 to 1995. Residential education and income levels were based on the 1990 census and ascribed to each case by zip code. Associations between race, area SES, and advanced-stage breast cancer stage, and the interaction between race and SES, were evaluated in bivariate and multivariate analyses. Results. After adjusting for age and year at diagnosis, living in areas with lower levels of education and income increased the odds of presenting with advanced-stage breast cancer by 50% for Black women and by 75% for White women. No significant qualitative interaction was present between area SES and race. Conclusions. This study confirmed independent racial and socioeconomic differences in the risk of advanced-stage breast cancer in a large and diverse population. The results emphasize the need to improve screening practices and clinical treatment in both high-risk populations and high-risk geographic areas. (Am J Public Health. 2002;92:64-70) [ABSTRACT FROM AUTHOR]

Conclusions. Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas. (Am J Public Health. 2001;91:1487-1493) [ABSTRACT FROM AUTHOR]

Conclusions. The counterintuitive findings raise hypotheses regarding the role of change and responsibilities in the survival of parents with HIV. (Am J Public Health. 2001;91:1303-1309) [ABSTRACT FROM AUTHOR]

Conclusions. Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation. (Am d Public Health. 2001;91:1082-1088) [ABSTRACT FROM AUTHOR]

Conclusions. Several differences in factors associated with prevalent HCV infection existed among 2 populations of young injection drug users from the same city. Indirect transmission of HCV may occur. (Am J Public Health. 2001; 91:23-30) [ABSTRACT FROM AUTHOR]

Deals with a study which examined the factors associated with gender differences in health insurance coverage and having a usual source of medical care. Methodology of the study; Presentation of results; Discussion of findings. [ABSTRACT FROM AUTHOR]

Objectives. We assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City. Methods. Data were compiled from 10 separate studies (N=4979), including 6 cohort studies, 2 "repeat service user" studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs. Results. In the 10 studies, 52 sero-conversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk, Conclusions. The recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a "declining phase" characterized by low incidence and declining prevalence. The data suggest that very large high-seroprevalence HIV epidemics may be "reversed." (Am J Public Health. 2000; 90:352-359) [ABSTRACT FROM AUTHOR]

Objectives. This study examined patients' satisfaction with New York State's tuberculosis (TB) directly observed therapy (DOT) programs in New York City. Methods. A survey was conducted of 435 patients at 19 public, private, and community-based TB DOT clinics about their satisfaction with various aspects of the programs. Results. Patients identified the opportunity to receive good medical care as the most important aspect of TB DOT. Also significant was the supportiveness of DOT staff. Receiving incentives to encourage participation was statistically less important. Half of the patients reported being better off with DOT than with self-supervised care. Conclusions. This study confirms the value of patient-focused care among inner-city TB patients. (Am J Public Health. 1999;89:1567-1570) [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to determine the impact of childhood moves and foreign birth on vaccination coverage among Latino children in New York City. Methods. Vaccination coverage was assessed in a survey of 314 children younger than 5 years at 2 immunization clinics. Results. Forty-seven percent of the study children had moved abroad. After adjustment for health insurance, regular source of care, and country of birth, child moves had no independent effect on vaccination coverage. Foreign-born children had diphtheria--pertussis-tetanus, oral polio vaccine, and measles-mumps--rubella vaccination coverage rates similar to those of US-born children, but they were underimmunized in regard to Haemophilus influenzae type b and hepatitis B. Conclusions. Foreign birth, but not childhood moves, is a barrier to vaccinations among low-income, urban Latino children. (Am J Public Health. 1999;89:1728-1731) [ABSTRACT FROM AUTHOR]

Objectives. This report describes the population of young men who use the Young Men's Clinic in New York City, presents a profile of their reproductive behaviors, and describes the clinic's model of service delivery. Methods. Data were gathered through a routine clinic visit form administered by clinic staff. Results. The clinic sees approximately 1200 predominately Dominican young men each year for a wide range of clinical and mental health services. Two thirds of clients had ever been sexually active, three quarters had ever used birth control, and 69% had used birth control at their last sexual encounter. Conclusions. The Young Men's Clinic may serve as a model for health care delivery to adolescent and young adult males. [ABSTRACT FROM AUTHOR]