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During the global pandemic of SARS-CoV-2, novel variants have continuously emerged (1). Some variants constitute an increased risk to global public health and are being monitored as variants of concern [...]

Cache Valley virus (CVV; family Peribunyaviridae, genus Orthobunyavirus) belongs to the order Bunyavirales, which consists of 12 families and 46 genera that are major human, livestock, and plant pathogens (1). [...]

Spatiotemporal analysis of high-resolution coronavirus disease (COVID-19) data can help health officials monitor disease spread and target interventions (1,2). Publicly available data have been used to detect COVID-19 spatiotemporal clusters [...]

The efficacy of COVID-19 mRNA vaccines is high, but breakthrough infections still occur. We compared the SARS-CoV-2 genomes of 76 breakthrough cases after full vaccination with BNT162b2 (Pfizer/BioNTech), mRNA-1273 (Moderna), or JNJ-78436735 (Janssen) to unvaccinated controls (February-April 2021) in metropolitan New York, including their phylogenetic relationship, distribution of variants, and full spike mutation profiles. The median age of patients in the study was 48 years; 7 required hospitalization and 1 died. Most breakthrough infections (57/76) occurred with B.1.1.7 (Alpha) or B.1.526 (Iota). Among the 7 hospitalized cases, 4 were infected with B.1.1.7, including 1 death. Both unmatched and matched statistical analyses considering age, sex, vaccine type, and study month as covariates supported the null hypothesis of equal variant distributions between vaccinated and unvaccinated in [chi square] and McNemar tests (P > 0.1), highlighting a high vaccine efficacy against B.1.1.7 and B.1.526. There was no clear association among breakthroughs between type of vaccine received and variant. In the vaccinated group, spike mutations in the N-terminal domain and receptor-binding domain that have been associated with immune evasion were overrepresented. The evolving dynamic of SARS-CoV-2 variants requires broad genomic analyses of breakthrough infections to provide real-life information on immune escape mediated by circulating variants and their spike mutations., Introduction The novel betacoronavirus SARS-CoV-2 arose as a new human pathogen at the end of 2019, and rapidly spread to every corner of the globe, causing a pandemic of enormous [...]

We used repeated cross-sectional data from intercept surveys conducted annually at lesbian, gay, and bisexual community events to investigate trends in club drug use in sexual minority men (N = 6489) in New York City from 2002 to 2007. Recent use of ecstasy, ketamine, and [gamma]-hydroxybutyrate decreased significantly. Crystal metethamphetamine use initially increased but then decreased. Use of cocaine and amyl nitrates remained consistent. A greater number of HIV-positive (vs HIV-negative) men reported recent drug use across years. Downward trends in drug use in this population mirror trends in other groups. (Am J Public Health. 2010;100:1892-1895. doi: 10.2105/AJPH.2009.175232)

ABSTRACT Background The importance of understanding age when estimating the impact of influenza on hospitalizations and deaths has been well described, yet existing surveillance systems have not made adequate use [...]

Objectives. Research has indicated that there is minimal use of pharmacies among injection drug users (IDUs) in specific neighborhoods and among Black and Hispanic IDUs. We developed a community-based participatory research partnership to determine whether a multilevel intervention would increase sterile syringe access through a new policy allowing nonprescription syringe sales in pharmacies. Methods. We targeted Harlem, NY (using the South Bronx for comparison), and disseminated informational material at community forums, pharmacist training programs, and counseling or outreach programs for IDUs. We compared cross-sectional samples in 3 target populations (pre- and postintervention): community members (attitudes and opinions), pharmacists (opinions and practices), and IDUs (risk behaviors). Results. Among community members (N=1496) and pharmacists (N=131), negative opinions of IDU syringe sales decreased in Harlem whereas there was either no change or an increase in negative opinions in the comparison community. Although pharmacy use by IDUs (N=728) increased in both communities, pharmacy use increased significantly among Black IDUs in Harlem, but not in the comparison community; syringe reuse significantly decreased in Harlem, but not in the comparison community. Conclusions. Targeting the individual and the social environment through a multilevel community-based intervention reduced high-risk behavior, particularly among Black IDUs. (doi:10.2105/ AJPH.2005.069591)

We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using information obtained from birth certificates. Gestational diabetes diagnoses among women who delivered babies increased 46%, from 2.6% (95% confidence interval [CI] = 2.5, 2.7) to 3.8% (95% CI = 3.7, 3.9) of births. Prevalence was highest among South and Central Asian women (11%). Given risks for adverse fetal outcomes and maternal chronic diabetes, prompt screening is critical. Metabolic control should be maintained during pregnancy and assessed postpartum for women with gestational diabetes. (Am J Public Health. 2005;95:15:36-1539. doi:10. 2105/AJPH.2005.066100)

New York State used the health commerce system to monitor the number of West Nile virus (WNV) human disease cases and the density of dead crows. In each year from [...]

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 140000 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. (Am J Public Health. 2005;95:1016-1023. doi:10.2105/AJPH.2004.058164)

Although oral diseases are among the most common chronic conditions affecting older adults, utilization of dental services by the elderly, especially minority elderly is low. This pilot study determined whether there are racial/ethnic differences in oral disease burden, perceived oral health-related quality of life, perceived need for dental services and dental services utilization between African-American and Latino seniors in Northern Manhattan. Subjects received an oral examination and a face-to-face survey to assess oral health status, perceived need, perceived oral health-related quality of life, and utilization of dental services. The data suggest that in both populations, oral disease burden is high and utilization of dental services is problematic--34.0% of the subjects were edentulous and average time since last dental visit was 40.1 months. The average DMFT was 23.8; 81.6% of the dental caries experience was accounted for by Missing Teeth, and there were significant differences in total caries experience, and Missing and Filled Teeth between African-American and Latino seniors. Although there were no racial/ethnic differences in the utilization of dental services, dentate individuals were more likely to have had a more recent dental visit (31.0 months) than edentulous individuals (57.7 months). The high proportion of Missing Teeth suggests that interventions aimed at improving the oral health of this population must target individuals at a younger age. KEY WORDS: oral disease burden; elderly; dental services utilization; dental caries.

During the 1990s, the number of new AIDS cases in New York City, USA, declined precipitously. The declines, beginning before highly active antiretroviral therapy (HAART) was introduced, were geographically heterogeneous across two New York City boroughs analyzed. From 1993 to 1998, zip codes in Lower Manhattan, with large white and affluent populations, had declines as much as 55% more than the rest of Manhattan. Bronx zip codes underwent still lesser declines. Declines also differed within zip codes among subpopulations. White zip code populations tended to have greater declines than Latino populations, which in turn tended to have greater declines than black populations. According to bivariate and stepwise regressions, an array of socioeconomic and community stress variables acted in combination on the decline in New York AIDS. Manhattan's declines in total AIDS incidence were primarily defined by changes in AIDS incidence for whites and for men who have sex with men, racial, segregation, and the proportions of households in upper income classes and under rent stress. Bronx declines in total AIDS are principally explained by a broader range of income classes, and social instability as marked by housing overcrowding and cirrhosis and drug mortalities. Whatever the combination of proximate causes for the decline in AIDS incidence in 1990s New York (educational campaigns, HAART, demographic stochasticity), the decline was shaped by the city's socioeconomic structure and political and ecological history. That structure and history generates the geographically defined aggregates of behaviors that promote or impede AIDS decline. Such spatial heterogeneity may provide for HIV refugia, areas where the virus can weather the epidemic's contraction, a troubling possibility with the accelerating microbicidal failures of combination therapies. Keywords: AIDS geography; HAART; Community stress; HIV refugia; New York; USA

During the late 1980s and early 1990s, the number of children reported with tuberculosis (TB) increased in New York City (NYC) as well as nationally. (1-6) Pediatric TB cases are […]

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city's response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city's health care and social service system. The authors suggest lessons that can inform the development of a post-September 11th agenda for strengthening urban health infrastructures. (Am J Public Health. 2003;93:400-406)

From January 1, 1995, to December 31, 1997, we reviewed records of all New York City patients who had multidrug-resistant tuberculosis (MDRTB); we performed insertion sequence (IS) 6110-based DNA genotyping [...]

The need for a reorganization of the economic aspects of the resident physician program is examined in New York, NY, to ensure adequate specialty coverage.

Objectives. This study examined the usefulness of computer-assisted active surveillance in identifying maternal deaths in New York City. Methods. Computerized searches of hospital discharge and autopsy record databases were conducted for maternal deaths occurring in 1997. Results. Active surveillance revealed 14 new maternal deaths not previously reported, an 88% increase. Nine of these deaths were found through the hospital discharge database search, i was found through the autopsy record search, and 4 were found in both searches. Overall maternal mortality ratios associated with active surveillance and routine surveillance were 24.3 and 13.0 deaths per 100 000 live births, respectively. Conclusions. Active surveillance of maternal mortality is useful in identifying new maternal deaths. Existing databases can be used relatively easily to augment routine surveillance of maternal mortality.

In 1999, a cluster of encephalitis cases was detected in New York City. The city applied larvicide to standing water and aerially sprayed pesticides to control adult mosquitoes. The causative agent was West Nile virus, a type of encephalitis that had never before been transmitted in the western hemisphere. This experience offers many lessons for the practitioners of public health and of public health law. A public health infrastructure that does not lose sight of the old threats must be maintained. The public health and environmental governmental establishments must work together. Law is closely intertwined with policy and programmatic initiatives and can facilitate a better public health outcome.

Tuberculosis among foreign-born people residing in New York City is mostly a reactivation of existing disease rather than a newly-acquired infection. Many cases of tuberculosis in the US occur in people who were born in another country.

An analysis is presented on the social, economic, cultural and political relevance of artistic stamps printed on bags of heroin, based on a study of 300 addicts and dealers in New York, New York. The stamps, which represent an artifact indigenous to the heroin culture, denote individual markets, provide ethnographic information and utilize prestige and advertising concepts.

This article uses an epidemiological approach to examine the health status and well-being of New York City residents. Statistics on infant mortality, life expectancy, poverty, and mental illness are included to provide insight into public health in New York City.

This article examines the social, economic, and health conditions in the poorest neighborhoods of New York City. Urban renewal programs and prosperity in neighboring communities have concentrated poverty into inner city ghettos resulting in a decline in public health, limited access to health services, and increased marginalization of the community.

Objectives. This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. Methods. Changes in birthweight distributions and in birthweight/age--, cause-, and birthweight/age/cause--specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. Results. Infant, neonatal, and postneonatal mortality of very-low-birthweight ([is less than] 1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/ age groups experiencing mortality declines. Conclusions. Widespread, multiple perinatal and postnatal factors contributed to the decline in infant mortality. (Am J Public Health. 1998;88:816-820)

Homeless youths are at high risk for poor health outcomes, including repeated exposure to STDs and high rates of unplanned pregnancies, untreated TB, HIV infection, and accelerated immune dysfunction associated with AIDS. This article examines the nature and distribution of HIV-risk behavior in a broad, street-based sample of homeless and runaway youths in New York City (N = 929). Although street youths in general are shown at high risk, the highest risks nest within older age segments of the male street youth population. Paradoxically, these youths are least likely to be in contact with prevention services. The data demonstrate the need to reconsider the use of chronological age as a determinant for service eligibility and to reconfigure funding streams so as to more effectively and consistently target older and more vulnerable youths.

Objective To examine food consumption patterns and related characteristics of schoolchildren. Design A representative survey involving a household questionnaire and child interview to conduct a nonquantitative 24-hour dietary recall. Indexes were developed to score the diets based on the Food Guide Pyramid and 5 A Day for Better Health recommendations. Subjects/setting Six hundred ninety-three 2nd-grade students and 704 5th-grade students from public and private schools in New York City. Statistical analyses performed Weighted means and gender-adjusted analysis of covariance models were used to account for a complex survey design in calculating variance estimates. Results Compared with a maximum of 50, the mean Food Guide Pyramid index score was 29.2 for 2nd-grade students and 30.4 for 5th-grade students. The mean 5 A Day consumption score was 3.4 and 3.6 servings of fruits and vegetables daily for 2nd and 5th graders, respectively. Measures of food consumption were significantly related to socioeconomic status, race/ethnicity, skipping meals, and participating in school lunch for both grades, and with meal preparation for 5th graders. Applications/conclusions The Food Guide Pyramid and 5 A Day recommendations provide guidelines for food selection beginning in childhood. Knowledge and skills training are needed to improve food consumption patterns as children consume foods away from home and as they take on greater responsibility for meal preparation and food selection., Increasing awareness of the importance of diet for health promotion and disease prevention has led to a greater concern about the diet and food consumption patterns of schoolchildren. Findings from [...]

Higher death rates from heart disease in blacks in New York City compared to whites may be a reflection of their birthplace rather than their race. Researchers used US Census Data and mortality records to compare death rates from cardiovascular disease among blacks and whites in New York City. Blacks born in the Northeast had similar death rates as whites, but blacks born in the South had higher death rates than blacks born in the Northeast. Blacks born in the Caribbean had lower death rates than blacks born in the Northeast. Caribbean-born blacks had lower death rates than whites.

The number of tuberculosis cases in New York City decreased from 1992 to 1994, possibly because of increases in supervised therapy and completion of treatment. Between 1978 and 1992 the number of tuberculosis cases in New York City almost tripled. Researchers reviewed death certificates and medical records from a variety of sources to confirm the accuracy of tuberculosis statistics between 1992 and 1994. The surveillance system appeared to be fairly accurate. The number of cases decreased among populations prone to recent infections, but increased among populations likely to have reactivated infections. This reduction in infection was probably due to an increase in the number of patients in programs where they are observed taking their medication. Other factors contributing to the decreased transmission may include decreases in the size of homeless shelters, improved tuberculosis control in hospitals and prisons, and the use of multiple drug regimens.

Mortal injury following cocaine use may be one of the five most common causes of death in people 15 to 44 years old in New York City. Researchers tested the blood or urine of 12,960 people who had died from fatal injuries in New York City, between 1990 and 1992 for cocaine or its metabolite, benzoylecgonine. Approximately 27% of these people had used cocaine within 3 days of their death, as indicated by benzoylecgonine in their blood or urine. Approximately 18% had used cocaine just before death, as indicated by free cocaine in their blood. Fatal injury following cocaine use was the cause of death in 14% of people aged 15 to 24, and 10% of people aged 25 to 44. Approximately 65% of deaths from fatal injury after cocaine use were the result of violence rather than the effect of cocaine on the body. Death from injuries following cocaine use was particularly high among young blacks and Hispanics.

It is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchanges has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges. Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking ("tagging") syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly. Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where "unauthorized" possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made.

The medical staff at a major New York City hospital was baffled Senegelese street vendors had been presenting to the emergency room with a series of abdominal complaints. After multiple [...]

Program dissemination and implementation represent critical components of effective school-based health promotion interventions. This study examined the dissemination and implementation of a nutrition teaching program, Nutrition For Life, in New York State secondary schools. Some 1,312 health, home economics, and physical education teachers in junior and senior schools provided information through random sample mail surveys. Logistic regression procedures examined teacher and school characteristics associated with receipt and use of the program. Overall, 50% of junior high school and 33% of senior high school teachers received the program and three-quarters of these teachers used it. At both levels, home economics teachers were more likely to receive and use the program than health teachers. Peer-led teacher training workshops organized through an existing community-based network provide an effective and efficient mechanism for disseminating nutrition teaching programs. (J Sch Health. 1993;63(8):343-348), With the link between diet and the major chronic diseases now well-recognized, nutrition intervention constitutes an important component of health promotion and disease prevention program.[1-3] School health programs, by promoting [...]

Objectives. During an epidemic of measles among preschool children in New York City, an investigation was conducted in 12 city hospitals to estimate reporting efficiency of measles to the New York City Department of Health. Methods. Measles cases were identified by review of hospital emergency room and infection control logs and health department surveillance records. The Chandra Sekar Deming method was used (1) to estimate the total number of measles cases in persons less than 19 years old who presented to the 12 hospitals from January through March 1991 and (2) to estimate reporting efficiency. Information on mechanisms for reporting measles cases was collected from hospital infection control coordinators. Results. The Chandra Sekar Deming method estimated that 1487 persons with measles presented to the 12 hospitals during the study period. The overall reporting efficiency was 45% (range = 19% to 83%). All 12 hospitals had passive surveillance for measles; 2 also had an active component. These 2 hospitals had the first and third highest measles reporting efficiencies. Conclusions. The reporting efficiency of measles cases by New York City hospitals to the health department was low, indicating that the magnitude of the outbreak was substantially greater than suggested by the number of reported cases. (Am J Public Health. 1993;83:1011-1015), Measles is a reportable disease, but it is not known how efficiently it is being reported. A study was conducted in 12 New York, NY, hospitals to see how efficiently incidences of measles were reported to the New York City Department of Health. Emergency department records, infection control logs and health department surveillance records were used to identify measles cases. The Chandra Sekar Deming method was then employed to estimate the total number of measles cases in those under 19 years of age and to estimate reporting efficiency. Hospital infection control coordinators were asked to provide information on the procedures for reporting cases of measles. During the 3-month period studied in 1991, 1,487 persons with measles were seen at the 12 hospitals. Overall reporting efficiency was 45%. It was concluded that reporting efficiency was low, suggesting that the incidence of measles was much greater than was reported to the department of health.

New York City's jail system may be fueling the tuberculosis epidemic. New York City's jail population exceeds 20,000, and the average prison stay is 65 days. Of 2,636 male inmates who tested negative for tuberculosis in 1985, 60 had developed tuberculosis by May 15, 1992. Inmates who had undergone methadone detoxification while in jail were 4.3 times more likely to have developed tuberculosis as those who had been in general prison housing. Inmates who were 30 or older were 2.4 times as likely to develop tuberculosis as younger inmates. The risk of tuberculosis increased with time spent in jail and number of admissions to jail. Race was not associated with risk of tuberculosis. More aggressive detection and treatment is needed to prevent the spread of tuberculosis among inmates and into the community as they return home.

The effects and costs of maternal substance abuse in New York, NY, were investigated by using a pooled time-series cross-section analysis of live births. The results indicated that low birth weights attributable to illicit drug abuse among pregnant women reached as much as 3,359, a 7.3% increase over normal levels. This increase represents an estimated $18 to $41 million in additional neonatal admission costs.

Children with no known prior vitamin A deficiency exhibited a significant decline in their serum retinol levels during the acute phase of measles. This decline in circulating retinol was associated with increased duration of fever, higher hospitalization rates, and decreased anti-body titers.

An earlier effort at projecting the future incidence of AIDS (acquired immune deficiency syndome) among adult male homosexuals in New York City is reviewed in the light of data for 18 more months. One of the previous computer models holds up well against the new data. The model projects a temporary levelling off or reduction in new AIDS incidence, followed by a long, slower resurge. The HIV (human immunodeficiency virus) transmission probability, given an infected partner, is estimated to be barely sufficient to sustain endogenous growth in the homosexual population. From this it tentatively may be concluded that the epidemic will not start to spread exponentially among the heterosexuals if their sexual behavior is less risky than homosexuals'.

There is a possibility that the United States Supreme Court will overturn the 1973 Roe versus Wade decision that legalized abortion. If this occurs, it is likely that states will gain the authority to regulate abortion. Statistical analyses were performed to estimate the effect that restriction of abortion would have on childbearing by adolescent girls. It was suggested that a ban on abortion would cause an increase in births equivalent to the decrease that followed the passage of a New York State law liberalizing abortion in 1970. The number of children born to teenaged girls in New York City was examined from 1963 to 1987 to assess the change that occurred in response to the 1970 law. After the liberalization of abortion, births to black adolescents decreased by 18.7 percent (142 fewer births per month) and births to white adolescents decreased by 14.1 percent (111 fewer births per month). From these results it was concluded that a ban on abortion would lead to major increases in childbearing by adolescents in New York City. Restrictions on abortion would also affect other parts of the nation, but the magnitude of the increase in births would vary according to local factors. Some factors that could affect birth rates after restriction of legal abortion are: the rate of abortion before the ban, distance to states where abortion remains legal, and the opportunity to obtain an illegal abortion. (Consumer Summary produced by Reliance Medical Information, Inc.)

This paper presents data on mortality by drug dependence among Puerto Rican residents aged 15-44 of New York City. While men show death rates for drug dependence several times those of women, when deaths by drug dependence are calculated as a proportion of all deaths, the ratios are nearly the same for both sexes. Factors relevant to analyzing mortality statistics on drug dependence in this population are an undercount of Puerto Rican males and competing causes of death, particularly homicide among men. Factors influencing deaths by drugs are gender roles as they influence patterns of drug use and types of chronic use: regular and intermittent., Research studies have determined that Puerto Ricans living in New York City are at high risk for death due to drug abuse. One major study found that 12.3 percent of New York Puerto Ricans aged 15 to 44 years died from drug dependence; this percentage was considered extremely high. Mortality data compiled by the New York City Department of Health was obtained from the National Center for Health Statistics in order to assess deaths due to drug dependence among Puerto Ricans aged 15 to 44 years old; data were for 1979 to 1981. Few deaths from drug dependence occur outside this age range in this population. The results showed that deaths from drug dependence were several times higher among men than women in the Puerto Rican communities of New York City, but when the figures were converted to a proportion of all deaths, the difference by sex was virtually eliminated. The percentage of deaths from drug dependence out of all deaths was 7.4 percent for men and 7.1 percent for women. Issues important to the interpretation of mortality data include the tendency to undercount Puerto Rican men and the need to consider the competing causes of death, of which homicide and accidents are especially significant among men. It also appears that Puerto Rican men are more frequently chronic drug abusers active in the drug subculture, while women tend to use drugs intermittently. (Consumer Summary produced by Reliance Medical Information, Inc.), INTRODUCTION Puerto Ricans in New York City have been identified as a high-risk population for death by drug dependence for at least two decades. The major reference has been Alers' [...]

Homeless children in New York City had an extremely high asthma prevalence--40%--in a cross-sectional study at 3 shelters (n = 740) during 1998 to 1999. We used the same protocol to summarize subsequent data through December 2002. Asthma prevalence was 33% (n = 1636); only 15% of the children previously diagnosed were taking an asthma controller medication. Emergency department use was 59%. These data were used to support a class action lawsuit that was resolved in favor of of homeless children with asthma in New York City. doi:10.2105/AJPH. 2005.070482

For New York City from 1978 to 1990, plotting the 3-year running averages of citywide new tuberculosis cases against the middle year yielded an 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. (Am J Public Health. 1994;84:1000-1002), The explosion of new tuberculosis cases in New York City appears to be due to the formation of secondary focal points outside the main epicenters, from which a wave of new cases could spread outwards. The development of secondary focal points is called hierarchical diffusion and the spread outwards from a single center is called spatial diffusion. These patterns can be seen by mapping the number of new cases per 100,000 population from 1978 through 1990. The year 1982 was the turning point in the epidemic. Before 1982 only Manhattan and Fort Greene in Brooklyn ranked in the top 20% for new cases (25 per square mile). By 1984, both Brooklyn and the Bronx had districts in the top quintile. By 1990, districts in the top 20% had 50 new cases per square mile. Data suggest that 25 cases per square mile is the threshold for formation of secondary epicenters as well as the trigger point from slow to rapid increase in incidence of new cases.

To determine if mortality differences between municipal and voluntary hospitals in New York City persist after adjustment for computerized administrative data (age, sex, principal diagnosis, and secondary diagnosis), six conditions in those hospitals from 1984 through 1987 were studied. Unadjusted mortality was significantly higher in municipal hospitals for myocardial infarction, stroke, and head trauma, and lower for congestive heart failure and pneumonia. Adjustment using administrative data eliminated differences for myocardial infarction, congestive heart failure, and pneumonia, but not for stroke and head trauma. We conclude that adjustment using administrative data eliminates some but not all mortality differences between municipal and voluntary hospitals. Medical record review is needed to determine why these differences persist. (Am J Public Health. 1993;83:1024-1026)

The resurgent tuberculosis epidemic represents - specially in New York City - a failure to maintain a public health infrastructure that was focused on preventing active disease in high-risk populations (i.e., individuals with the human immunodeficiency virus [HIV]) and on treating active tuberculosis patients until cured. Although the tuberculosis problem in New York City and other localities is worsened by homelessness, poverty, and substance abuse, it is possible to bring tuberculosis under control by directing public health resources into targeted programs that enhance compliance with tuberculosis treatment regimen and expand chemoprophylaxis efforts among HIV-infected individuals. These two avenues will decrease, respectively, the number of cases of multidrug-resistant tuberculosis and the total number of new cases. (Am J Public Health. 1993;83:766-768), Ensuring that patients complete their treatment for tuberculosis should be the first priority of New York City's effort to control the spread of the disease. Compliance is especially important in places with a large number of HIV-infected people. HIV patients are at a high risk for developing active tuberculosis and should be treated prophylactically to prevent the spread of tuberculosis. A commitment to the public health system must be sustained. The failure to maintain the previous system for detecting and treating tuberculosis is directly responsible for the current outbreak. Social conditions such as poverty, which contribute to the spread of the disease, must also be addressed if the disease is ever to be brought fully under control.

Private choice, public health. Fall 2006 was a perfect time for a scholar interested in the ethics of health promotion to arrive in New York City, which has been experimenting [...]

Objectives. This study examined sociodemographic and psychosocial factors that predict survival among parents living with HIV. Methods. Parents with HIM (n = 307) were recruited from 1993 to 1995 in New York City and repeatedly assessed. Survival was monitored among the sample (81% mothers; 45% Latino, 34% African American). Results. Over a median period of 28 months (range = 0-53 months), 44% (n = 135) of the parents died. Having an AIDS diagnosis and being African American were associated with earlier death. Sex, age, and financial status were not related to survival. Parents who survived had initially higher levels of anxiety that decreased over time; in contrast, parents who died reported initially lower, but constant, levels of anxiety over time. After HIV diagnostic status was controlled for, it was found that parents who reported having more children, using a coping style of seeking social support, and being sexually active at baseline survived longer. 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)