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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 of [...]

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)