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Objective: This study assessed the prevalence, diagnosis, and treatment of major depressive disorder and generalized anxiety disorder among New York City adults.Methods: As part of the first community-specific Health and Nutrition Examination Survey in the United States, depression and anxiety were assessed in a representative sample of 1,817 noninstitutionalized adults in 2004.Results: A total of 8% had major depressive disorder and 4% had generalized anxiety disorder. Respondents with depression were more likely to be formerly married, publicly insured, younger, and U.S. born. Only 55% of adults with depression were diagnosed, and 38% of those with depression or anxiety were in treatment; individuals with a diagnosis of depression were more likely to receive treatment than those without a diagnosis (61% versus 7%; p<.001). Immigrants with depression were 60% less likely to be diagnosed than their U.S.-born counterparts; immigrants arriving in this country ten or more years ago had slightly more anxiety than immigrants arriving less than ten years ago (3% versus 2%, not significant). Among respondents with anxiety, 23% reported disability compared with 15% of those with depression. Compared with adults with neither diagnosis, adults with depression or anxiety were twice as likely to smoke tobacco (p<.05), adults with depression were twice as likely to have diabetes (p<.01), and those with anxiety were twice as likely to have asthma (p<.01).Conclusions: Mental disorders are often disabling and inadequately diagnosed and treated. Foreign-born adults experience barriers to diagnosis and treatment despite having less depression; anxiety may increase with time since immigration. Increased awareness of and linkage to mental health services are needed, especially in larger, more diverse urban communities. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We assessed the extent of exposure to lead, cadmium, and mercury in the New York City (NYC) adult population. METHODS: We measured blood metal concentrations in a representative sample of 1,811 NYC residents as part of the NYC Health and Nutrition Examination Survey, 2004. RESULTS: The geometric mean blood mercury concentration was 2.73 microg/L [95% confidence interval (CI), 2.58-2.89]; blood lead concentration was 1.79 microg/dL (95% CI, 1.73-1.86); and blood cadmium concentration was 0.77 microg/L (95% CI, 0.75-0.80). Mercury levels were more than three times that of national levels. An estimated 24.8% (95% CI, 22.2-27.7%) of the NYC adult population had blood mercury concentration at or above the 5 microg/L New York State reportable level. Across racial/ethnic groups, the NYC Asian population, and the foreign-born Chinese in particular, had the highest concentrations of all three metals. Mercury levels were elevated 39% in the highest relative to the lowest income group (95% CI, 21-58%). Blood mercury concentrations in adults who reported consuming fish or shellfish 20 times or more in the last 30 days were 3.7 times the levels in those who reported no consumption (95% CI, 3.0-4.6); frequency of consumption explained some of the elevation in Asians and other subgroups. CONCLUSIONS: Higher than national blood mercury exposure in NYC adults indicates a need to educate New Yorkers about how to choose fish and seafood to maximize health benefits while minimizing potential risks from exposure to mercury. Local biomonitoring can provide valuable information about environmental exposures. [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).

Context: The Trump administration has enacted or proposed many policies that could impact public health. These include attempts to dismantle or repeal the Patient Protection and Affordable Care Act (ACA), restricting funding for women's health care, and loosening of environmental regulations., Objective: To develop a surveillance system to monitor the public health impacts of the Trump administration in New York City., Design: Epidemiologic assessment. Public health surveillance system., Setting: New York City., Participants: New York City residents., Main Outcomes Measures: We identified approximately 25 indicators across 5 domains: access to care, food insecurity, reproductive health, environmental health, and general physical and mental health. Sources of data include the New York City Department of Health and Mental Hygiene's (DOHMH's) health and risk behavior telephone survey, vital statistics, emergency department visits, DOHMH sexual health clinics, Federally Qualified Health Centers, lead and diabetes registries, Medicaid claims, Supplementary Nutrition Assistance Program enrollment, Women, Infant, and Children program enrollment, and 311 call records. Data are collected monthly or quarterly where possible. We identified measures to stratify indicators by individual and area-based measures of immigration and poverty., Results: Since April 2017, we have compiled quarterly reports, including establishing a historical baseline of 10 years to account for secular trends and encompass the establishment and enactment of the ACA. Indicators are interpreted within the context of changes in programming or local policy that might explain trends., Conclusions: We have successfully established an adaptive surveillance system that is poised to rapidly detect changes in the health of New York City residents resulting from changes by the Trump administration to public health policy. The development of such systems is a critical function for health departments across the country to play a role in the current political and policy environment.

Objectives. To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation). Methods. We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics. Results. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P  < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation. Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth. Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.

It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing. We linked data from a cohort of 21,689 persons without a previous HIV diagnosis who applied to a supportive housing program in New York City (NYC) during 2007-2013 to the NYC HIV surveillance registry. We used time-dependent Cox modeling to compare new HIV diagnoses among recipients of supportive housing (defined a priori, for program evaluation purposes, as persons who spent > 7 days in supportive housing; n = 6447) and unplaced applicants (remainder of cohort), after balancing the groups on baseline characteristics with propensity score weights. Compared with unplaced applicants, persons who received ≥ 3 continuous years of supportive housing had decreased risk for new HIV diagnosis (HR 0.10; CI 0.01-0.99). Risk of new HIV diagnosis decreased with longer duration placement in supportive housing. Supportive housing might aid in primary HIV prevention.

Former foster youth are at increased risk of housing instability and sexually transmitted infections (STIs) during the transitional period following foster care. We measured housing stability using sequence analysis and assessed whether a supportive housing program in New York, New York, was effective in improving housing stability and reducing STIs among former foster youth. Matched administrative records identified 895 former foster youth who were eligible for the housing program during 2007-2010. The main outcomes included housing stability (as determined from episodes of homelessness, incarceration, hospitalization, and residence in supportive housing) and diagnosed STI case rates per 1,000 person-years during the 2 years after baseline. Marginal structural models were used to assess impacts of the program on these outcomes. Three housing stability patterns (unstable housing, stable housing, and rare institutional dwelling patterns) were identified. The housing program was positively associated with a pattern of stable housing (odds ratio = 4.4, 95% confidence interval: 2.9, 6.8), and negatively associated with diagnosed STI rates (relative risk = 0.3, 95% confidence interval: 0.2, 0.7). These positive impacts on housing stability and STIs highlight the importance of the supportive housing program for youths aging out of foster care and the need for such programs to continue., (© The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

With 87% of providers using electronic health records (EHRs) in the United States, EHRs have the potential to contribute to population health surveillance efforts. However, little is known about using EHR data outside syndromic surveillance and quality improvement. We created an EHR-based population health surveillance system called the New York City (NYC) Macroscope and assessed the validity of diabetes, hyperlipidemia, hypertension, smoking, obesity, depression, and influenza vaccination indicators. The NYC Macroscope uses aggregate data from a network of outpatient practices. We compared 2013 NYC Macroscope prevalence estimates with those from a population-based, in-person examination survey, the 2013-2014 NYC Health and Nutrition Examination Survey. NYC Macroscope diabetes, hypertension, smoking, and obesity prevalence indicators performed well, but depression and influenza vaccination estimates were substantially lower than were survey estimates. Ongoing validation will be important to monitor changes in validity over time as EHR networks mature and to assess new indicators. We discuss NYC's experience and how this project fits into the national context. Sharing lessons learned can help achieve the full potential of EHRs for population health surveillance.

Background: In resource-limited settings, many HIV-infected patients are lost to follow-up (LTF) before starting ART; risk factors among those not eligible for ART at enrollment into care are not well described., Methods: We examined data from 4,278 adults (3,613 women, 665 men) enrolled in HIV care through March 2007 in the MTCT-Plus Initiative with a CD4 count ≥200 cells/mm(3) and WHO stage ≤ 2 at enrollment. Patients were considered LTF if > 12 months elapsed since their last clinic visit. Gender-specific Cox regression models were used to assess LTF risk factors., Results: The proportion LTF was 8.2 % at 12 months following enrollment, and was higher among women (8.4 %) than men (7.1 %). Among women, a higher risk of LTF was associated with younger age (adjusted hazard ratio [AHR]15-19/30+: 2.8, 95 % CI:2.1-3.6; AHR20-24/30+:1.9, 95 % CI:1.7-2.2), higher baseline CD4 count (AHR350-499/200-349:1.5; 95 % CI:1.0-2.1; AHR500+/200-349:1.5; 95 % CI:1.0-2.0), and being pregnant at the last clinic visit (AHR:1.9, 95 % CI:1.4-2.5). Factors associated with a lower risk of LTF included, employment outside the home (AHR:0.73, 95 % CI:0.59-0.90), co-enrollment of a family/household member (AHR:0.40, 95 % CI:0.26-0.61), and living in a household with ≥4 people (AHR:0.74, 95 % CI:0.64-0.85). Among men, younger age (AHR15-19/30+: 2.1, 95 % CI:1.2-3.5 and AHR30-34/35+:1.5, 95 % CI:1.0-2.4) had a higher risk of LTF. Electricity in the home (AHR:0.61, 95 % CI:0.41-0.91) and living in a household with ≥4 people (AHR:0.58, 95 % CI:0.39-0.85) had a lower risk of LTF., Conclusions: Socio-economic status and social support may be important determinants of retention in patients not yet eligible for ART. Among women of child-bearing age, strategies around sustaining HIV care during and after pregnancy require attention.

[This corrects the article DOI: 10.1289/ehp.10056.].

Hepatitis C virus (HCV) is the leading cause of chronic liver disease in the United States. Accurate hepatitis C prevalence estimates are important to guide local public health programs but are usually unavailable to local health jurisdictions. National surveys may not reflect local variation, a particular challenge for urban settings with disproportionately large numbers of residents in high-risk population groups. In 2004, the New York City Department of Health and Mental Hygiene conducted the NYC Health and Nutrition Examination Survey, a population-based household survey of non-institutionalized NYC residents ages 20 and older. Study participants were interviewed and blood specimens were tested for antibody to HCV (anti-HCV); positive participants were re-contacted to ascertain awareness of infection and to provide service referrals. Of 1,786 participants with valid anti-HCV results, 35 were positive for anti-HCV, for a weighted prevalence of 2.2% (95% confidence interval [CI] 1.5% to 3.3%). Anti-HCV prevalence was high among participants with a lifetime history of injection drug use (64.5%, 95% CI 39.2% to 83.7%) or a lifetime history of incarceration as an adult (8.4%, 95% CI 4.3% to 15.7%). There was a strong correlation with age; among participants born between 1945 and 1954, the anti-HCV prevalence was 5.8% (95% CI 3.3% to 10.0%). Of anti-HCV positive participants contacted (51%), 28% (n = 5) first learned of their HCV status from this survey. Continued efforts to prevent new infections in known risk behavior groups are essential, along with expansion of HCV screening and activities to prevent disease progression in people with chronic HCV.

Objectives: We sought to evaluate the contribution of the New York City Health and Nutrition Examination Survey (NYC-HANES) to local public health surveillance., Methods: Examination-diagnosed estimates of key health conditions from the 2004 NYC-HANES were compared with the National Health and Nutrition Examination Survey (NHANES) 2003-2004 national estimates. Findings were also compared with self-reported estimates from the Community Health Survey (CHS), an annually conducted local telephone survey., Results: NYC-HANES estimated that among NYC adults, 25.6% had hypertension, 25.4% had hypercholesterolemia, 12.5% had diabetes, and 25.6% were obese. Compared with US adults, NYC residents had less hypertension and obesity but more herpes simplex 2 and environmental exposures (P<.05). Obesity was higher and hypertension was lower than CHS self-report estimates (P<.05). NYC-HANES and CHS self-reported diabetes estimates were similar (9.7% vs 8.7%)., Conclusions: NYC-HANES and national estimates differed for key chronic, infectious, and environmental indicators, suggesting the need for local data. Examination surveys may provide more accurate information for underreported conditions than local telephone surveys. Community-level health and nutrition examination surveys complement existing data, providing critical information for targeting local interventions.

Background: Hypertension-related risk in urban areas may vary from national estimates; however, objective data on prevalence and treatment in local areas are scarce. We assessed hypertension prevalence, awareness, treatment, and control among New York City (NYC) adults., Methods and Results: The NYC Health And Nutrition Examination Survey (HANES), modeled on the national HANES, was conducted in 2004 with a representative sample of noninstitutionalized NYC residents > or =20 years of age. Hypertension outcomes were examined with interview and examination data (n=1975). Multiple logistic regression was used to assess factors associated with control among adults with hypertension. We found that 25.6% of NYC adults had hypertension. Blacks had a higher prevalence than whites (32.8% versus 21.1%, P<0.001), as did Hispanics (26.5% versus 21.1%, P<0.05). Foreign-born residents who had lived in the United States for <10 years had lower rates than those who had lived in the United States longer (20.0% versus 27.5%, P<0.05). Among adults with hypertension, 83.0% were diagnosed, 72.7% were treated, and 47.1% had hypertension controlled. Of those treated, 64.8% had hypertension controlled. After adjustment for sociodemographic variables among all adults with treated hypertension, lack of a routine place of medical care was most strongly associated with poor control levels (adjusted odds ratio 0.21, 95% confidence interval 0.07 to 0.66). Among nonelderly adults with treated hypertension, blacks had 4-fold lower odds than whites of having hypertension controlled (adjusted odds ratio 0.24, 95% confidence interval 0.06 to 0.92)., Conclusions: In NYC, hypertension is common and frequently uncontrolled. Low levels of control are associated with poor access to care. Racial disparities in prevalence and control are evident among nonelderly adults.

Background: Surveillance for HIV likely underestimates infection among the general population: 25% of US residents are estimated to be unaware of their HIV infection., Objective: To determine the prevalence of HIV infection and risk behaviors among New York City (NYC) adults and compare these with surveillance findings., Methods: The NYC Health and Nutrition Examination Survey (HANES) provided the first opportunity to estimate population-based HIV prevalence among NYC adults. It was conducted in 2004 among a representative sample of adults > 20 years. Previously reported HIV infection was identified from the NYC HIV/AIDS Surveillance Registry. A blinded HIV serosurvey was conducted on archived blood samples of 1626 NYC HANES participants. Data were used to estimate prevalence for HIV infection, unreported infections, high-risk activities, and self-perceived risk., Results: Overall, 18.1% engaged in one or more risky sexual/needle-use behaviors, of which 92.2% considered themselves at low or no risk of HIV or another sexually transmitted disease. HIV occurred in 21 individuals (prevalence 1.4%; 95% confidence interval (CI), 0.8-2.5]; one infection (5%; 95% CI, 0.7-29.9) was not reported previously and possibly undiagnosed. HIV infection was significantly elevated in those with herpes simplex virus 2 (4%), men who have sex with men (14%), and needle-users (21%) (P < 0.01)., Conclusions: Among NYC adults, HIV prevalence was consistent with surveillance findings overall. The proportion of unreported HIV was less than estimated nationally, but findings were limited by sample size. Most adults with risky behaviors perceived themselves to be at minimal risk, highlighting the need for risk reduction and routine HIV screening.

Introduction: Few state or local health agencies have accurate local-level information on the prevalence of the leading causes of morbidity and mortality. The New York City Health and Nutrition Examination Survey (NYC HANES) was designed as a new local surveillance initiative to determine the prevalence of health conditions among adult residents of New York City., Methods: Modeled after the National Health and Nutrition Examination Survey, the survey was initiated in June 2004 as a population-based cross-sectional study of New York City adults aged 20 and older. The survey was designed using a three-stage cluster sampling plan; 4026 households were randomly selected. Selected households were visited, and residents were given an initial eligibility screening questionnaire. Eligible participants were asked to schedule an appointment at an NYC-HANES-dedicated health center to complete the NYC HANES. A completed survey was defined as completion of a demographic interview and at least one examination component. Health conditions examined included cholesterol levels, diabetes status, blood pressure, environmental biomarkers, depression, anxiety, and antibodies to infectious diseases., Results: Of the 4026 households approached, eligibility screening questionnaires were completed for 3388 (84%) households, and 3047 survey participants were identified. Of the 3047 participants, 76% made an appointment, and 66% completed the survey. The overall response rate was 55% (n = 1999)., Conclusion: NYC HANES is the first successful local-level examination survey modeled on NHANES. With periodic repetition, NYC HANES will provide surveillance information on leading causes of morbidity and mortality.

Background: Identifying populations at risk for having asthma is an essential step toward appropriately allocating resources and reducing the burden of this disease. To date, the impact of demographic and social factors on asthma prevalence has not been assessed in a nationally representative sample of U.S. adults., Methods: We conducted weighted analyses using data from a random digit-dialed telephone survey of non-institutionalized persons > or = 18 years of age in 50 states, Puerto Rico, and the District of Columbia to assess risk factors for asthma prevalence., Results: We found that women were more likely than men to report current asthma [odds/ratio (OR): 1.91, 95% confidence interval (CI): 1.77-2.06]; adults aged 35-64 and >65 were less likely than adults aged 18-34 to report current asthma (OR: 0.79, 95% CI: 0.73-0.85 and OR: 0.65, 95% CI: 0.58-0.72, respectively); persons from the lower socioeconomic status (SES) were more likely to report current asthma than those in other SES (OR: 1.36, 95% CI: 1.25-1.49); overweight and obese people were more likely to report current asthma than were those of normal weight (OR: 1.10, 95% CI: 1.02-1.20 and OR: 1.65, 95% CI: 1.51-1.80, respectively); and current and former smokers were more likely than never smokers to report current asthma (OR: 1.28, 95% CI: 1.18-1.39 and OR: 1.36, 95% CI: 1.24-1.48, respectively)., Conclusions: While several important sociodemographic risk factors were associated with increased asthma prevalence in U.S. adults, the impact of generally modifiable risk factors such as elevated body mass index and cigarette smoking is of specific concern. These findings further underscore the need to target and diminish these risk factors among U.S. adults.

Various epidemiologic investigations have shown that ambient air pollution levels are associated with acute increases in hospital admissions and mortality in the United States and abroad. The objectives of this investigation were a) to determine if racial minorities are more adversely affected by ambient air pollution than their white counterparts and b) to assess the contribution of socioeconomic status to any observed racial differences in pollution effect. Time-series regression methods were conducted to investigate these hypotheses for daily respiratory hospital admissions in New York City, New York. Pollutants considered included mean daily levels of particulate matter with a mass median aerodynamic diameter less than 10 microm (PM(10), ozone (O3), strong aerosol acidity (H+), and sulfates (SO4(2). The relative risk for respiratory hospital admission was calculated for each pollutant for a maximum minus mean increment in mean daily pollutant concentration. The greatest difference between the white and nonwhite subgroups was observed for O(3), where the white relative risk (RR) was 1.032 [95% confidence interval (CI): 0.977-1.089] and the nonwhite RR was 1.122 (95%CI: 1.074-1.172). Although not statistically different from each other, the various pollutants' RR estimates for the Hispanic nonwhite category in New York City were generally larger in magnitude than those for the non-Hispanic white group. When these analyses incorporated differences in the underlying respiratory hospitalization rates across races (that for nonwhites, was roughly twice that for whites), the disparities in attributable risks from pollution (in terms of excess admissions per day per million persons) were even larger for nonwhites versus whites. However, when insurance status was used as an indicator of socioeconomic/health coverage status, higher RRs were indicated for the poor/working poor (i.e., those on Medicaid and the uninsured) than for those who were economically better off (i.e., the privately insured), even among non-Hispanic whites. Thus, although potential racial differences in pollution exposures could not be explored as a factor, within-race analyses suggested that most of the apparent differences in air pollutant effects found across races were explained by socioeconomic and/or health care disparities.

A component of particulate matter (PM) air pollution that may provide one biologically plausible pathway for the observed PM air pollution-health effect associations is aerosol acidity (H(+)). An increasing number of observational studies have demonstrated associations between H(+) and increased adverse health effects in the United States and abroad. Although studies have shown significant H(+) associations with increased morbidity in the United States, similar associations have yet to be shown with daily mortality. We considered a 2.5-year record of daily H(+) and sulfate measurements (May 1988-October 1990) collected in the Buffalo, New York, region in a time-series analysis of respiratory, circulatory, and total daily mortality and hospital admissions. Other copollutants considered included particulate matter [less than/equal to] 10 microm in aerodynamic diameter, coefficient of haze, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. Various modeling techniques were applied to control for confounding of effect estimates due to seasonality, weather, and day-of-week effects. We found multiple significant pollutant-health effect associations--most strongly between SO(4)(2-) and respiratory hospital admissions (as indicated by its t-statistic). Additionally, H(+) and SO(4)(2-) demonstrated the most coherent associations with both respiratory hospital admissions [H(+): relative risk (RR) = 1. 31; 95% confidence interval (CI), 1.14-1.51; and SO(4)(2-): RR = 1. 18, CI, 1.09-1.28] and respiratory mortality (H(+): RR = 1.55, CI, 1. 09-2.20; and SO(4)(2-): RR = 1.24, CI, 1.01-1.52). Thus, acidic sulfate aerosols represent a component of PM air pollution that may contribute to the previously noted adverse effects of PM mass on human health, and the associations demonstrated in this study support the need for further investigations into the potential health effects of acidic aerosols.