Helmet Use Among Cyclists in New York City

Lack of helmet use while bicycling can have deleterious effects on health. Despite evidence that helmets can greatly reduce the risk of head injury, the prevalence of helmet use among riders, including those in urban bicycle-share programs, has been shown to be very low. Building upon the authors’ previous work, this study’s aim was to assess prevalence of helmet use among cyclists riding on widely used New York City (NYC) bike lanes. Across a 2-month period, cyclists were filmed in five NYC locations with bike lanes. Filming took place at two separate time periods (recreation and commute) at each location. Helmet use was coded for each cyclist. A total of 1,921 riders were observed across 10 h. Overall, half (50.0 %) of all riders were observed wearing a helmet. Rates of using a helmet were consistent across all five locations. In addition, only 21.7 % of Citi Bike users and 15.3 % of other bicycle rentals were observed wearing helmets while cycling. The prevalence of helmet use was significantly higher among males than females (z = 4.48, p < .001). Cyclists observed during the recreational time period were also less likely than those observed during the commuting time period to be wearing a helmet (z = 7.17, p < .001). The results of this study contribute to the growing literature about cyclist helmet use in urban areas.     

Helmet Use Among Users of the Citi Bike Bicycle-Sharing Program: A Pilot Study in New York City

The use of bicycle helmets to prevent or reduce serious head injuries is well established. However, it is unclear how to effectively promote helmet use, particularly in the context of bicycle-sharing programs. The need to determine rates of helmet use specifically among users of bicycle-sharing programs and understand if certain characteristics, such as time of day, affect helmet use, is imperative if effective promotion and/or legislative efforts addressing helmet use are to be developed. We estimated the prevalence of helmet use among a sample of Citi Bike program users in New York City. A total of 1,054 cyclists were observed over 44 h and across the 22 busiest Citi Bike locations. Overall, 85.3 % (95 % CI 82.2, 88.4 %) of the cyclists observed did not wear a helmet. Rates of helmet non-use were also consistent whether cyclists were entering or leaving the docking station, among cyclists using the Citi Bikes earlier versus later in the day, and among cyclists using the Citi Bikes on weekends versus weekdays. Improved understanding about factors that facilitate and hinder helmet use is needed to help reduce head injury risk among users of bicycle sharing programs.     

Ecstasy use and its Association with Sexual Behaviors Among Drug Users in New York City

In the past two decades, recreational use of ecstasy has become a growing concern in the United States, although most studies assessing ecstasy use have focused on white, middle-class adolescents who use ecstasy during raves and in clubs. We assessed the prevalence of recent ecstasy use among predominantly minority heroin, cocaine, and crack users in New York City and the association between ecstasy and sexual risk above and beyond that of the other drugs. Between 2002 and 2004, injection and non-injection heroin, crack and cocaine users (N = 534) completed a risk behavior questionnaire that included items on ecstasy use. Logistic regression was used to investigate the relation between current ecstasy use and sexual behaviors. Of 534 illicit drug users, 69.7% were aged 25 years or older, 65.2% were Hispanic, 27.9% Black and 77.4% male; 36.7% were injectors. 17.2% of respondents reported recent (last six months) ecstasy use. In a multivariable logistic regression model, current ecstasy use was associated both with initiating sex before age 14 (adjusted odds ratio (AOR) = 1.51) and having two or more partners in the past two months (AOR = 1.86) after adjusting for age at study entry, current cocaine and marijuana use and being an injection drug user. This study suggests that ecstasy use may be more prevalent among urban drug users. Ecstasy use in urban settings, beyond clubs and raves, should continue to be monitored.     

The Impact of Cigarette Excise Tax Increases on Purchasing Behaviors Among New York City Smokers

Objectives. We examined the relationship between cigarette excise tax increases and tax-avoidant purchasing behaviors among New York City adult smokers.Methods. We analyzed data from the city’s annual Community Health Survey to assess changes in rates of tax avoidance over time (2003–2010) and smokers’ responses to the 2008 state cigarette tax increase. Multivariable logistic regression analysis identified correlates of buying more cigarettes on the street in response to the increase.Results. After the 2002 tax increase, the percentage of smokers engaged in tax-avoidant behavior decreased with time from 30% in 2003 to 13% in 2007. Following the 2008 tax increase, 21% of smokers reported buying more cigarettes from another person on the street. Low-income, younger, Black, and Hispanic smokers were more likely than respondents with other sociodemographic characteristics to purchase more cigarettes on the street.Conclusions. To maximize public health impact, cigarette tax increases should be paired with efforts to limit the flow of untaxed cigarettes entering jurisdictions with high cigarette pack prices.Increasing taxation on cigarettes is among the most effective ways to prevent and reduce smoking.1 Higher taxes are associated with lower cigarette consumption and higher rates of quit attempts,2–4 particularly among low-income and younger smokers5 and among racial/ethnic minorities.6–8 However, high cigarette prices also lead to increased tax-avoidant behaviors among smokers,9,10 limiting the effectiveness of taxes in reducing tobacco use.11,12 In response to tax hikes, smokers may seek untaxed sources of cigarettes in other jurisdictions, on the Internet, or from Native American reservations.13–18 The availability of untaxed cigarettes from illegal vendors, such as individuals selling cigarettes on the street, allows tax-avoidant smokers to continue to smoke more cigarettes at a lower price4,10,19; thus, trafficking of black market cigarettes across state or international lines into areas with high taxes is of particular concern.10,18,20We sought to better understand tax-avoidant behaviors in New York City, where city, state, and federal tax increases over the past decade have resulted in the highest cigarette pack price in the nation. In 2002, combined city and state tax increases raised the price of cigarettes by $1.81; in 2008, a state tax further increased the per-pack price by $1.25. We examined trends in tax-avoidant cigarette purchasing behaviors among adult smokers in the city between 2003 and 2010. We then assessed characteristics of smokers and the prevalence of tax avoidance among smokers in 2008. We also explored the impact of the 2008 tax increase on smoking behaviors. Finally, we used multivariable logistic regression analysis to identify correlates of buying more cigarettes on the street following the 2008 tax increase.     

Intimate Partner Violence and Consistent Condom Use Among Drug-Using Heterosexual Women in New York City

The present study examined the associations of relationship factors, partner violence, relationship power, and condom-use related factors with condom use with a main male partner among drug-using women. Over two visits, 244 heterosexual drug-using women completed a cross-sectional survey. Multivariate logistic regression models indicated that women who expected positive outcomes and perceived lower condom-use barriers were more likely to report condom use with their intimate partners. The findings suggest that future interventions aiming at reducing HIV risk among drug-using women should focus on women's subjective appraisals of risks based on key relationship factors in addition to the occurrence of partner violence.     

Extreme Heat Awareness and Protective Behaviors in New York City

Heat waves can be lethal and routinely prompt public warnings about the dangers of heat. With climate change, extreme heat events will become more frequent and intense. However, little is known about public awareness of heat warnings or behaviors during hot weather. Awareness of heat warnings, prevention behaviors, and air conditioning (AC) prevalence and use in New York City were assessed using quantitative and qualitative methods. A random sample telephone survey was conducted in September 2011 among 719 adults and follow-up focus groups were held in winter 2012 among seniors and potential senior caregivers. During summer 2011, 79 % of adults heard or saw a heat warning. Of the 24 % who were seniors or in fair or poor health, 34 % did not own AC or never/rarely used it on hot days. Of this subgroup, 30 % were unaware of warnings, and 49 % stay home during hot weather. Reasons for not using AC during hot weather include disliking AC (29 %), not feeling hot (19 %), and a preference for fans (18 %). Seniors in the focus groups did not perceive themselves to be at risk, and often did not identify AC as an important health protection strategy. While heat warnings are received by most New Yorkers, AC cost, risk perception problems, and a preference for staying home leave many at risk during heat waves. Improving AC access and risk communications will help better protect the most vulnerable during heat waves.     

Acculturation and Depressive Symptoms Among Dominicans in New York City

Journal of Immigrant and Minority Health - Little is known about the association between acculturation and mental health among Dominican populations in the United States. Data came from a community...     

Health Behaviors of Older Chinese Adults Living in New York City

The dramatic increase in the number of older immigrants living in the U.S. presents new challenges to policy makers concerned with promoting healthy aging. To date, however, strikingly little is known regarding the health and health trajectories of older immigrants. This paper examines the prevalence and predictors of important health behaviors associated with chronic disease prevention, including current smoking status, physical activity, alcohol use, and body mass index (BMI). We analyzed data from the 2003 New York City Chinese Health Survey (NYC CHS), the largest probability-based sample of Chinese immigrants residing in two distinct communities. In-person interviews were conducted with 517 representative men and women aged 55-75. Logistic regression modeling was used to test the influence of demographic, socioeconomic status, acculturation, and health characteristics on selected health behaviors. Results revealed that having more education and better physical health status were associated with greater participation in physical activity. Gender-specific analyses indicated that the effect of selected predictors varied between the sexes. For example, among older Chinese women, acculturation was negatively associated with alcohol use. This study provides some of the first evidence on health behaviors of one of the fastest growing older immigrant groups in the U.S. Study results add to the emerging literature on the complex nature of immigrant health trajectories, and demonstrate that contrary to prior research, living a greater proportion of time in the U.S. can be associated with selected positive health behaviors. Further longitudinal studies are needed to help inform policy initiatives to encourage healthy aging among diverse older immigrant groups.     

Quality-Adjusted Life-Years and Helmet Use Among Motorcyclists Sustaining Head Injuries

Objectives. We estimated loss of quality-adjusted life expectancy (QALE) among motorcyclists in Taiwan who sustained head injuries while wearing or not wearing a helmet.Methods. Patients with head injuries (n = 3328) were grouped into categories representing good and poor outcomes (moderate disability or death) at discharge. After linkage with the National Mortality Registry, survival functions were determined and extrapolated over a 50-year period on the basis of the survival ratio between patients and age- and gender-matched reference populations, as calculated from available Taiwan vital statistics. Survival functions were then multiplied by scores from quality-of-life measures.Results. Percentages of good and poor outcomes were 87.2% and 12.8%, respectively, in the helmeted group and 66.4% and 33.6% in the nonhelmeted group. The mean QALE for helmeted motorcyclists, calculated by weighting percentages of good and poor outcomes, was 31.7 quality-adjusted life-years (QALYs), with an average loss of 5.8 QALYs. For nonhelmeted motorcyclists, the mean QALE was 25.9 QALYs, with a loss of 10.7 QALYs.Conclusions. Helmet use could save approximately 5 QALYs among motorcyclists sustaining head injuries. Future cost-effectiveness analysis can calculate the incremental cost-effectiveness ratio for regulation of helmet use.Motorcycles have become one of the most popular means of transportation in many developing countries, particularly in Asia, because of their convenience, affordability, and relatively high fuel efficiency.^1,2 However, relative to car drivers, motorcyclists are more easily injured, and are more often killed as a result of even minor collisions with other, larger vehicles.According to traffic accident data from Taiwan''s National Police Agency,³ more than 1100 motorcyclists were killed on the country''s roads in 2007, accounting for 59.7% of all traffic accident deaths. Furthermore, 57.1% of all motorcycle-related fatalities involved injuries to the head, thereby indicating a distinct correlation between motorcycle-related injury and head injury.In a recent review of traffic accidents involving motorcyclists, Liu et al.⁴ concluded that if motorcyclists are wearing a helmet at the time of the crash, their risk of death is reduced by 42%, and their risk of head injury is reduced by 69%. These findings have been corroborated in many other studies indicating that, after implementation and enforcement of laws requiring motorcyclists to wear helmets, there are clear reductions in motorcycle-related head injuries, the severity of such injuries, and the overall length of patient hospital stays.^5–7 Nevertheless, relatively few studies have set out to investigate the long-term effects of helmet protection among motorcyclists sustaining head injuries.Many countries with national health insurance systems have been increasingly faced with a heavy financial burden, essentially as a result of an aging population and new forms of technology (e.g., gene therapy, positron emission tomography). Most of these countries have adopted economic analyses as a means of containing costs associated with medical care and increasing overall cost-effectiveness by improving the health outcomes achieved per dollar spent.⁸ One of the most basic methods used to achieve such improvements is that of evaluating the cost per quality-adjusted life-year (QALY) gained from different health care services, an approach applied to ensure that preventive measures are competitive by saving more lives than would treatment after an illness occurs. The fundamental concept involves adjusting the survival function with the mean quality of life at each time point t and then summing this adjusted value over a lifetime. The resulting measure, “quality-adjusted life expectancy” (QALE), is expressed in the following equation^9–13:where S(t|x) denotes the survival function for condition x at time t and Qol(t|x) denotes the quality-of-life function for condition x at time t. If an age- and gender-matched referent can be simulated from the vital statistics for every case of condition x, one should be able to calculate the QALE for a general referent (in the present case, if a head injury had not occurred).The difference between the QALE for head injury cases and referents just noted would be the expected loss of QALE for an average head injury case. In this study, we sought to quantify QALE and expected loss of QALE among motorcyclists in Taiwan who sustained head injuries while wearing or not wearing a helmet and to determine life-years saved as a result of helmet use in such cases.     

An Analysis of Mercury Exposures Among the Adult Population in New York State

The extent of methylmercury exposures among adults in New York State (NYS) has not been well characterized. Over the past few years, the NYS Heavy Metals Registry (HMR) has seen an increase in both blood mercury tests being reported, and nonoccupational exposures to mercury, which appear primarily due to fish consumption. This study will, (1) Characterize the adults who are tested for blood mercury in NYS; (2) Examine the circumstances for blood mercury testing; and (3) Characterize this population in terms of exposure history, specifically those individuals who are non-occupationally exposed through a diet of seafood consumption in reference to blood mercury levels. Data available from HMR laboratory results, including basic demographics and test results, were combined with data from telephone interviews. The interview contains information on the reasons for testing, possible sources of exposure, and the individual’s work and home environment. Approximately 99 % of adults reported to the HMR, with identifiable exposures to mercury, had non-occupational exposures resulting from seafood consumption. Common types of fish consumed include salmon, tuna, and swordfish, with 90 % of adults eating seafood a few times or more per week. Information will be provided on the reasons for being tested and the range of blood mercury levels in relation to their seafood consumption. NYS residents who frequently eat fish should be aware of what types of fish contain mercury and avoid or reduce consumption of fish with high mercury levels.     

Sexual Orientation and Risk of Pregnancy Among New York City High-School Students

Objectives. We examined associations between sexual orientation and pregnancy risk among sexually experienced New York City high-school students.Methods. We analyzed data from 2005, 2007, and 2009 New York City Youth Risk Behavior Surveys. We excluded students who had never engaged in sexual intercourse, only had same-gender sexual partners, or had missing data on variables of interest, resulting in a final sample of 4892 female and 4811 male students. We employed multivariable logistic regression to examine pregnancy risk by sexual orientation, measured as self-reported sexual identity and gender of sexual partners, with adjustment for demographics and sexual behaviors. We stratified analyses by gender.Results. Overall, 14.3% of female and 10.8% of male students had experienced a pregnancy. Students who identified as gay, lesbian, or bisexual or reported both male and female sexual partners had higher odds of pregnancy than heterosexual students or students who only had opposite-gender sexual partners. Sexual behaviors accounted for higher odds of pregnancy among female, but only partially accounted for higher odds of pregnancy involvement among male, sexual-minority students.Conclusions. Sexual orientation should be considered in future adolescent pregnancy-prevention efforts, including the design of pregnancy-prevention interventions.Over the past 2 decades, significant research and programmatic attention has been directed toward understanding and preventing adolescent pregnancy in the United States. As a result, the US adolescent pregnancy, birth, and abortion rates have reached historic lows, with significant downward trends reported among adolescents of all racial/ethnic and age groups.1 In New York City, the adolescent pregnancy rate fell by 30% in just 1 decade (2001–2011).2 Despite these significant improvements, rates of unplanned adolescent pregnancy in the United States have remained largely unchanged3 and US adolescent pregnancy and birth rates remain the highest among all developed countries.4 Moreover, although much adolescent pregnancy prevention research has been conducted over the past 2 decades, notably few studies have explored the risk of pregnancy among sexual-minority (nonheterosexual) adolescents.Among the studies that have explored the association between sexual orientation and adolescent pregnancy risk, adolescents who identified as lesbian, gay, and bisexual (LGB) have had either the same or a significantly (2–7 times) increased likelihood of experiencing a pregnancy compared with their heterosexual peers, despite being as likely to have engaged in vaginal intercourse.5–10 Furthermore, LGB youths are more likely than heterosexual youths to have had their first heterosexual intercourse before age 14 years, to have had more sexual partners, and to have experienced sexual abuse5–10—all factors associated with an increased risk of adolescent pregnancy.11 Bisexual-identified youths in particular report engaging in riskier sexual behaviors at younger ages than their peers.8–10 Moreover, having sexual partners of the same gender or both genders during the past year was a common occurrence among adolescent parents, especially fathers.8Despite the valuable contributions of the aforementioned research, there are some limitations to their applicability today. First, most of these studies analyzed data from the 1980s and early 1990s, before or during the early stages of adolescent pregnancy reductions.5–8 Second, most of these studies examined adolescent pregnancy risk among girls only6,9,10 (1 study combined male and female LGB students in its sample)7 and among predominately White populations,6,7,9 and others explored pregnancy risk beyond adolescence into young adulthood (ages 15–20 years).10 One study of British Columbia students in grades 7 through 12 found that adolescent pregnancy rates declined among all sexual orientation groups between 1992 and 2003, but the trends in pregnancy and related risk behaviors were less consistent for sexual-minority adolescents than for their heterosexual counterparts.8 Thus, to understand the current state of adolescent pregnancy among sexual-minority students, we need more recent data on the risk of adolescent pregnancy across sexual orientation for male and female students, particularly among racially diverse student populations.Furthermore, most of the previous research that explored pregnancy risk among sexual-minority students used either self-reported sexual identity10 (i.e., students identified themselves as heterosexual, gay or lesbian, bisexual, or unsure) or sexual attraction5,6,8 (i.e., students reported their feelings of attraction as 100% heterosexual to 100% homosexual, or “not sure”) as the sole measure of sexual orientation; 2 studies combined LGB self-identity and same-sex behavior into a single measure of sexual orientation.7,9 Few studies have employed more than 1 measure of sexual orientation to assess pregnancy risk. This is potentially problematic, as single-indicator measures do not sufficiently capture the complexities of sexual orientation.12 Increasingly, young people use different labels (such as queer, pansexual, or asexual) or use no label at all when referring to their sexual identity.13–15 Moreover, fear of discovery, stigma, or cultural values surrounding sexual orientation may lead some young people to report a sexual identity that is not in accordance with their sexual behavior or underlying sexual attraction.16–18 Thus, to obtain a more comprehensive understanding of pregnancy risk among sexual minority students, it is important to simultaneously examine multiple dimensions of sexual orientation (i.e., sexual identity, attraction, and behavior).12,17,18Our study addresses these limitations by using New York City’s 2005, 2007, and 2009 Youth Risk Behavior Surveillance System (YRBSS) data. We examined the risk of adolescent pregnancy by sexual orientation by using 2 indicators of sexual orientation—students’ self-reported sexual identity and gender of students’ sexual partners. We hypothesized that (1) sexual-minority students would be more likely to experience an adolescent pregnancy than heterosexual students, (2) this relationship would be found for both female and male students, and (3) sexual risk behaviors would explain the higher risk of adolescent pregnancy among sexual-minority students.     

Cervical Cancer Screening Among Homeless Women of New York City Shelters

Introduction Homeless persons have minimal opportunities to complete recommended cancer screening. The rates and predictors of cervical cancer screening are understudied among homeless women in the US. Methods We enrolled 297 homeless women 21–65 years old residing in 6 major New York City shelters from 2012 to 2014. We used a validated national survey to determine the proportion and predictors of cervical cancer screening using cytology (Pap test). Results Mean age was 44.72 (±11.96) years. Majority was Black, heterosexual, single, with high school or lower education; 50.9 % were smokers and 41.7 % were homeless more than a year. Despite a 76.5 % proportion of self-reported Pap test within the past 3 years, 65 % of women assumed their Pap test results were normal or did not get proper follow up after abnormal results. Forty-five-point-nine percent of women did not know about frequency of Pap test or causes of cervical cancer. Lower proportion of up-to-date Pap test was associated with lack of knowledge of recommended Pap test frequency (p < 0.01) and relationship between HPV and an abnormal Pap test (p < 0.01). Conclusions Self-reported Pap testing in homeless women was similar to a national sample. However, the majority of women surveyed were not aware of their results, received limited if any follow up and had significant education gaps about cervical cancer screening. We recommend improved counseling and patient education, patient navigators to close screening loops, and consideration of alternative test-and-treat modalities to improve effective screening.     

Chronic Physical Illness Burden and Suicidal Ideation Among Dominicans in New York City

Little is known about the association between chronic illness and suicidal ideation (SI) among Dominicans living in the United States. This study used data from a community survey of 2753 Dominican adults in New York City. SI included thoughts of self-harm or being better off dead in the past month. Chronic physical illness burden was categorized as having 0, 1, or 2+ diagnosed conditions. Adjusted logistic regressions evaluated the association between number of conditions and SI, overall and stratified by sex and age. Adjusted models yielded a strong association between chronic illness burden and SI among men [odds ratio (OR) 5.57, 95 % confidence interval (CI) 2.19–14.18] but not women (OR 0.80, 95 % CI 0.50–1.29; interaction p = 0.011). The association of interest did not differ significantly between younger and older adults. Screening for SI in health care practice, particularly among Dominican men with multiple chronic health conditions, may be warranted.     

Breast and Cervical Cancer Screening Among South Asian Women in New York City

The purpose of this paper is to document the breast and cervical cancer screening practices of a community sample of South Asian women living in the New York City area. A convenience sample of 98 women was engaged in face-to-face interviews regarding their socio-demographic characteristics and cancer screening utilization. Sixty-seven percent of women had ever had a Pap test; 54% had one in the last 3 years. Seventy percent of women over 40 had ever had a mammogram; 56% had one in the last 2 years. Sixty-six percent of women had knowledge of breast self-exam (BSE); 34% of women ever practiced BSE. Multiple logistic regression analysis indicated that insurance status was a significant predictor of ever having a Pap test or mammogram, receiving timely Pap tests, and ever practicing BSE. Education was a significant predictor of ever having a Pap test and having knowledge of BSE. Marital status was a predictor of receiving timely Pap tests, and having spent more time in the U.S. was a predictor of ever practicing BSE. The study concludes that increased educational efforts must be developed targeting immigrant South Asian women of low socioeconomic status with limited access to healthcare.     

蚌埠市初三年级学生危险行为分析

目的了解蚌埠市初三年级学生危险行为现状,为采取干预措施保护青少年健康提供依据。方法按照分层随机整群抽样的方法,共抽取蚌埠市14所中学19个班的初三年级学生为研究对象,获有效问卷935份。对其伤害行为、吸烟行为、饮酒和药物使用行为、性行为、饮食行为、锻炼行为和上网行为进行调查。结果4.3%的学生从不遵守或很少遵守交通规则,23.0%的学生有打架行为,2.7%的学生曾离家出走,20.6%的学生曾考虑过自杀,18.1%的学生曾经吸烟,64.1%的学生曾经饮酒,有1.4%的学生曾使用过摇头丸;1.2%的学生曾发生过性行为,但只有0.4%的性行为者每次性行为都使用安全套;30.9%的学生认为自己稍胖或很胖,54.0%和75.7%的学生每天吃水果和蔬菜次数≥1次,58.6%的学生每天喝牛奶≥1杯,72.2%的学生经常进行体育锻炼,参加校内外运动队的学生分别占17.2%和5.0%,9.1%的学生调查前1周上网≥3 d。结论多数伤害行为、吸烟行为、饮酒和药物使用行为、性行为、锻炼行为和上网行为男生高于女生。     

Predictors of Tobacco Use Among New York State Addiction Treatment Patients

Objectives. We used admissions data from the New York State addiction treatment system to assess patient self-reported tobacco use and factors associated with tobacco use.Methods. We compared prevalence of tobacco use in the state addiction treatment system with that of a national sample of people receiving addiction treatment and with that of the New York general population in 2005 to 2008. A random effects logistic model assessed relationships between patient- and program-level variables and tobacco use.Results. Prevalence of tobacco use in the New York treatment system was similar to that in national addiction treatment data and was 3 to 4 times higher than that in the general population. Co-occurring mental illness, opiate use, methadone treatment, and being a child of a substance-abusing parent were associated with higher rates of tobacco use.Conclusions. We call on federal leadership to build capacity to address tobacco use in addiction treatment, and we call on state leadership to implement tobacco-free grounds policies in addiction treatment systems.Since the 1964 Surgeon General’s report,1 public health and policy efforts have decreased smoking prevalence in the United States from 40% to 18%.2,3 The decrease in smoking since 2005 has been slight,4 however, and smoking is now concentrated in subgroups defined by demographics,5 diagnosis,6 or behavior.7–9 Behavioral health populations, especially, have not benefited from the overall population decline in smoking prevalence.10 People with mental health diagnoses are twice as likely to smoke as those without,11 and the highest prevalence rates reported are among people who seek treatment for alcohol or drug addiction. National Survey on Drug Use and Health (NSDUH) data show that, among people who reported past-year addiction treatment, annual smoking prevalence for 2000 to 2009 ranged from 67% to 75%.12Four million people receive addiction treatment annually, and 2.3 million receive services in specialty addiction programs.13 If 70% are smokers,12 then 1.6 million smokers enter such programs annually. Year after year, these settings serve a substantive proportion of the 43.8 million US adult smokers.5 Despite high rates of tobacco use, only 1 in 5 addiction treatment facilities in the United States has the financial resources to provide tobacco cessation services.14 Availability of nicotine replacement therapy in addiction programs decreased over 4 years (from 38% to 34%),15 and 40% of programs providing cessation counseling in 2006 to 2008 later discontinued this service.16 According to the 2011 National Survey of Substance Abuse Treatment Services (N-SSATS), only half of all addiction treatment programs screen clients for tobacco use.17Three fourths of all addiction treatment is provided in the public sector,18,19 and regulation and policy setting for these programs are centralized in Single State Agencies for Substance Abuse Services. Such agencies could disseminate tobacco practice guidelines, mandate counselor education on tobacco dependence,20 or reimburse programs for tobacco-related services.21 Several state addiction treatment systems have initiated or contemplated tobacco control efforts.22–24In July 2008, the New York Office of Alcoholism and Substance Abuse Services (OASAS) mandated smoke-free grounds and treatment of tobacco dependence for patients in addiction treatment.25 The largest such policy in the United States, it affects approximately 1000 programs, 20 000 staff, and 300 000 annual treatment admissions. Interviewing program administrators before and after the regulation, Brown et al.26 found increased tobacco screening and cessation services for patients. Surveying patients before and after the policy, another study found that smoking prevalence decreased from 69% to 63% (P < .05) and that tobacco-related services increased in methadone treatment settings but decreased in residential treatment.27 Studies assessing clinicians’ perspectives on implementation of the OASAS tobacco regulation identified both positive experiences (e.g., increased patient awareness about tobacco abuse) and negative experiences (e.g., enforcement difficulties),28 coupled with perceived increases in program-level commitment of resources and enforcement efforts over time.29,30Before implementing its tobacco control policy, OASAS included tobacco use status in the patient admission record. The resulting data set permits assessment of the relationships between tobacco use and other factors in statewide addiction treatment samples. By comparison, a review of 42 addiction treatment studies reporting smoking prevalence included sample sizes ranging from 29 to 3472.12NSDUH epidemiological data have been used to assess smoking prevalence among people with mental illness,31 people with concurrent alcohol and illicit drug misuse,32 and people receiving addictions treatment in the past year.12 We know of no studies using NSDUH or similar national data sets to explore factors associated with tobacco use in the addiction treatment population. Such data are of interest because tobacco policies in addictions treatment have potential to reduce tobacco use in a population in which use is highest, in which users are concentrated, and in which the burden of tobacco-related mortality is disproportionate.33,34We used admissions data from the New York State addiction treatment system (OASAS) over a 6-year period to estimate prevalence of tobacco use. Comparison with statewide data reflects how much people enrolled in the New York addiction treatment system may smoke in comparison with all New York State residents. Comparison with NSDUH data reflects how much people enrolled in the New York addiction treatment system may smoke in comparison with a national sample of people receiving addiction treatment. We also assessed how program and patient characteristics may be associated with tobacco use in this population.     

Acceptability of Rapid HIV Testing Among Latinos in Washington Heights,New York City,New York,USA

In the United States, human immunodeficiency virus (HIV) has a disproportionately large impact on Latino Americans. This study assessed the acceptability of rapid HIV testing among a sample of Latinos from New York City. A cross-sectional study was conducted with 192 participants from The Washington Heights/Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research (WICER) study. Participants were interviewed and offered rapid HIV testing and post-test counseling. Seventy-five percent (n?=?143) accepted rapid HIV testing when offered. More religious participants were less likely than less religious participants to undergo testing (RR?=?0.73; 95% CI 0.54–0.99). Participants tested for HIV within the past year were less likely than those who had not been tested within the past year to agree to undergo testing (RR?=?0.27; 95% CI 0.11–0.66). Community-based rapid HIV testing is feasible among Latinos in urban environments. Outreach efforts to engage religious individuals and encouraging routine testing should be reinforced.