Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments—2015

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.     

Disparities in Sleep Problems by Sexual Orientation among New York City Adults: an Analysis of the New York City Health and Nutrition Examination Survey, 2013–2014

We examined disparities in sleep problems by sexual orientation among a population-based sample of adults, using data from the New York City (NYC) Health and Nutrition Examination Survey (NYC HANES), a population-based, cross-sectional survey conducted in 2013–2014 (n?=?1220). Two log binomial regression models were created to assess the relative prevalence of sleep problems by sexual orientation. In model 1, heterosexual adults served as the reference category, controlling for gender, age, race/ethnicity, education, marital status, and family income. And in model 2, heterosexual men served as the reference category, controlling for age, race/ethnicity, education, marital status, and family income. We found that almost 42% of NYC adults reported sleep problems in the past 2 weeks. Bisexual adults had 1.4 times the relative risk of sleep problems compared to heterosexual adults (p?=?0.037). Compared to heterosexual men, heterosexual and bisexual women had 1.3 and 1.6 times the risk of sleep problems, respectively (p?<?0.05). Overall, adults who self-identified as bisexual had a significantly greater risk of sleep problems than adults who self-identified as heterosexual.     

Change in Diabetes Prevalence and Control among New York City Adults: NYC Health and Nutrition Examination Surveys 2004–2014

National examination surveys provide trend information on diabetes prevalence, diagnoses, and control. Few localities have access to such information. Using a similar design as the National Health and Nutrition Examination Survey (NHANES), two NYC Health and Nutrition Examination Surveys (NYC HANES) were conducted over a decade, recruiting adults ≥?20 years using household probability samples (n =?1808 in 2004; n =?1246 in 2013–2014) and physical exam survey methods benchmarked against NHANES. Participants had diagnosed diabetes if told by a health provider they had diabetes, and undiagnosed diabetes if they had no diagnosis but a fasting plasma glucose ≥?126 mg/dl or A1C?≥?6.5%. We found that between 2004 and 2014, total diabetes prevalence (diagnosed and undiagnosed) in NYC increased from 13.4 to 16.0% (P =?0.089). In 2013–2014, racial/ethnic disparities in diabetes burden had widened; diabetes was highest among Asians (24.6%), and prevalence was significantly lower among non-Hispanic white adults (7.7%) compared to that among other racial/ethnic groups (P <?0.001). Among adults with diabetes, the proportion of cases diagnosed increased from 68.3 to 77.3% (P =?0.234), and diagnosed cases with very poor control (A1C >?9%), decreased from 26.9 to 18.0% (P =?0.269), though both were non-significant. While local racial/ethnic disparities in diabetes prevalence persist, findings suggest modest improvements in diabetes diagnosis and management.     

Bedbug Complaints among Public Housing Residents—New York City, 2010–2011

Few studies have evaluated population-level risk factors for having a bedbug infestation. We describe characteristics associated with bedbug complaints among New York City Housing Authority (NYCHA) residents. Unique households receiving bedbug extermination services in response to a complaint during January 1, 2010 to December 31, 2011 were identified from NYCHA’s central facilities work order database. We examined associations between household characteristics and having a bedbug complaint using a generalized estimating equation Poisson regression model, accounting for clustering by housing development. Of the 176,327 NYCHA households, 11,660 (6.6 %) registered a bedbug complaint during 2010–2011. Bedbug complaints were independently associated with households having five or more children versus no children (prevalence ratio [PR] = 2.0), five or more adults versus one adult (PR = 1.6), a head of household (HOH) with impaired mobility (PR = 1.3), a household member receiving public assistance (PR = 1.2), a household income below poverty level (PR = 1.1), and a female HOH (PR = 1.1). Infestations were less likely to be reported by households with employed members (PR = 0.9), and an HOH aged 30–44 years (PR = 0.9) or 45–61 years (PR = 0.9), compared with an HOH aged 18–29 years. These results indicate that bedbug control efforts in public housing should be targeted toward households with low income and high occupancy.     

Estimating the Prevalence of Chronic Hepatitis B Virus Infection—New York City, 2008

Chronic hepatitis B virus (HBV) infection is a preventable cause of liver failure, cirrhosis, and liver cancer; estimated chronic HBV infection prevalence is 0.3–0.5% in the USA. Prevalence in New York City (NYC) is likely higher because foreign-born persons, who represent 36% of NYC’s population versus 11% nationwide, bear a disproportionate burden of chronic HBV infection. However, because no comprehensive, population-based survey of chronic HBV infection has been conducted in NYC, a reliable prevalence estimate is unavailable. We used two approaches to estimate chronic HBV infection prevalence in NYC: (1) a census-based estimate, combining local and national prevalence data for specific populations, and (2) a surveillance-based estimate, using data from NYC’s Department of Health and Mental Hygiene Hepatitis B Surveillance Registry and adjusting for out-migration and deaths. Results from both the census-based estimate and the surveillance-based estimate were similar, with an estimated prevalence of chronic HBV in NYC of 1.2%. This estimate is two to four times the estimated prevalence for the USA as a whole. According to the census-based estimate, >93% of all cases in NYC are among persons who are foreign-born, and approximately half of those are among persons born in China. These findings underscore the importance of local data for tailoring programmatic efforts to specific foreign-born populations in NYC. In particular, Chinese-language programs and health education materials are critical. Reliable estimates are important for policymakers in local jurisdictions to better understand their own population’s needs and can help target primary care services, prevention materials, and education.     

Social Vulnerability Index for the Older People—Hong Kong and New York City as Examples

Many world cities have suffered large-scale disasters, causing a significant loss of lives, property damage, and adverse social and economic impact. Those who are most vulnerable during and in the immediate aftermath of disaster crises are the elderly. Therefore, it is imperative to identify them and determine their specific needs in order to support them. Although several Social Vulnerability Indexes (SVIs) have been developed to assess different types of disaster vulnerability across geographic and population levels, few have been tailored to the older population. Building on the research of Gusmano et al., this study modifies and uses an SVI specifically designed to assess the vulnerability of older populations to emergencies and disasters across seven domains, namely, population size, institutionalization, poverty, living alone, disability, communication obstacles, and access to primary care. Moreover, it is acknowledged that availability of data largely depends on the local context and is always a barrier to production of indices across countries. The present study offers suggestions on how modifications can be made for local adaptation such that the SVI can be applied in different cities and localities. The SVI used in this study provides information to stakeholders in emergency preparedness, not only about natural disasters but also about health hazards and emergencies, which few existing SVI address.     

Gender and Race Disparities in Cardiovascular Disease Risk Factors among New York City Adults: New York City Health and Nutrition Examination Survey (NYC HANES) 2013–2014

While gender and racial/ethnic disparities in cardiovascular disease (CVD) risk factors have each been well characterized, few studies have comprehensively examined how patterns of major CVD risk factors vary and intersect across gender and major racial/ethnic groups, considered together. Using data from New York City Health and Nutrition Examination Survey 2013–2014—a population-based, cross-sectional survey of NYC residents ages 20 years and older—we measured prevalence of obesity, hypertension, hypercholesterolemia, smoking, and diabetes across gender and race/ethnicity groups for 1527 individuals. We used logistic regression with predicted marginal to estimate age-adjusted prevalence ratio by gender and race/ethnicity groups and assess for potential additive and multiplicative interaction. Overall, women had lower prevalence of CVD risk factors than men, with less hypertension (p?=?0.040), lower triglycerides (p?<?0.001), higher HDL (p?<?0.001), and a greater likelihood of a heart healthy lifestyle, more likely not to smoke and to follow a healthy diet (p?<?0.05). When further stratified by race/ethnicity, however, the female advantage was largely restricted to non-Latino white women. Non-Latino black women had significantly higher risk of being overweight or obese, having hypertension, and having diabetes than non-Latino white men or women, or than non-Latino black men (p?<?0.05). Non-Latino black women also had higher total cholesterol compared to non-Latino black men (184.4 vs 170.5 mg/dL, p?=?0.010). Despite efforts to improve cardiovascular health and narrow disparities, non-Latino black women continue to have a higher burden of CVD risk factors than other gender and racial/ethnic groups. This study highlights the importance of assessing for intersectionality between gender and race/ethnicity groups when examining CVD risk factors.     

Selected Findings from the “New York” and the “Metropolitan” Chaplaincy Studies: A 10-Year Comparison of Chaplaincy in the New York City Area

In recent years, the chaplain-to-patient ratio in U.S. hospitals has remained roughly the same while the role of the hospital chaplain has expanded. We compared data on 33,000 chaplain visits from the New York Chaplaincy Study (1994–1996) with 58,000 chaplain visits from the Metropolitan Chaplaincy Study (2005–2006), in order to explore whether changes in both the role of the healthcare chaplain and changes in the healthcare system itself have affected the amount of time that chaplains are able to spend with patients. The overall pattern of lengths of visits was stable over time, but chaplains in the Metropolitan Chaplaincy Study had proportionally fewer visits with family members and more visits with patients, more visits based on referrals, and spent more time dealing with end-of-life issues than chaplains in the earlier New York Chaplaincy Study. We discuss ways that chaplains seem to be adjusting successfully to increasing demands on their time.     

Residential Trajectory and HIV High-Risk Behaviors among Montréal Street Youth—A Reciprocal Relationship

Evidence has linked residential instability and engagement in high-risk behaviors. This paper longitudinally examines the relationship between changes in residential stability and changes in HIV risk behaviors among Montréal street youth (SY). Between April 2006 and May 2007, 419 SY (18–25 years old) were recruited in a cohort study. SY (using Montréal street youth agencies services) were eligible if they had had at least one 24-hour episode of homelessness in the previous 30 days. Baseline and follow-up interviews, carried out every 3 months, included completion of a questionnaire (based on Life History Calendar Technique) assessing daily sleeping arrangements since the last interview, and monthly sexual and drug use behaviors. Using mixed-effects logistic regression method, we examined the association between various risk behaviors and residential stability, reached when a youth resided in any of the following settings for a whole month: own place; friends’/partner’s/parent’s place; any types of housing service (excluding emergency shelters). Analyses were carried out controlling for gender, age, education level, lifetime duration of homelessness, childhood sexual trauma, and lifetime mental health disorders. As of January 2009, 360 SY (79% boys) had completed at least one follow-up interview, representing 4,889 months of follow-up. Residential stability was significantly associated with the following: sex exchange (adjusted odd ratio [AOR], 0.25; 95% confidence interval [CI], 0.14–0.37), drug injection (AOR, 0.55; CI, 0.33–0.76), daily alcohol consumption (AOR, 0.58; CI, 0.42–0.74), polydrug consumption (AOR, 0.61; CI, 0.50–0.73), polydrug consumption excluding marijuana (AOR, 0.55; CI, 0.45–0.65), and multiple sex partners (≥3 partners; AOR, 0.57; CI, 0.40–0.74). Our results suggest a reciprocal relationship between residential instability and HIV risk behaviors. This calls for more integrated services combining both individual and structural-level interventions to improve the health of street youth.     

What explains the association between neighborhood-level income inequality and the risk of fatal overdose in New York City?

Accidental drug overdose is a substantial cause of mortality for drug users. Using a multilevel case-control study we previously have shown that neighborhood-level income inequality may be an important determinant of overdose death independent of individual-level factors. Here we hypothesized that the level of environmental disorder, the level of police activity, and the quality of the built environment in a neighborhood mediate this association. Data from the New York City (NYC) Mayor's Management Report, the NYC Police Department, and the NYC Housing and Vacancy Survey were used to define constructs for the level of environmental disorder, the level of police activity and the quality of the built environment, respectively. In multivariable models the odds of death due to drug overdose in neighborhoods in the top decile of income inequality compared to the most equitable neighborhoods decreased from 1.63 to 1.12 when adjusting for the three potential mediators. Path analyses show that the association between income inequality and the rate of drug overdose mortality was primarily explained by an indirect effect through the level of environmental disorder and the quality of the built environment in a neighborhood. Implications of these findings for the reduction of drug overdose mortality associated with the distribution of income are discussed.     

Change in Obesity Prevalence among New York City Adults: the NYC Health and Nutrition Examination Survey, 2004 and 2013–2014

The objective of this study was to measure change in obesity prevalence among New York City (NYC) adults from 2004 to 2013–2014 and assess variation across sociodemographic subgroups. We used objectively measured height and weight data from the NYC Health and Nutrition Examination Survey to calculate relative percent change in obesity (≥?30 kg/m²) between 2004 (n =?1987) and 2013–2014 (n =?1489) among all NYC adults and sociodemographic subgroups. We also examined changes in self-reported proxies for energy imbalance. Estimates were age-standardized and statistical significance was evaluated using two-tailed T tests and multivariable regression (p <?0.05). Between 2004 and 2013–2014, obesity increased from 27.5 to 32.4% (p =?0.01). Prevalence remained stable and high among women (31.2 to 32.8%, p =?0.53), but increased among men (23.4 to 32.0%, p =?0.002), especially among non-Latino White men and men age ≥?65 years. Black adults had the highest prevalence in 2013–2014 (37.1%) and Asian adults experienced the largest increase (20.1 to 29.2%, p =?0.06), especially Asian women. Foreign-born participants and participants lacking health insurance also had large increases in obesity. We observed increases in eating out and screen time over time and no improvements in physical activity. Our findings show increases in obesity in NYC in the past decade, with important sociodemographic differences.     

A Water Availability Intervention in New York City Public Schools: Influence on Youths’ Water and Milk Behaviors

Objectives. We determined the influence of “water jets” on observed water and milk taking and self-reported fluid consumption in New York City public schools.Methods. From 2010 to 2011, before and 3 months after water jet installation in 9 schools, we observed water and milk taking in cafeterias (mean 1000 students per school) and surveyed students in grades 5, 8, and 11 (n = 2899) in the 9 schools that received water jets and 10 schools that did not. We performed an observation 1 year after implementation (2011–2012) with a subset of schools. We also interviewed cafeteria workers regarding the intervention.Results. Three months after implementation we observed a 3-fold increase in water taking (increase of 21.63 events per 100 students; P < .001) and a much smaller decline in milk taking (-6.73 events per 100 students; P = .012), relative to comparison schools. At 1 year, relative to baseline, there was a similar increase in water taking and no decrease in milk taking. Cafeteria workers reported that the water jets were simple to clean and operate.Conclusions. An environmental intervention in New York City public schools increased water taking and was simple to implement.Water intake is essential for many human biological and biochemical processes.1 To maintain a body water balance, the National Academy of Sciences recommends adequate intake level for water in any form (solid foods and beverages including plain water) for adolescents aged 14 to 18 years at 3.3 liters per day for boys and 2.3 liters per day for girls.1 According to the 2005–2006 National Health and Nutrition Examination Survey, adolescent boys aged between 14 and 18 years consumed 2.89 (95% confidence interval [CI] = 2.65, 3.13) liters of water and girls consumed 1.97 (95% CI = 1.84, 2.10) liters of water on average.2 Both were below the recommended cutoff. In addition, studies have shown that hydration is associated with improved memory recall,3,4 and fluoridated water intake with the prevention of dental caries.5Drinking water is a healthy no-calorie replacement for sugar-sweetened beverages (SSBs),6 which have been linked to obesity, dental caries, and displacement of nutrient-rich foods among children.7–9 Decreasing the daily amount of SSBs consumed is associated with lower total caloric consumption and reduced obesity prevalence.10,11In New York City, the obesity rate among young children (kindergarten through 8th grade) is nearly 21%.12,13 To address this, New York City has recently implemented a multifaceted approach to obesity reduction and prevention that includes an initiative to encourage water consumption, including a mayoral requirement that all city agencies, childcare centers, and public schools have water available at all meals. As part of the Healthy, Hunger Free Kids Act passed by Congress in 2010,14 all schools are required to make plain drinking water available to students at no cost during the lunch meal periods in the locations where meals are served, and during the School Breakfast Program when breakfast is served in the cafeteria. Furthermore, the US Department of Agriculture has proposed a new rule to implement local school wellness policies to provide water and maintain water fountains in schools.15In 2008, pursuant to a mayoral executive order, New York City became the first major city in the country to mandate a set of food and beverage nutrition standards governing all city agencies, including public schools. This policy included procurement, service, and vending standards. Beverage vending in schools limited calories to 10 calories per 8 ounces in elementary schools and 25 calories per 8 ounces in high schools with no artificial sugar added. To meet the city’s goal of increasing student water consumption, in 2010 the Fund for Public Health in New York, an arm of the New York City Department of Health and Mental Hygiene (DOHMH), received funding to provide “water jets” (drinking water dispensers) to 140 schools across the city from the Communities Putting Prevention to Work grant from the Centers for Disease Control and Prevention. Water jets are large, clear plastic jugs with push levers that dispense cooled, aerated tap water (similar to slushy machines found in convenience stores) that are placed near the lunch line in the school cafeteria. To assess the impact of the new water jets, New York University, the DOHMH, and the Centers for Disease Control and Prevention conducted an evaluation during the 2010–2011 school year with a subset of 9 schools that received the water dispensers and 10 comparison schools. The water jets were installed with no other school-based activities to promote water drinking; disposable cups were available next to the jet at all schools. We note that New York City water is delivered from sources in upstate New York essentially lead-free, but because lead introduction is possible from pipes, water in schools is periodically tested.Previous studies (using mainly self-report data or studies based in Europe) have provided preliminary evidence that water in schools could prevent overweight and help children maintain healthy weight.16–18 Potential changes in milk intake as result of increased water availability are a potential concern, however, because of the nutrients that milk confers to children. The current study, to our knowledge, is the first to look at the impact of providing elementary-school students, middle-school students, and high-school students with increased water access, with no promotions or parallel interventions. Thus, this evaluation study set out to address 4 research objectives: (1) determine whether the introduction of water jets increases students’ objectively measured taking of water for consumption, (2) determine whether the introduction of water jets has an impact on the students’ taking of milk for consumption, (3) evaluate whether the introduction of water jets improves students’ opinions of water, and (4) assess the cafeteria staff’s experience with the water jets.