Long-Term Asthma Trend Monitoring in New York City: A Mixed Model Approach

Objective

Show the benefits of using a generalized linear mixed model (GLMM) to examine long-term trends in asthma syndrome data.

Introduction

Over the last decade, the application of syndromic surveillance systems has expanded beyond early event detection to include long-term disease trend monitoring. However, statistical methods employed for analyzing syndromic data tend to focus on early event detection. Generalized linear mixed models (GLMMs) may be a useful statistical framework for examining long-term disease trends because, unlike other models, GLMMs account for clustering common in syndromic data, and GLMMs can assess disease rates at multiple spatial and temporal levels (1). We show the benefits of the GLMM by using a GLMM to estimate asthma syndrome rates in New York City from 2007 to 2012, and to compare high and low asthma rates in Harlem and the Upper East Side (UES) of Manhattan.

Methods

Asthma related emergency department (ED) visits, and patient age and ZIP code were obtained from data reported daily to the NYC Department of Health and Mental Hygiene. Demographic data were obtained from 2010 US Census. ZIP codes that represented high and low asthma rates in Harlem and the UES of Manhattan were chosen for closer inspection. The ratio of weekly asthma syndrome visits to total ED visits was modeled with a Poisson GLMM with week and ZIP code random intercepts (2). Age and ethnicity were adjusted for because of their association with asthma rates (3).

Results

The GLMM showed citywide asthma rates remained stable from 2007 to 2012, but seasonal differences and significant inter-ZIP code variation were present. The Harlem ZIP code asthma rate that was estimated with the GLMM was significantly higher (5.83%, 95% CI: 3.65%, 9.49%) than the asthma rate in UES ZIP code (0.78%, 95% CI: 0.50%, 1.21%). A linear time component to the GLMM showed no appreciable change over time despite the seasonal fluctuations in asthma rate. GLMM based asthma rates are shown over time (Figure 1).Open in a separate windowFigure 1:Harlem ZIP code (red), the Upper East Side ZIP code (blue), and citywide (black) estimates are shown as dotted lines surrounded by 30% credibility bands in solid lines.

Conclusions

GLMMs have several strengths as statistical frameworks for monitoring trends including:

1. Disease rates can be estimated at multiple spatial and temporal levels,
2. Standard error adjustment for clustering in syndromic data allows for accurate, statistical assessment of changes over time and differences between subgroups,
3. “Strength borrowed” (4) from the aggregated data informs small subgroups and smooths trends,
4. Integration of covariate data reduces bias in estimated rates.

GLMMs have previously been suggested for early event detection with syndromic surveillance data (5), but the versatility of GLMM makes them useful for monitoring long-term disease trends as well. In comparison to GLMMs, standard errors from single level GLMs do not account for clustering and can lead to inaccurate statistical hypothesis testing. Bayesian hierarchical models (6), share many of the strengths of GLMMS, but are more complicated to fit. In the future, GLMMs could provide a framework for grouping similar ZIP codes based on their model estimates (e.g. seasonal trends and influence on overall trend), and analyzing long-term disease trends with syndromic data.     

Reconsidering Access: Park Facilities and Neighborhood Disamenities in New York City

With increasing concern about rising rates of obesity, public health researchers have begun to examine the availability of parks and other spaces for physical activity, particularly in cities, to assess whether access to parks reduces the risk of obesity. Much of the research in this field has shown that proximity to parks may support increased physical activity in urban environments; however, as yet, there has been limited consideration of environmental impediments or disamenities that might influence individuals’ perceptions or usage of public recreation opportunities. Prior research suggests that neighborhood disamenities, for instance crime, pedestrian safety, and noxious land uses, might dissuade people from using parks or recreational facilities and vary by neighborhood composition. Motivated by such research, this study estimates the relationship between neighborhood compositional characteristics and measures of park facilities, controlling for variation in neighborhood disamenities, using geographic information systems (GIS) data for New York City parks and employing both kernel density estimation and distance measures. The central finding is that attention to neighborhood disamenities can appreciably alter the relationship between neighborhood composition and spatial access to parks. Policy efforts to enhance the recreational opportunities in urban areas should expand beyond a focus on availability to consider also the hazards and disincentives that may influence park usage.     

石家庄市城区支气管哮喘患病率及影响因素

目的 了解石家庄市支气管哮喘患者的患病率、控制现状且对影响控制水平的相关因素进行分析,为支气管哮喘的防治提供更多可靠依据.方法 结合石家庄实际情况制定调查表,以整群随机抽样的方法对年龄在14岁以上的市民进行问卷调查,并同时在2家三级甲等医院门诊调查前来就诊的支气管哮喘患者,全部患者符合2003年中华医学会呼吸病学分会哮喘学组制定的诊断标准.统计分析应用SPSS13.0软件进行.结果 在城区调查市民2 050例,资料完整且质控合格者2 011例,其中支气管哮喘患者55例,哮喘患病率为2.73％.在医院门诊调查支气管哮喘患者150例,累计调查哮喘患者205例.根据ACT评分显示,205例患者中,123例(60.00％)没有得到控制,达到良好控制以上的共82例(40.00％),经多因素非条件logistic回归分析显示:吸烟情况,过敏史,经济负担情况,没有长期规律吸人糖皮质激素或复合制剂与哮喘控制明显相关.结论 对哮喘患者的管理和教育工作有待进一步加强,应积极推广规范化治疗.     

Incarceration and Sexually Transmitted Infections: A Neighborhood Perspective

The social dynamics of some communities are affected by the loss of significant numbers of people to prison and by the release of others who encounter the challenge of coping with the negative effects of the incarceration experience. The effects on communities are evident, in part, in the high rates of sexually transmitted infections (STIs) in North Carolina (NC) counties that have a high rate of incarceration. In the present study, we examined whether the same associations can be observed at the census tract level in one urban city of NC. To identify the mechanisms by which incarceration can affect the transmission of STIs, we conducted ethnographic interviews with ex-offenders and people who lost a sexual partner to prison. We found that census tract rates of incarceration were consistently associated with gonorrhea rates in the subsequent year. An increase of the percentage of census tract person-time spent in prison from 2.0% to 2.5% corresponded to a gonorrhea rate increase of 7.1 cases per 100,000 person-years. The people interviewed spoke of sexual partnership changes including those left behind finding new partners, in part for help in making financial ends meet; men having sex with men for the first time in prison; and having multiple new partners upon reentry to the community. The statistical associations and stories of the effects of incarceration on sexual relationships provide additional evidence of unintended community health consequences of high rates of incarceration. Thomas, Levandowski, and Torrone are with the Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA; Isler is with the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, NC, USA; Wilson is with the Department of Criminal Justice, North Carolina Central University, Durham, NC, USA; Thomas is with the Program in Public Health Ethics, University of North Carolina, Chapel Hill, NC, USA.     

Asthma among homeless children in New York City: an update

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

Neighborhood Inequalities in Adverse Pregnancy Outcomes in an Urban Setting in Spain: A Multilevel Approach

The aim of the present study was to describe socioeconomic inequalities in low birth weight (LBW), premature birth (PM) and small size for gestational age at birth (SGA) between 2000 and 2005 in Barcelona, Spain, jointly evaluating the effect of mother’s country of origin, and neighborhood of residence socioeconomic level measured using unemployment and educational level. We performed a cross-sectional study of births to mothers aged 12–49 years who were residents in the city of Barcelona in 2000–2005, analyzing adverse pregnancy outcomes (n = 61,676). Weighted multilevel logistic regression models were fitted with individual data on level 1 and neighborhood data on level 2, to obtain adjusted odds ratios (aOR) with 95% confidence intervals and residual variance. Individually, pregnancy outcomes are more favorable in births to older mothers and to mothers from Maghrib and Central and South America than from developed countries (including Spain) or from other developing countries. After adjusting for individual variables, poor pregnancy outcomes were associated with poor neighborhoods (more unemployment was associated to LBW: aOR = 1.56; PM aOR = 1.51; SGA aOR = 1.66). The same trend was observed for associations with illiteracy rate. The present study shows that there are socioeconomic inequalities in adverse pregnancy outcomes in the city of Barcelona. One of the main challenges in perinatal health continues to be the reduction of adverse pregnancy outcomes in the city.     

Neighborhood contributions to psychological distress among Latino New York City adults

Objective: Neighborhood-level factors such as ethnic densities and social cohesion have been negatively associated with psychological distress among Latino Americans. Yet, existing evidence is based on either specific neighborhood factors or particular Latino subgroups. The objective of the study was to assess difference in psychological distress between each of four Latino subgroups (Puerto Ricans, Dominicans, Mexicans, other Latinos) and non-Latino white adults in New York City, and quantify total neighborhood-level influence on these differences.

Design: We used the combined Community Health Survey data from 2009, 2010, and 2012 surveys. We estimated the odds ratios (ORs) for self-reported non-specific psychological distress (Kessler-6 questions scale ≥ 13) by race/ethnicity using logistic regression models. We further adjusted these estimates for both observed and unobserved neighborhood-level confounding using the conditional pseudolikelihood method for complex survey data.

Results: Puerto Ricans were more likely to be psychologically distressed (OR?=?1.58, 95% CI?=?1.18, 2.12) compared with non-Latino whites, whereas the opposite was seen in other Latino subgroups. Accounting for full neighborhood-level confounding increased the disparity for Puerto Ricans (OR?=?1.79, 95% CI?=?1.26–2.54). For the other subgroups, lower odds of psychological distress were no longer observed or attenuated after accounting for neighborhood-level confounding. Overall neighborhood-level factors were associated with lower psychological distress at greater extent among all Latinos subgroups versus non-Latino whites in New York City.

Conclusion: Despite substantial variations of psychological distress across Latino subgroups, the study shows evidence that neighborhood-level factors might play a protective role in all Latino subgroups.     

On the Front Lines: An Environmental Asthma Intervention in New York City

Asthma is now the leading cause of school absence among children of color in impoverished urban neighborhoods. Environmental interventions have the potential to augment clinical approaches to asthma management by directly reducing exposure to environmental triggers (e.g., cockroaches, rodents, and mold). We implemented an apartment-based intervention to reduce exposures to indoor allergens among children living with asthma in 2 areas in New York City with rates of asthma morbidity and mortality that rank among the highest in the United States. Although the intervention phase of the present study is not yet complete, timely reporting of our field experiences may prove useful to other groups engaged in environmental intervention trials in urban communities.     

Neighborhood Walkability and Active Travel (Walking and Cycling) in New York City

Urban planners have suggested that built environment characteristics can support active travel (walking and cycling) and reduce sedentary behavior. This study assessed whether engagement in active travel is associated with neighborhood walkability measured for zip codes in New York City. Data were analyzed on engagement in active travel and the frequency of walking or biking ten blocks or more in the past month, from 8,064 respondents to the New York City 2003 Community Health Survey (CHS). A neighborhood walkability scale that measures: residential, intersection, and subway stop density; land use mix; and the ratio of retail building floor area to retail land area was calculated for each zip code. Data were analyzed using zero-inflated negative binomial regression incorporating survey sample weights and adjusting for respondents’ sociodemographic characteristics. Overall, 44 % of respondents reported no episodes of active travel and among those who reported any episode, the mean number was 43.2 episodes per month. Comparing the 75th to the 25th percentile of zip code walkability, the odds ratio for reporting zero episodes of active travel was 0.71 (95 % CI 0.61, 0.83) and the exponentiated beta coefficient for the count of episodes of active travel was 1.13 (95 % CI 1.06, 1.21). Associations between lower walkability and reporting zero episodes of active travel were significantly stronger for non-Hispanic Whites as compared to non-Hispanic Blacks and to Hispanics and for those living in higher income zip codes. The results suggest that neighborhood walkability is associated with higher engagement in active travel.     

Neighborhood Characteristics and Change in Depressive Symptoms Among Older Residents of New York City

Objectives. We investigated the relationship between the depressive symptoms of older adults over time and the characteristics of the neighborhoods in which they live.Methods. We surveyed a random sample of 1325 New York City residents aged 50 years or older in 2005 and conducted 808 follow-up interviews in 2007. We assessed the compositional characteristics of the respondents'' neighborhoods at a census-tract level and determined the relationships between these characteristics and changes in respondents'' depressive symptoms.Results. In multivariable models that adjusted for individual-level covariates including income, a range of neighborhood characteristics predicted worsening depressive symptoms. Factor analysis suggested that these characteristics operated in 3 clusters: neighborhood socioeconomic influences, residential stability, and racial/ethnic composition, with positive neighborhood socioeconomic influences being significantly protective against worsening symptoms. Life stressors, personality trait neuroticism, African American race, and daily baseline contact with social networks were also associated with worsening symptoms.Conclusions. An older adult''s neighborhood of residence is an important determinant of his or her mental health. Those making efforts to improve mental health among the elderly need to consider the role of residential context in improving or impairing mental health.Depression is an important cause of morbidity in the general community.¹ The prevalence of depression is high among elderly persons, and longitudinal studies have found modest increases in depressive symptoms with age.^2–4 The incidence of depression peaks in early adult life, but there appears to be a secondary peak in incidence among people in their 50s, suggesting that the transition to older age may present specific risks for depression.⁵ Depression is associated with significant disability among older adults and may place their functional independence at risk.⁶ At least 1 longitudinal study has also suggested that older African Americans may be at increased risk of symptoms of depression compared with older White adults.⁷Although a number of individual-level factors are known to increase the risk of depression,^8–10 it has long been thought that the physical and social environments in which people live may also influence their mental health.^11–13 The environment may play a particularly important role in the mental health of older adults, who, compared with younger adults, are more likely to spend time in their neighborhood of residence, more likely to suffer from disabilities that may be exacerbated by their environments,¹⁴ and are more vulnerable to threats to their safety.^15–17A number of theories have been proposed to explain this association between neighborhood characteristics and depression. Researchers have drawn on systemic theory to propose that neighborhoods characterized by higher levels of poverty and residential instability have lower levels of social cohesion and lower levels of control over deviant social networks.^18,19 The concomitant lack of social order may contribute to low levels of trust, which would impede collaborative efforts to control crime and reduce neighborhood disorder.²⁰ High levels of crime may generate higher levels of fear and stress, as could the deteriorating building conditions and high levels of physical disorder associated with disadvantaged neighborhoods.^20,21 In contexts of social isolation and limited social organization, residents may not benefit from the social networks necessary to buffer them from the stressors they face on a daily basis.²²These theories about the influence of the neighborhood context on collective and individual sources of stress agree with the “differential vulnerability” hypothesis and with social stress theory, both of which posit that environments can influence health by increasing the likelihood of personal stress events such as unemployment or traumatic events, or by providing resources to cope with such stressors.^23–26 Studies using multilevel analytic methods that can account for both individual-level and neighborhood-level effects suggest that neighborhood-level characteristics such as affluence, disadvantage, inequality, and residential stability have a significant impact on physical health, even after accounting for individual-level factors.^27–30 However, research into their possible influence on mental health has been more limited.Cross-sectional studies using multilevel approaches have suggested that symptoms of depression are more prevalent in residents of disadvantaged neighborhoods^31–33 and that this association may be stronger in neighborhoods having less residential turnover^34,35 or higher population density.³⁶ Similar associations have been observed among older adults, for whom living in a neighborhood that is poor or has few elderly people has been associated with higher levels of depressive symptoms, after accounting for individual vulnerabilities.³⁷ The presence of stress-buffering support systems has been associated with lower levels of depression in cross-sectional research, whereas low levels of social support in neighborhoods with high social isolation were related to higher depression levels.^38,39 However, other research has failed to replicate these findings.⁴⁰ Furthermore, the cross-sectional nature of this research means that even positive studies cannot exclude the possibility that the observed relationships simply reflect a tendency for depressed individuals to become disadvantaged or to live in disadvantaged neighborhoods.Longitudinal research can better explore the causal mechanisms behind these relationships, but there have been few prospective studies in this field. A study of individuals who were screened for an HIV prevention intervention found that perceptions of neighborhood characteristics predicted change in depressive symptoms 9 months later.⁴¹ The Alameda County Study found that living in a high-poverty area was associated with worse health status and more symptoms of depression; however, this association was lost when all individual-level covariates were included in multivariable analysis.⁴² In previous research conducted by members of our own team, we identified a significant association between incident depression and neighborhoods classified as low socioeconomic status, even after adjusting for individual income, adverse life events, and educational status.⁴³ This kind of prospective research, although suggestive, has often been weakened by reliance on perceived neighborhood characteristics, limitations of the measures used, or absence of information on possible confounders.To overcome these limitations, we examined the relationship between characteristics of the neighborhood of residence of older adults and symptoms of depression using longitudinal data from the New York City Neighborhood and Mental Health in the Elderly Study (NYCNAMES). We hypothesized that neighborhood socioeconomic status may either exacerbate or ameliorate the stressors confronting participants, thereby influencing levels of depression symptoms over the study period, even after accounting for key individual-level factors. We used information from the 2000 US Census to characterize neighborhoods, and we aggregated these characteristics into dimensions that might shed light on the mechanisms underlying observed relationships.     

Neighborhood ethnic density and preterm birth across seven ethnic groups in New York City

Residential segregation limits non-white ethnic groups' access to white neighborhood resources, but may also reduce their exposure to discrimination and facilitate social support. We computed adjusted preterm birth risk differences (RDs) for seven ethnic groups comparing >25% to ≤25% ethnic density neighborhoods using 1995-2003 New York City birth records and a spatial ethnic density measure. RDs ranged from -15.0 per 1000 (95% CI: -18.5, -11.4) for whites to 6.4 per 1000 (95% CI: 2.8, 9.9) for blacks, with Hispanic and Asian estimates falling in between but tending to be protective. Results suggest that ethnic density is uniquely harmful for non-Hispanic blacks.     

Multi-Level Socioenvironmental Contributors to Childhood Asthma in New York City: a Cluster Analysis

Childhood asthma exacerbation remains the leading cause of pediatric emergency department visits and hospitalizations and disproportionately affects Latinx and Black children, compared to non-Latinx White children in NYC. Environmental exposures and socioeconomic factors may jointly contribute to childhood asthma exacerbations; however, they are often studied separately. To better investigate the multiple contributors to disparities in childhood asthma, we compiled data on various individual and neighborhood level socioeconomic and environmental factors, including education, race/ethnicity, income disparities, gentrification, housing characteristics, built environment, and structural racism, from the NYC Department of Health’s KIDS 2017 survey and the US Census’ American Community Survey. We applied cluster analysis and logistic regression to first identify the predominant patterns of social and environmental factors experienced by children in NYC and then estimate whether children experiencing specific patterns are more likely to experience asthma exacerbations. We found that housing and built environment characteristics, such as density and age of buildings, were the predominant features to differentiate the socio-environmental patterns observed in New York City. Children living in neighborhoods with greater proportions of rental housing, high-density buildings, and older buildings were more likely to experience asthma exacerbations than other children. These findings add to the literature about childhood asthma in urban environments, and can assist efforts to target actionable policies and practices that promote health equity related to childhood asthma.     

Perceived Neighborhood Environment Affecting Physical and Mental Health: A Study with Korean American Older Adults in New York City

This study examined how subjective perceptions of the neighborhood environment (e.g., perceived ethnic density, safety, social cohesion, and satisfaction) influenced the physical and mental health of Korean American older adults. Using data from 420 residents of the New York City metropolitan area (M _age = 71.6, SD = 7.59), health perceptions and depressive symptoms were estimated with hierarchical regression models entered in the order of (1) demographics and acculturation, (2) health-related variables, and (3) perceived neighborhood environment. After controlling for the effects of the individual-level variables, perceived neighborhood environment was found to make a significant contribution to both outcomes. Individuals less satisfied with their overall neighborhood environment were more likely to have negative perceptions of health and depressive symptoms. A strong linkage between perceived neighborhood safety and depressive symptoms was also observed. Findings from the study highlight the importance of subjective evaluations of neighborhood environment and provide implications for health promotion.     

High HIV Prevalence and Diagnosis Rates in New York City Black Men

We sought to identify population and subpopulation disparities in rates of HIV diagnosis and prevalence among black males 13 years and older in New York City. We used population-based data from the New York City HIV/AIDS surveillance registry and US Census 2000 to calculate HIV prevalence in 2006 and HIV diagnosis rates in 2007. Black males were the largest demographic group of new HIV diagnoses (n = 1,161, 33%) and persons living with HIV/AIDS in New York City (n = 24,294, 29%) and had the highest diagnosis rates (1.7 per 1,000 population) and prevalence (3.7%). Prevalence and diagnosis rates among black males were higher in higher-poverty neighborhoods than in lower-poverty neighborhoods (p < 0.01). However, very high prevalence (19.3%) was found among black males in three adjacent Manhattan neighborhoods with relatively low poverty rates, and where overall diagnosis rates among black males (7.4 per 1,000) and proportions attributable to men who have sex with men (60.0%) were high. HIV-related disparities exist not only between black males and other groups but also within black males. Success addressing the citywide HIV epidemic will be linked to success in the various portions of this highly affected, heterogeneous population.     

Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984-1992

OBJECTIVES: The resurgence of tuberculosis (TB) in NewYork City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear.We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992. METHODS: Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census. RESULTS: For 1992, 3,343 TB cases were mapped to 5,482 neighborhoods, yielding a mean incidence of 46.5 per 100,000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty).This association persisted after adjustment for AIDS, proportion foreign born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income. CONCLUSIONS: Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.     

Neighborhood stressors, perceived neighborhood quality, and child mental health in New York City

This paper examines the relationship between neighborhood stressors, stressors related to parenting, children's evaluations of neighborhood quality, and child depression. One hundred and twenty-six young adolescents in three disadvantaged New York City neighborhoods completed surveys on neighborhood quality and child depression and the children's parents provided information on their mental health and parenting practices. Neighborhood stressors were measured through observations by outside raters. Children's evaluations of neighborhood quality were positively related to their assessments of depression and there was an unexpected positive association between the neighborhood drug/alcohol stressor and child depression. Moreover, the relationship between the drug/alcohol stressor and child depression was fully mediated by the children's assessments of neighborhood quality. Future directions for neighborhood and health research are discussed.     

Prevalence of Hepatitis C Infection in New York City, 2004

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.     

Prevalence of Overweight and Obesity in Chinese American Children in New York City

Childhood obesity has been a growing concern in recent years. The extent of obesity in various ethnic pediatric populations including Chinese Americans has not been fully explored. In this study, the prevalence of overweight and obesity in a Chinese American pediatric population (6–19 years) was determined through a chart review of 4,695 patients from a large community health center in New York City. Demographic characteristics including sex, age and immigrant status were used in a logistic regression to determine risk factors for obesity in this community. Overall, 24.6% of the children studied were overweight or obese (defined as BMI ≥ 85th percentile for age and sex). Among US born boys aged 6–12 years, the combined prevalence of overweight and obesity was found to be as high as 40%. Further studies are needed to understand the complex interplay of factors that contribute to obesity in pediatric immigrant groups.