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1.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S66-S68, 2021.
Article in English | MEDLINE | ID: mdl-33239565

Subject(s)
Racism , Humans , Public Health
3.
Am J Public Health ; 110(7): 1046-1053, 2020 07.
Article in English | MEDLINE | ID: mdl-32437270

ABSTRACT

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.


Subject(s)
Housing/statistics & numerical data , Premature Birth/epidemiology , Racism , Social Segregation , Female , Humans , Infant, Newborn , New York City/epidemiology , Poverty , Pregnancy , Residence Characteristics/classification
4.
N Engl J Med ; 382(11): 1009-1017, 2020 03 12.
Article in English | MEDLINE | ID: mdl-32160662

ABSTRACT

BACKGROUND: Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. METHODS: We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. RESULTS: A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. CONCLUSIONS: Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.


Subject(s)
Measles-Mumps-Rubella Vaccine , Measles , Vaccination , Adolescent , Adult , Aged , Child , Child, Preschool , Disease Outbreaks , Female , Health Resources/economics , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Measles/epidemiology , Measles/prevention & control , Measles-Mumps-Rubella Vaccine/administration & dosage , Medical History Taking , Middle Aged , New York City/epidemiology , Severity of Illness Index , Vaccination/statistics & numerical data , Young Adult
5.
J Public Health Manag Pract ; 26(2): 176-179, 2020.
Article in English | MEDLINE | ID: mdl-31995548

ABSTRACT

CONTEXT: While the New York City Department of Health and Mental Hygiene (DOHMH) can use agency-wide emergency activation to respond to a hepatitis A virus-infected food handler, there is a need to identify alternative responses that conserve scarce resources. OBJECTIVE: To compare the costs incurred by DOHMH of responding to a hepatitis A case in restaurant food handlers using an agency-wide emergency activation (2015) versus the cost of collaborating with a private network of urgent care clinics (2017). DESIGN: We partially evaluate the costs incurred by DOHMH of responding to a hepatitis A case in a restaurant food handler using agency-wide emergency activation (2015) with the cost of collaborating with a private network of urgent care clinics (2017) estimated for a scenario in which DOHMH incurred the retail cost of services rendered. RESULTS: Costs incurred by DOHMH for emergency activation were $65 831 ($238 per restaurant employee evaluated) of which DOHMH personnel services accounted for 85% ($55 854). Costs of collaboration would have totaled $50 914 ($253 per restaurant employee evaluated) of which personnel services accounted for 6% ($3146). CONCLUSIONS: Accounting for incident size, collaborating with the clinic network was more expensive than agency-wide emergency activation, though required fewer DOHMH personnel services.


Subject(s)
Costs and Cost Analysis/methods , Hepatitis A/economics , Public Health/economics , Costs and Cost Analysis/statistics & numerical data , Disease Outbreaks/statistics & numerical data , Food Handling , Hepatitis A/epidemiology , Hepatitis A virus/pathogenicity , Humans , New York City/epidemiology , Public Health/methods , Public Health/statistics & numerical data , Restaurants/organization & administration , Restaurants/statistics & numerical data
6.
J Public Health Manag Pract ; 26(6): 539-547, 2020.
Article in English | MEDLINE | ID: mdl-31592987

ABSTRACT

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.


Subject(s)
Patient Protection and Affordable Care Act , Poverty , Child , Emergency Service, Hospital , Female , Humans , Infant , New York City , United States
7.
Am J Prev Med ; 56(2): 187-195, 2019 02.
Article in English | MEDLINE | ID: mdl-30553691

ABSTRACT

INTRODUCTION: This study assesses preventable hospitalization rates among New York City residents living in public housing developments compared with all New York City residents and residents in low-income areas. Additionally, preventable hospitalization rates by development (one or multiple buildings in close proximity and served by the same management office) were determined. METHODS: The 2010-2014 New York City hospital discharge data were geocoded and linked with New York City Housing Authority records using building-level identifiers. Preventable hospitalizations resulting from ambulatory care-sensitive conditions were identified for public housing residents, citywide, and residents of low-income areas. Age-adjusted overall and ambulatory care-sensitive, condition-specific preventable hospitalization rates (11 outcomes) were determined and compared across groups to assess potential disparities. Additionally, rates were ranked and compared among public housing developments by quartiles. The analysis was conducted in 2016 and 2017. RESULTS: The age-adjusted rate of preventable hospitalization was significantly higher among public housing residents than citywide (rate ratio [RR]=2.67, 95% CI=2.65, 2.69), with the greatest disparities in hospitalizations related to diabetes (RR=3.12, 95% CI=3.07, 3.18) and asthma (RR=4.14, 95% CI=4.07, 4.21). The preventable hospitalization rate was also higher among residents of public housing than low-income areas (RR=1.33, 95% CI=1.31, 1.35). There were large differences between developments ranked in the top and bottom quartiles of preventable hospitalization (RR=1.81, 95% CI=1.76, 1.85) with the largest difference related to chronic obstructive pulmonary disease (RR=3.38, 95% CI=3.08, 3.70). CONCLUSIONS: Preventable hospitalization rates are high among public housing residents, and vary significantly by development and condition. By providing geographically granular information, geocoded hospital discharge data can serve as a valuable tool for health assessment and engagement of the healthcare sector and other stakeholders in interventions that address health inequities.


Subject(s)
Ambulatory Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Patient Discharge/statistics & numerical data , Preventive Health Services/standards , Public Housing/statistics & numerical data , Adolescent , Adult , Aged , Diabetes Mellitus/therapy , Female , Humans , Male , Middle Aged , New York City , Pulmonary Disease, Chronic Obstructive/therapy , Socioeconomic Factors , Young Adult
8.
Health Secur ; 16(5): 341-349, 2018.
Article in English | MEDLINE | ID: mdl-30299168

ABSTRACT

In late 2017 and early 2018, the New York City Department of Health and Mental Hygiene deployed multiple teams to Puerto Rico and the US Virgin Islands to support public health in those territories. This article is a description of how those teams were conceived, deployed, supported, and reintegrated into the agency. This was an unprecedented mission for our agency, and what follows is a reflection on what worked and what didn't work for us. It is our hope that other jurisdictions can use this information to organize and execute similar missions in the future, and that collectively we can continue to advance the field of public health preparedness and response.


Subject(s)
Civil Defense/methods , Civil Defense/organization & administration , Cyclonic Storms , Government Agencies , Population Surveillance/methods , Public Health , Humans , Natural Disasters , New York City , Puerto Rico , Surge Capacity , United States Virgin Islands
10.
Am J Public Health ; 106(6): 1036-41, 2016 06.
Article in English | MEDLINE | ID: mdl-27077350

ABSTRACT

OBJECTIVES: To assess potential reductions in premature mortality that could have been achieved in 2008 to 2012 if the minimum wage had been $15 per hour in New York City. METHODS: Using the 2008 to 2012 American Community Survey, we performed simulations to assess how the proportion of low-income residents in each neighborhood might change with a hypothetical $15 minimum wage under alternative assumptions of labor market dynamics. We developed an ecological model of premature death to determine the differences between the levels of premature mortality as predicted by the actual proportions of low-income residents in 2008 to 2012 and the levels predicted by the proportions of low-income residents under a hypothetical $15 minimum wage. RESULTS: A $15 minimum wage could have averted 2800 to 5500 premature deaths between 2008 and 2012 in New York City, representing 4% to 8% of total premature deaths in that period. Most of these avertable deaths would be realized in lower-income communities, in which residents are predominantly people of color. CONCLUSIONS: A higher minimum wage may have substantial positive effects on health and should be considered as an instrument to address health disparities.


Subject(s)
Mortality, Premature/ethnology , Poverty , Residence Characteristics/statistics & numerical data , Salaries and Fringe Benefits/legislation & jurisprudence , Adult , Female , Humans , Income , Male , Middle Aged , Minority Groups/statistics & numerical data , New York City , Salaries and Fringe Benefits/economics , Urban Health/statistics & numerical data
11.
PLoS One ; 8(1): e50916, 2013.
Article in English | MEDLINE | ID: mdl-23341877

ABSTRACT

INTRODUCTION: Children are important transmitters of influenza in the community and a number of non-pharmaceutical interventions (NPIs), including hand washing and use of hand sanitizer, have been recommended to mitigate the transmission of influenza, but limited information is available regarding schools' ability to implement these NPIs during an influenza outbreak. We evaluated implementation of NPIs during fall 2009 in response to H1N1 pandemic influenza (pH1N1) by New York City (NYC) public schools. METHODS: From January 25 through February 9, 2010, an online survey was sent to all the 1,632 NYC public schools and principals were asked to participate in the survey or to designate a school nurse or other school official with knowledge of school policies and characteristics to do so. RESULTS: Of 1,633 schools, 376(23%) accessed and completed the survey. Nearly all respondents (99%) implemented at least two NPIs. Schools that had a Flu Response Team (FRT) as a part of school emergency preparedness plan were more likely to implement the NPI guidelines recommended by NYC public health officials than schools that did not have a FRT. Designation of a room for isolating ill students, for example, was more common in schools with a FRT (72%) than those without (53%) (p<0.001). CONCLUSIONS: Implementing an NPI program in a large school system to mitigate the effects of an influenza outbreak is feasible, but there is potential need for additional resources in some schools to increase capacity and adherence to all recommendations. Public health influenza-preparedness plans should include school preparedness planning and FRTs.


Subject(s)
Health Plan Implementation/statistics & numerical data , Influenza, Human/prevention & control , Influenza, Human/therapy , Schools/statistics & numerical data , Adolescent , Communication , Data Collection/statistics & numerical data , Health Education/statistics & numerical data , Humans , Hygiene , Influenza A Virus, H1N1 Subtype/physiology , Influenza, Human/epidemiology , Influenza, Human/virology , Internet , New York City/epidemiology , Research Report , Sanitation/statistics & numerical data
12.
14.
J Sch Health ; 82(3): 123-30, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22320336

ABSTRACT

BACKGROUND: The effects of individual school dismissal on influenza transmission have not been well studied. During the spring 2009 novel H1N1 outbreak, New York City implemented an individual school dismissal policy intended to limit influenza transmission at schools with high rates of influenza-like illness (ILI). METHODS: Active disease surveillance data collected by the New York City Health Department on rates of ILI in schools were used to evaluate the impact. Sixty-four schools that met the Health Department's criteria for considering dismissal were included in the analysis. Twenty-four schools that met criteria subsequently dismissed all classes for approximately 1 school week. A regression model was fit to these data, estimating the effect of school dismissal on rates of in-school ILI following reconvening, adjusting for potential confounders. RESULTS: The model estimated that, on average, school dismissal reduced the rate of ILI by 7.1% over the entire average outbreak period. However, a large proportion of in-school ILI occurred before dismissal criteria were met. A separate model estimated that school absenteeism rates were not significantly affected by dismissal. CONCLUSION: Results suggest that individual school dismissal could be considered in situations where schools have a disproportionate number of high-risk students or may be unable to implement recommended preventive or infection control measures. Future work should focus on developing more sensitive indicators of early outbreak detection in schools and evaluating the impact of school dismissal on community transmission.


Subject(s)
Absenteeism , Disease Outbreaks/statistics & numerical data , Infection Control/organization & administration , Influenza A Virus, H1N1 Subtype , Influenza, Human/epidemiology , Urban Population/statistics & numerical data , Adolescent , Child , Child Welfare/statistics & numerical data , Disease Outbreaks/prevention & control , Humans , New York City/epidemiology , Regression Analysis , Risk Factors , School Health Services/organization & administration , Schools/organization & administration , Students/statistics & numerical data
16.
Emerg Infect Dis ; 11(1): 146-9, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15705342

ABSTRACT

After being notified that 2 high school football teammates from New York City were hospitalized with confirmed or suspected invasive group A streptococcal infections, we conducted an investigation of possible spread among other team members. This investigation highlights a need for guidelines on management of streptococcal and other infectious disease outbreaks in team sport settings.


Subject(s)
Football , Schools , Streptococcal Infections/diagnosis , Streptococcal Infections/transmission , Streptococcus pyogenes/isolation & purification , Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Bacteremia/diagnosis , Bacteremia/epidemiology , Bacteremia/microbiology , Electrophoresis, Gel, Pulsed-Field , Humans , Male , Microbial Sensitivity Tests , Middle Aged , New York City/epidemiology , Pyoderma/diagnosis , Pyoderma/epidemiology , Pyoderma/microbiology , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Streptococcus pyogenes/classification , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/genetics , Surveys and Questionnaires , Thrombophlebitis/diagnosis , Thrombophlebitis/epidemiology , Thrombophlebitis/microbiology
17.
JAMA ; 288(1): 82-90, 2002 Jul 03.
Article in English | MEDLINE | ID: mdl-12090866

ABSTRACT

Latinos recently became the largest racial/ethnic minority group of US children. The Latino Consortium of the American Academy of Pediatrics Center for Child Health Research, consisting of 13 expert panelists, identified the most important urgent priorities and unanswered questions in Latino child health. Conclusions were drawn when consensus was reached among members, with refinement through multiple iterations. A consensus statement with supporting references was drafted and revised. This article summarizes the key issues, including lack of validated research instruments, frequent unjustified exclusion from studies, and failure to analyze data by pertinent subgroups. Latino children are at high risk for behavioral and developmental disorders, and there are many unanswered questions about their mental health needs and use of services. The prevalence of dental caries is disproportionately higher for Latino children, but the reasons for this disparity are unclear. Culture and language can profoundly affect Latino children's health, but not enough cultural competency training of health care professionals and provision of linguistically appropriate care occur. Latinos are underrepresented at every level of the health care professions. Latino children are at high risk for school dropout, environmental hazards, obesity, diabetes mellitus, asthma, lack of health insurance, nonfinancial barriers to health care access, and impaired quality of care, but many key questions in these areas remain unanswered. This article suggests areas in which more research is needed and ways to improve research and care of Latino children.


Subject(s)
Health Services Accessibility , Health Services Research , Health Status , Hispanic or Latino , Asthma/ethnology , Child , Communication Barriers , Cost of Illness , Cultural Characteristics , Diabetes Mellitus/ethnology , Educational Status , Health Services Needs and Demand , Health Workforce , Humans , Insurance, Health , Language , Mental Health , Mental Health Services , Minority Groups , Needs Assessment , Obesity/ethnology , Oral Health , Quality of Health Care , Research , Risk Factors , Transients and Migrants , United States
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