Using Civic Service Design Methods to Redevelop a Data Communication Website With a Health Literacy Lens.

CONTEXT: Public health agencies routinely publish data in hopes that data influence public health policy and practice. However, data websites can often be difficult to use, posing barriers to people trying to access, understand, and use data. Working to make data websites easier to use can add value to public health data communication work. PROGRAM: The New York City Department of Health and Mental Hygiene (DOHMH) redesigned its Environment and Health Data Portal, a website used to communicate environmental health data, with the goal of making data more accessible and understandable to a broader audience. The DOHMH used Civic Service Design methods to establish priorities and strategies for the redesign work, to build a data communication website that emphasizes a high level of usability, and content that explains data. IMPLEMENTATION: By following a Civic Service Design process, the DOHMH synthesized findings from health communications, data visualization and communication, and web usability to create an easy-to-use website with explanations of data and findings alongside datasets. On the new site, automated dataset visualizations are supplemented with narrative content, explanatory content, and custom interactive applications designed to explain data and findings. EVALUATION: Web analytics showed that, in its first year of operation, the site's web traffic grew substantially, with the last 12 weeks recording weekly page views 150% higher than the first 12 weeks of operation (7185 average weekly page views compared with 2866 average weekly page views). Two-thirds (66.3%) of page views include recorded user engagement. Additional evaluations to measure specific aspects of usability compared with the previous version of the site are planned. DISCUSSION: By following a Civic Service Design process, the DOHMH redesigned a vital data communication platform to increase its usability and saw significant increase in engagement in its first year of operations. By designing data material with usability in mind, public health departments have the potential to improve public health data communication work.

Improving Patient Outcomes in the Dual Crises of Climate Change and COVID-19: Proceedings of the Third Annual Clinical Climate Change Meeting, January 8, 2021.

The tremendous global toll of the COVID-19 pandemic does not fall equally on all populations. Indeed, this crisis has exerted more severe impacts on the most vulnerable communities, spotlighting the continued consequences of longstanding structural, social, and healthcare inequities. This disparity in COVID-19 parallels the unequal health consequences of climate change, whereby underlying inequities perpetuate adverse health outcomes disproportionately among vulnerable populations. As these two crises continue to unfold, there is an urgent need for healthcare practitioners to identify and implement solutions to mitigate adverse health outcomes, especially in the face of global crises. To support this need, the 2021 Clinical Climate Change Conference held a virtual meeting to discuss the implications of the convergence of the climate crisis and COVID-19, particularly for vulnerable patient populations and the clinicians who care for them. Presenters and panelists provided evidence-based solutions to help health professionals improve and adapt their practice to these evolving scenarios. Together, participants explored the community health system and national solutions to reduce the impacts of COVID-19 and the climate crisis, to promote community advocacy, and foster new partnerships between community and healthcare leaders to combat systemic racism and achieve a more just and equitable society.

Intraurban Variation of Fine Particle Elemental Concentrations in New York City.

Few past studies have collected and analyzed within-city variation of fine particulate matter (PM2.5) elements. We developed land-use regression (LUR) models to characterize spatial variation of 15 PM2.5 elements collected at 150 street-level locations in New York City during December 2008-November 2009: aluminum, bromine, calcium, copper, iron, potassium, manganese, sodium, nickel, lead, sulfur, silicon, titanium, vanadium, and zinc. Summer- and winter-only data available at 99 locations in the subsequent 3 years, up to November 2012, were analyzed to examine variation of LUR results across years. Spatial variation of each element was modeled in LUR including six major emission indicators: boilers burning residual oil; traffic density; industrial structures; construction/demolition (these four indicators in buffers of 50 to 1000 m), commercial cooking based on a dispersion model; and ship traffic based on inverse distance to navigation path weighted by associated port berth volume. All the elements except sodium were associated with at least one source, with R(2) ranging from 0.2 to 0.8. Strong source-element associations, persistent across years, were found for residual oil burning (nickel, zinc), near-road traffic (copper, iron, and titanium), and ship traffic (vanadium). These emission source indicators were also significant and consistent predictors of PM2.5 concentrations across years.

Spatial and temporal estimation of air pollutants in New York City: exposure assignment for use in a birth outcomes study.

BACKGROUND: Recent epidemiological studies have examined the associations between air pollution and birth outcomes. Regulatory air quality monitors often used in these studies, however, were spatially sparse and unable to capture relevant within-city variation in exposure during pregnancy. METHODS: This study developed two-week average exposure estimates for fine particles (PM2.5) and nitrogen dioxide (NO2) during pregnancy for 274,996 New York City births in 2008-2010. The two-week average exposures were constructed by first developing land use regression (LUR) models of spatial variation in annual average PM2.5 and NO2 data from 150 locations in the New York City Community Air Survey and emissions source data near monitors. The annual average concentrations from the spatial models were adjusted to account for city-wide temporal trends using time series derived from regulatory monitors. Models were developed using Year 1 data and validated using Year 2 data. Two-week average exposures were then estimated for three buffers of maternal address and were averaged into the last six weeks, the trimesters, and the entire period of gestation. We characterized temporal variation of exposure estimates, correlation between PM2.5 and NO2, and correlation of exposures across trimesters. RESULTS: The LUR models of average annual concentrations explained a substantial amount of the spatial variation (R2 = 0.79 for PM2.5 and 0.80 for NO2). In the validation, predictions of Year 2 two-week average concentrations showed strong agreement with measured concentrations (R2 = 0.83 for PM2.5 and 0.79 for NO2). PM2.5 exhibited greater temporal variation than NO2. The relative contribution of temporal vs. spatial variation in the estimated exposures varied by time window. The differing seasonal cycle of these pollutants (bi-annual for PM2.5 and annual for NO2) resulted in different patterns of correlations in the estimated exposures across trimesters. The three levels of spatial buffer did not make a substantive difference in estimated exposures. CONCLUSIONS: The combination of spatially resolved monitoring data, LUR models and temporal adjustment using regulatory monitoring data yielded exposure estimates for PM2.5 and NO2 that performed well in validation tests. The interaction between seasonality of air pollution and exposure intervals during pregnancy needs to be considered in future studies.

Intra-urban spatial variability in wintertime street-level concentrations of multiple combustion-related air pollutants: the New York City Community Air Survey (NYCCAS).

Although intra-urban air pollution differs by season, few monitoring networks provide adequate geographic density and year-round coverage to fully characterize seasonal patterns. Here, we report winter intra-urban monitoring and land-use regression (LUR) results from the New York City Community Air Survey (NYCCAS). Two-week integrated samples of fine particles (PM(2.5)), black carbon (BC), nitrogen oxides (NO(x)) and sulfur dioxide (SO(2)) were collected at 155 city-wide street-level locations during winter 2008-2009. Sites were selected using stratified random sampling, randomized across sampling sessions to minimize spatio-temporal confounding. LUR was used to identify GIS-based source indicators associated with higher concentrations. Prediction surfaces were produced using kriging with external drift. Each pollutant varied twofold or more across sites, with higher concentrations near midtown Manhattan. All pollutants were positively correlated, particularly PM(2.5) and BC (Spearman's r=0.84). Density of oil-burning boilers, total and truck traffic density, and temporality explained 84% of PM(2.5) variation. Densities of total traffic, truck traffic, oil-burning boilers and industrial space, with temporality, explained 65% of BC variation. Temporality, built space, bus route location, and traffic density described 67% of nitrogen dioxide variation. Residual oil-burning units, nighttime population and temporality explained 77% of SO(2) variation. Spatial variation in combustion-related pollutants in New York City was strongly associated with oil-burning and traffic density. Chronic exposure disparities and unique local sources can be identified through year-round saturation monitoring.

Monitoring intraurban spatial patterns of multiple combustion air pollutants in New York City: design and implementation.

Routine air monitoring provides data to assess urban scale temporal variation in pollution concentrations in relation to regulatory standards, but is not well suited to characterizing intraurban spatial variation in pollutant concentrations from local sources. To address these limitations and inform local control strategies, New York City developed a program to track spatial patterns of multiple air pollutants in each season of the year. Monitor locations include 150 distributed street-level sites chosen to represent a range of traffic, land-use and other characteristics. Integrated samples are collected at each distributed site for one 2-week session each season and in every 2-week period at five reference locations to track city-wide temporal variation. Pollutants sampled include PM(2.5) and constituents, nitrogen oxides, black carbon, ozone (summer only) and sulfur dioxide (winter only). During the first full year of monitoring more than 95% of designed samples were completed. Agreement between colocated samples was good (absolute mean % difference 3.2-8.9%). Street-level pollutant concentrations spanned a much greater range than did concentrations at regulatory monitors, especially for oxides of nitrogen and sulfur dioxide. Monitoring to characterize intraurban spatial gradients in ambient pollution usefully complements regulatory monitoring data to inform local air quality management.

Spatial variability in levels of benzene, formaldehyde, and total benzene, toluene, ethylbenzene and xylenes in New York City: a land-use regression study.

BACKGROUND: Hazardous air pollutant exposures are common in urban areas contributing to increased risk of cancer and other adverse health outcomes. While recent analyses indicate that New York City residents experience significantly higher cancer risks attributable to hazardous air pollutant exposures than the United States as a whole, limited data exist to assess intra-urban variability in air toxics exposures. METHODS: To assess intra-urban spatial variability in exposures to common hazardous air pollutants, street-level air sampling for volatile organic compounds and aldehydes was conducted at 70 sites throughout New York City during the spring of 2011. Land-use regression models were developed using a subset of 59 sites and validated against the remaining 11 sites to describe the relationship between concentrations of benzene, total BTEX (benzene, toluene, ethylbenzene, xylenes) and formaldehyde to indicators of local sources, adjusting for temporal variation. RESULTS: Total BTEX levels exhibited the most spatial variability, followed by benzene and formaldehyde (coefficient of variation of temporally adjusted measurements of 0.57, 0.35, 0.22, respectively). Total roadway length within 100 m, traffic signal density within 400 m of monitoring sites, and an indicator of temporal variation explained 65% of the total variability in benzene while 70% of the total variability in BTEX was accounted for by traffic signal density within 450 m, density of permitted solvent-use industries within 500 m, and an indicator of temporal variation. Measures of temporal variation, traffic signal density within 400 m, road length within 100 m, and interior building area within 100 m (indicator of heating fuel combustion) predicted 83% of the total variability of formaldehyde. The models built with the modeling subset were found to predict concentrations well, predicting 62% to 68% of monitored values at validation sites. CONCLUSIONS: Traffic and point source emissions cause substantial variation in street-level exposures to common toxic volatile organic compounds in New York City. Land-use regression models were successfully developed for benzene, formaldehyde, and total BTEX using spatial indicators of on-road vehicle emissions and emissions from stationary sources. These estimates will improve the understanding of health effects of individual pollutants in complex urban pollutant mixtures and inform local air quality improvement efforts that reduce disparities in exposure.

An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees.

To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2-3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income < $25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600-70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.