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Digrande L.,25 Worth Street | Neria Y.,Columbia University | Neria Y.,New York State Psychiatric Institute | Brackbill R.M.,Agency for Toxic Substances and Disease Registry | And 2 more authors.
American Journal of Epidemiology | Year: 2011

Although the September 11, 2001, terrorist attacks were the largest human-made disaster in US history, there is little extant research documenting the attacks' consequences among those most directly affected, that is, persons who were in the World Trade Center towers. Data from a cross-sectional survey conducted 2-3 years after the attacks ascertained the prevalence of long-term, disaster-related posttraumatic stress symptoms and probable posttraumatic stress disorder (PTSD) in 3,271 civilians who evacuated World Trade Center towers 1 and 2. Overall, 95.6% of survivors reported at least 1 current posttraumatic stress symptom. The authors estimated the probable rate of PTSD at 15.0% by using the PTSD Checklist. Women and minorities were at an increased risk of PTSD. A strong inverse relation with annual income was observed. Five characteristics of direct exposure to the terrorist attacks independently predicted PTSD: being on a high floor in the towers, initiating evacuation late, being caught in the dust cloud that resulted from the tower collapses, personally witnessing horror, and sustaining an injury. Working for an employer that sustained fatalities also increased risk. Each addition of an experience of direct exposure resulted in a 2-fold increase in the risk of PTSD (odds ratio = 2.09, 95% confidence interval: 1.84, 2.36). Identification of these risk factors may be useful when screening survivors of large-scale terrorist events for long-term psychological sequelae. © 2010 The Author. Source


Angell S.Y.,Centers for Disease Control and Prevention | Cobb L.K.,General Electric | Curtis C.J.,Gotham Center | Konty K.J.,25 Worth Street | Silver L.D.,United Road Services
Annals of Internal Medicine | Year: 2012

Background: Dietary trans fat increases risk for coronary heart disease. In 2006, New York City (NYC) passed the first regulation in the United States restricting trans fat use in restaurants. Objective: To assess the effect of the NYC regulation on the trans and saturated fat content of fast-food purchases. Design: Cross-sectional study that included purchase receipts matched to available nutritional information and brief surveys of adult lunchtime restaurant customers conducted in 2007 and 2009, before and after implementation of the regulation. Setting: 168 randomly selected NYC restaurant locations of 11 fast-food chains. Participants: Adult restaurant customers interviewed in 2007 and 2009. Measurements: Change in mean grams of trans fat, saturated fat, trans plus saturated fat, and trans fat per 1000 kcal per purchase, overall and by chain type. Results: The final sample included 6969 purchases in 2007 and 7885 purchases in 2009. Overall, mean trans fat per purchase decreased by 2.4 g (95% CI, -2.8 to -2.0 g; P < 0.001), whereas saturated fat showed a slight increase of 0.55 g (CI, 0.1 to 1.0 g; P = 0.011). Mean trans plus saturated fat content decreased by 1.9 g overall (CI, -2.5 to -1.2 g; P < 0.001). Mean trans fat per 1000 kcal decreased by 2.7 g per 1000 kcal (CI, -3.1 to -2.3 gper 1000 kcal; P < 0.001). Purchases with zero grams of trans fat increased from 32% to 59%. In a multivariate analysis, the poverty rate of the neighborhood in which the restaurant was located was not associated with changes. Limitation: Fast-food restaurants that were included may not be representative of all NYC restaurants. Conclusion: The introduction of a local restaurant regulation was associated with a substantial and statistically significant decrease in the trans fat content of purchases at fast-food chains, without a commensurate increase in saturated fat. Restaurant patrons from high- and low-poverty neighborhoods benefited equally. However, federal regulation will be necessary to fully eliminate population exposure to industrial trans fat sources. Primary Funding Source: City of New York and the Robert Wood Johnson Foundation Healthy Eating Research program. © 2012 American College of Physicians. Source


Beletsky L.,Northeastern University | Beletsky L.,University of California at San Diego | Heller D.,25 Worth Street | Jenness S.M.,University of Washington | And 3 more authors.
International Journal of Drug Policy | Year: 2014

Background: Injection drug user (IDU) experience and perceptions of police practices may alter syringe exchange program (SEP) use or influence risky behaviour. Previously, no community-level data had been collected to identify the prevalence or correlates of police encounters reported by IDUs in the United States. Methods: New York City IDUs recruited through respondent-driven sampling were asked about past-year police encounters and risk behaviours, as part of the National HIV Behavioural Surveillance study. Data were analysed using multiple logistic regression. Results: A majority (52%) of respondents (n=514) reported being stopped by police officers; 10% reported syringe confiscation. In multivariate modelling, IDUs reporting police stops were less likely to use SEPs consistently (adjusted odds ratio [AOR]=0.59; 95% confidence interval [CI]=0.40-0.89), and IDUs who had syringes confiscated may have been more likely to share syringes (AOR=1.76; 95% CI=0.90-3.44), though the finding did not reach statistical significance. Conclusions: Findings suggest that police encounters may influence consistent SEP use. The frequency of IDU-police encounters highlights the importance of including contextual and structural measures in infectious disease risk surveillance, and the need to develop approaches harmonizing structural policing and public health. © 2013 Elsevier B.V. Source


Krishnan A.,Yale University | Wickersham J.A.,Yale University | Chitsaz E.,Yale University | Springer S.A.,Yale University | And 3 more authors.
AIDS and Behavior | Year: 2013

HIV-infected individuals with substance use disorders have a high prevalence of medical and psychiatric morbidities that complicate treatment. Incarceration further disrupts healthcare access and utilization. Without appropriate diagnosis and treatment, drug relapse upon release exceeds 85 %, which contributes to poor health outcomes. A prospective cohort of 1,032 HIV-infected jail detainees were surveyed in a ten-site demonstration project during incarceration and six-months post-release, in order to examine the effect of predisposing factors, enabling resources and need factors on their subsequent drug use. Homelessness, pre-incarceration cocaine and opioid use, and high drug and alcohol severity were significantly associated with cocaine and opioid relapse. Substance abuse treatment, though poorly defined, did not influence post-release cocaine and opioid use. An approach that integrates multiple services, simultaneously using evidence- based substance abuse, psychiatric care, and social services is needed to improve healthcare outcomes for HIV-infected persons transitioning from jails to the community. Source


Matte T.D.,25 Worth Street | Lane K.,25 Worth Street | Ito K.,25 Worth Street
Health Security | Year: 2016

Extreme heat event excess mortality has been estimated statistically to assess impacts, evaluate heat emergency response, and project climate change risks. We estimated annual excess non-external-cause deaths associated with extreme heat events in New York City (NYC). Extreme heat events were defined as days meeting current National Weather Service forecast criteria for issuing heat advisories in NYC based on observed maximum daily heat index values from LaGuardia Airport. Outcomes were daily non-external-cause death counts for NYC residents from May through September from 1997 to 2013 (n = 337,162). The cumulative relative risk (CRR) of death associated with extreme heat events was estimated in a Poisson time-series model for each year using an unconstrained distributed lag for days 0-3 accommodating over dispersion, and adjusting for within-season trends and day of week. Attributable death counts were computed by year based on individual year CRRs. The pooled CRR per extreme heat event day was 1.11 (95%CI 1.08-1.14). The estimated annual excess non-external-cause deaths attributable to heat waves ranged from -14 to 358, with a median of 121. Point estimates of heat wave-attributable deaths were greater than 0 in all years but one and were correlated with the number of heat wave days (r = 0.81). Average excess non-external-cause deaths associated with extreme heat events were nearly 11-fold greater than hyperthermia deaths. Estimated extreme heat event-associated excess deaths may be a useful indicator of the impact of extreme heat events, but single-year estimates are currently too imprecise to identify short-term changes in risk. © Mary Ann Liebert, Inc. 2016. Source

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