Angell S.Y.,Centers for Disease Control and Prevention |
Cobb L.K.,General Electric |
Curtis C.J.,Gotham Center |
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.
Kaplan D.L.,Gotham Center |
Jones E.J.,CAI |
Olson E.C.,Community Epidemiology Unit |
Yunzal-Butler C.B.,Research and Evaluation Unit
Journal of School Health | Year: 2013
BACKGROUND: Early sex is associated with high-risk behaviors and outcomes, including sexual risk behaviors, forced sex, physical dating violence, and becoming pregnant or impregnating someone. METHODS: Using 2005 and 2007 data from the New York City Youth Risk Behavior Survey (N=17,220), this study examined the prevalence of early sex among public high school students; associations between early sex and other sexual risk factors and violence indicators; and whether associations varied across 4 racial/ethnic groups. Bivariate and multiple logistic regression models estimated the relationship between sexual risk and violence outcomes and "early sex," defined as first having sexual intercourse before age 14. Separate models with an interaction term for early sex by race/ethnicity were also estimated. RESULTS: More than one third of students who ever had sex reported having early sex. Adolescents reporting early sex were significantly more likely than those reporting later sex to engage in most sexual risk behaviors and to experience violence. The magnitude of association varied significantly by race/ethnicity for sexual risk behaviors. CONCLUSIONS: The high prevalence of early sex, coupled with its associated high-risk behaviors and outcomes, underscores the necessity of implementing evidence-based interventions that have been found to positively impact these behaviors beginning in middle school. © 2013, American School Health Association.
Dietz P.M.,Centers for Disease Control and Prevention |
Bombard J.M.,Centers for Disease Control and Prevention |
Hutchings Y.L.,Centers for Disease Control and Prevention |
Gauthier J.P.,Agency of Human Services |
And 4 more authors.
American Journal of Obstetrics and Gynecology | Year: 2014
Objective The birth certificate variable obstetric estimate of gestational age (GA) has not been previously validated against GA based on estimated date of delivery from medical records. Study Design We estimated sensitivity, specificity, positive predictive value, negative predictive value and the corresponding 95% confidence intervals (CIs) for preterm delivery (<37 weeks' gestation) based on obstetric estimate using estimated date of delivery-based GA as the gold standard. Trained abstractors obtained the estimated date of delivery from the prenatal record (64.8% in New York City, and 94.6% in Vermont), or, when not available, from the hospital delivery record for 2 population-based samples: 586 live births delivered in New York City and 649 live births delivered in Vermont during 2009. Weights were applied to account for nonresponse and sampling design. Results In New York City, the preterm delivery rate based on estimated date of delivery was 9.7% (95% CI, 7.6-12.4) and 8.2% (95% CI, 6.3-10.6) based on obstetric estimate; in Vermont, it was 6.8% (95% CI, 5.4-8.4) based on estimated date of delivery and 6.3% (95% CI, 5.1-7.8) based on obstetric estimate. In New York City, sensitivity of obstetric estimate-based preterm delivery was 82.5% (95% CI, 69.4-90.8), specificity 98.1% (95% CI, 96.4-99.1), positive predictive value 98.0% (95% CI, 95.2-99.2), and negative predictive value 98.8% (95% CI, 99.6-99.9). In Vermont, sensitivity of obstetric estimate-based preterm delivery was 93.8% (95% CI, 81.8-98.1), specificity 99.6% (95% CI, 98.5-99.9), positive predictive value 100%, and negative predictive value 100%. Conclusion Obstetric estimate-based preterm delivery had excellent specificity, positive predictive value and negative predictive value. Sensitivity was moderate in New York City and excellent in Vermont. These results suggest obstetric estimate-based preterm delivery from the birth certificate is useful for the surveillance of preterm delivery. © 2014 Mosby, Inc. All rights reserved.
Neaigus A.,Gotham Center |
Reilly K.H.,Gotham Center |
Jenness S.M.,University of Washington |
Hagan H.,New York University |
And 2 more authors.
AIDS and Behavior | Year: 2013
HIV-negative injection drug users (IDUs) who engage in both receptive syringe sharing and unprotected sex ("dual HIV risk") are at high risk of HIV infection. In a cross-sectional study conducted in New York City in 2009, active IDUs aged ≥18 years were recruited using respondent-driven sampling, interviewed, and tested for HIV. Participants who tested HIV-negative and did not self-report as positive were analyzed (N = 439). Adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) were estimated using multinomial logistic regression. The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 % African-American/black. Dual risk was engaged in by 26.2 %, receptive syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither by 21.2 %. Variables independently associated with engaging in dual risk versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI = 1.0-4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5-15.9), homelessness (aOR = 3.4, 95 % CI = 1.6-7.1), ≥2 sex partners (aOR = 8.7, 95 % CI = 4.4-17.3), ≥2 injecting partners (aOR = 2.9, 95 % CI = 1.5-5.8), and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI = 0.2-0.9). A majority of IDUs engaged in HIV risk behaviors, and a quarter in dual risk. Interventions among IDUs should simultaneously promote the consistent use of sterile syringes and of condoms. © 2013 Springer Science+Business Media New York.
Lee K.K.,Gotham Center
Health and Place | Year: 2012
Physical inactivity is a leading cause of death in the United States and globally and is also associated with several additional leading causes of death, including obesity, high blood pressure and high blood glucose. The built environment plays a critical role in promoting or discouraging physical activity among adults and children. To create a healthier and more physically active city, a working group comprising several New York City agencies, including the Departments of Design and Construction, Health and Mental Hygiene, Transportation and City Planning, and in collaboration with design organizations and academics, published the Active Design Guidelines (ADG; 〈www.nyc.gov/adg〉) in January 2010. The ADG is a manual of evidence-based and best-practice strategies for increasing physical activity in the design and construction of neighborhoods, streets and buildings. The commentary discusses key activities and events leading up to the publication as well as current implementation activities. It also shares the lessons learned that could assist other communities interested in improving their built environments in developing and implementing similar activities and initiatives. © 2011.
Lederer A.,Gotham Center |
Curtis C.J.,Gotham Center |
Silver L.D.,Gotham Center |
Angell S.Y.,Gotham Center
American Journal of Preventive Medicine | Year: 2014
Poor diet is a leading cause of disability, death, and rising health care costs. Government agencies can have a large impact on population nutrition by adopting healthy food purchasing policies. In 2007, New York City (NYC) began developing a nutrition policy for all foods purchased, served, or contracted for by City agencies. A Food Procurement Workgroup was created with representatives from all City agencies that engaged in food purchasing or service, and the NYC Health Department served as technical advisor. The NYC Standards for Meals/Snacks Purchased and Served (Standards) became a citywide policy in 2008. The first of its kind, the Standards apply to more than 3,000 programs run by 12 City agencies. This paper describes the development process and initial implementation of the Standards. With more than 260 million meals and snacks per year covered, the Standards increase demand for healthier products, model healthy eating, and may also affect clients' food choices beyond the institutional environment. Our experience suggests that implementation of nutrition standards across a wide range of diverse agencies is feasible, especially when high-level support is established and technical assistance is available. Healthy procurement policies can ensure that food purchased by a jurisdiction supports its public health efforts. © 2014 American Journal of Preventive Medicine.
Sacks R.,Gotham Center |
Yi S.S.,Gotham Center |
Nonas C.,Gotham Center
American Journal of Public Health | Year: 2015
Broad recognition now exists that price, availability, and other structural factors are meaningful barriers to fruit and vegetable consumption, particularly among low-income adults. Beginning in 2005, the New York City Department of Health and Mental Hygiene used the social-ecological model to develop a multifaceted effort to increase fruit and vegetable access citywide, with emphasis in lowincome neighborhoods. Overall, the percentage of New York City adults who reported consuming no fruits and vegetables in the previous day decreased slightly over a 10-year period (2002:14.3% [95% confidence interval = 13.4%, 15.2%]; 2012:12.5% [95% confidence interval = 11.4%, 13.6%]; Pfor trend <.001). Our approach hypothesizes that complementary initiatives, implemented simultaneously, will create a citywide food environment that fuels changes in social norms and cultural preferences, increases consumer demand, and supports sustainable access to affordable produce.
Coady M.H.,Gotham Center
Tobacco control | Year: 2013
To increase knowledge of smoking-related health risks and provide smoking cessation information at the point of sale, in 2009, New York City required the posting of graphic point-of-sale tobacco health warnings in tobacco retailers. This study is the first to evaluate the impact of such a policy in the USA. Cross-sectional street-intercept surveys conducted among adult current smokers and recent quitters before and after signage implementation assessed the awareness and impact of the signs. Approximately 10 street-intercept surveys were conducted at each of 50 tobacco retailers in New York City before and after policy implementation. A total of 1007 adults who were either current smokers or recent quitters were surveyed about the awareness and impact of tobacco health warning signs. Multivariate risk ratios (RR) were calculated to estimate awareness and impact of the signs. Most participants (86%) were current smokers, and the sample was 28% African-American, 32% Hispanic/Latino and 27% non-Hispanic white. Awareness of tobacco health warning signs more than doubled after the policy implementation (adjusted RR =2.01, 95% CI 1.74 to 2.33). Signage posting was associated with an 11% increase in the extent to which signs made respondents think about quitting smoking (adjusted RR =1.11, 95% CI 1.01 to 1.22). A policy requiring tobacco retailers to display graphic health warning signs increased awareness of health risks of smoking and stimulated thoughts about quitting smoking. Additional research aimed at evaluating the effect of tobacco control measures in the retail environment is necessary to provide further rationale for implementing these changes.
Miller L.,Gotham Center |
Arakaki L.,Gotham Center |
Ramautar A.,Gotham Center |
Bodach S.,Gotham Center |
And 6 more authors.
Annals of Internal Medicine | Year: 2014
Background: An association between HIV and invasive meningococcal disease (IMD) has been suggested by several previous studies but has not been fully described in the era of highly active antiretroviral therapy in the United States. Objective: To estimate the risk for IMD and death in people living with HIV/AIDS (PLWHA) in New York City (NYC) and the contribution of CD4+ cell count and viral load (VL) to IMD risk. Design: Comparison of the incidence rate of IMD among PLWHA with that among HIV-uninfected persons. Surveillance data on IMD for patients aged 15 to 64 years from 2000 to 2011 were matched to death and HIV registries to calculate IMD risk and case-fatality ratios. A subset of PLWHA who had a CD4+ cell count and VL measurement near the time of their IMD infection was included in age-matched case-control analyses to assess HIV markers and IMD risk. Setting: Retrospective cohort from communicable disease surveillance. Patients: 265 persons aged 15 to 64 years with IMD during 2000 to 2011. Measurements: Meningococcal and HIV data abstracted from surveillance and registry databases, including CD4+ cell counts and VL. Results: The average annual incidence rate of IMD was 0.39 cases per 100 000 persons. The relative risk for IMD among PLWHA in NYC during 2000 to 2011 was 10.0 (95% CI, 7.2 to 14.1). Among PLWHA, patients with IMD were 5.3 times (CI, 1.4 to 20.4 times) as likely as age-matched control patients to have CD4+ counts less than 0.200 × 109 cells/L. Limitation: Missing data on smoking status and comorbidity. Conclusion: People living with HIV/AIDS in NYC are at increased risk for IMD. Cost-effectiveness and vaccine efficacy studies are needed to evaluate the value of a national recommendation for routine meningococcal vaccination of PLWHA. © 2014 American College of Physicians.
Harris T.G.,Gotham Center |
Sullivan Meissner J.,Gotham Center |
Proops D.,Gotham Center
American Journal of Infection Control | Year: 2013
Background: Demographic changes have increased the number of elderly individuals for whom age-related immunosenescence may increase latent tuberculosis (TB) infection (LTBI) activation risk. As TB rates decline, maintaining clinical suspicion for TB is challenging. Timely identification, isolation, and treatment of infectious patients are especially important in settings with vulnerable individuals. Methods: An outbreak investigation was conducted at a long-term care facility/hospital complex after a prolonged TB exposure associated with delayed diagnosis in a tuberculin skin test (TST)-negative cancer patient resulted in a secondary TB case along with other evidence of transmission. Results: Investigators identified 64 patient and 239 staff contacts. Among those tested with TST, 7 (23%) patients and 5 (8%) staff at the long-term care facility had conversions. Because of evidence of transmission, concerns about TST anergy, and the high number of patients with illnesses such as cancer and diabetes that increase TB risk, LTBI treatment was recommended for all exposed long-term care facility patients regardless of TST results once active TB was ruled out. After the investigation concluded, a former patient who tested TST-negative and did not receive LTBI treatment developed active TB. Conclusion: When evaluating symptomatic patients, especially elderly individuals, clinicians should "think TB" regardless of a negative test for TB infection. After known exposure and when transmission evidence exists, clinicians should consider providing LTBI treatment to elderly contacts with comorbidities regardless of LTBI test results. Copyright © 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.