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Cooper H.L.F.,Emory University | Des Jarlais D.C.,Rothschild | Tempalski B.,National Development and Research Institutes Inc | Bossak B.H.,Georgia Southern University | And 2 more authors.
Health and Place | Year: 2012

Drug-related law enforcement activities may undermine the protective effects of syringe exchange programs (SEPs) on local injectors' risk of injection-related infections. We explored the spatial overlap of drug-related arrest rates and access to SEPs over time (1995-2006) in New York City health districts, and used multilevel models to investigate the relationship of these two district-level exposures to the odds of injecting with an unsterile syringe. Districts with better SEP access had higher arrest rates, and arrest rates undermined SEPs' protective relationship with unsterile injecting. Drug-related enforcement strategies targeting drug users should be de-emphasized in areas surrounding SEPs. © 2011 Elsevier Ltd. Source


Cooper H.,Emory University | Des Jarlais D.,Rothschild | Ross Z.,ZevRoss Spatial Analysis | Tempalski B.,National Development and Research Institutes Inc | And 2 more authors.
Journal of Urban Health | Year: 2012

Despite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the USA, these interventions-and specifically SEP site locations-remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995-2006). Annual measures of spatial access to syringes in each UHF district (N=42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N=4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in >75% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms. © 2012 The New York Academy of Medicine. Source


Kheirbek I.,Bureau of Environmental Surveillance and Policy | Johnson S.,Bureau of Environmental Surveillance and Policy | Ross Z.,ZevRoss Spatial Analysis | Pezeshki G.,Bureau of Environmental Surveillance and Policy | And 3 more authors.
Environmental Health: A Global Access Science Source | Year: 2012

Background: Hazardous air pollutant exposures are common in urban areas contributing to increased risk ofcancer 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 or 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. © 2012 Kheirbek et al.; licensee BioMed Central Ltd. Source


Cooper H.L.F.,Emory University | Des Jarlais D.C.,Rothschild | Ross Z.,ZevRoss Spatial Analysis | Tempalski B.,National Development and Research Institutes Inc | And 2 more authors.
American Journal of Public Health | Year: 2011

Objectives: We examined relationships of spatial access to syringe exchange programs (SEPs) and pharmacies selling over-the-counter (OTC) syringes with New York City drug injectors' harm reduction practices. Methods: Each year from 1995 to 2006, we measured the percentage of 42 city health districts' surface area that was within 1 mile of an SEP or OTC pharmacy. We applied hierarchical generalized linear models to investigate relationships between these exposures and the odds that injectors (n=4003) used a sterile syringe for at least 75% of injections in the past 6 months. Results: A 1-unit increase in the natural log of the percentage of a district's surface area within a mile of an SEP in 1995 was associated with a 26% increase in the odds of injecting with a sterile syringe; a 1-unit increase in this exposure over time increased these odds 23%. A 1-unit increase in the natural log of OTC pharmacy access improved these odds 15%. Conclusions: Greater spatial access to SEPs and OTC pharmacies improved injectors' capacity to engage in harm reduction practices that reduce HIV and HCV transmission. Source


Ross Z.,ZevRoss Spatial Analysis | Clougherty J.E.,University of Pittsburgh | Ito K.,New York University | Markowitz S.,Center for the Biology of Natural Systems | Eisl H.,Center for the Biology of Natural Systems
Environmental Research | Year: 2011

Background: Epidemiological studies have linked both noise and air pollution to common adverse health outcomes such as increased blood pressure and myocardial infarction. In urban settings, noise and air pollution share important sources, notably traffic, and several recent studies have shown spatial correlations between noise and air pollution. The temporal association between these exposures, however, has yet to be thoroughly investigated despite the importance of time series studies in air pollution epidemiology and the potential that correlations between these exposures could at least partly confound statistical associations identified in these studies.Methods: An aethelometer, for continuous elemental carbon measurement, was co-located with a continuous noise monitor near a major urban highway in New York City for six days in August 2009. Hourly elemental carbon measurements and hourly data on overall noise levels and low, medium and high frequency noise levels were collected. Hourly average concentrations of fine particles and nitrogen oxides, wind speed and direction and car, truck and bus traffic were obtained from nearby regulatory monitors. Overall temporal patterns, as well as day-night and weekday-weekend patterns, were characterized and compared for all variables. Results: Noise levels were correlated with car, truck, and bus traffic and with air pollutants. We observed strong day-night and weekday-weekend variation in noise and air pollutants and correlations between pollutants varied by noise frequency. Medium and high frequency noise were generally more strongly correlated with traffic and traffic-related pollutants than low frequency noise and the correlation with medium and high frequency noise was generally stronger at night. Correlations with nighttime high frequency noise were particularly high for car traffic (Spearman rho=0.84), nitric oxide (0.73) and nitrogen dioxide (0.83). Wind speed and direction mediated relationships between pollutants and noise. Conclusions: Noise levels are temporally correlated with traffic and combustion pollutants and correlations are modified by the time of day, noise frequency and wind. Our results underscore the potential importance of assessing temporal variation in co-exposures to noise and air pollution in studies of the health effects of these urban pollutants. © 2011 Elsevier Inc. Source

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