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PubMed1995

Differential mortality in New York City (1988-1992). Part Two: excess mortality in the south Bronx.

To display the extent of variations in mortality according to geographic regions in New York City, we have compared mortality in New York City as a whole with that of the South Bronx. Mortality records for 1988 to 1992 and 1990 US census data for New York City were linked. The 471,000 residents of the South Bronx were younger, less educated, and more likely to lack health insurance than other New Yorkers. Using age- and gender-stratified populations and mortality in New York City as standards, age-adjusted death rates and excess mortality in the South Bronx were determined. All-cause mortality in the South Bronx was 26% higher than the city as a whole. Mortality for AIDS, injury and poisoning, drug and alcohol abuse, and cardiovascular diseases were 50% to 100% higher in the South Bronx than in New York City; years of potential life lost before age 65 in the South Bronx were 41.6% and 44.2% higher for men and women, respectively, than in New York City; AIDS accounted for the largest single share of excess premature deaths (21.8%). In summary, inequalities in health status, reflected by higher mortality rates in the South Bronx, are consistent with, and perhaps caused by, lower socioeconomic status and deficient medical care among residents of this inner-city community.

Cause of Death↗
PubMed1985

Health expenditures in New York City, 1983.

HIGHLIGHTS OF THE STUDY. Health expenditures in New York City totalled roughly $15.7 billion in 1983. Those expenditures represented 13.5 percent of the gross city product. Expenditures for personal health care services amounted to more than $1,900 per city resident. Despite comparatively high levels of health expenditures in New York City, such expenditures have risen much less dramatically over time than health expenditures nationally; from 1976 to 1983, city expenditures increased by 74.6 percent, compared with a national increase of 137.7 percent. More than one half (55.3%) of health expenditures in the city were accounted for by public funds. Nearly 50 percent of personal care expenditures were associated with the delivery of hospital services, for which expenditures totalled $6.9 billion. Fifty-five percent of Medicaid hospital outlays and 86 percent of Medicare hospital outlays went to private sector hospitals. More than $400 per capita was spent on physicians' services in New York City in 1983. Public sources of funds accounted for more than 80 percent of the $1.7 billion in long term care services expenditures; this contrasts with a much smaller proportion of public funding for such services nationally. More details on health expenditures in New York City follow. Data sources, definitions, study methods, and limitations are described in an appendix to this report.

Data Collection↗
PubMed1985

The financial condition of New York City voluntary hospitals: the first year of NYPHRM (New York Prospective Hospital Reimbursement Methodology).

HIGHLIGHTS OF THE STUDY. In 1983, for the first time since 1977, the average voluntary hospital in New York City did not incur a deficit. Nevertheless, voluntary hospitals in New York City continued to have a lower return on their assets than voluntary hospitals in the rest of the state, in the Mid-Atlantic region, and in the nation. New York City voluntary hospitals would need 85 percent of their total assets to repay their debt, while the comparison groups would use less than 60 percent. The annual rate of growth in hospital expenses among New York City voluntary hospitals declined from almost 12 percent between 1981 and 1982 to less than 9.5 percent between 1982 and 1983, which also was almost a full percentage point below the national rate of increase. Between 1982 and 1983, the value of uncompensated care provided by New York City voluntary hospitals increased from 3.4 percent to 3.7 percent of total operating expenses. Fourteen of the 49 New York City voluntary hospitals studied were financially stressed in 1983, compared to 18 in 1982. Without the additional revenues received from the NYPHRM pools, 10 more New York City voluntary hospitals would have had bottom-line deficits. More details on the financial condition of New York City voluntary hospitals in 1983, and first year of NYPHRM, follow. Definitions, data sources, and methods are described in an appendix to the report, which also includes a glossary of financial terms.

Costs and Cost Analysis↗
PubMed1993

Cigarette smoking trends in adolescents and young adults: the Stanford Five-City Project.

BACKGROUND: Data on smoking prevalence from four cross-sectional community-based surveys (1979-1990) are presented for 2,605 adolescents and young adults 12-24 years of age. METHODS: The surveys were conducted in two treatment and two control cities in Northern California as part of the Stanford Five-City Project, a multifactor cardiovascular disease prevention study. RESULTS: Over the 12-year study period, prevalence of daily smoking declined in all cities by approximately 50% among 16- to 19- and 20- to 24-year-olds but showed little change among those 12-15 years old. Although the declines were especially large in the two treatment cities and in one control city, the declines in treatment cities were not significantly different from those in control cities. During each period, smoking prevalence escalated most sharply between the ages of 12-15 and 16-19, the period of development when students advanced from junior high to high school. CONCLUSIONS: Despite impressive secular declines, it appears that the Five-City Project community intervention, which targeted smoking in adults, did not have a diffusion effect on the tobacco use habits of adolescents.

Adolescent↗
PubMed1981

The spatial structure of Latin American cities.

"Using published census data, metropolitan area population and employment statistics are constructed for several large Latin American cities in 1950, 1960, and 1970, and compared to similar statistics from selected North American cities. The Latin cities are experiencing decentralization of population and some decentralization of employment. Overall population density patterns of large Latin cities resemble those in older North American cities; newer North American cities have lower densities and are much more decentralized than Latin cities. High-status groups are somewhat concentrated in the central cities of Latin American metropolitan areas, but their concentrations there are declining."

Americas↗
PubMed2004

City centre violence.

Emergency medicine departments have often proved to be an important source of information concerning violence. These resulting studies of violence have not previously focused on city centre violence, but instead described violence from an entire casualty department or police district. Results from the Aarhus violence study of 1999-2000 revealed differences in characteristics of victims, place of assault and alcohol consumption when violence in the city was compared to violence elsewhere. The present study constitutes a one-year period (1999-2000), during which a total of 1106 assault victims were registered, and among these 230 were assaulted downtown. Forty-six percent of victims from the city centre were assaulted in public houses or streets nearby compared to 5% in the district outside city centre. Both in- and outside the city centre the number of victims decreased significantly in relation to the previous period. However, women who experienced violence in the city were then more likely to be assaulted in the streets, when compared to previous studies. Victims who were assaulted in the city were more frequently under the influence of alcohol than victims from the outside. It is believed that the present results are comparable with other major cities.

Alcohol Drinking↗
PubMed2001

[Health and the city: physical health and mental health].

In France, city size has very little bearing on the mortality rate as a function of age and life expectancy and it is in large cities that these indicators are the most favorable. No increase in maternal or infant mortality rates or deaths due to cancers has been observed in large cities. The lower mortality rate linked to respiratory and cardiovascular diseases in large urban areas contradicts the fears concerning the impact of air pollution. Deaths linked to lifestyle are less frequent in big cities, which could be due to social structures (socio-professional level: the proportion of white-collar workers and professionals is higher in bigger cities than in the suburbs or small cities). However, although the overall mortality rate is lower, it should be emphasized that there is in large cities a greater incidence of sexually transmitted diseases, AIDS and certain infectious diseases (because of social diversity and the fact that certain individuals seeking anonymity and marginality are drawn to large cities). In terms of mental health, the breakdown of family structures, instability, unemployment, the lack of parental authority and failing schools render adolescents vulnerable and hinder their social integration. When the proportion of adolescents at risk is high in a neighborhood, individual problems are amplified and social problems result. In order to restore mental and social health to these neighborhoods, ambitious strategies are necessary which take into account family and social factors as well as environmental ones. At the present time, when physical health is constantly improving, the most pressing problems are those related to lifestyle and mental health which depend for a large part on social factors.

France↗
PubMed1998

Incidence of hip fracture in Oslo, Norway: differences within the city.

Oslo, Norway has the highest incidence of hip fractures ever reported. There are great differences in life expectancy between city regions in Oslo, and we investigated if there were any differences in incidence of hip fracture within the city. In 1989, all new fractures of the proximal femur in Oslo residents 50 years or older were registered with each patient's address. Patients in nursing homes were registered according to preadmission address. All were localized to one of six city regions. The incidence of fracture of the total population of Oslo in 1 year age groups was projected on the population of the city regions to calculate the expected number of fractures compared with all of Oslo. The ratio between observed and expected number of fractures was calculated for each city region. The rural county of Sogn og Fjordane (S&F) has only two thirds the incidence of hip fractures compared with Oslo, and life expectancy is longer for both genders compared to Oslo. New hip fractures in 1989 were registered in S&F as in Oslo, and the ratio between observed and expected number of fractures calculated as for Oslo city regions. There were 1029 new fractures in Oslo women, and 284 in men. The relative risk (RR) for Oslo city regions using Inner Oslo West as the reference, showed significantly higher RRs for hip fracture in Inner Oslo East in women (1.23, 95% confidence interval 1.03-1.48) and in Inner and Outer Oslo East in men (1.67, 95% confidence interval 1.14-2.24; 1.45, 95% confidence interval 1.00-2.11, respectively). The risk in S&F compared with Inner Oslo West was significantly lower for women, but not for men (RR 0.74, 95% confidence interval 0.60-0.92; RR 0.82, 95% confidence interval 0.56-1.21, respectively). There were differences in annual incidence of hip fractures between different city regions in Oslo for both women and men, and the incidences were higher than in the rural county of S&F.

Aged↗
PubMedDate not supplied

Population sampling in European air pollution exposure study, EXPOLIS: comparisons between the cities and representativeness of the samples.

A personal air pollution exposure study, EXPOLIS, was accomplished in six European cities among 25- to 55-year-old citizens. In order to compare the exposure results and different microenvironmental concentrations between the cities it is crucial to know the extent and effects of the population bias that has developed in sampling procedure and the sociodemographic characteristics of each measured population sample. In each participating city a random Base sample of 2000 to 3000 individuals was drawn from the census and a Short Questionnaire (SQ) was mailed to them. Two subsamples of the Respondents of the mailed questionnaire were randomly drawn: Diary sample for 48-h time--microenvironment--activity diary and extensive exposure questionnaires, and Exposure sample for the same plus personal exposure and microenvironmental monitoring. Significant differences existed between the EXPOLIS cities in the population-sampling procedure. Population-sampling bias was evaluated by comparing the Respondents with the total city populations. The share of women and individuals with more than 14 years of education is higher among the Respondents than the overall population except in Athens. Men, younger (25-34 years old) and unmarried individuals were hardest to get to participate in the study at least in Helsinki. The two subsamples differ from Respondents in having more employed and higher- educated individuals. The largest sample bias occurred at the first and easiest step of responding to the mailed Short Screening Questionnaire, and not at the last and most demanding stage of participating in the exposure measurements. Exposure data from some of EXPOLIS cities can only be compared to other cities with caution considering their large population bias or different sample selections. However the selection bias is not necessarily a problem for analyses about predictors of personal exposures or analyses within a city.

Adult↗
PubMed2005

[Integrated sustainability-oriented reporting--key indicators for communities and cities. Results of a research and development project].

In our research project -- supported by the German Federal Ministry for Education and Research (BMBF) - 35 key indicators were developed in an ongoing process in co-operation with 10 East German cities, which are all members in the German cities healthy network. With these indicators the cities should take up integrated sustainability - oriented health reporting, from which actions and projects for health promotion and prevention can be derived. The conceptual background for the research project and the reports to be made by the project in co-operation with the cities, are the three policy programmes that to be realised on a county level: Healthy Cities, Local Agenda 21 and the German city development programme "Soziale Stadt (socially oriented city)". The common goal of these programmes is the sustainable improvement of the quality of life in the counties. The project is part of the BMBF-supported research field "problem - oriented regional reporting systems", in which other projects are involved which are mainly being conducted in the newly-formed East German "Lander". In this article we describe the co-operative process of the development of the indicators. A synopsis of already applied or proposed sets of indicators for municipal reporting was the basis for the development of the project's set of 35 key indicators. The set of indicators is presented according to its usefulness for planning and realisation of actions for health promotion on county level. For each of the 35 indicators a meta - data description was made to support the counties and cities in our project for health reporting. These indicator profiles are also helpful and supportive for all counties and citiesaiming at such health reporting. The project started in May 2002 and lasts till Mai 2005, so that most reports should be completed in the spring of 2005.

Community Health Services↗
PubMed2001

Healthy city projects in developing countries: the first evaluation.

The 'healthy city' concept has only recently been adopted in developing countries. From 1995 to 1999, the World Health Organization (WHO), Geneva, supported healthy city projects (HCPs) in Cox's Bazar (Bangladesh), Dar es Salaam (Tanzania), Fayoum (Egypt), Managua (Nicaragua) and Quetta (Pakistan). The authors evaluated four of these projects, representing the first major evaluation of HCPs in developing countries. Methods used were stakeholder analysis, workshops, document analysis and interviews with 102 managers/implementers and 103 intended beneficiaries. Municipal health plan development (one of the main components of the healthy city strategy) in these cities was limited, which is a similar finding to evaluations of HCPs in Europe. The main activities selected by the projects were awareness raising and environmental improvements, particularly solid waste disposal. Two of the cities effectively used the 'settings' approach of the healthy city concept, whereby places such as markets and schools are targeted. The evaluation found that stakeholder involvement varied in relation to: (i) the level of knowledge of the project; (ii) the project office location; (iii) the project management structure; and (iv) type of activities (ranging from low stakeholder involvement in capital-intensive infrastructure projects, to high in some settings-type activities). There was evidence to suggest that understanding of environment-health links was increased across stakeholders. There was limited political commitment to the healthy city projects, perhaps due to the fact that most of the municipalities had not requested the projects. Consequently, the projects had little influence on written/expressed municipal policies. Some of the projects mobilized considerable resources, and most projects achieved effective intersectoral collaboration. WHO support enabled the project coordinators to network at national and international levels, and the capacity of these individuals (although not necessarily their institutions) was increased by the project. The average annual running cost of the projects was approximately 132,000 US dollars per city, which is close to the costs of the only other HCP for which a cost analysis has been undertaken, Bangkok (115,000 US dollars per year) Recommendations for these and other HCPs are provided.

Community Health Planning↗
PubMed2004

Workplace health and safety concerns in service organizations in the inner city.

There is little known about occupational health and safety concerns or programs in workplaces in the inner city. This work was part of a needs assessment for development of occupational health and safety programs for workplaces in the inner city. Its key objective was to identify inner-city worker concerns regarding specific hazards. The work involved two phases. The first sampled workers in an inner-city hospital and church, and the second involved both paid and volunteer workers in inner-city community outreach programs. The key concerns raised by inner-city workers were infectious disease and personal safety and violence. Occupational health and safety programs need to address infectious disease and personal safety issues in this environment. Further research is needed regarding workplace health and safety in inner-city workplaces, both regarding hazards particular to the inner city and occupational health programs for the workers, both paid and volunteer, who work there.

Female↗
PubMed1993

Effect of community health education on plasma cholesterol levels and diet: the Stanford Five-City Project.

This paper examines the effects of community-wide health education on diet-related knowledge and behavior and on plasma cholesterol levels during an experimental field study in medium-sized cities in northern California. Samples of the population aged 12-74 years were drawn at baseline and every 2 years thereafter to obtain four cross-sectional surveys; participants aged 25-74 years are included in this paper (n = 6,814 or about 425 per city per survey). The baseline sample was asked to return to three follow-up surveys, also 2 years apart, constituting the cohort survey sample (n = 777). Diet was assessed by 24-hour recalls. In the serial cross-sectional survey samples, nutritional knowledge increased over time in both men and women in all cities; among women, this increase was significantly greater in the treatment cities. Plasma cholesterol declined significantly only in men and in neither sex was there evidence of a larger decline in treatment than in control cities. Dietary saturated fat intake tended to decline, but not significantly in either sex, and there was no evidence of treatment impact. Dietary cholesterol intake declined in both sexes. Results in the cohort samples were similar, except plasma cholesterol levels were unchanged over time in men and increased in women, and dietary saturated fat intake declined significantly among women. Secular improvements in knowledge of nutrition and in dietary cholesterol intake occurred during the early 1980s in both men and women in these four cities, while there was less consistent improvement in dietary saturated fat intake. Only nutritional knowledge among women achieved greater improvement in treatment cities than in control cities. Continued and greater change in nutrition probably requires more sustained effort and broader methods, including changes in the food supply.

Adult↗
PubMed2001

Confounding and effect modification in the short-term effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 project.

We present the results of the Air Pollution and Health: A European Approach 2 (APHEA2) project on short-term effects of ambient particles on mortality with emphasis on effect modification. We used daily measurements for particulate matter less than 10 microm in aerodynamic diameter (PM10) and/or black smoke from 29 European cities. We considered confounding from other pollutants as well as meteorologic and chronologic variables. We investigated several variables describing the cities' pollution, climate, population, and geography as potential effect modifiers. For the individual city analysis, generalized additive models extending Poisson regression, using a smoother to control for seasonal patterns, were applied. To provide quantitative summaries of the results and explain remaining heterogeneity, we applied second-stage regression models. The estimated increase in the daily number of deaths for all ages for a 10 microg/m3 increase in daily PM10 or black smoke concentrations was 0.6% [95% confidence interval (CI) = 0.4-0.8%], whereas for the elderly it was slightly higher. We found important effect modification for several of the variables studied. Thus, in a city with low average NO2, the estimated increase in daily mortality for an increase of 10 microg/m3 in PM10 was 0.19 (95% CI = 0.00-0.41), whereas in a city with high average NO2 it was 0.80% (95% CI = 0.67-0.93%); in a relatively cold climate the corresponding effect was 0.29% (95% CI = 0.16-0.42), whereas in a warm climate it was 0.82% (95% CI = 0.69-0.96); in a city with low standardized mortality rate it was 0.80% (95% CI = 0.65-0.95%), and in one with a high rate it was 0.43% (95% CI = 0.24-0.62). Our results confirm those previously reported on the effects of ambient particles on mortality. Furthermore, they show that the heterogeneity found in the effect parameters among cities reflects real effect modification, which is explained by specific city characteristics.

Aged↗
PubMed1996

Survey of city ordinances and local enforcement regarding commercial availability of tobacco to minors in Minnesota, United States.

OBJECTIVES: To determine the extent and nature of local ordinances to regulate tobacco sales to minors, the level of enforcement of local and state laws concerning tobacco availability to minors, and sanctions applied as a result of enforcement. DESIGN: Tobacco control ordinances were collected in 1993 from 222 of the 229 cities greater than or equal to 2000 population in Minnesota, United States. In addition a telephone survey with the head of the agency responsible for enforcement of the tobacco ordinances was conducted. MAIN OUTCOME MEASURES: Presence or absence of legislative provisions dealing with youth and tobacco, including licensure of tobacco retailers, sanctions for selling tobacco products to minors, and restrictions on cigarette vending machines, self-service merchandising, and point-of-purchase advertising; and enforcement of these laws (use of inspections and "sting" operations, and sanctions imposed on businesses and minors). RESULTS: Almost 94% of cities required tobacco licences for retailers. However, 57% of the cities specified licences for cigarettes only. Annual licence fees ranged from $10 to $250, with the higher fees adopted in the previous four years. More than 25% of the cities had adopted some kind of restriction on cigarette vending machines, but only six communities had banned self-service cigarette displays. Three cities specified a minimum age for tobacco sales staff. Fewer than 25% of police officials reported having conducted compliance checks with minors or in-store observations of tobacco sales to determine if minors were being sold tobacco during the current year. Police carrying out compliance checks with youth were almost four times as likely to issue citations as those doing in-store observations. More than 90% of police reported enforcement of the law against tobacco purchase or possession by minors, and nearly 40% reported application of penalties against minors. CONCLUSIONS: Almost 75% of the cities have done nothing to change policies or enforcement practices to encourage compliance with tobacco age-of-sale legislation, and only a few of the remaining cities have adopted optimal policies. In addition, officials in Minnesota cities are much more likely to use enforcement strategies against minors who buy tobacco than against merchants who sell tobacco.

Adolescent↗
PubMed1995

Myocardial infarction and cardiovascular risk factors in Mexico City and San Antonio, Texas.

Because the epidemiology of cardiovascular disease in Mexico is largely unknown, we examined the prevalence of cardiovascular risk factors and myocardial infarction (MI) in adults from low-income colonias in Mexico City. Data were collected as part of the Mexico City Diabetes Study, a population-based survey of diabetes and cardiovascular disease conducted between 1987 and 1992. Results were compared with those obtained from a comparable survey conducted previously among low-income Mexican Americans in San Antonio, Tex. A total of 2271 individuals between the ages of 35 and 64 years from Mexico City and 1143 adults of the same age range from San Antonio were studied. Despite being leaner and having lower levels of total cholesterol, Mexicans in Mexico City had markedly higher levels of triglycerides (P < .001) and lower levels of HDL cholesterol (P < .001) than Mexican Americans in San Antonio. MI was assessed by Minnesota-coded electrocardiograms and by a self-reported history of physician-diagnosed heart attack. In men, the prevalence of self-reported heart attack was significantly higher in San Antonio than in Mexico City (odds ratio, 5.85; P < .001), and in women, the prevalence of electrocardiogram-documented MI was significantly higher in San Antonio than Mexico City (odds ratio, 2.51; P < .001). The apparent excess of MI in San Antonio relative to Mexico City could be due to higher case-fatality in Mexico City or to a higher incidence in San Antonio.

Adult↗
PubMedDate not supplied

Healthy cities: overview of a WHO international program.

Health is the outcome of all the factors and activities impinging upon the lives of individuals and communities. The last decade has seen an emerging understanding within development circles that living conditions are greatly affected by local action, by the work of local government, and by community groups and organizations. In addressing health and environmental issues and making interventions, an integrated approach, based on 'settings', exemplified in the Healthy Cities approach, has proved most effective. A Healthy City project can involve people and organizations in the programs and activities that are needed for better health, and enables a city or neighborhood to mobilize the human and financial resources required to address many health and quality of life issues. The WHO program involves implementating city projects and networks in all regions of the world and serves as a vehicle for many health programs, including major disease control initiatives. Healthy City projects allow Ministries of Health to develop stronger partnerships with local government organizations (such as the Union of Local Authorities and its members, "Local Agenda 21" initiatives, and others). One focus for the program is the development of 'multi-'multi-city action plans' for major global priority issues, including AIDS, sanitation, women's health, and violence, to ensure that major public health programs are strengthened by wider community participation. It is recognized that city networking--at national, regional, and international levels--now must be better exploited by individual cities and municipalities to solve local health problems.

Environmental Health↗
PubMed2001

Cancer incidence in eighteen cities of the State of São Paulo, Brazil.

OBJECTIVE: As in Brazil cancer registries are mostly based on large cities, there are no estimates per state or per region and information on the disease incidence in the vast in-land areas is very scarce. An incidence survey was conducted in 18 major cities of the state of São Paulo, excluding the capital, aiming to collect information about cancer incidence in the state of São Paulo. METHODS: Of the 18 cities in state of São Paulo included in the survey, all had available resources for cancer management. Data from the year of 1991 were collected by the personnel of the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Statistics), who were especially trained by the study coordinators at the Fundação Oncocentro de São Paulo (Cancer Center of São Paulo). The collected data were processed and analyzed at the Oncocentro. Data collection, processing, and analyses were performed according to the recommendations of the International Agency for Research on Cancer. RESULTS: Although some discrepancies were observed in cancer incidence rates between the cities, results obtained for all 18 cities combined were remarkably close to those recently found for the city of São Paulo in the year 1993. One remarkable finding was the relatively high cancer incidence rates in both sexes in the city of Santos. CONCLUSIONS: The very similar all-sites cancer incidence rates found in the year 1991, when compared to those for the city of São Paulo in the year 1993, are suggestive that all regions have common cancer-related factors. Nevertheless, other explanations, such as the inclusion in the study of prevalent cases, as well as of non-residents, may have occurred in both studies, biasing the results. There is a need of further studies to confirm the high cancer incidence in Santos.

Brazil↗