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PubMed2002

Trends in the AIDS epidemic among New York City's injection drug users: localized or citywide?

The New York City injection drug user acquired immunodeficiency syndrome (IDU AIDS) epidemic accounts for almost one quarter of AIDS cases in IDUs in the United States. Recent studies have reported declines in seroprevalence and risk behaviors among IDUs in New York City during the 1990s. These trends, however, are based on studies primarily conducted in the city's central borough of Manhattan. This article analyzes data from all five boroughs of New York City to examine trends over phases of the epidemic and to determine the level of prevention services available; an exploratory qualitative study was also conducted to assess access to prevention services and injection practices in areas in the "outer boroughs." Findings indicated that (1) borough differences in services and behaviors existed from early in the epidemic; (2) services have been concentrated in Manhattan; and (3) declines in seroprevalence were greatest among Manhattan-recruited IDUs. Enhancing access to services for IDUs in the boroughs outside Manhattan may be needed to continue the positive trends in all areas of New York City.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Disparities by race in heat-related mortality in four US cities: the role of air conditioning prevalence.

Daily mortality is typically higher on hot days in urban areas, and certain population groups experience disproportionate risk. Air conditioning (AC) has been recommended to mitigate heat-related illness and death. We examined whether AC prevalence explained differing heat-related mortality effects by race. Poisson regression was used to model daily mortality in Chicago, Detroit, Minneapolis, and Pittsburgh. Predictors included natural splines of time (to control seasonal patterns); mean daily apparent temperature on the day of death, and averaged over lags 1-3; barometric pressure; day of week; and a linear term for airborne particles. Separate, city-specific models were fit to death counts stratified by race (Black or White) to derive the percent change in mortality at 29 degrees C, relative to 15 degrees C (lag 0). Next, city-specific effects were regressed on city- and race-specific AC prevalence. Combined effect estimates across all cities were calculated using inverse variance-weighted averages. Prevalence of central AC among Black households was less than half that among White households in all four cities, and deaths among Blacks were more strongly associated with hot temperatures. Central AC prevalence explained some of the differences in heat effects by race, but room-unit AC did not. Efforts to reduce disparities in heat-related mortality should consider access to AC.

Black or African American↗
PubMed1993

Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States.

OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990-1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV.

Adult↗
PubMed2001

Educational level is associated with condom use within non-spousal partnerships in four cities of sub-Saharan Africa.

BACKGROUND: Rates of condom use in sub-Saharan Africa have remained too low to curb HIV/sexually transmitted disease (STD) epidemics. A better understanding of the main determinants of condom use would aid promotion. METHODS: Cross-sectional population surveys were conducted in four cities in sub-Saharan Africa: Yaoundé, Cameroon; Cotonou, Benin; Ndola, Zambia; and Kisumu, Kenya. In each city, the aim was to interview a random sample of 1000 men and 1000 women aged 15--49 years, including questions on characteristics of non-spousal partnerships in the past 12 months. RESULTS: Data on condom use were available for 4624 non-spousal partnerships. In the four cities, the proportion of partnerships in which condoms were used always or most of the time ranged from 23.8 to 33.5% when reported by men and from 10.7 to 25.9% when reported by women. Based on the reports from men, condom use was associated with higher educational level of the male partner in Yaoundé [adjusted odds ratio (aOR) = 1.76] and Ndola (aOR = 2.94) and with higher educational level of the female partner in Cotonou (aOR = 2.36) and Kisumu (aOR = 2.76). Based on the reports from women, condom use was associated with higher educational level of the female partner in Kisumu (aOR = 2.60) and Ndola (aOR = 4.50) and with higher educational level of the male partner in Yaoundé (aOR = 3.32). Associations with other determinants varied across cities and for men and women. CONCLUSIONS: Education was found to be a key determinant of condom use in all four cities. This suggests that educational level increases response to condom promotion and highlights the need for special efforts to reach men and women with low educational attainment.

Adolescent↗
PubMed1999

Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City.

OBJECTIVE: To examine HIV risk behavior and HIV infection among new initiates into illicit drug injection in New York City. DESIGN AND METHODS: Cross-sectional surveys of injecting drug users (IDUs) recruited from a large detoxification treatment program (n=2489) and a street store-front research site (n=2630) in New York City from 1990 through 1996. Interviews covering demographics, drug use history, and HIV risk behavior were administered; serum samples were collected for HIV testing. Subjects were categorized into two groups of newer injectors: very recent initiates (just began injecting through 3 years) and recent initiates (injecting 4-6 years); and long-term injectors (injecting > or = 7 years). RESULTS: 954 of 5119 (19%) of the study subjects were newer injectors, essentially all of whom had begun injecting after knowledge about AIDS was widespread among IDUs in the city. New injectors were more likely to be female and white than long-term injectors, and new injectors were more likely to have begun injecting at an older age (median age at first injection for very recent initiates, 27 years; median age at first injection for recent initiates, 25 years; compared with median age at first injection for long-term injectors, 17 years). The newer injectors generally matched the long-term injectors in frequencies of HIV risk behavior; no significant differences were found among these groups on four measures of injection risk behavior. HIV infection was substantial among the newer injectors: HIV prevalence was 11% among the very recent initiates and 18% among the recent initiates. Among the new injectors, African Americans, Hispanics, females, and men who engaged in male-male sex were more likely to be infected. CONCLUSIONS: The new injectors appear to have adopted the reduced risk injection practices of long-term injectors in the city. HIV infection among new injectors, however, must still be considered a considerable public health problem in New York City.

Adult↗
PubMed1999

Restaurant employment before and after the New York City Smoke-Free Air Act.

The purpose of this study was to observe trends in the number of restaurants and restaurant employees two years before and two years after the New York City Smoke-Free Air Act took effect in April, 1995. Between April 1993 and April 1997, New York City added 19,347 new restaurant jobs (18% increase) while the rest of the state outside the immediate metropolitan area added 7,423 new jobs (5% increase). The rate of growth in the number of restaurants was comparable among New York City, neighboring counties, and the rest of the state. The data suggest that the New York City Smoke-Free Air Act did not result in job losses for the city's restaurant industry.

Employment↗
PubMed2004

Factors affecting HIV concordancy in married couples in four African cities.

OBJECTIVE: To determine risk factors for HIV transmission within married couples in four urban populations in sub-Saharan Africa. METHODS: Data from a cross-sectional population-based study were used. Representative random samples approximating 1000 men and 1000 women in each of four cities of Kisumu (Kenya), Ndola (Zambia), Cotonou (Benin), and Yaoundé (Cameroon), were interviewed and tested for sexually transmitted infections (STI). Married couples were identified as concordant negative, discordant, or concordant positive for each STI. After excluding concordant HIV negative couples, analysis of behavioural and STI risk factors for HIV positive concordancy was undertaken across the four cities and in each city separately where sample size allowed. RESULTS: Among 221 couples in which at least one member was HIV positive, we found that the only significant risk factor for positive HIV concordancy was herpes simplex type 2 (HSV-2) status. After adjusting for age and city of residence the odds ratio for HIV concordancy compared to couples with neither spouse HSV-2 positive was 3.4 (95% confidence interval, 0.62-18.4) for couples with one partner HSV-2 positive and 8.6 (95% confidence interval, 1.6-45.0) for couples with both partners HSV-2 positive. The same trends were seen in Kisumu and Ndola when they were analysed separately (numbers were small in the other cities). CONCLUSIONS: Although cross-sectional studies are not ideal for delineating the sequence of transmission events, this study adds to the evidence that HSV-2 is a key risk factor in promoting HIV transmission.

Adolescent↗
PubMed2006

Tackling alcohol related violence in city centres: effect of emergency medicine and police intervention.

OBJECTIVES: To identify correlates of alcohol related assault injury in the city centre of a European capital city, with particular reference to emergency department (ED) and police interventions, and number and capacity of licensed premises. METHODS: Assaults resulting in ED treatment were studied using a longitudinal controlled intervention, a three stage design during a three year period of rapid expansion in the night-time economy, when ED initiated targeted police interventions were delivered. A controlled ED intervention targeted at high risk night-clubs was carried out. Main outcome measure was ED treatment after assault in licensed premises and the street. RESULTS: Targeted police intervention was associated with substantial reductions in assaults in licensed premises but unexpected increases in street assault were also observed (34% overall: 105% in the principal entertainment thoroughfare). Combined police/ED intervention was associated with a significantly greater reduction compared with police intervention alone (OR = 0.61, 95% CI 0.40 to 0.91). Street assault correlated significantly with numbers and capacity of premises. Risk of assault was 50% greater in and around licensed premises in the city centre compared with those in the suburbs, although dispersion of violence to more licensed premises was not observed. CONCLUSIONS: Marked decreases in licensed premises assaults resulting from targeted policing were enhanced by the intervention of ED and maxillofacial consultants. Capacity of licensed premises was a major predictor of assaults in the city centre street in which they are clustered. City centre assault injury prevention can be achieved through police/ED interventions targeted at high risk licensed premises, which should also target the streets around which these premises are clustered.

Alcohol Drinking↗
PubMed2005

Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics.

BACKGROUND: Consistent evidence has shown increased all-cause mortality, and mortality from broad categories of causes associated with airborne particles. Less is known about associations with specific causes of death, and modifiers of those associations. AIMS: To examine these questions in 20 US cities, between 1989 and 2000. METHODS: Mortality files were obtained from the National Center for Health Statistics. Air pollution data were obtained from the Environmental Protection Agency website. The associations between daily concentrations of particulate matter of aero-diameter < or =10 microm (PM10) and daily mortality from all-cause and selected causes of death, were examined using a case-crossover design. Temporal effects of PM10 were examined using lag models, in first stage regressions. City specific modifiers of these associations were examined in second stage regressions. RESULTS: All-cause mortality increased with PM10 exposures occurring both one and two days prior the event. Deaths from heart disease were primarily associated with PM10 on the two days before, while respiratory deaths were associated with PM10 exposure on all three days. Analyses using only one lag underestimated the effects for all-cause, heart, and respiratory deaths. Several city characteristics modified the effects of PM10 on daily mortality. Important findings were seen for population density, percentage of primary PM10 from traffic, variance of summer temperature, and mean of winter temperature. CONCLUSIONS: There was overall evidence of increased daily mortality from increased concentrations of PM10 that persisted across several days, and matching for temperature did not affect these associations. Heterogeneity in the city specific PM10 effects could be explained by differences in certain city characteristics.

Air Pollutants↗
PubMed2006

Applying a moving total mortality count to the cities in the NMMAPS database to estimate the mortality effects of particulate matter air pollution.

OBJECTIVES: To apply a new method for estimating the association between daily ambient particulate matter air pollution (PM) and daily mortality to data from over 100 United States cities contained in the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) database and to see whether the results from the 90 cities NMMAPS analysis are robust to this different modelling approach. This new method has recently been shown to provide improved estimates for the association between PM and daily mortality when every-day PM data are unavailable. It avoids the need for selecting a lag of PM at which the mortality effects of PM are to be investigated. METHODS: With the aid of analytical methods and databases developed for NMMAPS, Poisson log linear models controlling for long term trends and weather effects were used to estimate the association between PM and mortality for cities in the NMMAPS database using the new method. A two stage Bayesian hierarchical model was then used to combine city specific estimates to form a national average PM mortality effect estimate. RESULTS: A 10 microg/m3 increase in PM was associated with a 0.12% increment in total mortality and a 0.17% increment in cardiovascular and respiratory mortality. These results are consistent with those found in the NMMAPS analysis. CONCLUSIONS: There is a statistically significant association between short term changes in PM and mortality on average for the cities contained in the NMMAPS database. These findings are further evidence that this widespread pollutant adversely affects public health.

Adult↗
PubMed1997

HIV seroprevalence among suicide victims in New York City, 1991-1993.

OBJECTIVE: The authors sought to determine the HIV seroprevalence among suicide victims in New York City. METHOD: All suicides of city residents from 1991 through 1993 were studied. The crude proportion of all suicide victims who were HIV positive and the proportion adjusted to the age, gender, and racial/ethnic characteristics of the New York City population were determined. The demographically adjusted proportion was then contrasted with HIV seroprevalence estimates for the New York City general population. HIV-seropositive suicide victims were assessed for pathological findings suggestive of HIV-related illnesses. RESULTS: The crude proportion of all suicide victims who were HIV seropositive was 0.088, and the demographically adjusted proportion was 0.049. Over 90% of all HIV-positive suicide victims were aged 25 to 54 years, and almost 90% were men. Among black and Hispanic men aged 35 to 54 years who committed suicide, the proportion who were HIV seropositive was 0.252--the highest seropositive rate of any demographic group. More than two-thirds of HIV-seropositive suicide victims had no HIV-related pathology or AIDS-indicator conditions at autopsy. CONCLUSIONS: The demographically adjusted proportion of suicide victims who were HIV positive (approximately 0.038 to 0.059), contrasted with the HIV seroprevalence estimates for the New York City general population (approximately 0.014 to 0.032), the absence of HIV-related pathology among suicide victims, and the likelihood that many HIV-positive individuals had other risk factors for suicide, such as substance abuse, suggests that a positive HIV serostatus is associated, at most, with a modest elevation in suicide risk.

Adult↗
PubMed2002

Indicator-based assessment of environmental hazards and health effects in the industrial cities of upper Silesia, Poland.

Using an indicator-based approach, we assessed environmental hazards and related health effects in populations of industrial cities with more than 100,000 inhabitants in Upper Silesia, Poland, and analyzed the relationship between environment and health. We adopted the method developed by Dutkiewicz et al. for assessing large geographic areas. Based on routinely collected environmental and health data, two groups of indicators, environmental indicators (EIs) and health status indicators (HSIs), related to environmental contamination were selected. The EI and HSI values were normalized and aggregated into synthetic measures using Strahl's taxonometric method. The synthetic measures indicated the intensity of environmental hazards and health outcomes. We used a three-level index scale to compare and rank the cities under the study and, consequently, to facilitate decision making. Findings of the assessment identified cities where actions aimed at reducing environmental hazards and improving population health status should be established as priorities. These cities included Chorzów, Katowice, Sosnowiec, Bytom, and Zabrze. We found a high correlation between the synthetic measures of environmental indicators and the synthetic measure of health status indicators (r = 0.77), as well as a high level of consistency between environmental hazard indices and environmental-related health status indices (73%). This may indicate the existence of a causal relationship between the environmental contamination within industrial cities and the health status of their inhabitants.

Adolescent↗
PubMed2002

Exposures to multiple air toxics in New York City.

Efforts to assess health risks associated with exposures to multiple urban air toxics have been hampered by the lack of exposure data for people living in urban areas. The TEACH (Toxic Exposure Assessment, a Columbia/Harvard) study was designed to characterize levels of and factors influencing personal exposures to urban air toxics among high school students living in inner-city neighborhoods of New York City and Los Angeles, California. This present article reports methods and data for the New York City phase of TEACH, focusing on the relationships between personal, indoor, and outdoor concentrations in winter and summer among a group of 46 high school students from the A. Philip Randolph Academy, a public high school located in the West Central Harlem section of New York City. Air pollutants monitored included a suite of 17 volatile organic compounds (VOCs) and aldehydes, particulate matter with a mass median aerodynamic diameter <or= 2.5 microm (PM2.5), black carbon, and a suite of 28 particle-associated trace elements. Sequential 48-hr ambient samples also were collected over 8 weeks in each season at an urban fixed site and an upwind, nonurban fixed site. Personal, indoor, and outdoor concentrations of particle elements were generally similar, suggesting that ambient sources may have driven indoor and personal exposures for most elements. More varied relationships among personal, home indoor, and home outdoor concentrations were observed for VOCs and aldehydes. For formaldehyde and acetaldehyde, and several VOCs, indoor concentrations far exceeded outdoor levels and appeared to dominate personal exposures. Strong seasonal differences in indoor to outdoor concentration ratios were observed for these compounds, reflecting the influence of home air exchange rates. For other VOCs, especially those related to motor vehicle exhaust, more consistent indoor, outdoor, and personal concentrations were observed, suggesting that ambient concentrations may have been the driving force for personal exposures to some VOCs. These results demonstrate exposures to a wide range of air toxic pollutants among young people attending school in inner-city New York.

Adolescent↗
PubMed1995

New York City's 1993 child immunization day: planning, costs, and results.

OBJECTIVES: This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. METHODS: The methodology was designed to (1) document the planning and implementation process, (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. RESULTS: Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2949 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. CONCLUSIONS: The differences between inner cities and developing nations have a bearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities.

Child Health Services↗
PubMedDate not supplied

An overview of heroin trends in New York City: past, present and future.

Heroin abuse has been a long-standing problem in the United States, especially in New York City, which is a major heroin trafficking center and home to the largest population of heroin addicts in the country. As a consequence, New York City is also the major center for methadone treatment. Over time, however, the heroin problem seems to have changed in terms of demographic characteristics of abusers, as well as heroin purity, its associated health consequences, modes of use, and other drug patterns. Past and present heroin-involved events for New York City are examined, with some projection about the future of the heroin problem. To identify these changes, a variety of indirect indicators of heroin abuse are analyzed. These indirect indicators include admissions to New York City heroin treatment programs, as well as heroin-involved deaths, arrests and emergency room episodes, and heroin purity levels. Additionally, a recent study of heroin abusers in New York City yielded patterns of heroin use and estimates of heroin prevalence. The salient results indicate that, over time, Hispanics have become the predominant user group, the population of abusers is an aging cohort, heroin purity levels have risen dramatically, and intranasal use has become more prominent than injecting. The findings have important consequences for prevention, treatment, and programs that target special populations.

Adult↗
PubMed1986

Changes in the metropolitan and large city populations of the USSR: 1979-85.

"This paper investigates the post-census growth of metropolitan areas and large cities in the USSR from 1979 to 1985. The Soviet population continues to be increasingly concentrated in large metropolitan areas and large cities, and although suburbanization occurs within metropolitan areas, a striking feature is that all central cities continue to grow and typically contain the vast majority of the metropolitan population. This reflects the fact that individual large cities continue to loom large, despite policies to limit their growth. Although the growth rates of large cities have slowed, so have those of smaller towns, and a merging of growth rates by size class is occurring."

Demography↗
PubMed2004

[Distribution patterns of moss species in Shanghai city].

The mosses on the floor of 22 sites at 20 main parks and 2 chemical plants in Shanghai city were investigated and sampled. Based on 75 recorded moss species and their coverage, Two-way Indicator Species Analysis (TWINSPAN) and Detrended Correspondence Analysis (DCA) were used to analyze their distribution patterns. The results showed that the study sites could be identified as three groups. Group 1 included two chemical plants and two parks at the center of the city, with 23 moss species and the smallest total coverage of 21.29%; group 2 included part of the parks at the center of the city and surrounding areas, with 44 moss species and total coverage of 37.94%; and group 3 mainly included the parks at surrounding areas and suburbs of the city, with 49 moss species and total coverage of 49.66%. The results reflected a certain correlation of the distribution of moss species with different habitats and polluted and disturbed environments in the city.

Bryophyta↗
PubMed2005

Study of dust pollution caused by traffic in Aligarh city.

In the present study the dust pollution caused by vehicles in Aligarh city was estimated. Four major national roads viz. Anoopshahar road, Delhi road, Agra road and Kanpur road of Aligarh city were selected. The dust pollution was maximum on Kanpur road (46.44 gm/m2/ month) followed by Agra road (38.94 gm/m2/month) and Delhi road (34.52 gm/m2/month). The least dust pollution was recorded on Anoopshahar road (20.10gm/m2/month). In general, the dust fall rate per unit area was highest at 3 km inside city (38.66 gm/m2/month) closely followed by starting point (37.27gm/m2/month) and least at 3 km outside city (29.09 gm/m2/ month). The average dust fall rate per unit area was estimated to be about 35 gm/m2/month in Aligarh city.

Air Pollutants↗