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PubMed1997

Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study.

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 U.S. poverty line. Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p < .001). This study suggests that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City.

Adolescent↗
PubMed2006

Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men.

BACKGROUND: Persons reporting sexual identity that is discordant with their sexual behavior may engage in riskier sexual behaviors than those with concordant identity and behavior. The former group could play an important role in the spread of sexually transmitted diseases. OBJECTIVE: To describe discordance between self-described sexual identity and behavior among men who have sex with men and associations between identity-behavior and risk behaviors. DESIGN: Cross-sectional, random digit-dialed telephone survey of health status and risk behaviors. SETTING: New York City. PARTICIPANTS: Population-based sample of 4193 men. MEASUREMENTS: Concurrent measures of sexual identity and sexual behaviors, including number and sex of sex partners, condom use during last sexual encounter, and recent testing for HIV infection. Sex partner information was ascertained in a separate section from sexual identity; all participants were asked about the number of male sex partners and then were asked about the number of female sex partners in the past year. RESULTS: Of New York City men reporting a sexual identity, 12% reported sex with other men. Men who had sex with men exclusively but self-identified as heterosexual were more likely than their gay-identified counterparts to belong to minority racial or ethnic groups, be foreign-born, have lower education and income levels, and be married. These men were more likely than gay-identified men who have sex with men to report having only 1 sexual partner in the previous year. However, they were less likely to have been tested for HIV infection during that time (adjusted prevalence ratio, 0.6 [95% CI, 0.4 to 0.9]) and less likely to have used condoms during their last sexual encounter (adjusted prevalence ratio, 0.5 [CI, 0.3 to 1.0]). LIMITATIONS: The survey did not sample groups that cannot be reached by using residential telephone services. CONCLUSIONS: Many New York City men who have sex with men do not identify as gay. Medical providers cannot rely on patients' self-reported identities to appropriately assess risk for HIV infection and sexually transmitted diseases; they must inquire about behavior. Public health prevention messages should target risky sexual activities rather than a person's sexual identity.

Adolescent↗
PubMed1997

Do training programs help AFDC recipients leave the welfare rolls? An evaluation of New York City's BEGIN (Begin Employment Gain Independence Now) program.

Guided by the Federal Family Support Act of 1988 and the Job Opportunity and Basic Skills Program (JOBS), welfare reform initiatives on state and local levels were designed to foster employability among the public assistance population. Reform has focused on enhancing the supply of labor rather than the demand for labor as a route to labor force participation for the public assistance population. Program reforms assume that, by providing job training, educational services, and training-related expenses, labor market entry of the participating clientele would be facilitated while caseloads and public expenditures would decline. To date, analysis of similar programs in many states indicates that the impact of such programs in reducing public assistance caseloads is marginal. In New York City, despite the large investment of public funds in such programs, prior to this study the outcome of program implementation remained largely unknown. This study evaluates New York City's BEGIN program outcome target defined as the ability of the program to move welfare clients off public assistance and into the labor market. While the results of the study indicate that New York City's BEGIN program does not improve client's odds of leaving welfare, when compared to the odds of a non-participation client, there are several significant findings. The impact of program participation can be distinguished among distinct age groups. While older clients responded positively to BEGIN participation, access to day care was the only factor that significantly improved the probability that clients younger than 36 years of age would leave the welfare rolls within a two-year period. In response to the findings, the researchers suggest that future welfare reform efforts should grant localities broader flexibility to determine their own target population so that resources can be allocated to those groups that are most likely to benefit from specific programs.

Adolescent↗
PubMedDate not supplied

Collaborating with congregations: opportunities for financial services in the inner city.

In all economies, financial systems perform a basic set of functions, which include the need to pool resources, to save and borrow, to make payments, and to collect information. And yet, in rich and poor communities, the ways in which those needs are met differ greatly. In part, this is because traditional financial service firms have found it too expensive to serve poor neighborhoods. But it is possible to work with less traditional institutions to meet those needs. According to the authors, inner cities face two core impediments to financial services: lack of economies of scale and lack of good information. An inner-city investor with $500, for instance, does not warrant much attention from financial service firms. But 20,000 parishioners investing $500 apiece can collectively wield $10 million. By partnering with strong social organizations such as churches, financial institutions can benefit both themselves and investors. A lack of good information concerning credit histories--a common problem in poor communities--also makes low-income customers much less appealing to financial institutions. Churches can help close such information gaps by vouching for parishioners' reliability. There are certainly problems that come with mixing business and religion, as the authors concede. Ethical issues, trust issues, and issues of experience all come to mind. But understanding that functions need to dictate the structure of the financial service sector may be the first step toward achieving inner-city prosperity.

Capital Financing↗
PubMed2003

Air pollution: a new respiratory risk for cities in low-income countries.

Since the major accidents that occurred in the 1960s, air pollution has commonly been considered as a respiratory risk factor whose effects are most often studied in industrialised countries. Our aim is to show that it is now the turn of low- and middle-income countries to take this risk factor into account. After a discussion of the characteristics of air pollution, how it is diffused and the main known health effects (short- and long-term effects), we describe the specific differences between the cities in the North and the South. As a result of late industrialisation, cities in the South are now faced with pollution from industrial sources and urban traffic with polluting vehicles. The case of Algeria and Morocco illustrates this situation and its potential health risks. In order to prevent the health risks of air pollution in the cities of the South, systems for measuring pollution levels and epidemiological surveillance need to be put in place rapidly. This strategy can only work if it is supported by a strong partnership from industrialised countries.

Africa↗
PubMed2003

An ounce of prevention is a ton of work: mass antibiotic prophylaxis for anthrax, New York City, 2001.

Protocols for mass antibiotic prophylaxis against anthrax were under development in New York City beginning in early 1999. This groundwork allowed the city's Department of Health to rapidly respond in 2001 to six situations in which cases were identified or anthrax spores were found. The key aspects of planning and lessons learned from each of these mass prophylaxis operations are reviewed. Antibiotic distribution was facilitated by limiting medical histories to issues relevant to prescribing prophylactic antibiotic therapy, formatting medical records to facilitate rapid decision making, and separating each component activity into discrete work stations. Successful implementation of mass prophylaxis operations was characterized by clarity of mission and eligibility criteria, well-defined lines of authority and responsibilities, effective communication, collaboration among city agencies (including law enforcement), and coordination of staffing and supplies. This model can be adapted for future planning needs including possible attacks with other bioterrorism agents, such as smallpox.

Anthrax↗
PubMed2004

Vertical distributions of COS and CS2 in Beijing City.

Vertical distributions of COS and CS2 were measured at a meteorological tower in Beijing City. The mixing ratios of COS and CS2 are in the range of 371-1681 pptv and 246-1222 pptv, respectively. The significant high mixing ratios of the two compounds at ground level and distinct vertical distributions indicated the existence of strong anthropogenic sources of COS and CS2 in Beijing City. Domestic stoves and central heaters are important sources of COS during winter season. Cesspools may play significant role on COS over whole seasons. Chemical productions may be responsible for the observed high mixing ratios of CS2 in Beijing City.

Air Pollutants↗
PubMed2004

Reducing overall health care costs for a city municipality: a real life community based learning model.

City municipalities implementing health and wellness programs patterned after North Little Rock, Arkansas, can significantly reduce the cost of health care for employees, as well as reduce costs associated with workers' compensation claims and lost time caused by injury. In addition to primary care services, effective programs include health risk assessments through pre-placement physicals, employee physicals, drug screening, employee health and wellness promotion programs, and immunization and registry. In implementing the program, a team from the University of Arkansas for Medical Sciences College of Nursing worked with city officials to establish a steering committee, safety initiatives through first responders, systems for monitoring immunizations, criteria for pre-placement physicals, and an employee health and wellness program. While the benefits for the city are well documented, the contract also created opportunities for education, research, and services in a real life community based learning laboratory for students in the College of Nursing. In addition, it provided opportunities for faculty to participate in faculty practice and meet the College's service missions. The College's model program holds promise for use by other major health care centers across the region and nation.

Arkansas↗
PubMed2004

Parental beliefs about vaccination among an ethnically diverse inner-city population.

To characterize the knowledge and attitudes of an ethnically diverse group of inner-city parents regarding childhood immunizations, we conducted structured telephone interviews with 102 primary caretakers at an academic ambulatory pediatric practice during the winter of 2001-2002. The sample was ethnically diverse, with 36% African-American, 41% Hispanic, and 15% white. Half the households had infants or toddlers in the home, and 36% had children with conditions placing them at high risk for influenza. Almost all parents felt that their children should be immunized against diseases in general (98%), but significant proportions also believed that children received more immunizations than necessary (23%), that immunizations could weaken a child's immune system (36%), or that the influenza vaccine could itself make a child ill (48%). Younger parents, those with infants, and parents of children at risk for complications of influenza were less likely to hold these beliefs while race/ethnicity, marital status, parent's education, or socioeconomic status could not be shown to have any effect. We conclude that many inner-city parents question the effects of childhood immunizations and hold erroneous beliefs about them irrespective of age, race, socioeconomic status, or educational background. Practitioners should address these beliefs in efforts to diminish disparities in immunization levels associated with inner-city multiethnic populations.

Adult↗
PubMed2004

Epidemiology of central nervous system tumors at the Instituto Nacional de Neurología y Neurocirugía in Mexico City.

The purpose of this study was to determine the frequency of different Central Nervous System Tumors (CNST) diagnosed at the Instituto Nacional de Neurología y Neurocirugía (National Institute of Neurology and Neurosurgery) from Mexico City over a 10-year period (1990 to 1999) by means of a hospital survey. This institute is a reference hospital that provides medical attention to a very high number of adult neurological patients every year (approximately 6,000 new patients per year besides emergency cases). From a total number of 2,041 CNST cases, we found that the most frequent tumors were those affecting the neuroepithelial tissue (32.8 %), followed by tumors of the anterior pituitary gland (26.2 %) and tumors of the meninges and similar tissues (24.1 %). In both, male and female patients the higher frequency of CNST was found in patients whose age ranged from 25 to 44 years, and CNST were slightly more frequent in women than in men. Most of the CNST patients lived in the southern districts of Mexico City, it could be because of the great number of people living in the southern districts of the city, or perhaps due to the presence of certain yet unidentified environmental carcinogenic substance in this area. Since CNST are among the more frequent malignant neoplasms, it is necessary to improve the registration system to include frequency, prevalence, incidence and mortality of these diseases in Mexico, in order to plan health policies like in developed countries.

Adolescent↗
PubMed2004

Health-seeking patterns among Chinese immigrant patients enrolled in the directly observed therapy program in New York City.

SETTING: Outreach services and chest clinics of the Department of Health in New York City. OBJECTIVE: To investigate the health-seeking behavior patterns of Chinese immigrant patients enrolled in the directly observed therapy (DOT) program in New York City, and to suggest service provision strategies. DESIGN: Data were collected by means of participant observation, semi-structured interviews, and patient narratives. These data were then analyzed statistically as well as qualitatively, based on grounded theory. RESULTS: Of 60 patient informants, 38 had sought treatment for the relief of symptoms, and 22 were diagnosed by physical examination. Among 125 consultations made by 38 symptomatic patients during the period of their illness, there were more Chinatown physicians, including traditional Chinese practitioners, than other types of health providers, but they proportionally made the fewest referrals to the DOT program. CONCLUSIONS: Chinatown physicians are the main health providers to whom Chinese immigrants with tuberculosis resort. Education and collaboration with Chinese doctors, practitioners of both biomedical and traditional Chinese medicine, in New York City's Chinatown, are essential to reduce enrolment delays in the DOT program. The free services of the DOT program should be made more widely known to the Chinese immigrant population.

Adult↗
PubMedDate not supplied

[The "Healthy City" program: concept, strategy, methods of shaping and criteria].

The "Healthy City"program, its development methodology, main stages and criteria are described. The method was tested within the development of a strategy for the city of Novosibirsk for a period of up to 2020, which comprises elements of city survival systems targeted at improving the life quality, its expectancy and healthy young generations.

Adolescent↗
PubMed2005

Ecofriendly approach of urban solid waste management: a case study of Jalgaon city, Maharashtra.

In India, the traditional methods are used for urban solid waste management. These practices are associated with degradation of the urban environment Hence, an environmentally sound garbage management system is required for the urban waste management. The concept of waste minimization needs to be adopted in such systems. It is possible to implement certain corrective measures at collection, storage, transport and disposal of urban solid waste to minimize the adverse impacts on the environment The present investigations are emphasized on generation, characterzation and ecofriendly disposal of solid waste generated in Jalgaon city, Maharashtra. In the present study the waste generation at source was studied in the various income groups of the city. The per capita waste generation was studied by sampling the waste directly from the source of generation. The study reveals that the waste generation is large in the high-income group followed by middle and low-income group public. Further the physicochemical characterization of the waste was also studied. The data generated will help to develop environmentally sound and economically feasible solid waste management system for Ihe city.

Cities↗
PubMed2006

[Survey of contraceptive knowledge in married couples at reproductive age in 5 Chinese cities].

OBJECTIVE: To survey the married couples at reproductive age for contraceptive knowledge in 5 Chinese cities. METHODS: The data derived from a questionnaire-based research conducted in 2002 on family planning among married couples in 5 Chinese cities were statistically analyzed. RESULTS: The total rate of good contraceptive knowledge was 70.10% in the couples. Among all the contraceptive measures, condom use was the most familiar one. The understanding of contraceptive knowledge in couples working in official departments and educational institutes was better than that among the couples working in common enterprises, affected by such factors as gender, geographic regions, educational background and willingness of child-bearing. CONCLUSION: The married couples in the Chinese cities have generally good understanding of contraceptive knowledge, which can be affected by different factors among different populations.

Adult↗
PubMed2006

Study design and participation rates of the New York City Health and Nutrition Examination Survey, 2004.

INTRODUCTION: Few state or local health agencies have accurate local-level information on the prevalence of the leading causes of morbidity and mortality. The New York City Health and Nutrition Examination Survey (NYC HANES) was designed as a new local surveillance initiative to determine the prevalence of health conditions among adult residents of New York City. METHODS: Modeled after the National Health and Nutrition Examination Survey, the survey was initiated in June 2004 as a population-based cross-sectional study of New York City adults aged 20 and older. The survey was designed using a three-stage cluster sampling plan; 4026 households were randomly selected. Selected households were visited, and residents were given an initial eligibility screening questionnaire. Eligible participants were asked to schedule an appointment at an NYC-HANES-dedicated health center to complete the NYC HANES. A completed survey was defined as completion of a demographic interview and at least one examination component. Health conditions examined included cholesterol levels, diabetes status, blood pressure, environmental biomarkers, depression, anxiety, and antibodies to infectious diseases. RESULTS: Of the 4026 households approached, eligibility screening questionnaires were completed for 3388 (84%) households, and 3047 survey participants were identified. Of the 3047 participants, 76% made an appointment, and 66% completed the survey. The overall response rate was 55% (n = 1999). CONCLUSION: NYC HANES is the first successful local-level examination survey modeled on NHANES. With periodic repetition, NYC HANES will provide surveillance information on leading causes of morbidity and mortality.

Data Collection↗
PubMed2005

Disparity in maternal mortality in New York City.

OBJECTIVE: To describe maternal deaths and 10-year trends in maternal mortality in New York City. METHODS: All maternal deaths reported by surveillance of vital records (bearing ICD-9 codes 630-676) in New York City between 1989 and 1998 were studied. Were viewed death certificates and medical and autopsy records to collect age, race/ethnicity, country of birth, marital status, education level, residence at time of death, cause of death, and outcome of pregnancy. Trends analysis for maternal mortality rates was conducted, stratified by race. We conducted univariate and multivariate analysis to identify risk factors for maternal death. RESULTS: Two hundred forty-three maternal deaths were reported, for an average maternal mortality rate (MMR) of 18.4 deaths per 100,000 live births during this period. Although the overall MMR decreased from 17.4 in 1989 to 13.7 in 1998, the MMR varied widely during the period with a non significant trend (x2 for trend 2.09, p=.15). However, the individual MMR for whites and blacks decreased significantly from 1989 to 1998. The black-white MMR ratio remained high throughout this period and varied from 2.2 in 1994 to 14.8 in 1998. Women who were 35 years of age or older or non-Hispanic black had an increased risk of a pregnancy-related death. The leading causes of death were hemorrhage, embolism, and infection. CONCLUSION: Racial disparity in maternal mortality is a cause for concern in New York City. Further studies of maternal mortality are needed to develop interventions to reduce the MMR and the black-white gap.

Black or African American↗
PubMed1991

Cancer incidence in New York City Hispanics, 1982 to 1985.

Hispanics constitute a significant segment of New York City's population. The incidence of cancer in this group has not been previously documented. This report compares cancer incidence among Hispanics in New York City with cancer incidence among non-Hispanic whites (whites) in New York City and among Puerto Ricans residing in Puerto Rico, for the years 1982 through 1985. For most major cancer sites, including colon, rectum, malignant melanoma of the skin, lung and bronchus, urinary bladder and kidney, incidence rates for whites were substantially higher than rates for Hispanics or Puerto Ricans. Incidence rates for Puerto Ricans were generally lower than those observed in whites or Hispanics in general, including Puerto Ricans. Incidence rates for cancers of the buccal cavity and pharynx were lower among whites than Hispanics and only half those of Puerto Ricans. Stomach cancer rates varied in a similar manner. The striking exception was cancer of the cervix uteri. The incidence rate for cancer of the uterine cervix in Hispanic women was more than 2.5 times higher than the rate for white women (19.35 vs 7.33). The difference between Puerto Ricans and whites was nearly as great.

Adolescent↗
PubMed1990

Childhood lead poisoning, New York City, 1988.

In 1988, a total of 796 cases of childhood lead poisoning were identified through surveillance by the New York City Bureau of Lead Poisoning Control (BLPC), an estimated 0.3 cases identified per 100 children screened. Sixty-two percent of the case-group children had blood-lead levels between 25 and 34 micrograms/dl. One- and two-year-old children accounted for 61% of cases. Of the children in the case group, 59% were black and 27% were Hispanic. From 1986 through 1989, the annual number of children screened increased by 27%, while the annual number of new cases fell by 30%. Because of incomplete screening, false negative results, and lack of information on children with lower but potentially harmful levels of blood lead (10-24 micrograms/dl), the magnitude of excessive lead absorption in New York City children is underestimated. These surveillance data indicate that lead poisoning among children is a persistent public health problem in New York City.

Black or African American↗