Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown.

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)-albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits. We focused on fine particulate matter (PM2.5) and modeled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality. We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015-2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021-2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion. This "natural experiment," tragic though the cause, has provided a hypothetical clean air scenario that can be considered aspirational-one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.

Intraurban Variation of Fine Particle Elemental Concentrations in New York City.

Few past studies have collected and analyzed within-city variation of fine particulate matter (PM2.5) elements. We developed land-use regression (LUR) models to characterize spatial variation of 15 PM2.5 elements collected at 150 street-level locations in New York City during December 2008-November 2009: aluminum, bromine, calcium, copper, iron, potassium, manganese, sodium, nickel, lead, sulfur, silicon, titanium, vanadium, and zinc. Summer- and winter-only data available at 99 locations in the subsequent 3 years, up to November 2012, were analyzed to examine variation of LUR results across years. Spatial variation of each element was modeled in LUR including six major emission indicators: boilers burning residual oil; traffic density; industrial structures; construction/demolition (these four indicators in buffers of 50 to 1000 m), commercial cooking based on a dispersion model; and ship traffic based on inverse distance to navigation path weighted by associated port berth volume. All the elements except sodium were associated with at least one source, with R(2) ranging from 0.2 to 0.8. Strong source-element associations, persistent across years, were found for residual oil burning (nickel, zinc), near-road traffic (copper, iron, and titanium), and ship traffic (vanadium). These emission source indicators were also significant and consistent predictors of PM2.5 concentrations across years.

The contribution of motor vehicle emissions to ambient fine particulate matter public health impacts in New York City: a health burden assessment.

BACKGROUND: On-road vehicles are an important source of fine particulate matter (PM2.5) in cities, but spatially varying traffic emissions and vulnerable populations make it difficult to assess impacts to inform policy and the public. METHODS: We estimated PM2.5-attributable mortality and morbidity from on-road vehicle generated air pollution in the New York City (NYC) region using high-spatial-resolution emissions estimates, air quality modeling, and local health incidence data to evaluate variations in impacts by vehicle class, neighborhood, and area socioeconomic status. We developed multiple 'zero-out' emission scenarios focused on regional and local cars, trucks, and buses in the NYC region. We simulated PM2.5 concentrations using the Community Multi-scale Air Quality Model at a 1-km spatial resolution over NYC and combined modeled estimates with monitored data from 2010 to 2012. We applied health impact functions and local health data to quantify the PM2.5-attributable health burden on NYC residents within 42 city neighborhoods. RESULTS: We estimate that all on-road mobile sources in the NYC region contribute to 320 (95 % Confidence Interval (CI): 220-420) deaths and 870 (95 % CI: 440-1280) hospitalizations and emergency department visits annually within NYC due to PM2.5 exposures, accounting for 5850 (95 % CI: 4020-7620) years of life lost. Trucks and buses within NYC accounted for the largest share of on-road mobile-attributable ambient PM2.5, contributing up to 14.9 % of annual average levels across 1-km grid cells, and were associated with 170 (95 % CI: 110-220) PM2.5-attributable deaths each year. These contributions were not evenly distributed, with high poverty neighborhoods experiencing a larger share of the exposure and health burden than low poverty neighborhoods. CONCLUSION: Reducing motor vehicle emissions, especially from trucks and buses, could produce significant health benefits and reduce disparities in impacts. Our high-spatial-resolution modeling approach could improve assessment of on-road vehicle health impacts in other cities.

Ambient Fine Particulate Matter, Nitrogen Dioxide, and Hypertensive Disorders of Pregnancy in New York City.

BACKGROUND: Previous studies suggested a possible association between fine particulate matter air pollution (PM2.5) and nitrogen dioxide (NO2) and the development of hypertensive disorders of pregnancy, but effect sizes have been small and methodologic weaknesses preclude firm conclusions. METHODS: We linked birth certificates in New York City in 2008-2010 to hospital discharge diagnoses and estimated air pollution exposure based on maternal address. The New York City Community Air Survey provided refined estimates of PM2.5 and NO2 at the maternal residence. We estimated the association between exposures to PM2.5 and NO2 in the first and second trimester and risk of gestational hypertension, mild preeclampsia, and severe preeclampsia among 268,601 births. RESULTS: In unadjusted analyses, we found evidence of a positive association between both pollutants and gestational hypertension. However, after adjustment for individual covariates, socioeconomic deprivation, and delivery hospital, we did not find evidence of an association between PM2.5 or NO2 in the first or second trimester and any of the outcomes. CONCLUSIONS: Our data did not provide clear evidence of an effect of ambient air pollution on hypertensive disorders of pregnancy. Results need to be interpreted with caution considering the quality of the available exposure and health outcome measures and the uncertain impact of adjusting for hospital. Relative to previous studies, which have tended to identify positive associations with PM2.5 and NO2, our large study size, refined air pollution exposure estimates, hospital-based disease ascertainment, and little risk of confounding by socioeconomic deprivation, does not provide evidence for an association.

Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012.

OBJECTIVES: We evaluated the use of New York City's (NYC's) electronic death registration system (EDRS) to conduct mortality surveillance during and after Hurricane Sandy. METHODS: We used Centers for Disease Control and Prevention guidelines for surveillance system evaluation to gather evidence on usefulness, flexibility, stability, timeliness, and quality. We assessed system components, interviewed NYC Health Department staff, and analyzed 2010 to 2012 death records. RESULTS: Despite widespread disruptions, NYC's EDRS was stable and collected timely mortality data that were adapted to provide storm surveillance with minimal additional resources. Direct-injury fatalities and trends in excess all-cause mortality were rapidly identified, providing useful information for response; however, the time and burden of establishing reports, adapting the system, and identifying indirect deaths limited surveillance. CONCLUSIONS: The NYC Health Department successfully adapted its EDRS for near real-time disaster-related mortality surveillance. Retrospective assessment of deaths, advanced methods for case identification and analysis, standardized reports, and system enhancements will further improve surveillance. Local, state, and federal partners would benefit from partnering with vital records to develop EDRSs for surveillance and to promote ongoing evaluation.

Area-level socioeconomic deprivation, nitrogen dioxide exposure, and term birth weight in New York City.

Numerous studies have linked air pollution with adverse birth outcomes, but relatively few have examined differential associations across the socioeconomic gradient. To evaluate interaction effects of gestational nitrogen dioxide (NO2) and area-level socioeconomic deprivation on fetal growth, we used: (1) highly spatially-resolved air pollution data from the New York City Community Air Survey (NYCCAS); and (2) spatially-stratified principle component analysis of census variables previously associated with birth outcomes to define area-level deprivation. New York City (NYC) hospital birth records for years 2008-2010 were restricted to full-term, singleton births to non-smoking mothers (n=243,853). We used generalized additive mixed models to examine the potentially non-linear interaction of nitrogen dioxide (NO2) and deprivation categories on birth weight (and estimated linear associations, for comparison), adjusting for individual-level socio-demographic characteristics and sensitivity testing adjustment for co-pollutant exposures. Estimated NO2 exposures were highest, and most varying, among mothers residing in the most-affluent census tracts, and lowest among mothers residing in mid-range deprivation tracts. In non-linear models, we found an inverse association between NO2 and birth weight in the least-deprived and most-deprived areas (p-values<0.001 and 0.05, respectively) but no association in the mid-range of deprivation (p=0.8). Likewise, in linear models, a 10 ppb increase in NO2 was associated with a decrease in birth weight among mothers in the least-deprived and most-deprived areas of -16.2g (95% CI: -21.9 to -10.5) and -11.0 g (95% CI: -22.8 to 0.9), respectively, and a non-significant change in the mid-range areas [ß=0.5 g (95% CI: -7.7 to 8.7)]. Linear slopes in the most- and least-deprived quartiles differed from the mid-range (reference group) (p-values<0.001 and 0.09, respectively). The complex patterning in air pollution exposure and deprivation in NYC, however, precludes simple interpretation of interactive effects on birth weight, and highlights the importance of considering differential distributions of air pollution concentrations, and potential differences in susceptibility, across deprivation levels.

The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012.

BACKGROUND: Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits. METHODS: Nine clinically-relevant spring tree pollen genera (elm, poplar, maple, birch, beech, ash, sycamore/London planetree, oak, and hickory) measured in Armonk, NY, were analyzed for their associations with over-the-counter allergy medication sales and daily asthma syndrome ED visits from patients' chief complaints or diagnosis codes in New York City during March 1st through June 10th, 2002-2012. Multi-day impacts of pollen on the outcomes (0-3 days and 0-7 days for the medication sales and ED visits, respectively) were estimated using a distributed lag Poisson time-series model adjusting for temporal trends, day-of-week, weather, and air pollution. For asthma syndrome ED visits, age groups were also analyzed. Year-to-year variation in the average peak dates and the 10th-to-90th percentile duration between pollen and the outcomes were also examined with Spearman's rank correlation. RESULTS: Mid-spring pollen types (maple, birch, beech, ash, oak, and sycamore/London planetree) showed the strongest significant associations with both outcomes, with cumulative rate ratios up to 2.0 per 0-to-98th percentile pollen increase (e.g., 1.9 [95% CI: 1.7, 2.1] and 1.7 [95% CI: 1.5, 1.9] for the medication sales and ED visits, respectively, for ash). Lagged associations were longer for asthma syndrome ED visits than for the medication sales. Associations were strongest in children (ages 5-17; e.g., a cumulative rate ratio of 2.6 [95% CI: 2.1, 3.1] per 0-to-98th percentile increase in ash). The average peak dates and durations of some of these mid-spring pollen types were also associated with those of the outcomes. CONCLUSIONS: Tree pollen peaking in mid-spring exhibit substantive impacts on allergy, and asthma exacerbations, particularly in children. Given the narrow time window of these pollen peak occurrences, public health and clinical approaches to anticipate and reduce allergy/asthma exacerbation should be developed.

Using tracking infrastructure to support public health programs, policies, and emergency response in New York City.

OBJECTIVE: To describe how the New York City (NYC) Tracking Program has used nationally mandated Secure Portal infrastructure and staff analytical expertise to support programs and inform policy. SETTING: The NYC Health Department assesses, investigates, and acts on a wide range of environmental concerns to protect the health of New Yorkers. DESIGN: Specific examples of highly effective policies or initiatives that relied on the NYC Tracking Program are described, including restaurant sanitary grade posting, rat indexing, converting boilers to cleaner-burning fuels, reducing exposure to mercury from fish and contaminated products, and responding to Superstorm Sandy. CONCLUSIONS: The NYC Tracking Program supports the Health Department in using inspectional, administrative, and health data to guide operations. Tracking has also allowed internal and external partners to use these data to guide policy development.

Ambient fine particulate matter, nitrogen dioxide, and term birth weight in New York, New York.

Building on a unique exposure assessment project in New York, New York, we examined the relationship of particulate matter with aerodynamic diameter less than 2.5 µm and nitrogen dioxide with birth weight, restricting the population to term births to nonsmokers, along with other restrictions, to isolate the potential impact of air pollution on growth. We included 252,967 births in 2008-2010 identified in vital records, and we assigned exposure at the residential location by using validated models that accounted for spatial and temporal factors. Estimates of association were adjusted for individual and contextual sociodemographic characteristics and season, using linear mixed models to quantify the predicted change in birth weight in grams related to increasing pollution levels. Adjusted estimates for particulate matter with aerodynamic diameter less than 2.5 µm indicated that for each 10-µg/m(3) increase in exposure, birth weights declined by 18.4, 10.5, 29.7, and 48.4 g for exposures in the first, second, and third trimesters and for the total pregnancy, respectively. Adjusted estimates for nitrogen dioxide indicated that for each 10-ppb increase in exposure, birth weights declined by 14.2, 15.9, 18.0, and 18.0 g for exposures in the first, second, and third trimesters and for the total pregnancy, respectively. These results strongly support the association of urban air pollution exposure with reduced fetal growth.

The public health benefits of reducing fine particulate matter through conversion to cleaner heating fuels in New York City.

In recent years, both New York State and City issued regulations to reduce emissions from burning heating oil. To assess the benefits of these programs in New York City, where the density of emissions and vulnerable populations vary greatly, we simulated the air quality benefits of scenarios reflecting no action, partial, and complete phase-out of high-sulfur heating fuels using the Community MultiScale Air Quality (CMAQ) model conducted at a high spatial resolution (1 km). We evaluated the premature mortality and morbidity benefits of the scenarios within 42 city neighborhoods and computed benefits by neighborhood poverty status. The complete phase-out scenario reduces annual average fine particulate matter (PM2.5) by an estimated 0.71 µg/m(3) city-wide (average of 1 km estimates, 10-90th percentile: 0.1-1.6 µg/m(3)), avoiding an estimated 290 premature deaths, 180 hospital admissions for respiratory and cardiovascular disease, and 550 emergency department visits for asthma each year. The largest improvements were seen in areas of highest building and population density and the majority of benefits have occurred through the partial phase out of high-sulfur heating fuel already achieved. While emissions reductions were greatest in low-poverty neighborhoods, health benefits are estimated to be greatest in high-poverty neighborhoods due to higher baseline morbidity and mortality rates.

Spatial variation in environmental noise and air pollution in New York City.

Exposure to environmental noise from traffic is common in urban areas and has been linked to increased risks of adverse health effects including cardiovascular disease. Because traffic sources also produce air pollutants that increase the risk of cardiovascular morbidity, associations between traffic exposures and health outcomes may involve confounding and/or synergisms between air pollution and noise. While prior studies have characterized intraurban spatial variation in air pollution in New York City (NYC), limited data exists on the levels and spatial variation in noise levels. We measured 1-week equivalent continuous sound pressure levels (Leq) at 56 sites during the fall of 2012 across NYC locations with varying traffic intensity and building density that are routinely monitored for combustion-related air pollutants. We evaluated correlations among several noise metrics used to characterize noise exposures, including Leq during different time periods (night, day, weekday, weekend), Ldn (day-night noise), and measures of intermittent noise defined as the ratio of peak levels to median and background levels. We also examined correlations between sound pressure levels and co-located simultaneous measures of nitric oxide (NO), nitrogen dioxide (NO2), fine particulate matter (PM2.5), and black carbon (BC) as well as estimates of traffic and building density around the monitoring sites. Noise levels varied widely across the 56 monitoring sites; 1-week Leq varied by 21.6 dBA (range 59.1-80.7 dBA) with the highest levels observed during the weekday, daytime hours. Indices of average noise were well correlated with each other (r > 0.83), while indices of intermittent noise were not well correlated with average noise levels (r < 0.41). One-week Leq correlated well with NO, NO2, and EC levels (r = 0.61 to 0.68) and less so with PM2.5 levels (r = 0.45). We observed associations between 1-week noise levels and traffic intensity within 100 m of the monitoring sites (r = 0.58). The high levels of noise observed in NYC often exceed recommended guidelines for outdoor and personal exposures, suggesting unhealthy levels in many locations. Associations between noise, traffic, and combustion air pollutants suggest the possibility for confounding and/or synergism in intraurban epidemiological studies of traffic-related health effects. The different spatial pattern of intermittent noise compared to average noise level may suggest different sources.

Extreme heat awareness and protective behaviors in New York City.

Heat waves can be lethal and routinely prompt public warnings about the dangers of heat. With climate change, extreme heat events will become more frequent and intense. However, little is known about public awareness of heat warnings or behaviors during hot weather. Awareness of heat warnings, prevention behaviors, and air conditioning (AC) prevalence and use in New York City were assessed using quantitative and qualitative methods. A random sample telephone survey was conducted in September 2011 among 719 adults and follow-up focus groups were held in winter 2012 among seniors and potential senior caregivers. During summer 2011, 79 % of adults heard or saw a heat warning. Of the 24 % who were seniors or in fair or poor health, 34 % did not own AC or never/rarely used it on hot days. Of this subgroup, 30 % were unaware of warnings, and 49 % stay home during hot weather. Reasons for not using AC during hot weather include disliking AC (29 %), not feeling hot (19 %), and a preference for fans (18 %). Seniors in the focus groups did not perceive themselves to be at risk, and often did not identify AC as an important health protection strategy. While heat warnings are received by most New Yorkers, AC cost, risk perception problems, and a preference for staying home leave many at risk during heat waves. Improving AC access and risk communications will help better protect the most vulnerable during heat waves.

NPCC4: Climate change, energy, and energy insecurity in New York City.

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report provides an overview of energy trends in New York City and the State of New York, as well as accompanying challenges and barriers to the energy transition-with implications for human health and wellbeing. The link between energy trends and their impact on health and wellbeing is brought to the fore by the concept of "energy insecurity," an important addition to the NPCC4 assessment.

NPCC4: Concepts and tools for envisioning New York City's futures.

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report discusses the many intersecting social, ecological, and technological-infrastructure dimensions of New York City (NYC) and their interactions that are critical to address in order to transition to and secure a climate-adapted future for all New Yorkers. The authors provide an assessment of current approaches to "future visioning and scenarios" across community and city-level initiatives and examine diverse dimensions of the NYC urban system to reduce risk and vulnerability and enable a future-adapted NYC. Methods for the integration of community and stakeholder ideas about what would make NYC thrive with scientific and technical information on the possibilities presented by different policies and actions are discussed. This chapter synthesizes the state of knowledge on how different communities of scholarship or practice envision futures and provides brief descriptions of the social-demographic and housing, transportation, energy, nature-based, and health futures and many other subsystems of the complex system of NYC that will all interact to determine NYC futures.

NPCC4: Climate change and New York City's health risk.

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.

Spatial and temporal estimation of air pollutants in New York City: exposure assignment for use in a birth outcomes study.

BACKGROUND: Recent epidemiological studies have examined the associations between air pollution and birth outcomes. Regulatory air quality monitors often used in these studies, however, were spatially sparse and unable to capture relevant within-city variation in exposure during pregnancy. METHODS: This study developed two-week average exposure estimates for fine particles (PM2.5) and nitrogen dioxide (NO2) during pregnancy for 274,996 New York City births in 2008-2010. The two-week average exposures were constructed by first developing land use regression (LUR) models of spatial variation in annual average PM2.5 and NO2 data from 150 locations in the New York City Community Air Survey and emissions source data near monitors. The annual average concentrations from the spatial models were adjusted to account for city-wide temporal trends using time series derived from regulatory monitors. Models were developed using Year 1 data and validated using Year 2 data. Two-week average exposures were then estimated for three buffers of maternal address and were averaged into the last six weeks, the trimesters, and the entire period of gestation. We characterized temporal variation of exposure estimates, correlation between PM2.5 and NO2, and correlation of exposures across trimesters. RESULTS: The LUR models of average annual concentrations explained a substantial amount of the spatial variation (R2 = 0.79 for PM2.5 and 0.80 for NO2). In the validation, predictions of Year 2 two-week average concentrations showed strong agreement with measured concentrations (R2 = 0.83 for PM2.5 and 0.79 for NO2). PM2.5 exhibited greater temporal variation than NO2. The relative contribution of temporal vs. spatial variation in the estimated exposures varied by time window. The differing seasonal cycle of these pollutants (bi-annual for PM2.5 and annual for NO2) resulted in different patterns of correlations in the estimated exposures across trimesters. The three levels of spatial buffer did not make a substantive difference in estimated exposures. CONCLUSIONS: The combination of spatially resolved monitoring data, LUR models and temporal adjustment using regulatory monitoring data yielded exposure estimates for PM2.5 and NO2 that performed well in validation tests. The interaction between seasonality of air pollution and exposure intervals during pregnancy needs to be considered in future studies.

Spatial variability in levels of benzene, formaldehyde, and total benzene, toluene, ethylbenzene and xylenes in New York City: a land-use regression study.

BACKGROUND: Hazardous air pollutant exposures are common in urban areas contributing to increased risk of cancer 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 for 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.

Noise, air pollutants and traffic: continuous measurement and correlation at a high-traffic location in New York City.

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.

Prevalence, awareness, treatment, and control of high LDL cholesterol in New York City, 2004.

INTRODUCTION: Low-density lipoprotein (LDL) cholesterol is a major contributor to coronary heart disease and the primary target of cholesterol-lowering therapy. Substantial disparities in cholesterol control exist nationally, but it is unclear how these patterns vary locally. METHODS: We estimated the prevalence, awareness, treatment, and control of high LDL cholesterol using data from a unique local survey of New York City's diverse population. The New York City Health and Nutrition Examination Survey 2004 was administered to a probability sample of New York City adults. The National Health and Nutrition Examination Survey 2003-2004 was used for comparison. High LDL cholesterol and coronary heart disease risk were defined using National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines. RESULTS: Mean LDL cholesterol levels in New York City and nationally were similar. In New York City, 28% of adults had high LDL cholesterol, 71% of whom were aware of their condition. Most aware adults reported modifying their diet or activity level (88%), 64% took medication, and 44% had their condition under control. More aware adults in the low ATP III risk group than those in higher risk groups had controlled LDL cholesterol (71% vs 33%-42%); more whites than blacks and Hispanics had controlled LDL cholesterol (53% vs 31% and 32%, respectively). CONCLUSION: High prevalence of high LDL cholesterol and inadequate treatment and control contribute to preventable illness and death, especially among those at highest risk. Population approaches - such as making the food environment more heart-healthy - and aggressive clinical management of cholesterol levels are needed.

Secular changes in mortality disparities in New York City: a reexamination.

Previously published analyses showed that inequalities in mortality rates between residents of poor and wealthy neighborhoods in New York City (NYC) narrowed between 1990 and 2000, but these trends may have been influenced by population in-migration and gentrification. The NYC public housing population has been less subject to these population shifts than those in other NYC neighborhoods. We compared changes in mortality rates (MRs) from 1989-1991 to 1999-2001 among residents of NYC census blocks consisting entirely of public housing residences with residents of nonpublic housing low-income and higher-income blocks. Public housing and nonpublic housing low-income blocks were those in census block groups with > or =50% of residents living at <1.5 times the federal poverty level (FPL); nonpublic housing higher-income blocks were those in census block groups with <50% of residents living at <1.5 times the FPL. Information on deaths was obtained from NYC's vital registry, and US Census data were used for denominators. Age-standardized all-cause MRs in public housing, low-income, and higher-income residents decreased between the decades by 16%, 28%, and 22%, respectively. While mortality rate ratios between low-income and higher-income residents narrowed by 8%, the relative disparity between public housing and low-income residents widened by 21%. Diseases amenable to prevention including malignancies, diabetes, and chronic lung disease contributed to the increased overall mortality disparity between public housing and lower-income residents. These findings temper previous findings that inequalities in the health of poor and wealthier NYC neighborhood residents have narrowed. NYC public housing residents should be a high-priority population for efforts to reduce health disparities.