Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations.

INTRODUCTION: New York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007. METHODS: We used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System. RESULTS: Early childhood obesity prevalence declined in all study neighborhoods from 2004-2006 to 2008-2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004-2006 to 15.3% in 2008-2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn. CONCLUSION: The reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.

Comparison of two measures of gestational age among low income births. The potential impact on health studies, New York, 2005.

Recently, the National Association for Public Health Statistics and Information Systems considered changing the definition of gestational age from the current definition based on mother's last normal menstrual period (LMP) to the clinical/obstetric estimate determined by the physician (CE).They determined additional information was needed. This study provides additional insight into the comparability of the LMP and CE measures currently used on vital records among births at risk for poor outcomes. The data consisted of all New York State (NYS) (excluding New York City) singleton births in 2005 among mothers enrolled in the NYS Women Infants and Children (WIC) program during pregnancy. Prenatal WIC records were matched to NYS' Statewide Perinatal Data System. The analysis investigates differences between LMP and CE recorded gestations. Relative risks between risk factors and preterm birth were compared for LMP and CE. Exact agreement between gestation measures exists in 49.6% of births. Overall, 6.4% of records indicate discordance in full term/preterm classifications; CE is full term and LMP preterm in 4.9%, with the converse true for 1.5%. Associations between risk factor and preterm birth differed in magnitude based on gestational age measurement. Infants born to mothers with high risk indicators were more likely to have a CE of preterm and LMP full term. Changing the measure of gestational age to CE universally likely would result in overestimation of the importance of some risk factors for preterm birth. Potential overestimation of clinical outcomes associated with preterm birth may occur and should be studied.

Privacy in the pharmacy environment: analysis of observations from inside the pharmacy.

OBJECTIVE: To measure the extent to which pharmacist-patient conversations are private. DESIGN: Cross sectional. SETTING: New York State, April to June 2007. PARTICIPANTS: No individual participants were enrolled; the study consisted of observations of the pharmacy environment and pharmacy patient-staff interactions. INTERVENTION: Measurement of privacy-related distances in the pharmacy. MAIN OUTCOME MEASURES: Distance between patients at the pharmacy counter and staff behind the counter, distance between patient waiting area and pharmacy counter, and distance that a pharmacy counter conversation was audible. RESULTS: Observational data were recorded from 597 pharmacy staff-patient interactions in 282 pharmacies across New York State. Of the 597 interactions, 167 occurred while a second patient was within 6 ft. Of the 282 pharmacies, pharmacy staff-patient conversations were audible to observers more than 6 ft away in 229 pharmacies; 142 could be heard more than 15 ft away. CONCLUSION: Most staff-patient conversations in the pharmacy setting are not private and, as a result, have a high potential for incidental protected health information disclosures.

Alternative approaches to partner notification, diagnosis, and treatment: perspectives of New York County Health Departments, 2007.

OBJECTIVES: The Centers for Disease Control and Prevention is encouraging states to consider patient-delivered partner therapy (PDPT) as a treatment option for Chlamydia and gonorrhea. We sought to assess current sexually transmitted disease (STD) control practices in New York State county health departments, and gather their perspectives on PDPT and alternative interventions. METHODS: A cross-sectional study reviewed county websites to assess STD service information provided. County STD programs were surveyed from January to March 2007 by telephone to determine conditions diagnosed and treated, current partner notification practices, and to assess perspectives on PDPT and alternative interventions. Descriptive statistics were computed. RESULTS: County officials were divided about legalizing PDPT, with 45% for, 45% against, and 10% undecided. Reasons for support included the perception PDPT would result in more infections treated (61%) and improved STD control (29%). Reasons for lack of support included potential contraindication/side effects (28%), potential for medication not reaching partners (28%), and malpractice risk (20%). Stratified analysis by STD morbidity levels showed high morbidity counties were against legalization (67%). PDPT with health department follow-up of partners was the most preferred strategy, followed by patient distribution of educational materials and express care for partners in STD clinics; PDPT alone was the least preferred. New York State County officials' perspectives on PDPT are polarized along lines of program size and morbidity. CONCLUSIONS: Further research on alternative partner intervention strategies and discussion of PDPT is necessary to develop a forward-thinking strategic plan for STD control in the state.

Alternative approaches to partner notification, diagnosis, and treatment: pharmacists' perspectives on proposed patient delivered partner therapy in New York State, 2007.

BACKGROUND: Supported by the American Medical Association, patient delivered partner therapy (PDPT) is becoming legal in many states. For some individuals exposed to sexually transmitted infections, the pharmacist may become the sole point of contact with the medical system. METHODS: To determine pharmacists' perceptions about PDPT, education on sexually transmitted infections, and potential barriers that need to be addressed in pharmacies for successful implementation of PDPT, we conducted a survey of pharmacists and observed privacy-related spaces in pharmacies. In 8 counties of the Capital Region, all community pharmacies were invited to participate. In 8 additional counties convenience sampling was utilized. The response proportion was 67.3% overall. RESULTS: Of the 193 pharmacists responding to the survey, 63% supported PDPT for Chlamydia and 78% do not want a behind-the-counter status for Chlamydia antibiotics. The majority (88%) of pharmacists want prescriptions marked as PDPT to alert them to counseling needs. About half the pharmacists reported they would automatically submit PDPT prescriptions to insurance company, a confidentiality issue. The barrier cited most often to patient counseling was time (49%). CONCLUSIONS: Pharmacists are open to considering PDPT as part of their professional functions. Although pharmacists need additional sexually transmitted infections education in general, capacity for this training can be developed. Confidentiality issues remain a priority issue to address to protect individuals treated through PDPT.