Using Civic Service Design Methods to Redevelop a Data Communication Website With a Health Literacy Lens.

CONTEXT: Public health agencies routinely publish data in hopes that data influence public health policy and practice. However, data websites can often be difficult to use, posing barriers to people trying to access, understand, and use data. Working to make data websites easier to use can add value to public health data communication work. PROGRAM: The New York City Department of Health and Mental Hygiene (DOHMH) redesigned its Environment and Health Data Portal, a website used to communicate environmental health data, with the goal of making data more accessible and understandable to a broader audience. The DOHMH used Civic Service Design methods to establish priorities and strategies for the redesign work, to build a data communication website that emphasizes a high level of usability, and content that explains data. IMPLEMENTATION: By following a Civic Service Design process, the DOHMH synthesized findings from health communications, data visualization and communication, and web usability to create an easy-to-use website with explanations of data and findings alongside datasets. On the new site, automated dataset visualizations are supplemented with narrative content, explanatory content, and custom interactive applications designed to explain data and findings. EVALUATION: Web analytics showed that, in its first year of operation, the site's web traffic grew substantially, with the last 12 weeks recording weekly page views 150% higher than the first 12 weeks of operation (7185 average weekly page views compared with 2866 average weekly page views). Two-thirds (66.3%) of page views include recorded user engagement. Additional evaluations to measure specific aspects of usability compared with the previous version of the site are planned. DISCUSSION: By following a Civic Service Design process, the DOHMH redesigned a vital data communication platform to increase its usability and saw significant increase in engagement in its first year of operations. By designing data material with usability in mind, public health departments have the potential to improve public health data communication work.

Extreme Heat and COVID-19 in New York City: An Evaluation of a Large Air Conditioner Distribution Program to Address Compounded Public Health Risks in Summer 2020.

In summer 2020, New York City (NYC) implemented a free air conditioner (AC) distribution program in response to the threats of extreme heat and COVID-19. The program distributed and installed ACs in the homes of nearly 73,000 older, low-income residents of public and private housing. To evaluate the program's impact, survey data were collected from October 2020 to February 2021 via mail and online from 1447 program participants and 902 non-participating low-income NYC adults without AC as a comparison group. Data were examined by calculating frequencies, proportions, and logistic regression models. Participants were 3 times more likely to report staying home during hot weather in summer 2020 compared to non-participants (adjusted odds ratio [AOR] = 3.0, 95% confidence interval [CI] = 2.2, 4.1), with no difference between groups in summer 2019 (AOR = 1.0, CI = 0.8, 1.3). Participants were less likely to report that 2020 hot weather made them feel sick in their homes compared to non-participants (AOR = 0.2, CI = 0.2, 0.3). The program helped participants-low-income residents and primarily people of color-stay home safely during hot weather. These results are relevant for climate change health-adaptation efforts and heat-health interventions.

A randomized trial of a one-time pest intervention: impact on childhood asthma outcomes.

Objectives: To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation.Study design: In a randomized controlled trial of 384 children aged 5-12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use.Results: The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma (p = 0.04) and larger declines that fell short of statistical significance in asthma symptom days (p = 0.22), severe symptoms (p = 0.16), missed school (p = 0.27) and rescue medication use (p = 0.27). Both roach (p = 0.001) and mice (p = 0.11) infestations decreased much more in the IPM group than the UC group.Conclusions: After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma.

Characteristics of the Built Environment and the Presence of the Norway Rat in New York City: Results From a Neighborhood Rat Surveillance Program, 2008-2010.

Characteristics of an urban setting such as New York City (NYC), including readily available putrescible waste and ample underground infrastructure, make it highly attractive to the Norway rat (Rattus norvegicus). To identify property and neighborhood characteristics associated with rat presence, recent inspectional results were analyzed from over 77,000 properties in the Bronx and Manhattan. Variables capturing the location and density of factors believed to promote rat populations were tested individually and in combination in models predicting rat activity. We found that property-specific characteristics typically associated with high garbage volume, including large numbers of residential units, public ownership, and open-space designation (parks, outdoor recreation, or vacant land) were the most important factors in explaining increased rat presence across neighborhoods in NYC. Interventions that involved improved garbage management and street sanitation within a designated area reduced the likelihood of finding rats, especially in medium- and high-poverty neighborhoods. Neighborhood characteristics, such as being near a railroad or subway line, having a school nearby, the presence of numerous restaurants, or having older infrastructure, also contributed to the increased likelihood of rats. Our results support the use of built environment data to target community-level interventions and capture emerging rat infestations.

Fatal and nonfatal drowning outcomes related to dangerous underwater breath-holding behaviors - New York State, 1988-2011.

Drowning is an important cause of preventable injury and mortality, ranking fifth among leading causes of unintentional injury death in the United States. In 2011, two healthy young men died in a drowning incident at a New York City (NYC)-regulated swimming facility. The men became unconscious underwater after performing intentional hyperventilation before submersion. The phenomenon of healthy swimmers becoming unconscious underwater has been described elsewhere as hypoxic blackout. Prompted by this incident, the NYC Department of Health and Mental Hygiene (DOHMH) in collaboration with the New York State Department of Health (SDOH) conducted a case review of New York state fatal and nonfatal drownings reported during 1988-2011 to investigate similar behaviors in other incidents. DOHMH identified 16 cases, three in NYC, with a consistent set of voluntary behaviors associated with unintentional drowning and designated this class of behaviors as "dangerous underwater breath-holding behaviors" (DUBBs). For this small sample, the frequency of different DUBBs varied by age and swimming level, and practicing more than one DUBB increased the risk for fatality. This research contributes to the literature on drowning by focusing on contributing behaviors rather than drowning outcomes. NYC recently enacted public health education and regulations that discourage DUBBs; these interventions have the potential to effectively reduce unintentional drowning related to these behaviors and could be considered by other municipalities and jurisdictions.

Predictors of senior center use among older adults in New York City public housing.

Despite agreement among stakeholders that senior centers can promote physical and mental health, research on senior center use in urban populations is limited. Our objective was to describe demographic and health factors associated with senior center use among urban, low-income older adults in order to inform programming and outreach efforts. We used data from a 2009 telephone survey of 1036 adults randomly selected from rosters of New York City public housing residents aged 65 and older. We analyzed senior center use by race/ethnicity, age, gender, health, housing type, and income, and used a forward selection approach to build best-fit models predicting senior center use. Older adults of all ages and of both genders reported substantial use of senior centers, with nearly one third (31.3%) reporting use. Older adults living alone, at risk of depression, or living in specialized senior housing had the greatest use of centers. Senior center use varied by race/ethnicity, and English-speaking Hispanics had a higher prevalence of use than Spanish-speaking Hispanics (adjusted prevalence ratio [PR]=1.69, 95% CI: 1.11-2.59). Spanish-speaking communities and older adults living in non-senior congregate housing are appropriate targets for increased senior center outreach efforts.

Immediate Injury Deaths Related to the Remnants From Hurricane Ida in New York City, September 1-2, 2021.

The remnants from Hurricane Ida in September 2021 caused unprecedented rainfall and inland flooding in New York City (NYC) and resulted in many immediate deaths. We reviewed death records (electronic death certificates and medical examiner reports) to systematically document the circumstances of death and demographics of decedents to inform injury prevention and climate adaptation actions for future extreme precipitation events. There were 14 Ida-related injury deaths in NYC, of which 13 (93%) were directly caused by Ida, and 1 (7%) was indirectly related. Most decedents were Asian (71%) and foreign-born (71%). The most common circumstance of death was drowning in unregulated basement apartments (71%). Themes that emerged from the death records review included the suddenness of flooding, inadequate exits, nighttime risks, and multiple household members were sometimes affected. These deaths reflect interacting housing and climate crises, and their disproportionate impact on disadvantaged populations needing safe and affordable housing. Climate adaptation actions, such as improving stormwater management infrastructure, informing residents about flood risk, implementing Federal Emergency Management Agency recommendations to make basements safer, and expanding emergency notification measures can mitigate risk. As climate change increases extreme precipitation events, multi-layered efforts are needed to keep residents safe.

Energy Insecurity Indicators Associated With Increased Odds Of Respiratory, Mental Health, And Cardiovascular Conditions.

Energy insecurity, defined as the inability to meet household energy needs, has multiple economic, physical, and coping dimensions that affect health. We conducted the first citywide representative survey of energy insecurity and health in a sample of 1,950 New York City residents in 2022. We compiled ten indicators that characterize energy insecurity as experienced in New York City housing settings and then examined associations between number and types of indicators and health conditions. Nearly 30 percent of residents experienced three or more indicators, with significantly higher levels among Black non-Latino/a and Latino/a residents compared with White non-Latino/a residents, renters compared with owners, recent immigrants compared with those living in the United States for longer, and those in households with children compared with those with no children. Residents with three or more indicators of energy insecurity had higher odds of respiratory, mental health, and cardiovascular conditions and electric medical device dependence than residents with no indicators. Our study demonstrates that broadening the understanding of energy insecurity with context-specific metrics can help guide interventions and policies that address disparities relevant to health and energy equity.

Increased screening colonoscopy rates and reduced racial disparities in the New York Citywide campaign: an urban model.

OBJECTIVES: In 2003, in response to low colonoscopy screening rates and significant sociodemographic disparities in colonoscopy screening in New York City (NYC), the NYC Department of Health and Mental Hygiene, together with the Citywide Colon Cancer Control Coalition, launched a multifaceted campaign to increase screening. We evaluated colonoscopy trends among adult New Yorkers aged 50 years and older between 2003 and 2007, the first five years of this campaign. METHODS: Data were analyzed from the NYC Community Health Survey, an annual, population-based surveillance of New Yorkers. Annual prevalence estimates of adults who reported a timely colonoscopy, one within the past 10 years, were calculated. Multivariate models were used to analyze changes over time in associations between colonoscopy screening and sociodemographic characteristics. RESULTS: Overall, from 2003 to 2007 the proportion of New Yorkers aged 50 years and older who reported timely colonoscopy screening increased from 41.7% to 61.7%. Racial/ethnic and sex disparities observed in 2003 were eliminated by 2007: prevalence of timely colonoscopy was similar among non-Hispanic whites, non-Hispanic blacks, Hispanics, men, and women. However, Asians, the uninsured, and those with lower education and income continued to lag in receipt of timely colonoscopies. CONCLUSIONS: The increased screening colonoscopy rate and reduction of racial/ethnic disparities observed in NYC suggest that multifaceted, coordinated urban campaigns can improve low utilization of clinical preventive health services and reduce public-health disparities.

Soil science. Soil and human security in the 21st century.

Human security has and will continue to rely on Earth's diverse soil resources. Yet we have now exploited the planet's most productive soils. Soil erosion greatly exceeds rates of production in many agricultural regions. Nitrogen produced by fossil fuel and geological reservoirs of other fertilizers are headed toward possible scarcity, increased cost, and/or geopolitical conflict. Climate change is accelerating the microbial release of greenhouse gases from soil organic matter and will likely play a large role in our near-term climate future. In this Review, we highlight challenges facing Earth's soil resources in the coming century. The direct and indirect response of soils to past and future human activities will play a major role in human prosperity and survival.

Attitudes about intimate partner violence screening among an ethnically diverse sample of young women.

PURPOSE: This clinic-based study investigated attitudes about intimate partner violence (IPV) screening among an ethnically diverse population of adolescent and young adult women (n = 645). METHODS: A cross-sectional quantitative and qualitative survey assessed experiences with and attitudes toward IPV screening. RESULTS: Almost all participants supported universal IPV screening and over 90% believed that a health care provider was the most appropriate adult to ask them about interpersonal violence. Young women's concerns toward screening varied by age and violence experience; those most likely to mind being screened were younger, had a history of childhood sexual abuse, and were victims of physical violence in the last year. However, even in these groups, over 70% supported IPV screening. Qualitative analyses suggested that provider qualities and confidentiality will affect the amount of disclosure to provider-initiated screening. Women also raised important questions about how to define IPV in relationships. CONCLUSIONS: Young women generally favor universal screening of interpersonal violence, but provider qualities and confidentiality issues affect responses to screening questions.