Micromobility Vehicles, Obstructions, and Rider Safety Behaviors in New York City Bike Lanes.

Micromobility vehicles (MMVs) have become increasingly popular, particularly in urban areas where infrastructure has improved in recent years to facilitate their use. The purpose of this study was to observe protected bike lanes in 10 zones of Manhattan, NYC to: (1) describe the MMVs in bike lanes by type, phone and helmet use; and (2) document MMV users' responses to obstructions. Approximately 1 in 4 of all riders (260/998) were wearing a helmet. Fewer than 2% were observed using a phone while moving. Fewer than 9% of Citi Bike users were wearing a helmet. In contrast, over one-third of non-Citi Bike users were wearing a helmet (228 of 670, 34.03%). This difference was determined to be significant by a chi-squared test (a = 0.05) with a p-value less than 0.0001. Of the 988 MMVs observed in this study, 398 (40.28%) were motorized and 590 (59.72%) were non-motorized. A similar proportion of users of motorized riders versus non-motorized vehicles were wearing a helmet (28.14%, 112/398 versus 24.41%, 144/590). A total of 232 riders (23.50%) encountered an obstruction in their bike lane. Of these obstructions in a bike lane, 82.33% (191/232) were a car/vehicle and 17.67% (41/232) was garbage. A large majority of riders (87.93%) reacted by riding into the traffic lane. These findings suggest that further research and local education, enforcement, and legislative efforts are needed to examine and implement best practices in the safe operation of MMVs, decreasing bike lane obstructions, promoting helmet use, and raising awareness of MMV legislation.

An analysis of nutrient facts labels of pediatric multi-vitamin and mineral supplements: Is there a risk of overexposure?

BACKGROUND: Voluntary and mandatory fortification of pediatric foods, along with widespread consumption of dietary supplements have resulted in an increased proportion of children with excessive micronutrient intake. AIM: This study aimed to analyze the proportion of pediatric dietary supplements that exceed the Recommended Dietary Allowance (RDA) and Tolerable Upper Limit for the individual micronutrients. We further identified the proportion of supplements with large amounts of micronutrients that were marketed through child-friendly and parent-geared promotional language and graphics on the packaging. METHODS: The nutrient facts label on pediatric supplement packages sold by three large retail pharmacy chains was analyzed for micronutrient content. Labels were examined for the presence of trademarked or generic cartoon characters and parent-geared health promotional statements. RESULTS: More than a third and almost a fifth of the samples contained vitamin A and niacin respectively in amounts equivalent to or above the established tolerable upper limit for one- to three-year-old children. A major proportion of these supplements had child-friendly and parent-targeted promotional language on the package. CONCLUSION: The potential for pediatric supplements as a source for excessive micronutrient consumption underscores the need for parents and health care professionals to use nutrition labels as a valuable tool to prevent micronutrient toxicity.

Communicating Mental Health Support to College Students During COVID-19: An Exploration of Website Messaging.

College counseling centers are assumed to play a vital role in addressing students' mental health needs during the COVID-19 pandemic. The aim of this study was to characterize the extent to which NYC metropolitan area school websites communicated to students their updated mental health service offerings, psychoeducational information related to COVID-19, and community-based resources after the abrupt end to on-campus services during the Spring semester. A total of 138 websites were analyzed. Overall, only half of the surveyed web pages provided information about remote counseling, and just under two thirds of schools (57.97%) had directions for students experiencing a mental health emergency. As predicted, enrollment size was associated with whether psychoeducation about mental health and COVID-19 and information about remote counseling were available on a school's website. In both cases, medium-sized schools were the most likely to have these resources available on their websites as compared to small and large-sized schools. College counseling center web pages should include robust and current information that targets schools' diverse student bodies.

Bike Lane Obstructions in Manhattan, New York City: Implications for Bicyclist Safety.

Over the past 5 years, the number of regular cyclists in New York City (NYC) increased by ~ 140,000 to over 800,000 regular riders. Aiming to promote safe cycling, NYC has developed over 1000 miles of planned commuting and recreational bike paths across its five boroughs. Bike lane obstructions pose a safety risk to cyclists but the extent of such obstructions is unknown. The purpose of this cross-sectional study was to document the frequency and rate of obstructions in protected bike lanes throughout Manhattan, NYC. During the fall of 2018, bicycle obstructions were observed in ten zones of Manhattan, NYC. Three kinds of obstructions within the bicycle lanes were coded: object, pedestrian, and vehicle. A total of 233 obstructions in the protected bike lanes were observed in this study. Obstructions per zone ranged from 11 to 39. The most common type of obstruction was objects, which accounted for 53.2% (n = 124) of obstructions and ranged through zones from 2 to 22. People were the second most common obstruction, which accounted for 28.3% (n = 66) of the obstructions, with a range of 1-22. Vehicles accounted for the remaining 18.5% (n = 43) of the obstructions with a range of 1-9 throughout zones. Findings of this study indicate that, even in "protected" lanes, bikers may be forced into traffic or to approach parked cars, increasing the risk of being "doored."

A Description of Advertisements for Alcohol on LinkNYC Kiosks in Manhattan, New York City: A Pilot Study.

Excessive alcohol consumption compromises health and increases risk of mortality. Advertisements for alcohol in city environments have been shown to influence consumption. The aim of this pilot study was to estimate the prevalence of alcohol advertisements displayed on LinkNYC kiosks, a new communication channel that provides outdoor Wi-Fi access and advertising on streets within urban environments. Direct observations were conducted to document advertisements on a 20% random sample of the 500 LinkNYC kiosks in Manhattan, NYC. From May to September of 2017, each of the 100 selected kiosks was observed for a 10-min period to document advertisements for alcohol. In addition, differences in prevalence of alcohol advertisements were examined by the location of the kiosk based on NYC zip codes' median annual income. Of the 2025 advertisements observed, 5.09% (N = 103) were for an alcohol product (including duplicates). Such advertisements were observed on 17% of the kiosks. No health warnings or age warnings were presented in any of the alcohol advertisements. Compared with kiosks located in zip codes with lower median annual income, significantly more alcohol advertisements were displayed in zip codes with higher median annual income. This is the first study to estimate the prevalence of alcohol advertising on the LinkNYC Wi-Fi and telecommunication system, now ubiquitous on Manhattan's sidewalks. This study adds to the current literature that suggests New York City residents could benefit from health-promoting versus health-compromising advertising. The findings also highlight the potential of LinkNYC kiosk marketing to undermine health-related social marketing efforts by City government and other organizations.

Health Information Seeking Behavior Among College Students.

Individuals have a wide range of resources when searching for health topics. The aim of this research was twofold: (1) to identify and assess the resources college students use when exercising health information seeking behavior (HISB); and (2) to examine perceptions and behaviors regarding adoption of online tools. A questionnaire was developed to assess HISB in a sample of college students. Items pertaining to HISB were adapted from a Health Information National Trends Survey with permission from the National Cancer Institute at the National Institutes of Health. During Spring 2018, 258 students in 9 sections of a personal health class at a public university in NJ completed the questionnaire. Students were most likely to often or always use the Internet for health information (n = 74%) over other sources. Females were more likely to use the Internet for health information (p = .030), to consult a health or medical professional (p = .042) and to confirm the health information they find with a health or medical professional (p = .028). Females also reported spending significantly more time on social media (mean 4.96 h/day) compared to males (4.00 h/day, p = .041). Non-white students were significantly more likely to often use the Internet to find health information (p = .039), while white students reported spending significantly less time on the Internet (p < .001) and on social media (p < .001). Future research is needed to understand motivating factors for HISB, and to tailor interventions accordingly to assure that college students who exhibit HISB have appropriate levels of e-health literacy.

An Analysis of Technology-Related Distracted Biking Behaviors and Helmet Use Among Cyclists in New York City.

Bicycling is becoming an increasingly utilized mode of transportation in New York City. Technology-related distracted bicycling and helmet use are behaviors that can impact bike safety. The aims of this study were twofold: (1) to determine rates and types of technology-related distracted behaviors among bicyclists in the borough of Manhattan in New York City; and (2) to assess the rate of bicycle helmet use among these cyclists. Bicyclists in five popular riding areas in Manhattan were observed for a total of 50 h using a digital video camera during summer months in 2014. Videos were coded and enumerated for the total number and gender of cyclists, type of bicycle, number wearing headphones/earbuds and/or using a mobile phone, and whether the cyclist was wearing a helmet. Almost 25,000 cyclists were observed across the five selected locations (n = 24,861). Riders were almost four times more likely not to wear a helmet on rental bikes as compared with non-rentals (Citi Bike(®) OR 3.8; 95% CI 2.5, 5.9: other rental OR 3.8; 95% CI 3.0, 4.9). Significantly increased odds of not wearing a helmet were observed for females relative to males (OR 1.4; 95% CI 1.1, 1.8) across varied times and locations. Overall, rates of technology-related distraction were low, with headphone use being most prevalent. Males were more likely to wear headphones/earbuds (OR 2.0; 95% CI 1.4, 2.9), as were cyclists on Citi Bikes relative to other rental bikes (OR 2.2; 95% CI 1.3, 3.6). Findings from this study contribute to the growing literature on distracted biking and helmet use among bike share program riders and other cyclists and can inform policymakers and program planners aiming to improve bicycle safety in urban settings.

Pedestrian Behavior at Five Dangerous and Busy Manhattan Intersections.

Technology-related distracted behavior is an emergent national concern. Listening to, looking at or talking into an electronic device while walking divides attention, increasing the risk of injury. The purpose of this study was to quantify technology-related distracted pedestrian behavior at five dangerous and busy Manhattan intersections. Data were collected over ten cycles of signal changes at each of the four corners of five intersections at four times of day. Data for 'Walk' and 'Don't Walk' signals were tallied separately. A total of 21,760 pedestrians were observed. Nearly one-third crossing on a 'Walk' signal (n = 5414, 27.8%), and nearly half crossing on a 'Don't Walk' signal (n = 974; 42.0%) were wearing headphones, talking on a mobile phone, and/or looking down at an electronic device. Headphone use was the most common distraction.

An examination of product packaging marketing strategies used to promote pediatric multivitamins.

The purpose of this study was to describe the nature of marketing strategies for multivitamin and multimineral (MVM) supplement packaging and to assess the extent to which these supplements are marketed as food products. A cross-sectional study of children's supplement packaging was conducted. Descriptive statistics identified common marketing practices. Websites of the three largest retail chain pharmacies in the United States and MVM manufacturers were accessed. The study's sample consisted of packaging for 52 children's MVM supplements. Child-targeted marketing included reference to trademarked characters on 42.3% of MVM packaging (n = 22). More than 80% of the sample (n = 42) listed fruity flavors and almost all packaging included descriptive words related to the MVMs' shape and/or flavor (88.5%, n = 46). Nearly one-fifth of the packaging (n = 10) pictured a food item. With respect to parent-targeted promotional language, almost 83% of the supplement packages (n = 43) included text on the support of bodily structure/function. More than half of the sample (53.8%, n = 28) had promotional language related to dietary practice (e.g. organic, gluten-free). Pediatricians can play a role in ensuring that parents are aware of (1) possible risks associated with MVM overconsumption, and (2) the importance of deriving vitamins and minerals from a balanced diet. Given the high number of exposures to pediatric MVMs among youth and established influence of food marketing on shaping children's perceptions and behaviors, further research is necessary to determine the extent to which children's MVMs are marketed as a food product and perceived as such by children.

Public bike sharing in New York City: helmet use behavior patterns at 25 Citi Bike™ stations.

Urban public bicycle sharing programs are on the rise in the United States. Launched in 2013, NYC's public bicycle share program, Citi Bike™ is the fastest growing program of its kind in the nation, with nearly 100,000 members and more than 330 docking stations across Manhattan and Brooklyn. The purpose of this study was to assess helmet use behavior among Citi Bike™ riders at 25 of the busiest docking stations. The 25 Citi Bike™ Stations varied greatly in terms of usage: total number of cyclists (N = 96-342), commute versus recreation (22.9-79.5% commute time riders), weekday versus weekend (6.0-49.0% weekend riders). Helmet use ranged between 2.9 and 29.2% across sites (median = 7.5 %). A total of 4,919 cyclists were observed, of whom 545 (11.1%) were wearing helmets. Incoming cyclists were more likely to wear helmets than outgoing cyclists (11.0 vs 5.9%, p = .000). NYC's bike share program endorses helmet use, but relies on education to encourage it. Our data confirm that, to date, this strategy has not been successful.

Technology-related distracted walking behaviours in Manhattan's most dangerous intersections.

Use of mobile devices has been cited as a distraction while driving, and more recently, among pedestrians crossing urban streets. In 2010, over half of New York City traffic fatalities were pedestrians. The aim of this study was to estimate the prevalence of distracted walking due to pedestrians' use of headphones, mobile phones, or both. Data were gathered by direct observations at the 10 intersections in Manhattan with the highest frequency of pedestrian-motor vehicle collisions. More than 1 in 4 of the >3500 pedestrians observed were distracted by mobile electronic devices while crossing during the 'walk' (28.8%) and 'don't walk' (26.3%) signals. Poisson regression analyses established there was a significant difference in individuals talking on a mobile device during the 'walk' signal versus the 'don't walk' signal; however, no other significant differences in other distracted walking behaviours were observed. This study contributes to the emerging literature on distracted walking behaviour by pedestrians in busy urban areas and can help to inform pedestrian-focused safety efforts.

Helmet use among cyclists in New York City.

Lack of helmet use while bicycling can have deleterious effects on health. Despite evidence that helmets can greatly reduce the risk of head injury, the prevalence of helmet use among riders, including those in urban bicycle-share programs, has been shown to be very low. Building upon the authors' previous work, this study's aim was to assess prevalence of helmet use among cyclists riding on widely used New York City (NYC) bike lanes. Across a 2-month period, cyclists were filmed in five NYC locations with bike lanes. Filming took place at two separate time periods (recreation and commute) at each location. Helmet use was coded for each cyclist. A total of 1,921 riders were observed across 10 h. Overall, half (50.0 %) of all riders were observed wearing a helmet. Rates of using a helmet were consistent across all five locations. In addition, only 21.7 % of Citi Bike users and 15.3 % of other bicycle rentals were observed wearing helmets while cycling. The prevalence of helmet use was significantly higher among males than females (z = 4.48, p < .001). Cyclists observed during the recreational time period were also less likely than those observed during the commuting time period to be wearing a helmet (z = 7.17, p < .001). The results of this study contribute to the growing literature about cyclist helmet use in urban areas.

Helmet use among users of the Citi Bike bicycle-sharing program: a pilot study in New York City.

The use of bicycle helmets to prevent or reduce serious head injuries is well established. However, it is unclear how to effectively promote helmet use, particularly in the context of bicycle-sharing programs. The need to determine rates of helmet use specifically among users of bicycle-sharing programs and understand if certain characteristics, such as time of day, affect helmet use, is imperative if effective promotion and/or legislative efforts addressing helmet use are to be developed. We estimated the prevalence of helmet use among a sample of Citi Bike program users in New York City. A total of 1,054 cyclists were observed over 44 h and across the 22 busiest Citi Bike locations. Overall, 85.3% (95% CI 82.2, 88.4%) of the cyclists observed did not wear a helmet. Rates of helmet non-use were also consistent whether cyclists were entering or leaving the docking station, among cyclists using the Citi Bikes earlier versus later in the day, and among cyclists using the Citi Bikes on weekends versus weekdays. Improved understanding about factors that facilitate and hinder helmet use is needed to help reduce head injury risk among users of bicycle sharing programs.

An analysis of Bronx-based online grocery store circulars for nutritional content of food and beverage products.

With the rising rates of diabetes and obesity in New York City's poorest communities, efforts to assist low-income residents in spending money to promote nutritious food consumption have increased. The objective of this study was to assess the extent to which Bronx-based grocery stores offered nutritious foods on sale through their weekly circulars. Over a 2-month period, we analyzed 2,311 food and beverage products placed on the first page of online circulars for fifteen Bronx-based grocery stores. For each circular, we recorded the number of starchy and non-starchy fruits and vegetables; for each product, total fiber and carbohydrate content per serving (in grams), whether the product was processed, and sale price were recorded. Total sugar content (in grams) was recorded for all sugar-sweetened beverages. Over 84 % of the products were processed, and almost 40 % had at least one carbohydrate choice (15 g) per food serving. Only 16.5 % of the products were fresh fruits and green leafy vegetables, and 1.4 % had fiber content of 5 or more grams per serving. Requiring the purchase of multiples of unhealthy products to receive the sale price was also noted. Almost three-quarters of the sugar-sweetened beverages were advertised with promotional sales compared to over half of the fresh fruits and only one-third of fresh vegetables. We identified no other studies that address nutritional content of foods found in grocery store circulars. More research is necessary to determine if purchasing nutritious products at grocery stores in low-income neighborhoods is influenced by sale prices.

Readability of online information about HPV Immunization.

The human papillomavirus (HPV) vaccine is highly effective in preventing anogenital cancers, but vaccination rates in the United States remain low. In deciding whether to vaccinate their children, parents are increasingly using the internet to gather information. This study aimed to examine the level of readability of information on HPV vaccines written on 100 websites that were found via an internet search. To create the website sample, the first 50 websites from the search "HPV immunization" were recorded, followed by the first 50 non-duplicated websites from the search "Gardasil." The content of the sites was analyzed using established readability scales. Websites were compared based on keyword search and on whether they had a commercial or non-commercial URL extension. The majority of websites were found to have information of a difficult reading level. Websites with commercial URL extensions and websites found using the search "Gardasil" had higher mean readability scores. These results suggest that many parents may not understand the information currently presented on the internet and that interventions aimed at improving the readability of online information could help to increase parental approval of the vaccine.

An assessment of the readability of online material related to fluoride.

Community water fluoridation has been deemed one of the greatest public health achievements, yet it remains a controversial topic. As those who are concerned about the benefits and safety of community water fluoridation are likely to turn to the Internet to find information, it is important to know the ease with which a person can read popular materials online. The aim of this study was to assess the readability levels of pro- and anti-fluoride articles on the Internet. Using a highly-recommended readability site, the first 100 articles garnered from websites in a Google were analyzed for a multitude of scores on popular readability tests. Of the 100 articles analyzed, 71 were deemed to be pro-fluoride, and 29 were anti-fluoride. Anti-fluoride materials were more readable across all scores when compared to the pro-fluoride materials. It is critical for consumers to be aware of the credibility of the health information they are reading and to be educated on how to determine if a website or source is reliable, especially when information is conflicting. It is also critical that health associations and other websites devoted to public health promotion develop and provide more accessible health information in terms of readability.

Readability of online patient-based information on bariatric surgery.

Background: Web-based patient education literature has been shown to be written at reading levels far above what is recommended. Little is known about the overall readability of current internet-based bariatric surgery information. The purpose of this study was to assess the readability of current bariatric material on the internet. Methods: The term "weight loss surgery" was searched using the Chrome browser on the first 15pages of URLs that appeared with content written in English. Using five readability measures, scores were generated using Readable.io for written content on a sample of 96 websites. Scores were sorted into the readability categories of "easy," "average," and "difficult." Results: Almost 93% of websites, both .com and .org, sampled received an unacceptable readability score on each assessment. Conclusion: Accurate and appropriate information about bariatric procedures is critical for patient comprehension and adherence to recommended protocols.

Readability of Colorectal Cancer Online Information: A Brief Report.

PURPOSE: Colorectal cancer (CRC) is the third leading cause of cancer-related death in the United States. A decline in deaths caused by CRC has been largely attributable to screening and prompt treatment. Motivation, shown to influence cancer-related screening and treatment decisions, can be shaped by information from the Internet. The extent to which this information is easily readable on cancer-related websites is not known. The purpose of this study was to assess the readability levels of CRC information on 100 websites. METHODS: Using methods from a prior study, the keyword, "colorectal cancer," was searched on a cleared Internet browser. Scores for each website (n = 100) were generated using five commonly recommended readability tests. RESULTS: All five tests demonstrated difficult readability for the majority of the websites. CONCLUSIONS: Online information related to CRC is difficult to read and highlights the need for developing cancer-related online material that is understandable to a wider audience.

Violence depicted in advertisements on LinkNYC kiosks in Manhattan, New York City.

Violence has a profound negative impact on the lives of youth. Exposure to violence may be a precursor to violence later in life. The purpose of this study was two-fold: (1) to estimate the prevalence of violence depicted in advertisements on LinkNYC kiosks in Manhattan, NYC, and (2) to determine if violent advertising varied based on the median annual income of the zip code in which the kiosk was located. This cross-sectional study involved observations of advertisements on 100 LinkNYC kiosks that were selected randomly from 500 that were listed in Manhattan, NYC. The frequency and type of violent depictions were recorded. The kiosks were grouped into quartiles of median annual income (1) $40,782 and below (2) $40,783 to $86,801 (3) $86,802 to $105,500 and (4) $105,501 and above. Of the 2025 total advertisements observed, including duplicates, a total of 190 (9.4%) included violent content. These 190 advertisements were observed on 68 of the 100 kiosks and included 339 depictions of violence. The overwhelming majority (n = 136; 71.6%) of violent depictions were for movies. There were significant differences in the frequency of violent content based on income quartiles, χ2 (3, n = 190) = 19.00, p < 0.001. The highest two income quartiles had fewer violent advertisements than would be expected and the lowest quartile had more violent advertisements than expected. Symbols of violence were the most frequent type of violence portrayed observed in 85% of the violent advertisements observed (n = 161). Weapons, crime and fighting were observed in 5-11% of the advertisements. Our study suggests that greater alignment between the city's aims to improve community health and reduce health disparities and advertising policies on LinkNYC warrants consideration.

Readability of Prostate Cancer Information Online: A Cross-Sectional Study.

Reading and understanding health information, both components of health literacy, can influence patient decisions related to disease management. Older adults, the population of males at greatest risk for prostate cancer, may have compromised capacity to understand and use health information. The purpose of this study was to determine the readability of prostate cancer materials on the Internet using five recommended readability tests. Using a cleared Internet browser, a search was conducted for "prostate cancer." The URLs of the first 100 websites in English were recorded to create the sample. The readability scores for each website were determined using an online, recommended service. This service generates five commonly recommended readability tests. All five tests revealed that the majority of websites had difficult readability. There were no significant differences identified between websites with .org, .gov, or .edu extension versus those with .com, .net, or other extension. It is apparent that the Internet is used often as a resource for health-related information. This study demonstrates that the large majority of information available on the Internet about prostate cancer will not be readable for many individuals.