Home testing for SARS-CoV-2 and impact on surveillance in New York State.

PURPOSE: To determine the distribution of diagnosed SARS-CoV-2 infections by testing modality (at-home rapid antigen [home tests] versus laboratory-based tests in clinical settings [clinical tests]), assess factors associated with clinical testing, and estimate the true total number of diagnosed infections in New York State (NYS). METHODS: We conducted an online survey among NYS residents and analyzed data from 1012 adults and 246 children with diagnosed infection July 13-December 7, 2022. Weighted descriptive and logistic regression model analyses were conducted. Weighted percentages and prevalence ratios by testing modality were generated. The percent of infections diagnosed by clinical tests via survey data were synthesized with daily lab-reported results to estimate the total number of diagnosed SARS-CoV-2 infections in NYS July 1-December 31, 2022. RESULTS: Over 70% of SARS-CoV-2 infections in NYS during the study period were diagnosed exclusively with home tests. Diagnosis with a clinical test was associated with age, race/ethnicity, and region among adults, and sex, age, and education among children. We estimate 4.1 million NYS residents had diagnosed SARS-CoV-2 infection July 1-December 31, 2022, compared to 1.1 million infections reported over the same period. CONCLUSIONS: Most SARS-CoV-2 infections in NYS were diagnosed exclusively with home tests. Surveillance metrics using laboratory-based reporting data underestimate diagnosed infections.

The Relationship between Written District Policies and School Practices among High-Need Districts in New York State.

BACKGROUND: This study tested the hypothesis that written district wellness policies are associated with higher rates of implementation of nutrition and physical activity practices. METHODS: Written wellness policies and building level practices were assessed for schools (N = 295) within high-need districts (N = 70) in New York State. The relationship between policies and practices was measured using multi-level mixed-effects logistic regressions. RESULTS: Overall, stronger written district policies significantly increase the likelihood of practice implementation in schools. This relationship is strongest for physical education and physical activity items, followed by nutrition standards for competitive foods in middle and high schools. Most elementary schools implemented nutrition practices with or without a policy and there were differences in implementation rates between elementary and middle/high schools. When examined separately, policies were for the most part not significantly associated with implementation of corresponding practices. CONCLUSIONS: Strong and comprehensive written policies are associated with higher rates of practice implementation overall, but the consistency of this relationship varies by policy-practice domain. The newer policy topics areas of school wellness promotion and marketing were less frequently included in written policies. Future research should examine whether districts that strengthen their written policies achieve greater implementation over time.

Changes in Sugary Beverage Consumption and Public Perceptions in Upstate New York After Implementation of a Community Awareness Campaign and Healthier Vending Strategies.

OBJECTIVE: We evaluated the impact of a community-based healthy beverage procurement and serving practices program, and educational media campaign, on residents' behaviors and beliefs regarding sugary beverages. DESIGN: Repeated cross-sectional population surveys in 2013 and 2014 were conducted, as well as semistructured interviews with key informants. We employed multivariate differences-in-differences regression analysis, adjusting for demographics and weight status, using the survey data. Key informant interviews were reviewed for common themes. SETTING: Three rural counties in upstate New York with high prevalence of children living in poverty and childhood obesity. PARTICIPANTS: Residents of Broome, Cattaraugus, and Chautauqua, with Chemung as a control, reached through cross-sectional random-digit-dial landline and cellular telephones, and practitioners involved in intervention implementation. INTERVENTION: Community organizations were encouraged through presentations to leadership to adopt healthier vending policies, providing more low- and no-sugar options, and were provided assistance with implementation. In addition, a media campaign supported by presentations to the public aimed to educate residents regarding the health consequences of sugary beverage consumption. OUTCOME MEASURES: The survey measured population demographics and sugary beverage consumption frequency, availability, beliefs about harmfulness, and support for regulation, pre- and postintervention. Key informant interviews elicited perceived program challenges and successes. RESULTS: Compared with temporal trends in the control county, availability of regular soda in the intervention counties decreased (differences-in-differences estimator: ß = -.341, P = .04) and support for regulation increased (differences-in-differences estimator: ß = .162, P = .02). However, there were no differences regarding beliefs about harmfulness or consumption. Practitioners confirmed that the intervention increased awareness but was insufficient to spur action. CONCLUSION: Although public education on the harmfulness of sugary beverages and provision of healthier options in some vending machines successfully impacted soda availability and support for regulation, it did not reduce consumption. This intervention seems promising but should be paired with other community-based interventions for a more comprehensive approach.

Increases in Sugary Drink Marketing During Supplemental Nutrition Assistance Program Benefit Issuance in New York.

INTRODUCTION: The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program, providing $67 billion in benefits to 44 million Americans. Some states distribute SNAP benefits over one or a few days each month, which may create an incentive for retailers to heavily promote top-selling products, like sugar-sweetened beverages, when benefits are disbursed. METHODS: A beverage environment scan assessing presence of displays, advertisements, and price promotions for sugar-sweetened, low-calorie, and unsweetened beverages was administered in a census of SNAP-authorized beverage retailers (n=630) in three cities in New York from September to November 2011. Multilevel regression models controlling for store type; county; and percentage SNAP enrollment, poverty, and non-Hispanic white population in the store's census tract were used to estimate the odds of in-store beverage marketing during the SNAP benefit issuance period compared to other days of the month. Data were analyzed in 2016. RESULTS: There were higher odds of in-store sugar-sweetened beverage marketing during SNAP benefit issuance days (first to ninth days of the month) compared with other days of the month, particularly for sugar-sweetened beverage advertisements (OR=1.66, 95% CI=1.01, 2.72) and displays (OR=1.88, 95% CI=1.16, 3.03). In census tracts with high SNAP enrollment (>28%), the odds of a retailer having sugar-sweetened beverage displays were 4.35 times higher (95% CI=1.93, 9.98) during issuance compared with non-issuance days. There were no differences in marketing for low-calorie or unsweetened beverages. CONCLUSIONS: Increases in sugar-sweetened beverage marketing during issuance may exacerbate disparities in diet quality of households participating in SNAP. Policy changes, like extending SNAP benefit issuance, may mitigate these effects.

Evaluating the Contribution of the Built Environment on Obesity Among New York State Students.

OBJECTIVES: One third of school-aged children in New York State (NYS) are overweight or obese, with large geographic disparities across local regions. We used NYS student obesity surveillance data to assess whether these geographical variations are attributable to the built environment. METHOD: We combined NYS Student Weight Status Category Reporting System 2010-2012 data with other government publicly available data. Ordinary least squares regression models identified key determinants of school district-level student obesity rates for elementary and middle/high schools. Geographical weighted regression models explored spatial variations in local coefficients of the built environment predictors. RESULTS: From ordinary least squares models, higher farmers' market density was only significantly associated with lower obesity rates among elementary school students (b = -0.116; p < .01). Higher fast-food restaurant density was significantly associated with higher obesity rates (b = 0.014; p < .05), and higher land use mix was only significantly associated with lower obesity rates (b = -0.054; p < .01) among middle/high school students. In geographical weighted regression analyses, the inverse association between market density and obesity rates among elementary school students was more pronounced in the eastern portion of the state. The relationship between higher fast-food restaurant density and higher obesity rates among middle/high school students was found in the southeastern portion of the state. CONCLUSIONS: Different patterns of food consumption may explain varying determinants of obesity between younger and older students. Regional variations in local associations between the built environment variables and obesity may suggest differences in how healthy food sources are accessed locally.

Establishing Recommendations for Stroke Systems in the Thrombectomy Era: The Upstate New York Stakeholder Proceedings.

BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale. Six weeks later, participants finalized recommendations. RESULTS: Seventy-one stakeholders (45% of invitees) attended. Six themes around goals/concerns emerged: (1) emergency medical services capacity, (2) validated prehospital screening tools, (3) facility capability, (4) triage/transport guidelines, (5) data capture/feedback tools, and (6) facility competition. In response, high-impact (level A) prehospital recommendations, stratified by implementation feasibility, were (1) use of online medical control for triage (6%); (2) regional transportation strategy (31%), standardized emergency medical services checklists (18%), quality metrics (14%), standardized prehospital screening tools (13%), and feedback for performance improvement (7%); and (3) smartphone application algorithm for screening/decision-making (6%) and ambulance-based telemedicine (6%). Level A interfacility transfer recommendations were (1) standardized transfer process (32%)/timing goals (16%)/regionalized systems (11%), performance metrics (11%), image sharing capabilities (7%); (2) provider education (9%) and stroke toolbox (5%); and (3) interfacility telemedicine (7%) and feedback (2%). CONCLUSIONS: The methods used and recommendations generated provide models for stroke system enhancement. Implementation may vary based on geographic need/capacity and be contingent on establishing standard care practices. Further research is needed to establish optimal implementation strategies.

Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012.

BACKGROUND: Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). HYPOTHESIS: Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. METHODS AND RESULTS: We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. CONCLUSIONS: Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC status on outcomes after ICH. For conditions with clear treatments such as ischemic stroke and SAH, being treated in a DSC improves outcomes, but this trend was not observed in those with strokes, in those who did not have clear treatment guidelines. Identifying hospital-level factors associated with ICH and SAH represents a means to identify and improve gaps in stroke systems of care.

HIV test offers and acceptance: New York State findings from the behavioral risk factor surveillance system and the National HIV behavioral surveillance, 2011-2012.

BACKGROUND: The New York State HIV testing law requires that patients aged 13-64 years be offered HIV testing in health care settings. We investigated the extent to which HIV testing was offered and accepted during the 24 months after law enactment. METHODS: We added local questions to the Behavioral Risk Factor Surveillance System (BRFSS) and the National HIV Behavioral Surveillance (NHBS) surveys asking respondents aged 18-64 years whether they were offered an HIV test in health care settings, and whether they had accepted testing. Statewide prevalence estimates of test offers and acceptance were obtained from a combined 2011-2012 BRFSS sample (N = 6,223). Local estimates for 2 high-risk populations were obtained from NHBS 2011 men who have sex with men (N = 329) and 2012 injection drug users (N = 188) samples. RESULTS: BRFSS data showed that 73% of New Yorkers received care in any health care setting in the past 12 months, of whom 25% were offered an HIV test. Sixty percent accepted the test when offered. The levels of test offer increased from 20% to 29% over time, whereas acceptance levels decreased from 68% to 53%. NHBS data showed that 81% of men who have sex with men received care, of whom 43% were offered an HIV test. Eighty-eight percent accepted the test when offered. Eighty-five percent of injection drug users received care, of whom 63% were offered an HIV test, and 63% accepted the test when offered. CONCLUSIONS: We found evidence of partial and increasing implementation of the HIV testing law. Importantly, these studies demonstrated New Yorkers' willingness to accept an offered HIV test as part of routine care in health care settings.

By Ounce or By Calorie: The Differential Effects of Alternative Sugar-Sweetened Beverage Tax Strategies.

The obesity epidemic and excessive consumption of sugar-sweetened beverages have led to proposals of economics-based interventions to promote healthy eating in the United States. Targeted food and beverage taxes and subsidies are prominent examples of such potential intervention strategies. This paper examines the differential effects of taxing sugar-sweetened beverages by calories and by ounces on beverage demand. To properly measure the extent of substitution and complementarity between beverage products, we developed a fully modified distance metric model of differentiated product demand that endogenizes the cross-price effects. We illustrated the proposed methodology in a linear approximate almost ideal demand system, although other flexible demand systems can also be used. In the empirical application using supermarket scanner data, the product-level demand model consists of 178 beverage products with combined market share of over 90%. The novel demand model outperformed the conventional distance metric model in non-nested model comparison tests and in terms of the economic significance of model predictions. In the fully modified model, a calorie-based beverage tax was estimated to cost $1.40 less in compensating variation than an ounce-based tax per 3,500 beverage calories reduced. This difference in welfare cost estimates between two tax strategies is more than three times as much as the difference estimated by the conventional distance metric model. If applied to products purchased from all sources, a 0.04-cent per kcal tax on sugar-sweetened beverages is predicted to reduce annual per capita beverage intake by 5,800 kcal.

Evaluating the Wellness School Assessment Tool for use in public health practice to improve school nutrition and physical education policies in New York.

BACKGROUND: Addressing the limitations of existing Local Wellness Policies (LWPs) and promoting their implementation remain priorities for health and education agencies. One gap has been the absence of a standard assessment to support LWP revision. During planning for an initiative to improve school nutrition and physical education policy, the Wellness School Assessment Tool (WellSAT) was evaluated. METHODS: Five public health practitioners used WellSAT to assess 50 LWPs. A randomized, counterbalanced design ensured each LWP was coded twice by separate raters. Models evaluated the extent to which WellSAT ratings reflected differences in the LWPs and order, familiarity and rater effects. During field testing, 18 public health practitioners used WellSAT as part of a statewide public health initiative. RESULTS: In pilot testing the majority of the variability in WellSAT scores (median = 88%; range = 76% to 100%) was attributable to differences between policies. Correlations between independent raters' strength and comprehensiveness scores were strong, r = .88 and r = .77, respectively. During field testing, WellSAT was well accepted by public health practitioners and members of the school community. CONCLUSIONS: WellSAT represents a reliable and feasible tool for health and education agencies to use in improving LWPs and aligning them with recognized standards.

Predictors of total calories purchased at fast-food restaurants: restaurant characteristics, calorie awareness, and use of calorie information.

OBJECTIVE: To examine purchase patterns at fast-food restaurants and their relation to restaurant characteristics, customer characteristics, and use of calorie information. DESIGN: Cross-sectional survey. SETTING: Fast-food restaurants in New York State. PARTICIPANTS: Adult fast-food restaurant customers (n = 1,094). VARIABLES MEASURED: Restaurant characteristics (fast-food chain type, presence of calorie labels, and poverty of location), participant characteristics (demographics, calorie knowledge, awareness, and use), and customer purchasing patterns (ordering low-calorie or no beverage, small or no fries, or < 3 items) were used as predictors of total calories purchased. ANALYSIS: Multiple regression. RESULTS: In a regression model including restaurant and customer characteristics, fast-food chain customer age, sex, calorie use, and calorie awareness were independently associated with total calories purchased (all P < .05; model R2 = .19). When 3 purchasing patterns were added to the model, calorie use (P = .005), but not calorie awareness, remained associated with total calories purchased. The 3 purchase patterns collectively accounted for the majority of variance in calorie totals (Δ model R2 = .40). CONCLUSIONS AND IMPLICATIONS: Promoting use of calorie information, purchase strategies, and calorie awareness represents complementary ways to support lower-calorie choices at fast-food chains.

Evaluation of a communications campaign to increase physician reporting to a surveillance system.

While all states have regulations requiring reporting of diseases from healthcare professionals and facilities, underreporting is substantial. To improve reporting to the New York State (NYS) Occupational Lung Disease Registry (OLDR), the NYS Department of Health's Bureau of Occupational Health initiated a multimedia campaign to increase case ascertainment and establish communication channels and partnerships for conducting prevention. The outreach campaign was successful in raising physician awareness about the OLDR, familiarizing physicians with reporting forms and procedures, and increasing physician reporting. It also raised awareness of the contribution of occupational factors to respiratory illness and other conditions. However, while our evaluation indicated it is possible to affect short-term outcomes, such as knowledge, attitudes, and behavior among health-care providers, the campaign was not as successful in promoting sustained reporting.

Randomized controlled trial of a mailed toolkit to increase use of body mass index percentiles to screen for childhood obesity.

INTRODUCTION: Despite epidemic increases in childhood obesity rates, many providers fail to diagnose obesity. Body mass index (BMI)-for-age percentiles are the recommended screening test. We evaluated whether mailing a toolkit to physicians would increase use of sex-specific BMI-for-age percentiles to screen for childhood obesity. METHODS: We assigned a random sample of family physicians and pediatricians from New York State's medical licensing database to either intervention or control groups in the summer of 2004. At baseline and at follow-up, we sent physicians a survey that asked how often they used various screening methods to identify childhood obesity. Between the surveys, we sent physicians in the intervention group a toolkit that consisted of professional guidelines for childhood obesity screening, a tool for calculating BMI, BMI-for-age growth charts, and educational information. RESULTS: At follow-up, more physicians in the intervention group than in the control group reported using BMI percentiles to screen for childhood obesity. Compared with physicians in the control group, physicians in the intervention group had a larger increase in their routine use of BMI percentiles to screen children aged 2 to 5, 6 to 11, and 12 to 20 years, although the differences in the older 2 groups did not attain statistical significance. CONCLUSION: Directly mailing an educational toolkit to physicians can have a small but positive effect on clinical practice.

Worksite characteristics and environmental and policy supports for cardiovascular disease prevention in New York state.

INTRODUCTION: Worksite policy and environmental supports that promote physical activity, healthy eating, stress management, and preventive health screenings can contribute to the prevention of cardiovascular disease and lower employer costs. This study examines the availability of these four categories of supports in a statewide survey of New York State worksites. METHODS: In 2002, we recruited a statewide sample of worksites in New York State with 75 or more employees to participate in a mailed survey assessing worksite policy and environmental supports for wellness and health promotion. The overall response rate was 34.8%. The analysis included data from 832 worksites. RESULTS: Worksite size was an independent predictor of health promotion supports with small (75-99 employees) and medium-small (100-199 employees) worksites reporting significantly fewer policy and environmental supports in all four categories than worksites with 300 or more employees. Worksites in which most employees were nonwhite reported fewer supports for physical activity, healthy eating, and stress management than worksites in which most employees were white. A wellness committee or wellness coordinator was associated with more health promotion supports, regardless of the size of the worksite or composition of its workforce. CONCLUSION: Worksites with fewer than 200 employees have an increased need for assistance in establishing environmental and policy supports promoting cardiovascular health. Worksites that have a wellness committee or coordinator are better able to establish and sustain supports with the potential to improve the health of their workers.

The effect of message type on physician compliance with disease reporting requirements.

OBJECTIVE: Despite the existence of mandatory reporting laws, the underreporting of disease conditions to public health authorities is widespread. This article describes an evaluation of the effects of using different appeals to promote complete and timely reporting to the New York State Occupational Lung Disease Registry (NYS OLDR). METHODS: Three-hundred sixty-eight physicians who had not reported patients were randomly assigned to receive correspondence emphasizing either the legal obligation to report, the public health benefits of reporting, or both. Chi-square tests were used to determine if the proportion of physicians who subsequently reported patients differed by message group. Chi-square tests and the Kruskall Wallis rank sum test were used to test for differences in the completeness and timeliness of reports received from physicians in the three message groups. RESULTS: Physicians receiving correspondence describing the legal obligation to report were more likely to report patients than those receiving only the benefit message, while those receiving correspondence describing the public health benefits of reporting submitted more complete reports than those receiving only the obligation message. CONCLUSIONS: To maximize physician reporting, it is important for public health agencies to emphasize both the legal and public health basis for reporting conditions in correspondence to physicians.

Observer ratings of health and sickness: can other people tell us anything about our health that we don't already know?

After administering interviews covering health conditions, physical limitations, optimism, and affect to 851 older adults, interviewers rated the health and sickness of the interviewees. Observers' ratings of health and sickness were more highly correlated with the severity of participants' self-reported health conditions than were participants' self-ratings of health. This finding is likely attributable to participants' self-ratings of health being more highly correlated with their optimism and positive affect than the observers' ratings. Participants rated as sicker and less healthy at baseline were at a 3 times greater risk for mortality over 114 months. This association was independent of participants' self-rated health as well as demographics, self-reported health conditions, years of smoking, physical limitations, body mass index, optimism, and affect.

The role of optimism in social network development, coping, and psychological adjustment during a life transition.

The authors investigated the extent to which social support and coping account for the association between greater optimism and better adjustment to stressful life events. College students of both genders completed measures of perceived stress, depression, friendship network size, and perceived social support at the beginning and end of their 1st semester of college. Coping was assessed at the end of the 1st semester. Greater optimism, assessed at the beginning of the 1st semester of college, was prospectively associated with smaller increases in stress and depression and greater increases in perceived social support (but not in friendship network size) over the course of the 1st semester of college. Mediational analyses were consistent with a model in which increases in social support and greater use of positive reinterpretation and growth contributed to the superior adjustment that optimists experienced.