YouTube as a Source of Information on Air Pollution: Significance for Community Health.

Air pollution is a pervasive global public health threat. The purpose of this study was to assess the content of 100 widely viewed English language YouTube videos on air pollution using the search term 'air pollution.' Content categories were created using comprehensive fact sheets and were coded as being present or not in each video. Cumulatively, the 100 videos sampled received 32,826,294 views and 303,692 likes, with averages of 328,263 and 3,068 respectively. The majority of videos (n = 72) were created by broadcast or internet-based news, 12 of the videos were created by professionals, 7 were created by a consumer and 9 were created by others. Three kinds of content were featured in a majority (> 50%) of the videos: "sources of pollution," "environmental impacts," and "solutions offered" and the videos covering each of these topics collectively garnered more than 26 million views and 249,000 likes. Independent one-tailed t-tests (α = 0.05) showed an association between covering sources of pollution and the number of views and likes. For both, videos featuring this content had a higher average number of views (467,391.08 vs. 80,924.03, p = .0383) and likes (4,450.78 vs. 647.03, p = .0383). Additionally, videos showing environmental impacts received more views than those that did not (547,901.49 vs. 80,585.43, p = .0373). This research can serve as a starting point to describe information being conveyed about an important global public health problem. Future research is needed to improve understanding about ways to utilize YouTube and other social media for public health education and advocacy to increase consumers' awareness and facilitate the informed decision-making process.

Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study.

BACKGROUND: Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. OBJECTIVE: Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. METHODS: We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities. RESULTS: Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. CONCLUSIONS: The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.

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.

Debate in Public Versus Independent Secondary Schools in New York City: Post-COVID-19 Health literacy and Equal Access to Basic Educational Opportunities.

Speech and debate (referred to hereafter as debate) has the potential to play an integral role in increasing the health literacy of secondary school students, yet we did not identify published studies examining the prevalence of debate programs in public and independent secondary schools. The purpose of this study was to describe the presence of debate in a probability sample of public and independent secondary schools in New York City (NYC) and explore whether there were differences in the availability of debate programs when schools were classified based on public versus independent status, school enrollment, borough location, and proportion of non-white students enrolled. The sampling frame was constructed using NYC Open Data for the public schools and the publicly available membership directory of the New York State Association of Independent Schools. This cross-sectional study included a ~ 30% random sample comprising 255 public and 17 independent secondary schools. To identify whether schools offered debate programs, school websites were reviewed and follow-up calls were conducted to verify the information online. Independent one-tailed t-tests (a = 0.05), showed that access to a debate program was associated with public/independent status (p = .0000), larger enrollment (p = .0046), borough location (p = .0392), and proportion of non-white students enrolled (p = .0000). Schools with a higher proportion of non-white students were less likely to offer debate programs. Compared with students in public schools, students attending independent schools were more than three times as likely to have debate opportunities. These findings have implications for health literacy and educational equity.

Social Media, Public Health, and Community Mitigation of COVID-19: Challenges, Risks, and Benefits.

Shortly after the first case reports in 2019, COVID-19 was declared a pandemic. Early messages from trusted experts, which later proved to be inadequate or incorrect, highlight the need for continual adjustment of messages to the public as scientific knowledge evolves. During this time, social media exploded with greatly sought-after information, some of which was misinformation based on incomplete or incorrect facts or disinformation purposefully spread to advance a specific agenda. Because of the nature of social media, information, whether accurate or not at the time posted, lives on and remains accessible to the public even when its usefulness has been discredited. While the impact of mis/disinformation on COVID-19 risk-reducing behaviors is debatable, it is clear that social media has played a significant role in both extending the reach of COVID-19-related falsehoods and promoting evidence-based content. Over the last decade, social media has become a dominant source of information that consumers turn to for health information. A great deal of misinformation and disinformation has reached large numbers of social media users, which points to a need for the agencies of the US Public Health Service to create communications to convey accurate and current information and appeals that will actually be viewed. This viewpoint highlights the challenges, risks, and potential benefits that social media present in mitigating the COVID-19 pandemic.

DNA testing information on YouTube: Inadequate advice can mislead and harm the public.

Direct-to-consumer (DTC) DNA (i.e., genetic) testing has become very popular, with close to 30 million Americans having used these services. The 100 most widely viewed DNA YouTube testing videos were analyzed to determine whether they are providing adequate information for consumers. The top 100 videos had more than 300 million cumulative views, showing the popularity and reach of the information source. While many videos addressed the specimen collection process, family roots and ancestry, and the prospect of uncovering unexpected information about family or health leading to possible distress, almost none of the videos addressed accuracy or confidentiality issues, which are major issues of DNA testing. It is recommended that further information on those issues be made readily available, and more vigilant oversight by regulatory agencies be implemented. Such oversight should include monitoring what information is and is not readily provided by each company, and the veracity of information being communicated to existing and prospective consumers. We also recommend that for medical issues, clinical genetic testing, along with genetic counseling by genetic counselors, be the method of choice.

Coverage of Transmission of COVID-19 Information on Successive Samples of YouTube Videos.

Mitigating transmission of SARS-Co-2 virus is critical to stopping the COVID-19 pandemic. Messages about the pandemic on YouTube reach millions of people and should be a part of a more comprehensive strategy for educating the public to reduce transmission. We examined successive samples of the 100 most widely viewed YouTube videos regarding COVID-19 at three time points between January and June 2020 and examined characteristics of videos that specifically mentioned COVID-19 transmission. We described the cumulative and mean number of views, video length, and video source and assessed differences across the samples. Historical events and confirmed worldwide cases are compared with cumulative views of videos mentioning disease transmission over time. Across the three successive samples, views for all videos increased from ~ 125 million to over 560 million views, and from ~ 63 million to more than 273 million for those videos specifically mentioning disease transmission, respectively. This increase coincided with the increase in the worldwide number of cases and the occurrence of COVID-19 transmission informational milestones. Despite its importance for community mitigation, the majority of the widely viewed videos we sampled did not specifically mention disease transmission. Because of its very widespread reach, YouTube can be an effective way to communicate with the public, especially to those who have lower levels of reading literacy and who may be inclined to search for information on YouTube. Greater efforts are needed to more fully realize the potential of YouTube for educating the public about COVID-19 transmission.

Protocol for a family-centered behavioral intervention to reduce early childhood caries: the MySmileBuddy program efficacy trial.

BACKGROUND: Although largely preventable through diet management and topical fluoride use, early childhood caries (ECC) often progresses to severity that necessitates surgical repair. Yet repair often fails to mitigate caries progression. Needed is an effective behavioral intervention to address underlying behavioral causes. METHODS: This randomized controlled trial will evaluate the efficacy of a behaviorally focused, family-centered intervention, the MySmileBuddy Program (MSB Program), to reduce ECC progression in high-risk preschoolers in New York City. Recruitment will target 858 children ages 24-71 months with ECC and their parents from primary care medical and dental clinics. The study aims to assess the MSB Program's efficacy to: (1) decrease ECC progression measured 12-months post-randomization; and (2) enhance adoption of a low cariogenic diet and twice-daily fluoridated toothpaste use compared to control group. Potential causal pathways (mediators and moderators) will be explored. The MSB Program equips community health workers (CHWs) with an app that facilitates multilevel risk assessment and provides motivational interviewing-based counseling to inform parents about the caries process, develop personalized goals, and create family-level action plans to achieve targeted behaviors. Social support from CHWs (4 interactions during the 6-month intervention, supplemented by up to 4 in-person/remote contacts throughout the 12-month study period, based on need) is bolstered by automated text messages. Participants will be randomized to a Control Group (paper-based educational handout plus toothbrushes and fluoridated toothpaste for the child) or Intervention Group (MSB Program, two tooth-brushing observations with feedback and instruction, and toothbrushes and toothpaste for the entire family). All children will receive visual ICDAS dental examinations and parents will complete study measures at baseline and 12-months. An incentive up to $150 plus round-trip transit cards ($5.50 value) will be provided. DISCUSSION: This study hypothesizes that the MSB Program can reduce ECC progression in a high-risk population. Sufficient incentives and a focus on establishing rapport between participants and CHWs are anticipated to mitigate recruitment and retention challenges. If successful, this study will advance the long-term goal of reducing pediatric oral health disparities by demonstrating the efficacy of an acceptable and feasible intervention that shifts attention from dental repair to behavioral risk mitigation. TRIAL REGISTRATION: Trial registration was completed on 4/13/2021 through the U.S. National Library of Medicine ClinicalTrials.gov website (Identifier: NCT04845594).

Incidental Alcohol Appearances in Advertisements on City Buses in Manhattan, New York City: A Descriptive Study.

This paper describes incidental exposure to alcohol in advertisements on buses in Manhattan, New York City. From April to July 2019, researchers observed advertisements on all bus lines in Manhattan and coded the content of these advertisements, including the kinds of products and services advertised and whether alcoholic beverages or images were present. Despite a ban on direct alcohol beverage advertising within the Metropolitan Transit Authority in 2017 (and expanded in 2019), almost one in five of the 136 advertisements observed (n = 25) included incidental exposure to images of alcohol portrayed in a favorable way and/or associated with well-known movie stars and television personalities. Advertisements on city buses are unlike any other, as they traverse the city streets and create considerable exposure to residents, including youth. This study demonstrates that banning advertisements for alcohol will not necessarily restrict favorable images containing alcohol and that youth continue to be exposed to these images.

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.

Fear as a Barrier to Asymptomatic Colonoscopy Screening in an Urban Minority Population with Health Insurance.

This study identified barriers to colonoscopy in a high-risk population and examined associations between barriers and both intention to comply with physician recommendation to receive colonoscopy and documented receipt of colonoscopy. Participants, enrollees in a randomized controlled trial assessing the effectiveness of educational interventions to promote colorectal cancer screening, were all 50+ years old and out of compliance with recommended screening guidelines. Direct financial cost of the procedure was not a barrier. The most commonly cited barriers were being afraid of the colonoscopy procedure (43.1 %), embarrassment (42.3 %), having to take a powerful laxative (36.2 %), fear of cancer (31.2 %), and fear of sedation (30.3 %). There were dose-response relationships between barriers and both intention to comply with physician recommendation of colonoscopy: 0, 1, 2, 3 barriers, 88.9, 79.0, 69.2 and 60.0 % intending to comply, respectively (linear trend χ(2) = 27.9, p = .000) and documented receipt of a colonoscopy: 0, 1, 2, 3 barriers, 21.7, 21.6, 8.5, 12.0 %, respectively (linear trend χ(2) = 8.4, p = .004). Only 6.9 % of the 102 expressing both fear of procedure and concern about taking a powerful laxative had a colonoscopy. These findings highlight the need to address patients' fear and suggest the importance of offering alternative colorectal cancer screening tests. ClinicalTrials.gov Identifier: NCT02392143.

Failure of Colonoscopy Knowledge to Predict Colonoscopy Uptake.

UNLABELLED: Despite an increase in colorectal cancer screening uptake, a substantial minority of individuals over 50 years of age remains unscreened. In the context of an RCT evaluating three educational interventions to increase CRC screening uptake, we examined the relationship of baseline colonoscopy knowledge and both intention to receive a colonoscopy and documented receipt of colonoscopy. Colonoscopy knowledge score, generally high, was positively associated with intention to receive colonoscopy but not with receipt of colonoscopy within 1 year post-randomization. Knowledge score was, however, positively associated with certain perceived barriers to colonoscopy: embarrassment and having to take a powerful laxative. CONCLUSION: Knowledge is not sufficient to trigger colonoscopy uptake. If CRC screening promotion campaigns fail to acknowledge and address patients' emotional barriers to colonoscopy, CRC screening rates will not improve. CLINICAL TRIALS: gov: Identifier: NCT02392143.

Glove Changing When Handling Money: Observational and Microbiological Analysis.

The purpose of this study was to determine the rate of glove changing by mobile food vendors after monetary transactions, and the presence of bacterial contamination on a sample of dollar bills obtained from 25 food vendors near five hospitals in Manhattan, New York City. During 495 monetary transactions observed there were only seven glove changes performed by the workers. Eleven of 34 food workers wore no gloves at all while handling money and food. Nineteen of 25 one-dollar bills collected (76 %) had 400 to 42,000 total bacterial colony-forming units. Colonies were of varied morphology and size. Of these 19 samples, 13 were selected (based on level of growth), and tested for the presence of coliform bacteria, which was found in 10 of the 13 samples. Effective strategies to monitor and increase glove wearing and changing habits of mobile food vendors are needed to reduce risk of foodborne illness.

Patient Test Preference for Colorectal Cancer Screening and Screening Uptake in an Insured Urban Minority Population.

The study examines the role of patient colorectal cancer (CRC) screening test preference and CRC screening uptake in an insured, urban minority population. Study subjects were enrolled in a randomized controlled trial to promote CRC screening. The interventions were educational, with an emphasis on colonoscopy screening. Subjects were 50+ years of age, fully insured for CRC screening, and out of compliance with current CRC screening recommendations. This paper includes those who answered a question about CRC screening test preference and indicated that they intended to receive such a test in the coming year (n = 453). CRC screening uptake was ascertained from medical claims data. Regardless of test preference, few received CRC screening (22.3 %). Those preferring the home stool test (HST) were less likely to get tested than those preferring a colonoscopy (16.6 vs 29.9 %, χ(2) = 9.9, p = .002). Preference for HST was more strongly associated with beliefs about colonoscopy than with knowledge about colonoscopy. In the context of an RCT emphasizing colonoscopy screening for CRC, patients expressing a preference for HST are at heightened risk of remaining unscreened. Colonoscopy should be recommended as the preferred CRC test, but HSTs should be accessible and encouraged for patients who are averse to colonoscopy.Clinical trials.gov: Identifier: NCT02392143.

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.

Glove Changing Habits in Mobile Food Vendors in New York City.

The aim of this study was to determine how often mobile food cart vendors in New York City (NYC) changed gloves after exchanging money, which is required by the current NYC health code as one of various measures to prevent foodborne illness. A total of 100 carts (10 carts in 10 zones) throughout Manhattan were observed. In the majority (56.9%, n = 1,026) of the 1,804 money exchanges, food cart vendors did not change their gloves. Not changing gloves after exchanging money was widespread regardless of food type served (46.6% for breakfast to 63.7% for lunch), and across all 10 zones. Not changing gloves after touching money may result in indirect transmission of agents of disease and pose health risks for consumers.

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.

Diet-Related Colorectal Cancer Prevention Beliefs and Dietary Intakes in an Urban Minority Population.

In the United States, colorectal cancer (CRC) is the third leading cause of cancer-related death and third most commonly diagnosed cancer among adults. This study is the first to examine the relationship between diet-related beliefs for colorectal cancer prevention and dietary intake among an urban, predominantly Black population (n = 169). More than two-thirds reported diet-related CRC prevention beliefs. Those with diet-related CRC prevention beliefs had healthier intakes for dietary fiber (p = .005), fruit, vegetable, bean (p = .027), red meat (p = .032), vitamin C (p = .039), and cholesterol (p = .045). Most people may already have diet-related CRC prevention beliefs and having them is associated with a more healthful dietary intake.

A Randomized Trial to Compare Alternative Educational Interventions to Increase Colorectal Cancer Screening in a Hard-to-Reach Urban Minority Population with Health Insurance.

This randomized controlled trial assessed different educational approaches for increasing colorectal cancer screening uptake in a sample of primarily non-US born urban minority individuals, over aged 50, with health insurance, and out of compliance with screening guidelines. In one group, participants were mailed printed educational material (n = 180); in a second, participants' primary care physicians received academic detailing to improve screening referral and follow-up practices (n = 185); in a third, physicians received academic detailing and participants received tailored telephone education (n = 199). Overall, 21.5% of participants (n = 121) received appropriate screening within one year of randomization. There were no statistically significant pairwise differences between groups in screening rate. Among those 60 years of age or older, however, the detailing plus telephone education group had a higher screening rate than the print group (27.3 vs. 7.7%, p = .02). Different kinds of interventions will be required to increase colorectal cancer screening among the increasingly small population segment that remains unscreened. ClinicalTrials.gov Identifier: NCT02392143.