New York City Department of Health and Mental Hygiene

OBJECTIVE Pet ownership among people experiencing homelessness (PEH) is common, but access to shelter, veterinary care, and flea-preventative products for PEH who own pets in the US is not well described. We sought to evaluate current knowledge of fleas and flea-borne diseases and characterize practices around pets and service animals among staff at homeless shelters and outreach organizations METHODS In-person surveys were administered to staff at homeless shelters and on outreach teams in 7 states from August 2022 to April 2023 to evaluate knowledge, attitudes, and practices and to assess homeless shelter/organizational characteristics. RESULTS Surveys were administered to 333 staff members at 60 homeless shelters and among 29 outreach teams. Seventy-eight percent of homeless shelters allowed pets or service animals. Only 2% of homeless shelters and 7% of outreach teams provided veterinary care; 15% of homeless shelters and 7% of outreach teams provided flea preventatives. Nearly three-quarters of surveyed homeless shelter staff responded that no steps were taken to treat fleas at their shelters. CONCLUSIONS Veterinary care and availability of flea-preventative products are limited in homeless shelter and outreach organizations serving people experiencing homelessness. CLINICAL RELEVANCE Pets of PEH might be at an increased risk of flea infestation and flea-borne diseases because of limited access to veterinary care and preventatives. Improving knowledge and access to flea prevention, screening, and treatment are critical to ensure PEH and their pets can consistently access homeless shelters or outreach services, and to prevent flea-borne disease transmission.

The objective of this study was to determine the association between acute and chronic pain and various economic and quality-of-life outcomes. The study sample was drawn from the World Trade Center Health Registry. Both acute and chronic pain were measured in 2020–2021. Logistic regression models were constructed to determine the odds of several economic and quality-of-life variables: early retirement, low household income, decline in household income, quality of life, and not working due to health. Those who had extreme pain in the last four weeks that interfered with normal work had 3.12 (95% confidence interval (CI): 2.36, 4.39) times the odds of early retirement, 5.34 (95% CI: 3.47, 8.21) times the odds of having a household income below USD 50,000, 2.56 (95% CI: 1.51, 4.33) times the odds of having an income decrease, and 14.4 (95% CI: 11.3, 18.3) times the rate of poor health days compared to those with no pain. Similar results were found for chronic pain. The detrimental effects of pain may influence multiple facets of a patient’s life, and both financial and overall well-being may diminish even several years after a pain diagnosis.

Background Despite accounting for approximately 20% of new HIV diagnoses in the United States, cisgender women are consistently under-represented and under-engaged in HIV prevention services such as HIV testing and pre-exposure prophylaxis (PrEP). Black and Latina cisgender woman (BLCW) are disproportionately impacted by HIV, and face additional barriers to accessing prevention services due to racial/ethnic bias, sexism, and their intersection. Offering self-testing for sexually transmitted infections (STIs) and HIV is one potential strategy for increasing access to—and engagement in—preventative sexual health care among BLCW. Methods We conducted a study in consultation with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and their collaborators in order to identify preferences for sexual health kits—including HIV and STI tests—among BLCW in New York City. Results We assessed the extent to which BLCW would be willing to accept and use HIV and STI self-testing. Additionally, we identified the components of potential sexual health kits that would make them most attractive and would most increase the reach of a sexual health kit program in NYC. Finally, we examined differences in acceptability and preferences (by demographic factors, sexual behavior, and past service utilization) that may impact the development of future programs and interventions. Conclusions Self-testing for STIs and HIV represents a promising strategy for engaging BLCW in preventative sexual health services and increasing access to care.

Background Despite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI. Methods Eighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation. Results Important facilitators to implementation included: lived experience of CHWs, as well as NYC HJN’s voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication. Conclusions Findings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16–24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from “not IPS” to “exemplary,” on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment) item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

Public knowledge and awareness about radiation (both natural and manmade) tend to be low, while perceived risk of radiation tends to be high. High perceptions of risk associated with radiation have been linked to the affect heuristic and general feelings of dread, which are often not proportionate to actual risk. For example, studies routinely show that members of the public rate the risk of radiation from nuclear power plants as significantly higher (and riskier) than radiation from medical X‐rays. This disconnect can have implications for adoption of protective actions during a potential radiation emergency and the perceived efficacy of these actions. This study explores how risk communication efforts influence public risk perceptions, intended protective action, and perceived efficacy of those actions. Using unique data from a survey of New York City adults, we analyze how information provision using different formats—no information, an infographic, an informational video—impact perceptions and response to a hypothetical radiation emergency. We hypothesize that respondents who receive some information, either through the infographic or the video, will have higher perceived efficacy and are more likely to take protective action. Findings suggest that providing information about what to do during a radiation emergency has a statistically significant impact on both perceived efficacy and adoption of protective action. Respondents who saw the informational video were most likely to say that they would take the correct protective actions and had the highest perceived efficacy, followed by those who saw the infographic.

OBJECTIVES Previous analyses of New York City (NYC) health department’s lead registry indicated that, among children with lead poisoning, an increased prevalence of sickle cell disease (SCD) exists. However, SCD is not considered a risk factor for lead poisoning. We assessed the association between SCD and childhood lead poisoning to determine if specific lead poisoning prevention efforts are needed for children with SCD. METHODS We analyzed NYC’s lead registry data for children with venous blood lead levels (BLLs) ≥15 mcg/dL during 2005 to 2019. t tests and χ2 tests were performed to compare demographic characteristics, BLLs, and lead exposure risks in non-Hispanic Black children with and without SCD. A t test was used to compare observed SCD prevalence among Black children with BLLs ≥15 mcg/dL with an estimated 0.43% SCD prevalence among Black NYC children. RESULTS Among 1728 Black children with BLLs ≥15 mcg/dL identified, 37 (2.14%) had SCD. When comparing children with and without SCD, both mean age at peak BLL (62.8 versus 42.7 months; P = .003) and peak BLL (42.59 versus 23.06 mcg/dL; P = .008) were higher for children with SCD. Among risk factors for lead exposure, children with SCD had higher prevalence of pica. Observed SCD prevalence was 1.71% higher than estimated SCD prevalence among Black NYC children (P < .001). CONCLUSIONS We found a potential association between SCD and childhood lead poisoning. Pica emerged as a potentially important risk factor. Our findings might have implications for lead poisoning prevention guidelines for children with SCD.

OBJECTIVES We aimed to describe the characteristics of traditional eye cosmetics and cultural powders, including the types, lead concentrations, origin, and regional variation in product names, and assess the differences in blood lead levels (BLLs) between product users and non-users. METHODS We analyzed 220 samples of traditional eye cosmetics and cultural powders collected in New York City between 2013 and 2022 during lead poisoning investigations and store surveys. We compared the BLLs of children who used these products with those of non-users. RESULTS Lead levels in traditional eye cosmetics surma and kohl were much higher than levels in kajal and other cultural powders. Although the terminologies surma, kohl, and kajal are often used interchangeably, findings suggest regional variations in the product names. The majority of the surma in this study were from Pakistan, kohl was from Morocco, and kajal was from India. The results also show that these products can contribute to elevated BLLs in children. CONCLUSIONS Our study reveals that traditional eye cosmetics and cultural powders are used among children as young as newborns, and exposure to these products can significantly add to their lead body burden. The study findings also reveal that lead concentrations in these products can vary by product type and product names can vary by region. Public health officials must be cognizant of these unique variations and use culturally appropriate terminologies for these types of products because such distinctions can be critical when conducting risk assessments, risk communication, and risk reduction activities.

TB is a priority pathogen for the application of whole-genome sequencing (WGS) into routine public health practice. In low-incidence settings, a growing number of services have begun to incorporate routine WGS into standard practice. The increasing availability of real-time genomic information supports a variety of aspects of the public health response, including the detection of drug resistance, monitoring of laboratory and clinical practices, contact tracing investigations and active case finding. Optimal structures and approaches are needed to support the rapid translation of genomic information into practice and to evaluate outcomes and impact. In this consensus paper, we outline the elements needed to systemically incorporate routine WGS into the TB public health response, including the sustainability of services, multidisciplinary team models and monitoring and evaluation frameworks. If integrated in an efficient and thoughtful manner, routine WGS has the potential to significantly improve clinical TB care for individuals and the overall public health response.

Importance Sodium nitrite is a curing agent increasingly used for self-harm and suicide, and multiple locales have reported increasing cases. However, approaches to forensic investigation of these cases are not standardized, and current modes of surveillance in the United States may be inadequate. Objective To define a potential standard approach for identifying sodium nitrite deaths based on forensic confirmation, and compare findings based on this standard to poison center surveillance. Design, Setting, and Participants This retrospective case series of sodium nitrite exposures and deaths was conducted in 2 urban medical examiner jurisdictions in New York State from 2000 to 2022. The population-based sample included individuals from (1) medical examiner reports of decedents where the cause of death was sodium nitrite and (2) poison center reports of intentional exposures to sodium nitrite. Exposure Sodium nitrite as either cause of death (medical examiner reports) or intentional exposure (poison center reports). Main Outcomes and Measures Medical examiner determination of sodium nitrite deaths was considered the criterion standard and relied largely on confirmatory blood nitrite testing. Poison center records were assessed for intentional exposures to sodium nitrite. Results In this case series of 36 decendents, median (range) age was 28 (20-57) years; 23 (63.8%) were male; 6 (16.7%) were African-American, 5 (13.9%) were Chinese, 13 (36.1%) were White, and 4 (11.1%) had unknown race; and 6 (16.7%) were Hispanic. No deaths were found from 2000 to 2018, and yearly increases in deaths from 2019 to 2022; these deaths were largely missed by local poison center surveillance. Most cases (83.3% [n = 30]) had postmortem blood nitrite concentrations available, and multiple decedents had evidence of suicide kit recommendations from internet sources. Conclusions and Relevance In this case series of decedents in 2 New York medical examiner jurisdictions, sodium nitrite deaths increased yearly, and the medical examiners were able to obtain confirmatory nitrite concentrations in most cases. These findings suggest that poison center surveillance underestimates confirmed deaths from sodium nitrite; public health authorities should rely on multiple data sources when analyzing this problem, and forensic analyses should be standardized.

Introduction People living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi‐month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication. Methods We conducted a cross‐sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio‐demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year. Results We surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3‐month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0−1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1‐ to 3‐month dispensing vs. 28% with 4‐month dispensing vs. 40% with 6‐month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self‐reported adherence to blood pressure medications (89% missing 0−1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year. Conclusions Uncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.

Background The Manhattan Lupus Surveillance Program (MLSP), a population-based retrospective registry of patients with systemic lupus erythematosus (SLE), was used to investigate the prevalence of cardiovascular disease events (CVE) and compare rates among sex, age and race/ethnicity to population-based controls. Methods Patients with prevalent SLE in 2007 aged ≥ 20 years in the MLSP were included. CVE required documentation of a myocardial infarction or cerebrovascular accident. We calculated crude risk ratios and adjusted risk ratios (ARR) controlling for sex, age group, race and ethnicity, and years since diagnosis. Data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES) and the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) were used to calculate expected CVE prevalence by multiplying NHANES and NYC HANES estimates by strata-specific counts of patients with SLE. Crude prevalence ratios (PRs) using national and NYC estimates and age standardized prevalence ratios (ASPRs) using national estimates were calculated. Results CVE occurred in 13.9% of 1,285 MLSP patients with SLE, and risk was increased among men (ARR:1.7, 95%CI:1.2–2.5) and older adults (age > 60 ARR:2.5, 95%CI:1.7–3.8). Compared with non-Hispanic Asian patients, CVE risk was elevated among Hispanic/Latino (ARR:3.1, 95%CI:1.4-7.0) and non-Hispanic Black (ARR:3.5, 95%CI1.6-7.9) patients as well as those identified as non-Hispanic and in another or multiple racial groups (ARR:4.2, 95%CI:1.1–15.8). Overall, CVE prevalence was higher among patients with SLE than nationally (ASPR:3.1, 95%CI:3.0-3.1) but did not differ by sex. Compared with national race and ethnicity-stratified estimates, CVE among patients with SLE was highest among Hispanics/Latinos (ASPR:4.3, 95%CI:4.2–4.4). CVE was also elevated among SLE registry patients compared with all NYC residents. Comparisons with age-stratified national estimates revealed PRs of 6.4 (95%CI:6.2–6.5) among patients aged 20–49 years and 2.2 (95%CI:2.1–2.2) among those ≥ 50 years. Male (11.3, 95%CI:10.5–12.1), Hispanic/Latino (10.9, 95%CI:10.5–11.4) and non-Hispanic Black (6.2, 95%CI:6.0-6.4) SLE patients aged 20–49 had the highest CVE prevalence ratios. Conclusions These population-based estimates of CVE in a diverse registry of patients with SLE revealed increased rates among younger male, Hispanic/Latino and non-Hispanic Black patients. These findings reinforce the need to appropriately screen for CVD among all SLE patients but particularly among these high-risk patients.

Surveillance systems that monitor pathogen genome sequences are critical for rapidly detecting the introduction and emergence of pathogen variants. To evaluate how interactions between surveillance capacity, variant properties, and the epidemiological context influence the timeliness of pathogen variant detection, we developed a geographically explicit stochastic compartmental model to simulate the transmission of a novel SARS-CoV-2 variant in New York City. We measured the impact of (1) testing and sequencing volume, (2) geographic targeting of testing, (3) the timing and location of variant emergence, and (4) the relative variant transmissibility on detection speed and on the undetected disease burden. Improvements in detection times and reduction of undetected infections were driven primarily by increases in the number of sequenced samples. The relative transmissibility of the new variant and the epidemic context of variant emergence also influenced detection times, showing that individual surveillance strategies can result in a wide range of detection outcomes, depending on the underlying dynamics of the circulating variants. These findings help contextualize the design, interpretation, and trade-offs of genomic surveillance strategies of pandemic respiratory pathogens.

Adoption of electric stoves and rooftop solar can reduce fossil-fuel reliance and improve health by decreasing indoor air pollution and alleviating energy insecurity. This study assessed prevalence and perceptions of these clean-energy technologies to increase adoption in New York City (NYC). A representative survey of 1950 NYC adults was conducted from February 28 to April 1, 2022. Fourteen percent of people had an electric stove; 86% had gas stoves. Black, Latino/a, and lower-income residents were more likely to have electric stoves than White and higher-income residents. Only 14% of residents were interested in switching from gas to electric stoves. Of the 71% with gas stoves uninterested in switching, nearly half (45%) preferred gas cooking, particularly among White and higher-income residents, indicating a large opportunity to shift preferences. About 5% used solar for their home or building; another 77% were interested in solar. Of the 18% uninterested in solar, reasons included lack of agency, confusion about operation, and costs. Education about health and cost benefits, induction technology, how to transition, available subsidies, and other efforts to reduce adoption barriers can support clean technology uptake. Residential clean energy metrics should be tracked regularly to ensure that technology adoption proceeds equitably.

Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV, yet it is underutilized among women. The current study aims to evaluate the awareness, attitudes, and perceptions of PrEP among a large survey sample of Black and Latina women in New York City (NYC). Interviewer-administered surveys were conducted in high HIV incidence neighborhoods in NYC among Black, Latina, and Afro-Latina women who reported recent sex with a man in 2017 (n = 398) and 2018 (n = 405). About 40% of participants were aware of PrEP, whereas 30.4% indicated interest in using it. The top reason for not utilizing it was low HIV risk perception. However, most participants supported the idea that using PrEP meant asserting control over their health (94.1%). Primary care providers and obstetricians/gynecologists were participants' preferred sources for PrEP (91.6%). Across survey cycles, compared to non-Black Latina participants, Black participants had significantly higher PrEP awareness (44.4% vs. 29.1%). PrEP awareness was also significantly higher among survey participants in 2018 (45.2%) than in 2017 (34.3%). Less than half of the participants were aware of PrEP, but those who were aware expressed largely positive attitudes toward the medication. Our findings may inform future PrEP implementation strategies to optimize awareness and access to PrEP among women disproportionately affected by HIV, like focusing on personal empowerment instead of risk-based messaging and training women's sexual health care providers in PrEP provision.

Importance Subclinical hyperglycemia before pregnancy may be associated with the likelihood of maternal morbidity but is understudied among young people. Objective To explore the association of preconception hemoglobin A 1c (HbA 1c ) levels among adolescents and young adults with risk of gestational diabetes at first live birth. Design, Setting, and Participants This retrospective cohort study used linked 2009 to 2017 birth registry, hospital discharge, and New York City Department of Health A1C Registry data for birthing individuals aged 10 to 24 years with no history of diabetes and at least 1 preconception HbA 1c test in New York, New York. Statistical analysis was performed from August to November 2022. Exposure Preconception HbA 1c values categorized as no diabetes (HbA 1c <5.7%) or prediabetes (HbA 1c ≥5.7% to <6.5%). Main Outcomes and Measures The primary outcome was gestational diabetes at first birth. Secondary outcomes included hypertensive disorders of pregnancy, preterm birth, cesarean delivery, and macrosomia. Log binomial regression was used to estimate the relative risk (RR) of gestational diabetes at first birth by preconception HbA 1c level, adjusting for prepregnancy characteristics. The optimal HbA 1c threshold for gestational diabetes was examined using receiver operating curve regression. Results A total of 14 302 individuals (mean [SD] age, 22.10 [1.55] years) met study eligibility criteria. Of these, 5896 (41.0%) were Hispanic, 4149 (29.0%) were Black, 2583 (18.1%) were White, 1516 (10.6%) were Asian, and 185 (1.3%) had other or unknown race and ethnicity. Most (11 407 individuals [79.7%]) had normoglycemia before pregnancy, and 2895 individuals (20.2%) had prediabetes. Adjusting for prepregnancy characteristics, those with preconception prediabetes had more than twice the risk of gestational diabetes vs those with normoglycemia (adjusted RR [aRR], 2.21; 95% CI, 1.91-2.56). Preconception prediabetes was associated with small increases in the likelihood of a hypertensive disorder of pregnancy (aRR, 1.18; 95% CI, 1.03-1.35) and preterm delivery (aRR, 1.18; 95% CI, 1.02-1.37). The aRRs for cesarean delivery (aRR, 1.09; 95% CI, 0.99-1.20) and macrosomia (aRR, 1.13; 95% CI, 0.93-1.37) were increased but not statistically significant. The optimal HbA 1c threshold to identify gestational diabetes among adolescents and young adults was 5.6%. The threshold did not vary by obesity status but was slightly lower among Hispanic individuals (HbA 1c of 5.5%). Conclusions and Relevance In this study of adolescents and young adults with at least 1 preconception HbA 1c test, prediabetes was associated with increased likelihood of maternal cardiometabolic morbidity at first birth. Efforts to optimize cardiometabolic health before pregnancy may avert excess maternal risk.

Introduction There are well‐documented racial and ethnic disparities in mortality after cancer in the general population, but less is known about whether disparities also exist in disaster‐exposed populations. Methods We conducted a longitudinal cohort study of 4341 enrollees in the World Trade Center Health Registry (WTCHR) with a first‐ever primary invasive cancer diagnosis after 9/11/2001 and followed through 2020. We examined associations of race and ethnicity with all‐cause mortality risk and cause‐specific mortality risk using multivariable Cox proportional hazards regression models and Fine and Gray's proportional sub‐distribution hazards models, respectively. Models were adjusted for baseline characteristics and tumor characteristics. We also examined models further adjusted for socioeconomic status (SES), and we used inverse odds weighting to formally test for mediation by SES. Results Compared to non‐Hispanic White enrollees with cancer, non‐Hispanic Blacks had higher risks for all‐cause mortality (adjusted hazard ratio (aHR) = 1.20, 95% CI = 1.02–1.41) and non‐cancer mortality (aHR = 1.48, 95% CI = 1.09–2.01) in the full model. In the model without SES, Hispanic enrollees with cancer had higher risks for all‐cause mortality (aHR = 1.32, 95% CI = 1.09–1.60) and cancer mortality (aHR = 1.31, 95% CI = 1.05–1.64) compared to non‐Hispanic Whites; these associations became not statistically significant in the full model. In the inverse odds weighting analysis, SES explained 24% and 29% of the disparity in all‐cause mortality risk observed in non‐Hispanic Blacks and Hispanics, respectively, compared to non‐Hispanic Whites. Conclusion This study found that there are racial and ethnic disparities in mortality after cancer in the WTCHR. Additional studies are needed to further explore the factors mediating these disparities.