Legacies of Punishment Vulnerability: Revisiting the Seven Neighborhoods Study

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p=0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I=0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.

1593 Background: Disparities in stage at diagnosis among melanoma patients are often seen between urban and rural communities, with patients in rural areas being diagnosed with more advanced tumors. Factors contributing to the disparities include decreased access to dermatologists in rural areas, and lower socioeconomic status (SES). We investigated urban disparities in melanoma T stage at diagnosis among patients residing in 2 New York City (NYC) neighborhoods of differing SES and receiving care within the NYU Langone Health System. The neighborhoods were: Upper East Side (UES) and Brighton Beach/Coney Island (BB/CI). Methods: We conducted a retrospective chart review (NYU IRB 23-01020) of melanoma patients (N=243) diagnosed from 2018-2022 using ICD-10-CM codes: C43 (malignant melanoma of skin); D03 (melanoma in situ); and Z85.820 (personal history of malignant melanoma of skin). For community-level data we used the American Academy of Dermatology’s “Find a Dermatologist” search function to locate member-dermatologists; New York State Cancer Registry data (2016-2020) to determine annual melanoma incidence; and the United States Census Bureau Public Use Microdata Areas to determine the proportion of Non-Hispanic Whites (NHW), income levels, and educational attainment. The distribution of T stages was compared using a chi-square test. A two-sample test was used to assess equality of proportions. Results: In UES, the annual melanoma incidence was 30.2/100,000 (95% CI: 27.4-33.2); NHW comprised 74.6% of the population; the median household income was $135,820; 78% attained education higher than high school; and there are 190 dermatologists within a 0.5-mile radius. In BB/CI the annual melanoma incidence was 14/100,000 (95% CI: 11.6-16.9); NHW comprised 55.1% of the population; the median household income was $43,118; 46% attained education higher than high school; and there is 1 dermatologist within a 0.5-mile radius. There are 15 dermatologists within a 3.0-mile radius. 155 and 88 patients met inclusion criteria in UES and BB/CI respectively. The distribution of T stages (i.e. Tis to T4) was significantly different between UES and BB/CI with higher proportions of advanced stage tumors in BB/CI (p=0.0002). Specifically, the proportion of (T2+T3+T4) tumors/total melanomas was 35/155 (23%) in UES; and 41/88(47%) in BB/CI (p<0.0001). For reference, the proportion of T2+T3+T4 melanomas in the United States is 30%. Conclusions: We identified substantial disparities in the initial presentation of melanoma in 2 NYC neighborhoods, with proportionately more advanced stage tumors in the community of low educational attainment, less access to dermatologic services, and lesser household income. Neighborhood-based approaches to uncover melanoma disparities can identify areas for community outreach and engagement efforts to improve melanoma awareness and access to dermatologic care.

Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke® or Pepsi®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.

Background: The role of neighborhood factors in the association between adverse childhood experiences (ACEs) and body mass index (BMI) has not been widely studied. A neighborhood ACEs index (NAI) captures neighborhood environment factors associated with ACE exposure. This study examined associations between BMI and an NAI among New York City (NYC) youth. An exploratory objective examined the NAI geographic distribution across NYC neighborhoods. Methods: Data for students attending NYC public general education schools in kindergarten-12th grade from 2006-2017 (n = 1,753,867) were linked to 25 geospatial datasets capturing neighborhood characteristics for every census tract in NYC. Multivariable hierarchical linear regression tested associations between BMI and the NAI; analyses also were conducted by young (<8 years), school age (8-12 years), and adolescent (>12 years) subgroups. In addition, NAI was mapped by census tract, and local Moran's I identified clusters of high and low NAI neighborhoods. Results: Higher BMI was associated with higher NAI across all sex and age groups, with largest magnitude of associations for girls (medium NAI vs. low NAI: unstandardized β = 0.112 (SE 0.008), standardized β [effect size] = 0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.122 (SE 0.014), standardized β = 0.095, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.217 (SE 0.015), standardized β = 0.187, p < 0.001 for adolescent boys). Each borough of NYC included clusters of neighborhoods with higher and lower NAI exposure, although clusters varied in size and patterns of geographic dispersion across boroughs. Conclusions: A spatial index capturing neighborhood environment factors associated with ACE exposure is associated with higher BMI among NYC youth. Findings complement prior literature about relationships between neighborhood environment and obesity risk, existing research documenting ACE-obesity associations, and the potential for neighborhood factors to be a source of adversity. Collectively, evidence suggests that trauma-informed place-based obesity reduction efforts merit further exploration as potential means to interrupt ACE-obesity associations.

Grocery stores can be an important resource for health and nutrition with the variety and economic value of foods offered. Weekly circulars are a means of promoting foods at a sale price. To date, little is known about the extent that nutritious foods are advertised and prominently placed in circulars. This study’s aim was to compare the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). Circulars from grocery stores in the five highest and five lowest median household income NYC zip codes were analyzed. Nutrition information for food products was collected over a two-month period with a total of 805 products coded. The study found no significant difference between the nutritional quality of products advertised on the front page of online circulars from grocery stores in high- versus low-income neighborhoods in New York City (NYC). In both groups, almost two-thirds of the products advertised were processed, one-quarter were high in carbohydrates, and few to no products were low-sodium, high-fiber, or reduced-, low- or zero fat. Through innovative partnerships with health professionals, grocery stores are increasingly implementing in-store and online health promotion strategies. Weekly circulars can be used as a means to regularly advertise and prominently place more healthful and seasonal foods at an affordable price, particularly for populations at higher risk for nutrition-related chronic disease.

This master’s thesis identifies the potential impacts of planning policies and key stakeholder groups on Red Hook, Brooklyn given current development trends and the neighborhood changes such as gentrification. The premise of this thesis is that through understanding the catalysts and impacts of social and economic change in similar neighborhoods, together with the analysis of current zoning, planning policies, and neighborhood culture and demographics in Red Hook, it is possible to identify how future changes may generate positive outcomes for the neighborhood. A review of planning literature provides a perspective on the disinvestment to reinvestment process seen in many New York City neighborhoods during the second half of the 20th century. The case study research method relying primarily on qualitative data is applied to gain a contextual analysis of the complex urban planning issues in Red Hook. A study of the planning and development impacts on three waterfront neighborhoods in New York City – Battery Park City, the Lower East Side, and Williamsburg – reveals the catalysts of neighborhood change in those neighborhoods and suggests the potential socio-economic impacts of future redevelopment in Red Hook.

Tracking Community Naloxone Dispensing: Part of a Strategy to Reduce Overdose Deaths

Assessment of spatial mobility among young men who have sex with men within and across high HIV prevalence neighborhoods in New York city: The P18 neighborhood study

Health care disparities are introduced at various points along the patient care continuum. This study explores disparities in initial health care access for patients with brain tumor (BT) in New York City (NYC) and New York State (NYS), comparing emergency department (ED) and elective admissions (EA). Using 2010-2020 data from the Statewide Planning and Research Cooperative System of NYS, patients were identified through relevant billing codes. Demographic, socioeconomic, and health care access variables were examined using univariate analysis and logistic mixed effects regression. The data were dichotomized by care location-NYC or NYS- and entry care site, ED vs EA. The cross-sectional study included 48 135 patients. Over the decade, there was a significant decrease in the percentage of patients with BT admitted through the ED ( P < .001) without differences between the 2 cohorts. The NYC cohort (24 283 patients) had a higher proportion of younger, affluent individuals, racial/ethnic minorities, and publicly insured patients ( P < .001). Male sex and older age were significantly associated with ED admissions in both cohorts ( P < .05). Black, Hispanic/Latinx patients, and those with public health insurance were more likely to be admitted through ED ( P < .001). Residing in census tracts within the lowest 3 quartiles was positively associated with ED admission in the NYC but not the NYS cohort ( P < .001). Racial minorities with public insurance who reside in urban areas of low median household income are more likely to access BT care through ED rather than EA. Additional studies are needed to evaluate the impact of proximity to a hospital on access to care in rural areas. This study highlights the opportunities for policy and health care delivery changes to address current inequities.

New York City Panel on Climate Change 2019 Report Chapter 5: Mapping Climate Risk

Men slurp banana pudding from the hips of a black-latex-clad woman lying on atable in a room filled with liquid nitrogen smoke. This is just a single episode inthe culinary life of New York City (Parasecoli, 2009). Elsewhere, a long queue ofAfrican-Americans is patiently waiting for a soup kitchen in Harlem to open. Thetemperature is 35°C in the shade. These two images are at the extreme oppositesof the spectrum of the subject of food.1 The role of food in planning sustainableforms of land use in the United States – and in New York City in particular – isthe theme of this chapter.The culinary culture of New York City mirrors the ethnic and social structureof the population of this metropolis. In other words, you are what you eat. NewYork City is sometimes referred to as a ‘gastropolis’ (gaster is the Ancient Greekword for ‘stomach’), a metropolis where life revolves around eating and being eaten (Hauck-Lawson & Deutsch, 2009; Lee & Audant, 2009; de Silva, 2009). Thisknowledge is essential for planners and designers who want to promote sustainability;the food chain is the key to a more sustainable way of life. Spatial planningcan play an important part in this in terms of design, such as establishing frameworks for combining and separating types of space at various levels of scale. In the state of New York, this primarily occurs at the level of the local community (town, borough), which makes it difficult to keep an eye on the bigger picture (city, county, region, state, metropolitan area, watershed, climate zone). This is just a single observation after a three-month visit to New York City and the Hudson Valley.The investigation described below focuses on a region with a radius of about100 kilometres from downtown Manhattan. This region includes New York City(with its five boroughs of Manhattan, Queens, Brooklyn, the Bronx, and StatenIsland), with a population of more than 8 million, plus another several millionpeople in the New York metropolitan area extending into four or five states. TheHudson Valley, which stretches north from New York City up past Albany, is usedas a sample for this metropolitan area. By selecting this river valley, it is possible to look at conurbations, expanses of water, agricultural fields, meadows, and forests. The Hudson River Valley is part of the metropolitan landscape of New York City. 6292 T&F Sustainable Urban Agriculture and Food Planning.qxp_Royal_A 08/04/2016 10:06 Page 53The label ‘metropolitan landscape’ refers to the fact that land use in this area canonly be indicated by constantly referring to the economic strength, lifestyles andpatterns of behaviour of the residents of the metropolis in question. The metropolis is an economic, social, and political force field, which shapes and moulds the landscape in a constant process of change. In this ontext, ‘landscape’ is seen as a complex of physical characteristics in the environs, which give visual expression to the way people and animals use the land, constructed objects, vegetation, water, and air. A central question in this chapter relates to the way in which the food systemdoes or does not have an impact on the metropolitan landscape. Changes inpatterns of behaviour and land use (which are closely connected to the food chainin New York City and its surroundings) will be examined in detail. Specifically, wewill look at whether there are signs of a change or transition into a more sustainable way of dealing with the environment under the influence of changing ideas about the quality of food. The findings are based on conversations with experts,visual observation, websites, and a study of the literature.2 The motivation for thisexploratory study is the idea that the developments in New York City may provideinspiration for planning and designing the metropolitan landscape in theNetherlands and Western Europe (LaBelle, 2005a).

Distrust in government among people of color is a response to generations of systemic racism that have produced preventable health inequities. Higher levels of trust in government are associated with better adherence to government guidelines and policies during emergencies, but factors associated with trust and potential actions to increase trust in local government are not well understood. The COVID-19 Community Recovery study sampled participants from the New York City (NYC) Department of Health and Mental Hygiene's NYC Health Panel, a probability-based survey panel who complete health surveys periodically. Participants who lived in one of three historically disinvested communities in NYC where the NYC Department of Health and Mental Hygiene has dedicated resources to reduce health inequities were included. The cross-sectional survey was fielded from September 30 to November 4, 2021 and could be self-administered online or conducted via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese (Mandarin and Cantonese by phone). Demographic data were summarized by descriptive statistics. Crude and adjusted logistic regression analyses were used to assess factors predictive of trust in local government as a source of information about COVID-19 vaccines. Open-ended responses about strengthening residents' trust in local government were coded using an iteratively generated codebook. In total, 46% of respondents indicated NYC local government was a trusted source of information about COVID-19 vaccines, relatively high compared to other sources. In bivariate analyses, race/ethnicity, age group, educational attainment, length of time living in NYC, and household income were significantly associated with identifying NYC government as a trusted source of information about COVID-19 vaccines. In multivariable logistic regression, no variables remained significant predictors of selecting local government as a trusted source of information. Key recommendations for local government agencies to build residents' trust include communicating clearly and honestly, addressing socioeconomic challenges, and enhancing public COVID-19 protection measures. Study findings demonstrate that nearly half of residents in three historically divested NYC communities consider local government to be a trusted source of information about COVID-19 vaccines. Strategies to increase trust in local government can help reduce community transmission of COVID-19 and protect public health.

The Pandemic Special with a Side of Shut-Downs: A Note on NYC's Restaurants in the Age of COVID-19

BackgroundUnderstanding the social environmental around obesity has been limited by available data. One promising approach used to bridge similar gaps elsewhere is to use passively generated digital data.PurposeThis article explores the relationship between online social environment via web-based social networks and population obesity prevalence.MethodsWe performed a cross-sectional study using linear regression and cross validation to measure the relationship and predictive performance of user interests on the online social network Facebook to obesity prevalence in metros across the United States of America (USA) and neighborhoods within New York City (NYC). The outcomes, proportion of obese and/or overweight population in USA metros and NYC neighborhoods, were obtained via the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance and NYC EpiQuery systems. Predictors were geographically specific proportion of users with activity-related and sedentary-related interests on Facebook.ResultsHigher proportion of the population with activity-related interests on Facebook was associated with a significant 12.0% (95% Confidence Interval (CI) 11.9 to 12.1) lower predicted prevalence of obese and/or overweight people across USA metros and 7.2% (95% CI: 6.8 to 7.7) across NYC neighborhoods. Conversely, greater proportion of the population with interest in television was associated with higher prevalence of obese and/or overweight people of 3.9% (95% CI: 3.7 to 4.0) (USA) and 27.5% (95% CI: 27.1 to 27.9, significant) (NYC). For activity-interests and national obesity outcomes, the average root mean square prediction error from 10-fold cross validation was comparable to the average root mean square error of a model developed using the entire data set.ConclusionsActivity-related interests across the USA and sedentary-related interests across NYC were significantly associated with obesity prevalence. Further research is needed to understand how the online social environment relates to health outcomes and how it can be used to identify or target interventions.

MP28-02 WHAT FACTORS INFLUENCE BPH MEDICATION PRICING? A STUDY OF CHAIN, INDEPENDENT, AND ONLINE PHARMACIES IN ADJACENT, SOCIOECONOMICALLY DISPARATE NEIGHBORHOODS IN NEW YORK CITY