NYC DOHMH Research Articles

Increasing engagement in HIV prevention among cisgender women in New York City with sexual health self-testing kits: A MaxDiff analysis.

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. 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. 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. Self-testing for STIs and HIV represents a promising strategy for engaging BLCW in preventative sexual health services and increasing access to care.

1495. Mpox Vaccine Immunity in People Living with HIV (PLWH) During The 2022 Mpox Outbreak in New York City

Abstract Background The WHO estimated that in 2022 49% of people affected by Mpox were PLWH. Due to initial vaccine shortage in 2022, a 1/5 dose of vaccine given intradermally (ID) was FDA-authorized (8/9/22). The ID regimen had never been evaluated in PLWH. Here we describe the characteristics, and IgG responses of Mpox vaccination in PLWH and HIV-negative participants. Methods We are conducting a longitudinal, observational study of adults with and without HIV who received the JYNNEOS vaccine or had Mpox infection in NYC. Clinical, demographic information, and Mpox H3L-specific serum IgG titers are assessed. Results 145 participants are enrolled: 25% are PLWH (median CD4 685 cells/mm3), 14% had Mpox disease and 21% had prior smallpox vaccination. 71% with Mpox disease were PLWH. The cohort is racially/ethnically diverse, mostly men (81%) and LGBTQ+ (90%). A third of the participants were recruited from NYC DOHMH pop-up vaccination site (34%), followed by peer or professional referral (20% & 19%). Routes of vaccination were: SC-ID (49%), ID-ID (21%), SC-SC (20%), and ID-SC (10%). Redness (37%) & swelling (21%) at site of injection were common reactions. Prior smallpox vaccination was associated with higher and sustained IgG titers even after one vaccine dose. Excluding such participants, antibody titers start declining post-dose 2 (antibody half-life of 103 days). There was no difference in IgG titers at 3 months post-dose 2 between PLWH and HIV-negative for ID or any other route. Titers at 3 months post-dose 2 in PLWH correlated with CD4 counts. Longer interval between the two doses contributed to higher titers. Mpox infection yielded to significantly higher titers than vaccination post-dose 1, but no after 2 doses. Conclusion Our study highlights the disproportionate burden of Mpox infection on PLWH. A diverse population representative of those most affected by 2022 Mpox was recruited. The vaccine, whether ID or SC, was well tolerated in PLWH and HIV-negative. More than two-thirds of participants with Mpox disease were PLWH. Individuals with prior smallpox vaccination maintain strong antibody levels post-dose 2, however, levels decline in individuals with no anterior prime. Our preliminary results show no negative impact of the ID dose regimen on antibody levels in PLWH. Disclosures Ellie Carmody, MD, MPH, AstraZeneca: Stocks/Bonds|Merck: Stocks/Bonds Lalitha Parameswaran, MD, MPH, Pfizer: Grant/Research Support Mark J. Mulligan, M.D., Lilly: Grant/Research Support|Meissa Vaccines, Inc.: Advisor/Consultant|Meissa Vaccines, Inc.: Board Member|Merck: Advisor/Consultant|Merck: Board Member|Pfizer: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support

The Community Assessment to Inform Rapid Response (CAIRR): A Novel Qualitative Data Collection and Analytic Process to Facilitate Hyperlocal COVID-19 Emergency Response Operations in New York City.

All disasters are local but implementing a hyperlocal response in the midst of a public health emergency is challenging. The availability of neighborhood-level qualitative data that are both timely and relevant to evolving objectives and operations is a limiting factor. In 2020, the New York City Department of Health and Mental Hygiene (NYC DOHMH) responded to the COVID-19 emergency using a novel, hyperlocal approach. Key to the implementation of this approach was the creation of the Community Assessment to Inform Rapid Response (CAIRR), a process for rapid collection and analysis of neighborhood-specific, objective-focused, qualitative data to inform tailored response operations. This paper describes the process of developing the CAIRR and its contribution to the NYC DOHMH's hyperlocal response in order to guide other jurisdictions seeking to employ a hyperlocal approach in future disaster responses.

Health Data for New York City (HD4NYC): A collaborative research model to advance policy-relevant environmental health research

In the spring of 2019, the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the New York Academy of Medicine (NYAM), with Robert Wood Johnson Foundation funding, launched Health Data for NYC (HD4NYC), a multi-institutional research platform focused on improving health equity in NYC. HD4NYC utilizes a working group model to promote data sharing, advance actionable policy-relevant, equity-focused research, and connect a diverse group of early-career academic and Health Department researchers with senior mentorship. The partnership involves over 30 multidisciplinary faculty from nine NYC-area academic institutions. Under the Birth and Childhood Equity working group, the Environmental Health subgroup’s initial project utilizes data from NYC KIDS 2017, a DOHMH-led cross-sectional health survey of over 7,500 households with children 0-13 years, to explore the association of socio-environmental and housing factors with child asthma prevalence and outcome disparities. Environmental factors within the NYC KIDS survey include both indoor and outdoor exposures, such as housing quality, prevalence of indoor pests, and perceptions of neighborhood traffic. To explore the influence of large-scale social determinants of health using an equity lens, survey data are merged with neighborhood-level data from the American Community Survey on education, race/ethnicity, income disparities, and gentrification and structural racism metrics. The analysis uses multiple machine learning methods (e.g. random forest) to rank the most salient exposures to inform public health intervention prioritization by neighborhood. All partners benefit from this unique partnership: academics gain facilitated access to robust, local health data; the health department gains access to additional expertise and person-power for innovative research using their data; and all partners receive support and mentorship to enhance productivity. Moreover, this collaboration helps achieve health department priorities for producing actionable policy-relevant research that promotes health equity and might serve as a model for future research endeavors nationally.

Multidimensional Semantic Scan for Pre-Syndromic Disease Surveillance

Multidimensional Semantic Scan for Pre-Syndromic Disease Surveillance

Lessons learned from the development and implementation of a citywide stair prompt initiative.

Stair climbing is a readily available form of vigorous-intensity physical activity. Evidence indicates that placing stair prompt signs at points-of-decision (e.g. near elevators and stairways) is an inexpensive, effective strategy for increasing physical activity through stair use.This article aims to share the experience of the New York City Department of Health and Mental Hygiene (NYC DOHMH) in the outreach and implementation of a population-scale stair prompt initiative, including lessons learned from process evaluations, with other public health authorities conducting a similar program. Between May 2008 and August 2012, NYC DOHMH implemented a stair prompt initiative as one strategy in a comprehensive program to increase physical activity and healthy eating through physical improvements to NYC's buildings, streets and neighborhoods, particularly targeting facilities in underserved and low-income neighborhoods. Program evaluation was conducted using program planning documents to examine the process, and data from NYC information line call center, outreach tracking database, and site and phone audits to examine process outcomes.The initiative successfully distributed more than 30,000 stair prompts to building owners/managers of over 1000 buildings. Keys to success included multi-sector partnerships between NYC's Health Department and non-health government agencies and organizations (such as architecture and real estate organizations), a designated outreach coordinator, and outreach strategies targeting building owners/managers owning/managing multiple buildings and buildings serving underserved and at risk populations.A NYC citywide initiative successfully distributed stair prompts to the wider community to promote population-level health impacts; lessons learned may assist other jurisdictions considering similar initiatives to increase physical activity.

Disparities in Zika Virus Testing and Incidence Among Women of Reproductive Age-New York City, 2016.

The New York City Department of Health and Mental Hygiene (NYC DOHMH) performs surveillance for reportable diseases, including Zika virus (ZIKV) infection and disease, to inform public health responses. Incidence rates of other mosquito-borne diseases related to international travel are associated with census tract poverty level in NYC, suggesting that high poverty areas might be at higher risk for ZIKV infections. We assessed ZIKV testing rates and incidence of travel-associated infection among reproductive age women in NYC to identify areas with high incidence and low testing rates and assess the effectiveness of public health interventions. We analyzed geocoded ZIKV surveillance data collected by NYC DOHMH. Women aged 15 to 44 years tested during January-July 2016 (n = 4733) were assigned to census tracts, which we grouped by poverty level and quartile of the number of persons born in countries or territories with mosquito-borne ZIKV transmission as a proxy for risk of travel to these areas. We calculated crude ZIKV testing rates, incidence rates, and incidence rate ratios (IRRs). New York City. Eight percent of patients (n = 376) tested had evidence of ZIKV infection. Cumulative incidence was higher both in areas with higher versus lower poverty levels (IRR = 2.4; 95% confidence interval [CI], 2.0-3.0) and in areas with the largest versus smallest populations of persons born in countries or territories with mosquito-borne ZIKV transmission (IRR = 11.3; 95% CI, 6.2-20.7). Initially, ZIKV testing rates were lowest in higher poverty areas with the largest populations of persons born in countries or territories with mosquito-borne ZIKV transmission (15/100 000), but following targeted interventions, testing rates were highest in these areas (80/100 000). Geocoded data enabled us to identify communities with low testing but high ZIKV incidence rates, intervene to promote testing and reduce barriers to testing, and measure changes in testing rates.

Impact of Users’ Experience with a Web-Based Reporting Portal on Timeliness and Quality of Reporting ABSTRACT BODY:

Impact of Users’ Experience with a Web-Based Reporting Portal on Timeliness and Quality of Reporting ABSTRACT BODY:

Modeling pathogens for oceanic contact recreation advisories in the New York City area using total event simulations

A simulation of transport and fate of pathogen indicators for the New York City open waters was completed using a coupled numerical model. Modeled concentrations for Enterococci in receiving waters were extracted from the model and compared with NYC beach observations and NYC Harbor Surveys to validate and bias-correct the result. Results, both before and after bias-correction, were then used to calculate model-based contact recreation advisories and compare to existing advisories: NYC DEP advisory guidance for waterbodies, and NYC DOHMH advisory guidance for NYC beaches. The model was able to simulate the transport and fate of Enterococci. Receiving water Enterococci concentrations grew responsively to rainfall, and decreased notably after rainfall. The model showed the ability to take complexity of natural effects into account, and was conservative in most cases after bias-correction. Based on an exceedance criterion of 110cfu/100mL, simulated Enterococci concentrations exceeded that criterion 54% (109%) of the total advisory days that existing NYC DOHMH guidance would suggest throughout all NYC beaches, on average, before (after) bias-correction. The model exceeded that criterion 217% (246%) of the total advisory days that existing NYC DEP guidance would suggest throughout all NYC waterbodies, on average, before (after) bias-correction. Simulation results were provided to NYC DEP and NYC DOHMH for the refinement of existing advisories.

Witnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue

With the opioid overdose mortality rates rising nationally, The New York City Department of Health and Mental Hygiene (NYC DOHMH) has worked to expand overdose rescue training (ORT) and naloxone distribution. This study sought to determine rates of overdose witnessing and naloxone use among overdose rescue-trained visitors to the NYC jails on Rikers Island. We conducted a six-month prospective study of visitors to NYC jails on Rikers Island who received ORT. We collected baseline characteristics of study participants, characteristics of overdose events, and responses to witnessed overdose events, including whether the victim was the incarcerated individual the participant was visiting on the day of training. Bivariate analyses compared baseline characteristics of participants who witnessed overdoses to those who did not, and of participants who used naloxone to those who did not. Overall, we enrolled 283 participants visiting NYC's Rikers Island jails into the study. Six months after enrollment, we reached 226 participants for follow-up by phone. 40 participants witnessed 70 overdose events, and 28 participants reported using naloxone. Of the 70 overdose events, three victims were the incarcerated individuals visited on the day of training; nine additional victims were recently released from jail and/or prison. Visitors to persons incarcerated at Rikers Island witness overdose events and are able to perform overdose rescues with naloxone. This intervention reaches a population that includes not only those recently released, but also other people who experienced overdose.

Case 2: A Neonate Affected by Maternal Pica

A male infant is born at 38 6/7 weeks’ gestation via vaginal delivery to a 23-year-old gravida 3, para 2-0-0-2 woman. On the first day after birth, he is found to have a critically elevated blood lead level (BLL). The infant was tested because of the mother’s prenatal history of an elevated BLL. History revealed the mother had ingested soil from her backyard and used ethnic products from a local store (not tested for lead) throughout the pregnancy. The backyard soil was later tested by the New York City Department of Health and Mental Hygiene (NYC DOHMH), which revealed high lead levels. Five months before delivery, the maternal BLL was 10 μg/dL (0.48 μmol/L). Repeat maternal BLL on postpartum day 2 was 49 μg/dL (2.3 μmol/L). At birth, the newborn Apgar scores were 9 and 9 at 1 and 5 minutes, respectively, the birthweight was 3.57 kg, and the length was 50 cm (body surface area of 0.21 m2). The infant’s venous BLL on the first and second day after birth was 78 μg/dL (3.8 μmol/L). On admission, the infant had unremarkable routine chemistry studies, a hemoglobin of 17 g/dL (170 g/L), and mean corpuscular volume of 90 um3 (90 fL). On the third day after birth, the newborn was transferred from the NICU of an affiliate hospital to our institution for dual chelation therapy with calcium disodium versenate (CaNa2EDTA) and succimer, as recommended by the Centers for Disease Control and Prevention (CDC) and NYC DOHMH guidelines. Succimer is a chelating agent that has 2 sulfhydryl groups capable of complexing to lead, making it water soluble, and thus increasing the urinary excretion of lead. CaNa2EDTA is another chelating agent that chelates lead that has taken the place of calcium and promotes its urinary excretion. …

Antiretroviral medication treatment for all HIV-infected individuals: a protocol using innovative multilevel methodologies to evaluate New York City's universal ART policy among problem substance users.

BackgroundThe intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of “treatment as prevention,” in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The “ART for ALL” (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use.Methods/DesignThe AFA Study is informed by two complementary frameworks: Glasgow and colleagues’ RE-AIM model, a multi-level framework developed to guide the evaluation of implementation of new policies, and Bronfrenbrenner’s ecological systems model, which conceptualizes the bi-directional interplay between people and their environment. Using multi-level data and mixed methods, the primary aims of the AFA Study are to assess rates of viral load suppression, using the NYC HIV Surveillance Registry, within 12 months of HIV diagnosis with (a) yearly cohorts of high-risk-to-transmit, difficult-to-treat, substance using patients recruited from NYC Sexually Transmitted Disease clinics and a large detoxification unit and (b) yearly cohorts of all newly HIV diagnosed people in NYC. Further goals include (c) recruiting cross-sectional samples of HIV/AIDS service providers to assess ART initiation with problem substance users and d) examining geographic factors that influence rates of viral load suppression. An Implementation Collaborative Board meets regularly to guide study procedures and interpret results.DiscussionThe AFA Study has the unique strength of accessing and analyzing data at multiple levels using mixed methodology, taking advantage of NYC DOHMH biomedical surveillance data. If successful, others may benefit from lessons learned to inform local and state policies to improve the health of PLWH and further reduce HIV transmission.

956 The Effect of an Organized Screening Program on Racial and Ethnic Disparities and Choice of Colorectal Cancer Screening Test

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third most common cause of cancer deaths in both men and women in the United States. Blacks have been reported to have a higher incidence and mortality and a more proximal anatomic distribution of CRC compared to whites and Hispanics. However, it is unclear whether this is due to biological differences in the pathology of adenomatous polyps or lower screening rates. Existing data consisting of retrospective studies and one single center prospective study indicate that factors such as access to health care and modifiable risk factors may be responsible for these racial disparities as opposed to biological differences. Methods: In 2003, the New York City Department of Health and Mental Hygiene (NYC DOHMH) implemented the Colonoscopy Patient Navigator Program (CPNP). Ten New York City Hospital Sites, five public and five private, participated in the study. Through a one to one relationship, PN helped to bridge disparities by scheduling appointments, educating regarding bowel preparation and addressing obstacles. Data were prospectively collected from 2005 through the first quarter of 2012 from centers with at least three consecutive years of reporting while using PN. Patient information including name, contact information, gender, date of birth, ethnicity and insurance information was collected by each PN during the initial contact after the patient was referred for screening colonoscopy (sCo). Adenoma and cancer detection rates, pathology and location were recorded and stratified by patient demographic characteristics including age, gender, and race. Results: With the assistance of PN, 29,711 individuals ages 50 and older underwent complete sCo. A total of 6226 adenomas and 35 cancers were found. The prevalence of adenomas was higher among white patients than black patients (27.45% versus 19.35%, p value < 0.05) (See tables 1 and 2). With the exception of the hepatic flexure, whites had a statistically significant higher prevalence of adenomas, segment by segment, than blacks and Hispanics. Conclusion: This is a prospective multicenter center study of a large urban cohort investigating the prevalence of adenomas in blacks versus whites and Hispanics using a PN program. Preliminary data do not show that blacks have an increased risk of adenomas compared to whites and Hispanics. This suggests that the higher incidence and mortality from CRC in blacks that was reported in other studies aremore likely a function of access to colonoscopy as opposed to biologic factors. Table 1: Results of completed screening colonoscopy exams cross-tabulated by patient race (age ≥ 50)

954 Prevalence of Colorectal Adenomas in Blacks, Whites and Hispanics Having Screening Colonoscopy in a Patient Navigation Program: A Prospective Multicenter Study

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third most common cause of cancer deaths in both men and women in the United States. Blacks have been reported to have a higher incidence and mortality and a more proximal anatomic distribution of CRC compared to whites and Hispanics. However, it is unclear whether this is due to biological differences in the pathology of adenomatous polyps or lower screening rates. Existing data consisting of retrospective studies and one single center prospective study indicate that factors such as access to health care and modifiable risk factors may be responsible for these racial disparities as opposed to biological differences. Methods: In 2003, the New York City Department of Health and Mental Hygiene (NYC DOHMH) implemented the Colonoscopy Patient Navigator Program (CPNP). Ten New York City Hospital Sites, five public and five private, participated in the study. Through a one to one relationship, PN helped to bridge disparities by scheduling appointments, educating regarding bowel preparation and addressing obstacles. Data were prospectively collected from 2005 through the first quarter of 2012 from centers with at least three consecutive years of reporting while using PN. Patient information including name, contact information, gender, date of birth, ethnicity and insurance information was collected by each PN during the initial contact after the patient was referred for screening colonoscopy (sCo). Adenoma and cancer detection rates, pathology and location were recorded and stratified by patient demographic characteristics including age, gender, and race. Results: With the assistance of PN, 29,711 individuals ages 50 and older underwent complete sCo. A total of 6226 adenomas and 35 cancers were found. The prevalence of adenomas was higher among white patients than black patients (27.45% versus 19.35%, p value < 0.05) (See tables 1 and 2). With the exception of the hepatic flexure, whites had a statistically significant higher prevalence of adenomas, segment by segment, than blacks and Hispanics. Conclusion: This is a prospective multicenter center study of a large urban cohort investigating the prevalence of adenomas in blacks versus whites and Hispanics using a PN program. Preliminary data do not show that blacks have an increased risk of adenomas compared to whites and Hispanics. This suggests that the higher incidence and mortality from CRC in blacks that was reported in other studies aremore likely a function of access to colonoscopy as opposed to biologic factors. Table 1: Results of completed screening colonoscopy exams cross-tabulated by patient race (age ≥ 50)

Invasive Meningococcal Disease in Men Who Have Sex With Men

Invasive Meningococcal Disease in Men Who Have Sex With Men

NYC Condom Use and Satisfaction and Demand for Alternative Condom Products in New York City Sexually Transmitted Disease Clinics

In 2007, via a high-profile media campaign, the New York City Department of Health and Mental Hygiene (NYC DOHMH) introduced the "NYC Condom," the first specially packaged condom unique to a municipality. We conducted a survey to measure NYC Condom awareness of and experience with NYC Condoms and demand for alternative male condoms to be distributed by the DOHMH. Trained interviewers administered short, in-person surveys at five DOHMH-operated sexually transmitted disease (STD) clinics in Spring 2008. We systematically sampled eligible patients: NYC residents aged ≥18 years waiting to see a physician. We approached 539; 532 agreed to be screened (98.7% response rate); 462 completed the survey and provided NYC zip codes. Most respondents were male (56%), non-Hispanic black (64%), aged 18-24 years (43%) or 25-44 years (45%), employed (65%), and had a high school degree/general equivalency diploma or less (53%). Of those surveyed, 86% were aware of the NYC Condom, and 81% of those who obtained the condoms used them. NYC Condom users were more likely to have four or more sexual partners in the past 12 months (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.0-3.8), use condoms frequently (AOR = 2.1, 95% CI = 1.3-3.6), and name an alternative condom for distribution (AOR = 2.2, 95% CI = 1.3-3.9). The most frequently requested condom types respondents wanted DOHMH to provide were larger size (28%), ultra thin/extra sensitive (21%), and extra strength (16%). We found high rates of NYC Condom use. NYC Condom users reported more sexual partners than others, suggesting the condom initiative successfully reached higher-risk persons within the STD clinic population. Study results document the condom social marketing campaign's success.

NYC Epi Scholars Program

Although health disparities research has already contributed to decreased mortality and morbidity in underserved communities, more work is needed. The NYC Epi Scholars program of the New York City Department of Health and Mental Hygiene (NYC DOHMH) aims to address gaps in critical public health needs and to train future public health leaders in epidemiology. The program is designed to increase racial/ethnic and socioeconomic diversity in the public health workforce, to provide fieldwork and practica opportunities, and to cultivate future leaders in epidemiology and public health. Since its inception in 2007, the NYC Epi Scholars program of the NYC DOHMH has sought talented epidemiology students interested in gaining practical experience in applied health disparities research. NYC Epi Scholars is open to graduate epidemiology students who have demonstrated achievement and leadership potential and gives them an opportunity to provide high-quality research assistance to projects that identify and address health disparities of public health significance. Many of the program's 32 alumni have made notable contributions to public health: publishing articles in peer-reviewed journals; making presentations at national and international conferences; and after graduating, pursuing careers at the DOHMH, Centers for Disease Control and Prevention, the Environmental Protection Agency, and the National Institutes of Health. Because of its noted success, the NYC Epi Scholars program may serve as a "best-practice" model for expansion in other urban health departments.

A Brief Overview of New York City's Calorie Labeling Regulation and Evaluation

In Brief In 2008, the New York City Department of Health and Mental Hygiene (NYC DOHMH) adopted a regulation that requires chain restaurants with 15 or more locations nationwide to post calorie information prominently on menu boards and menus. This regulation is intended to help customers make informed choices at the point of purchase. To assess the impact of this calorie labeling requirement, NYC DOHMH is conducting 3 studies to examine changes in (1) customer purchasing behavior, (2) awareness about calorie posting, and (3) menu options at fast-food chains, before and after implementation of the regulation. Preliminary results suggest that posting calorie information prominently at the point of purchase can increase the number of customers who see and use that information. The city's approach to calorie labeling helps provide customers with important information to make food choices. Calorie labeling policies have gained support in jurisdictions across the nation as implementing regulations such as this one can have broad implications at the population level Calorie counts and maybe counting hit the Big Apple

Public Compliance with Mass Prophylaxis Guidance

In 2008, the New York City Department of Health and Mental Hygiene (NYC DOHMH) conducted a series of 8 focus groups to determine what improvements could be made to existing plans to ensure that the public would adhere to instructions issued during an emergency that required mass antibiotic distribution following an aerosolized anthrax attack. Discussion focused on perceptions surrounding public health emergencies, overall point-of dispensing (POD) strategy, willingness to pick up medications for others, and additional information that participants would need before and during an emergency. Participation in each group ranged from 7 to 10 members. Most participants indicated a willingness to actively participate in emergency response and to follow directions issued by authorities. Some said they would wait to see how others reacted to medication being provided before taking theirs. Participants expressed a universal desire for education on both dispensing plans and diseases before an incident occurs. They expressed concerns about anxiety levels among the public and maintaining adequate security at dispensing sites, though they felt that NYC's plans were generally realistic. The most trusted sources identified to disseminate information were the mayor, the city health commissioner, and a local cable news channel. While many participants indicated they would use the internet to find information during an emergency, multiple delivery methods must be used to ensure the broadest reach within the community, as not everyone has internet access. Health authorities must partner with the public before, during, and after an emergency to achieve the best possible outcomes from a response effort that relies greatly on public cooperation.

Results From a New York City Emergency Department Rapid HIV Testing Program

Results From a New York City Emergency Department Rapid HIV Testing Program