York City Adults Research Articles

Tobacco Use Patterns

Tobacco Use Patterns

Metabolic Syndrome Among Adults in New York City, 2004 New York City Health and Nutrition Examination Survey

The objective of this study was to describe the prevalence of and factors associated with metabolic syndrome among adult New York City residents. The 2004 New York City Health and Nutrition Examination Survey was a population-based, cross-sectional study of noninstitutionalized New York City residents aged 20 years or older. We examined the prevalence of metabolic syndrome and its components as defined by the National Cholesterol Education Program's Adult Treatment Panel III revised guidelines, according to demographic subgroups and comorbid diagnoses in a probability sample of 1,263 participants. We conducted bivariable and multivariable analyses to identify factors associated with metabolic syndrome. The age-adjusted prevalence of metabolic syndrome was 26.7% (95% confidence interval, 23.7%-29.8%). Prevalence was highest among Hispanics (33.9%) and lowest among whites (21.8%). Prevalence increased with age and body mass index and was higher among women (30.1%) than among men (22.9%). More than half (55.4%) of women and 33.0% of men with metabolic syndrome had only 3 metabolic abnormalities, 1 of which was abdominal obesity. The most common combination of metabolic abnormalities was abdominal obesity, elevated fasting blood glucose, and elevated blood pressure. Adjusting for other factors, higher body mass index, Asian race, and current smoking were positively associated with metabolic syndrome; alcohol use was inversely associated with metabolic syndrome among women but increased the likelihood of metabolic syndrome among men. Metabolic syndrome is pervasive among New York City adults, particularly women, and is associated with modifiable factors. These results identify population subgroups that could be targeted for prevention and provide a benchmark for assessing such interventions.

PTSD and alcohol use after the World Trade Center attacks: A longitudinal study

Research suggests that posttraumatic stress disorder (PTSD) is associated with increased alcohol use, but the findings have not been consistent. We assessed alcohol use, binge drinking, and psychotropic medication use longitudinally in 1,681 New York City adults, representative of the 2000 census, 2 years after the World Trade Center attacks. We found that, with the exception of a modified CAGE Questionnaire index for alcohol, alcohol use showed a modest increase over time and was related to PTSD symptoms, with an increase of about 1 more drink per month for those with PTSD, even though overall levels appeared to be within the National Institute on Alcohol Abuse and Alcoholism's safe range. Psychotropic medication use followed a similar trend; those with PTSD used psychotropics about 20 more days over the past year than those without. Because the study analyses adjusted for key psychosocial variables and confounders, it is not clear if the increased alcohol use following trauma exposure is associated with self-medication of PTSD symptoms, whether increased alcohol use prior to exposure is a risk for delayed-onset PTSD, or whether a third unmeasured variable is involved. Further research is warranted.

Erratum: "A Biomonitoring Study of Lead, Cadmium, and Mercury in the Blood of New York City Adults".

[This corrects the article DOI: 10.1289/ehp.10056.].

Self-rated general and oral health in New York City adults: assessing the effect of individual and neighborhood social factors

This study investigates the independent and joint effects of individual and neighborhood socioeconomic characteristics on self-rated general and oral health before and after controlling for selected characteristics in adults aged 18 years and older in New York City. Data for 1168 individuals who participated in the 2004 Social Indicators Survey were linked to neighborhood data from the 2000 US Census. Log-binomial regression models fitted using generalized estimating equations were used to calculate prevalence ratios (PR) and 95% confidence intervals (CI). sudaan was used to accommodate the complex sampling design of the survey and the intra-neighborhood correlation of outcomes of individuals residing within the same neighborhoods. After adjusting for selected characteristics, survey participants with 12 years of education or less were almost twice more likely to rate their general health as fair/poor than counterparts with more than 12 years of education [PRs 1.86 (95%CI: 1.16, 3.00) and 1.82 (95%CI: 1.18, 2.82)]. Participants earning <$20,000 (PR: 2.29; 95%CI: 1.23, 4.29) or between $20,000 to $39,999 yearly (PR: 2.24; 95%CI: 1.11, 4.53) were more than twice as likely to rate their general health as fair/poor compared to their counterparts earning over $40,000 yearly. When compared to participants with more than 12 years of education and those reporting an annual income ≥$40,000, the probability of rating oral health as fair/poor was at least 50% greater in participants with <12 years of education (PR: 1.58; 95%CI: 1.11, 2.26) and in participants earning an annual income of <$20,000 (PR: 1.55; 95%CI: 1.10, 2.19). No association was found between neighborhood characteristics for either self-rated general or oral health. Individual socioeconomic characteristics may be important for both self-rated general and oral health by affecting individuals' behaviors and access to resources.

Prevalence and control of diabetes and impaired fasting glucose in New York City.

OBJECTIVE—To determine the prevalence of diabetes and impaired fasting glucose (IFG) and to assess clinical management indicators among adults with diabetes in a representative sample of New York City adults.RESEARCH DESIGN AND METHODS—In 2004, New York City implemented the first community-level Health and Nutrition Examination Survey (NYC HANES), modeled after the National Health and Nutrition Examination Survey (NHANES). We used an interview to determine previously diagnosed diabetes and measured fasting plasma glucose to determine undiagnosed diabetes and IFG in a probability sample of 1,336 New York City adults. We assessed glycemic control and other clinical indicators using standardized NHANES protocols.RESULTS—The prevalence of diabetes among New York City adults was 12.5% (95% CI 10.3–15.1): 8.7% diagnosed and 3.8% undiagnosed. Nearly one-fourth (23.5%) of adults had IFG. Asians had the highest prevalence of impaired glucose metabolism (diabetes 16.1%, IFG 32.4%) but were significantly less likely to be obese. Among adults with diagnosed diabetes, less than one-half (45%) had A1C levels <7%; one-half (50%) had elevated blood pressure measures at interview, 43% of whom were not on antihypertensive medications; nearly two-thirds (66%) had elevated LDL levels, and only 10% had their glucose, blood pressure, and cholesterol all at or below recommended levels. Most adults (84%) with diagnosed diabetes were on medication, but only 12% were receiving insulin.CONCLUSIONS—In New York City, diabetes and IFG are widespread. Policies and structural interventions to promote physical activity and healthy eating should be prioritized. Improved disease management systems are needed for people with diabetes.

Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City

Hypertension-related risk in urban areas may vary from national estimates; however, objective data on prevalence and treatment in local areas are scarce. We assessed hypertension prevalence, awareness, treatment, and control among New York City (NYC) adults. The NYC Health And Nutrition Examination Survey (HANES), modeled on the national HANES, was conducted in 2004 with a representative sample of noninstitutionalized NYC residents > or =20 years of age. Hypertension outcomes were examined with interview and examination data (n=1975). Multiple logistic regression was used to assess factors associated with control among adults with hypertension. We found that 25.6% of NYC adults had hypertension. Blacks had a higher prevalence than whites (32.8% versus 21.1%, P<0.001), as did Hispanics (26.5% versus 21.1%, P<0.05). Foreign-born residents who had lived in the United States for <10 years had lower rates than those who had lived in the United States longer (20.0% versus 27.5%, P<0.05). Among adults with hypertension, 83.0% were diagnosed, 72.7% were treated, and 47.1% had hypertension controlled. Of those treated, 64.8% had hypertension controlled. After adjustment for sociodemographic variables among all adults with treated hypertension, lack of a routine place of medical care was most strongly associated with poor control levels (adjusted odds ratio 0.21, 95% confidence interval 0.07 to 0.66). Among nonelderly adults with treated hypertension, blacks had 4-fold lower odds than whites of having hypertension controlled (adjusted odds ratio 0.24, 95% confidence interval 0.06 to 0.92). In NYC, hypertension is common and frequently uncontrolled. Low levels of control are associated with poor access to care. Racial disparities in prevalence and control are evident among nonelderly adults.

Profiling risk of fear of an intimate partner among men and women

Objective Fear of a partner, a component of intimate partner violence (IPV), can be used in clinical IPV assessment. This study examines correlates of fear in a population-based, urban sample to inform a gender-specific health care response to IPV. Methods This study used pooled data on 9687 men and 13,903 women collected in 2002, 2004 and 2005 through three random-digit-dial surveys of New York City adults. Bivariate and multivariable analyses were used to examine associations between fear and sociodemographic and health-related factors. Results There was no significant difference in age-adjusted prevalence of reported fear of a partner between women (2.7%) and men (2.2%). In multivariable analysis, fear was correlated with being female, younger age, divorced or separated marital status, poor self-reported health status, and multiple sex partners. The most striking gender difference was in the stronger association with multiple sex partners among women (adjusted Odds Ratio [aOR] = 6.2; p < 0.01). Binge drinking was correlated with fear only among low-income adults (aOR = 2.8; p < 0.01). Conclusion IPV is a health concern for both men and women, and a risk profile for fear can guide IPV assessment in health care. Physicians should consider multiple sex partners in women and alcohol misuse in low-income patients as potential markers for IPV.

Prevalence, Diagnosis, and Treatment of Depression and Generalized Anxiety Disorder in a Diverse Urban Community

This study assessed the prevalence, diagnosis, and treatment of major depressive disorder and generalized anxiety disorder among New York City adults. As part of the first community-specific Health and Nutrition Examination Survey in the United States, depression and anxiety were assessed in a representative sample of 1,817 noninstitutionalized adults in 2004. A total of 8% had major depressive disorder and 4% had generalized anxiety disorder. Respondents with depression were more likely to be formerly married, publicly insured, younger, and U.S. born. Only 55% of adults with depression were diagnosed, and 38% of those with depression or anxiety were in treatment; individuals with a diagnosis of depression were more likely to receive treatment than those without a diagnosis (61% versus 7%; p<.001). Immigrants with depression were 60% less likely to be diagnosed than their U.S.-born counterparts; immigrants arriving in this country ten or more years ago had slightly more anxiety than immigrants arriving less than ten years ago (3% versus 2%, not significant). Among respondents with anxiety, 23% reported disability compared with 15% of those with depression. Compared with adults with neither diagnosis, adults with depression or anxiety were twice as likely to smoke tobacco (p<.05), adults with depression were twice as likely to have diabetes (p<.01), and those with anxiety were twice as likely to have asthma (p<.01). Mental disorders are often disabling and inadequately diagnosed and treated. Foreign-born adults experience barriers to diagnosis and treatment despite having less depression; anxiety may increase with time since immigration. Increased awareness of and linkage to mental health services are needed, especially in larger, more diverse urban communities.

Demographic and Behavioral Factors Associated with Daily Sugar-sweetened Soda Consumption in New York City Adults

The objective of the study was to assess the relations of socioeconomic and behavioral factors to frequent consumption of sugar-sweetened soda among New York City (NYC) adults and the relation of frequent consumption to body mass index (BMI; kg/m(2)). Data from the 2005 NYC Community Health Survey, a population-based telephone survey, were analyzed. Frequent consumption was defined as drinking one or more 12-oz servings of sugar-sweetened soda on an average day; 9,865 adults, aged 18 years and older, provided valid responses. Logistic regression was used to identify factors associated with frequent consumption, and linear regression models were used to assess the relation of frequent consumption to BMI. An estimated 27.5% of NYC adults are frequent sugar-sweetened soda consumers. Frequent consumption is independently associated with low household income (odds ratio [OR] = 1.7, 95% confidence interval [CI] 1.4-2.1 for <200% vs. > or =600% federal poverty level) and with ethnic group and nativity (e.g., OR = 3.1, 95% CI 2.6-3.7 for U.S.-born blacks vs. whites). Men report more consumption then women, but an association of less education with frequent consumption is stronger among women. Adjusting for demographics, frequent consumption is associated with more television viewing and with less physical activity. Adjusting for demographics and behaviors, frequent consumption was associated with higher BMI among women (0.7 BMI units, 95% CI 0.1-1.2) but not among men. Disparities in sugar-sweetened soda consumption mirror obesity disparities. Improved surveillance and interventions are needed to better quantify and reduce consumption of sugar-sweetened beverages, especially in groups most impacted by obesity.

Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004

Surveillance for HIV likely underestimates infection among the general population: 25% of US residents are estimated to be unaware of their HIV infection. To determine the prevalence of HIV infection and risk behaviors among New York City (NYC) adults and compare these with surveillance findings. The NYC Health and Nutrition Examination Survey (HANES) provided the first opportunity to estimate population-based HIV prevalence among NYC adults. It was conducted in 2004 among a representative sample of adults > 20 years. Previously reported HIV infection was identified from the NYC HIV/AIDS Surveillance Registry. A blinded HIV serosurvey was conducted on archived blood samples of 1626 NYC HANES participants. Data were used to estimate prevalence for HIV infection, unreported infections, high-risk activities, and self-perceived risk. Overall, 18.1% engaged in one or more risky sexual/needle-use behaviors, of which 92.2% considered themselves at low or no risk of HIV or another sexually transmitted disease. HIV occurred in 21 individuals (prevalence 1.4%; 95% confidence interval (CI), 0.8-2.5]; one infection (5%; 95% CI, 0.7-29.9) was not reported previously and possibly undiagnosed. HIV infection was significantly elevated in those with herpes simplex virus 2 (4%), men who have sex with men (14%), and needle-users (21%) (P < 0.01). Among NYC adults, HIV prevalence was consistent with surveillance findings overall. The proportion of unreported HIV was less than estimated nationally, but findings were limited by sample size. Most adults with risky behaviors perceived themselves to be at minimal risk, highlighting the need for risk reduction and routine HIV screening.

A biomonitoring study of lead, cadmium, and mercury in the blood of New York city adults.

ObjectivesWe assessed the extent of exposure to lead, cadmium, and mercury in the New York City (NYC) adult population.MethodsWe measured blood metal concentrations in a representative sample of 1,811 NYC residents as part of the NYC Health and Nutrition Examination Survey, 2004.ResultsThe geometric mean blood mercury concentration was 2.73 μg/L [95% confidence interval (CI), 2.58–2.89]; blood lead concentration was 1.79 μg/dL (95% CI, 1.73–1.86); and blood cadmium concentration was 0.77 μg/L (95% CI, 0.75–0.80). Mercury levels were more than three times that of national levels. An estimated 24.8% (95% CI, 22.2–27.7%) of the NYC adult population had blood mercury concentration at or above the 5 μg/L New York State reportable level. Across racial/ethnic groups, the NYC Asian population, and the foreign-born Chinese in particular, had the highest concentrations of all three metals. Mercury levels were elevated 39% in the highest relative to the lowest income group (95% CI, 21–58%). Blood mercury concentrations in adults who reported consuming fish or shellfish 20 times or more in the last 30 days were 3.7 times the levels in those who reported no consumption (95% CI, 3.0–4.6); frequency of consumption explained some of the elevation in Asians and other subgroups.ConclusionsHigher than national blood mercury exposure in NYC adults indicates a need to educate New Yorkers about how to choose fish and seafood to maximize health benefits while minimizing potential risks from exposure to mercury. Local biomonitoring can provide valuable information about environmental exposures.

Variation in Adult Asthma Prevalence in Hispanic Subpopulations in New York City

Background. We compared asthma prevalence among New York City Hispanics–Puerto Rican, Dominican, and other Hispanics–in relation to nativity, socioeconomic status, and asthma risk factors. Methods. Weighted logistic regression analyses on telephone survey data for New York City (NYC) adults in 2003/2004. Results. Asthma prevalence was highest among Puerto Ricans (11.8%) compared with Dominicans and other Hispanics. Non–US-born Dominicans and other Hispanics were significantly less likely to report current asthma than were Puerto Ricans (OR = 0.27, 95% CI 0.18-0.41 and OR = 0.17, 95% CI 0.11-0.26, respectively). In multivariate analyses, US-born Dominicans and other Hispanics had rates comparable to Puerto Ricans. Conclusions. Puerto Ricans, both mainland- and native-born, report the highest rates of adult asthma. Non–US-born Hispanics report lower rates. Acculturation and patterns of residential settlement may account for this variation.

Oral health and health care for older adults: A spatial approach for addressing disparities and planning services

The purpose of this paper was to examine the geographic distribution of New York City adults aged 65 and older by race/ethnicity and poverty status. Also analyzed was seniors' access to dental care as defined by the location of dental providers and their proximity to the subway system lines in Manhattan and the Bronx. ArcGIS software was used to create a geographic information system (GIS) incorporating relevant data from a variety of sources. Individual and overlay maps were then produced to examine the aims of this analysis. Data showed that Black race, Hispanic ethnicity, and poverty status tend to co-occur spatially among seniors in Northern Manhattan and the South Bronx. Further, a spatial/transportation barrier may inhibit access to dental care for seniors who reside in these areas. By presenting multiple layers of local information juxtaposed, GIS can help provide directions for planning oral health service delivery for seniors.

Predictors of PTSD and Delayed PTSD After Disaster

In the present study we sought to identify factors associated with posttraumatic stress disorder (PTSD) following the World Trade Center Disaster (WTCD) and examine changes in PTSD status over time. Our data come from a two-wave, prospective cohort study of New York City adults who were living in the city on September 11, 2001. We conducted a baseline survey 1 year after the attacks (year 1), followed by a survey 1 year later (year 2). Overall, 2368 individuals completed the year 1 survey, and 1681 were interviewed at year 2. Analyses for year 1 indicated that being younger, being female, experiencing more WTCD events, reporting more traumatic events other than the WTCD, experiencing more negative life events, having low social support, and having low self-esteem increased the likelihood of PTSD. For year 2, being middle-aged, being Latino, experiencing more negative life events and traumas since the WTCD, and having low self-esteem increased the likelihood of PTSD. Exposure to WTCD events was not related to year 2 PTSD once other factors were controlled. Following previous research, we divided study respondents into four categories: resilient cases (no PTSD years 1 or 2), remitted cases (PTSD year 1 but not year 2), delayed cases (no PTSD year 1 but PTSD year 2), and acute cases (PTSD both years 1 and 2). Factors predicting changes in PTSD between year 1 and year 2 suggested that delayed PTSD cases were more likely to have been Latino, to have experienced more negative life events, and to have had a decline in self-esteem. In contrast, remitted cases experienced fewer negative life events and had an increase in self-esteem. We discuss these findings in light of the psychosocial context associated with community disasters and traumatic stress exposures.

Alcohol use in New York after the terrorist attacks: A study of the effects of psychological trauma on drinking behavior

Research has suggested that exposure to psychological trauma is associated with increased abuse of psychoactive substances, particularly alcohol. To assess this, we analyzed alcohol consumption, binge drinking, and alcohol dependence among a random sample of 1681 New York City adults 1 year and 2 years after the September 11 attacks. In multivariate models controlling for demographic factors, other stressor exposures, social psychological resources, and history of anti-social behavior, we found that greater exposure to the World Trade Center disaster (WTCD) was associated with greater alcohol consumption at 1 year and 2 years after this event. In addition, our analyses also indicated that exposure to the WTCD was associated with binge drinking at 1 year after but not 2 years after this event. Alcohol dependence, assessed as present in either year 1 or year 2, also was positively associated with greater WTCD exposures. Posttraumatic stress disorder was not associated with alcohol use, once WTCD exposure and other covariates were controlled. Our study suggests that exposure to psychological trauma may be associated with increases in problem drinking long after exposure and deserves further investigation.

Adult tobacco use levels after intensive tobacco control measures: New York City, 2002-2003.

We sought to determine the impact of comprehensive tobacco control measures in New York City. In 2002, New York City implemented a tobacco control strategy of (1) increased cigarette excise taxes; (2) legal action that made virtually all work-places, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking. From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US-born and foreign-born persons; and in all 5 boroughs. Increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third. Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing.

Smoking Practices in New York City: The Use of a Population-Based Survey to Guide Policy-Making and Programming

To inform New York City's (NYC's) tobacco control program, we identified the neighborhoods with the highest smoking rates, estimated the burden of second-hand smoke exposure, assessed the early response to state taxation, and examined cessation practices. We used a stratified random design to conduct a digit-dialed telephone survey in 2002 among 9,674 New York City adults. Our main outcome measures included prevalence of cigarette smoking, exposure to second-hand smoke, the response of smokers to state tax increases, and cessation practices. Even after controlling for sociodemographic factors (age, race/ethnicity, income, education, marital status, employment status, and foreign-born status) smoking rates were highest in Central Harlem and in the South Bronx. Sixteen percent of nonsmokers reported frequent exposure to second-hand smoke at home or in a workplace. Among smokers with a child with asthma, only 33% reported having a no-smoking policy in their homes. More than one fifth of smokers reported reducing the number of cigarettes they smoked in response to the state tax increase. Of current smokers who tried to quit, 65% used no cessation aid. These data were used to inform New York City's smoke-free legislation, taxation, public education, and a free nicotine patch give-away program. In conclusion, large, local surveys can provide essential data to effectively advocate for, plan, implement, and evaluate a comprehensive tobacco control program.

Post‐Trauma Intervention: Basic Tasks

When persons are traumatized, much of what they assume about themselves, others, and the purposes of their lives are disrupted and lose connectedness. The model is designed to help individuals and the community of which they are a part recreate these connections in meaningful, creative, and responsible ways, which may result in change on informative, reformative, or transformative levels. The model makes use of nine basic tasks in which the practitioner, individuals, and community are active participants. The tasks comprise welcoming, reflecting, reframing, educating, grieving, amplifying, integrating, empowering, and terminating/revisiting. Use of the model is illustrated in the first author’s work with employees of the New York City Adult Protection Services, who were witness to the World Trade Center disaster. [Brief Treatment and Crisis Intervention 2:39–47 (2001)]

New York City Adult Education Remembers Sept. 11

New York City Adult Education Remembers Sept. 11