York City Children Research Articles

Asthma among WTC Children: Registry Yields First Child Health Report

The World Trade Center Health Registry (WTCHR), comprising persons most likely to have been heavily exposed to traumatic events and air pollution related to the World Trade Center attacks of 11 September 2001, includes 3,184 children under age 18 years who were living or attending school in lower Manhattan at the time, who were otherwise near the World Trade Center that morning, or who assisted in recovery efforts. In the first report of children enrolled in this registry, researchers observe that preschoolers exposed to smoke and dust from the collapsing towers had asthma rates twice the national average following the 9/11 attack, whereas asthma rates in exposed older children remained about average [EHP 116:1383–1390; Thomas et al.]. Children in certain ethnic groups also experienced disproportionate asthma rates, although the reasons for this are unclear. Data were collected in 2003 and 2004 by telephone interviews with parents of younger children or the children themselves if they had turned 18 since the attacks. More than half the children reported having respiratory symptoms after the attacks, including cough and sinus problems. Nearly 6% of all children reported having asthma diagnosed after 9/11. At the time of the interviews, 16% of children then aged 2–4 years had been diagnosed with asthma, more than twice the average of 7% for children that age in the Northeast. Asthma rates in older subjects, however, were just slightly higher than the Northeast rate. Childhood asthma normally develops in a child’s first five years of life, often after exposure to an environmental irritant. Smoke and dust from the collapsing towers might have acted as such an early trigger in susceptible preschoolers. The researchers speculate that older youngsters could have had fewer new diagnoses because most susceptible children had been diagnosed before 9/11. The researchers noted racial disparities in asthma rates. Black and Hispanic children in the WTCHR were twice as likely to be diagnosed with asthma as whites or Asians, both before and after the attacks. Reasons for the racial disparities are unclear, although prior studies on ethnic disparities in asthma suggest that both genetics and environment may play a role in etiology of the disease. Children of all ages and ethnicities were more likely to develop asthma if they were caught in the cloud of cement dust created by the collapsing towers, as pulverized cement dust is known to irritate mucous membranes. The WTCHR data have several limitations, including lack of information on how long after 9/11 symptoms appeared and the presence of co-factors for asthma. Despite these limitations, findings from the WTCHR, which constitutes the largest collection of post-disaster data of children, could have broad impact, given that tens of thousands of New York City children may have been exposed to smoke and dust on 9/11. Researchers also expect their data to improve understanding of risks to children exposed to other polluting disasters, such as the California wildfires.

Clinical Characteristics of New York City Children Who Received Tympanostomy Tubes in 2002

Tympanostomy tube insertion is the most common procedure that requires general anesthesia for children in the United States. We report on the clinical characteristics of a cohort of New York City children who received tympanostomy tubes in 2002. This retrospective cohort study included all 1046 children who received tubes in 2002 in any of 5 New York City area hospitals. We analyzed clinical data for all 682 (65%) children for whom we were able to abstract data for the preceding year from all of 3 sources: hospital, pediatrician, and otolaryngologist medical charts. Mean age was 3.8 years, 57% were male, and 74% had private insurance. More than 25% of children had received tubes previously. The stated reason for surgery was otitis media with effusion for 60.4% of children, recurrent acute otitis media for 20.7%, and eustachian tube dysfunction for 10.6%. Children with recurrent acute otitis media averaged 3.1 +/- 0.2 episodes (median: 3.0) in the previous year; those with otitis media with effusion averaged effusions that were 29 +/- 1.7 days long (median: 16 days) at surgery. Twenty-five percent of children had bilateral effusions of >42 days' duration at surgery. Despite a clinical practice guideline for otitis media with effusion that recommends withholding tympanostomy tubes for otherwise healthy children until a bilateral effusion is at least 3 to 4 months old, 50% of children had surgery without having had 3 months of effusion cumulatively during the year before surgery. The clinical characteristics of children who received tympanostomy tubes varied widely. Many children with otitis media with effusion had shorter durations of effusions than are generally recommended before surgery. The extent of variation in treating this familiar condition with limited treatment options suggests both the importance and the difficulty of managing common practice in accordance with clinical practice guidelines.

Immigration and risk of childhood lead poisoning: findings from a case control study of New York City children.

We investigated whether foreign birthplace and residence were associated with an increased risk of childhood lead poisoning. We conducted a matched case-control study among New York City children (mean age=3 years) tested for lead poisoning in 2002 (n=203 pairs). Children were matched on age, date of test, and residential area. Blood lead and housing data were supplemented by a telephone survey administered to parents or guardians. Conditional logistic regression analysis was used to examine the relationship of lead poisoning status to foreign birthplace and time elapsed since most recent foreign residence after adjustment for housing and behavioral risk factors. Both foreign birthplace and time since most recent foreign residence had strong adjusted associations with lead poisoning status, with children who had lived in a foreign country less than 6 months before their blood test showing a particularly elevated risk of lead poisoning relative to US-born children with no foreign residential history before their blood test (odds ratio [OR]=10.9; 95% confidence interval [CI]=3.3, 36.5). Our findings demonstrate an increased risk of lead poisoning among immigrant children.

Temporal variability in urinary concentrations of phthalate metabolites, phytoestrogens and phenols among minority children in the United States

Background Exposure to endocrine disruptors (EDs), including some phthalates, phytoestrogens and phenols can be quantified using biomarkers of exposure. However, reliability in the use of these biomarkers requires an understanding of the timeframe of exposure represented by one measurement. Data on the temporal variability of ED biomarkers are sparse, especially among children. Objective To evaluate intraindividual temporal variability in 19 individual urinary biomarkers (eight phthalate metabolites from six phthalate diesters, six phytoestrogens (two lignans and four isoflavones) and five phenols) among New York City children. Methods Healthy Hispanic and Black children ( N=35; 6–10 years old) donated several urine samples over 6 months. To assess temporal variability we used three statistical methods: intraclass correlation coefficient (ICC), Spearman correlation coefficients (SCC) between concentrations measured at different timepoints, and surrogate category analysis to determine how well the tertile categories based on a single measurement represented a 6-month average concentration. Results Surrogate category analysis indicated that a single sample provides reliable ranking for all analytes; at least three of four surrogate samples predicted the 6-month mean concentration. Of the 19 analytes, the ICC was >0.2 for 18 analytes and >0.3 for 10 analytes. Correlations among sample concentrations throughout the 6-month period were observed for all analytes; 14 analyte concentrations were correlated at 16 weeks. Conclusions The reasonable degree of temporal reliability and the wide range of concentrations of phthalate metabolites, phytoestrogens and phenols suggest that these biomarkers are appropriate for use in epidemiologic studies of environmental exposures in relation to health outcomes in children.

Focus Groups with Children After the World Trade Center Attacks

Focus groups with 23 New York City children examined their reactions to the September 11 terrorist attacks, their parents' reactions, and their expectations about the future. We identified an initial set of six topics; these topics were reviewed and assigned to a final set of thematic categories—understanding the events and motives, emotional responses, boredom, and coping. This final set was used to independently code the transcripts. The children reported using distraction and avoidant emotion-focused coping strategies. They were confused about some aspects of the events, but they understood the magnitude and gravity of what had occurred.

Service Utilization and Event Reaction Patterns Among Children Who Received Project Liberty Counseling Services

Service Utilization and Event Reaction Patterns Among Children Who Received Project Liberty Counseling Services

Treatment with children and adolescents traumatized by the September 11th attack

In the aftermath of the September 11th attack on the World Trade Center, a myriad of complicated issues faced us all. Among these issues were how to provide support and ease anxiety during a time when taking in what had occurred was painful for us all, and everyone felt uncertain about the future. In this article, we describe how some New York City children and adolescents in close proximity to the devastation experienced the day and managed in the aftermath. We offer two case examples as characteristic reactions and describe the fine balance of getting to the material while respecting the defenses of our young clients. These school-based sessions offer insight into the unique parameters of school-based work, and the flexibilities and limitations available in this setting. We describe treatment grounded in psychodynamic theory and in the adolescent case, the implementation of some cognitive techniques. Both cases illustrate that the effects of prior trauma play significant element in the experience of present day trauma.

NANDA Diagnoses, NIC Interventions, and NOC Outcomes used in an Electronic Health Record with Elementary School Children

This is a report of a secondary analysis of data from a published quasi-experimental feasibility study of the effects of implementing diagnoses from North American Nursing Diagnosis Association International, interventions from the Nursing Interventions Classification, and outcomes from the Nursing Outcomes Classification (referred to as NNN) on nurses' power and children's health outcomes. For this study, the NNN terms that were frequently used by nurses in the original study were identified through the nurses' printed reports of health-related visits (N = 766) with 103 New York City children in the 4th and 5th grades in six schools. The findings indicate that a large majority of nurses' efforts were focused on health promotion and management of risk states. Health problems such as pain and ineffective airway clearance were identified and were treated when present. Findings from this study can be combined with findings from previous studies to identify the diagnoses, interventions, and outcomes that are relevant for school settings. Use of the relevant NNN terms will provide data to support evidenced-based school nursing practice, education of school nurses, development of policies, and communication of the value of school nursing practice to stakeholders.

Supporting children and teens after school: a library approach

PurposeTo report on New York Public Library's implementation of the Learning in Libraries initiative, which has the goal of serving New York City's children and teens more effectively.Design/methodology/approachBreaks the initiative down into phases, describing each phase with its goals and outcomes. Includes descriptions of what was needed for the project, and how initiatives were vetted for implementation.FindingsOverall, youth participation at the library increased between 4 and 15 percent, with the number of books read increasing between 1 and 34 percent. The greatest increase in participation was with teens, who had not been included in previous outreach initiatives.Originality/valueDocuments the process of developing a new library initiative and implementing it system‐wide.

Prevalence of Childhood Asthma in Urban Communities: The Impact of Ethnicity and Income

The goal of this study was to assess the relationship between hospitalization rates and asthma prevalence in New York City children and investigate the role that sociodemographic factors play in asthma. A parent-report questionnaire was distributed in 26 randomly selected New York City public elementary schools, stratified according to neighborhood hospitalization rates. The overall student response rate was 76.9% (5250 students). Prevalence of current asthma was 17.9%, 9.59%, 6.39% (p < .001) in areas of high, median, and low asthma hospitalization rates, respectively. The overall prevalence of current asthma was 13.0%. Children living in predominantly low socioeconomic status (SES) communities had a 70% greater risk of current asthma, independent of their own ethnicity and income level. Asthma prevalence within different ethnic and income groups was consistently lower in neighborhoods of greater socioeconomic status, except among Puerto Rican children, who had high asthma prevalence, regardless of school attended or income. Prevalence of current asthma is strongly associated with attending a school in a low-income neighborhood. Although hospitalization rates have been used as an indicator of the burden of asthma in a neighborhood, it alone does not reflect the level of disparities that exist among communities with different socioeconomic backgrounds.

TEMPORAL VARIABILITY IN URINARY PHTHALATE METABOLITES, PHENOLS AND PHYTOESTROGENS AMONG CHILDREN

ISEE-85 Introduction: Exposure to endocrine disruptors (ED) such as phthalates, phenols and phytoestrogens has been shown to be ubiquitous in the United States. Given their potential to perturb hormonal balance, it is of great interest to use biomarkers of exposure to these ED in epidemiologic studies. However, use of these biomarkers as reliable indicators of exposure requires an understanding of the time frame of exposure represented by a single measurement. Yet, data on the temporal variability of many ED biomarkers is sparse, especially among children. Aim: To address this gap in knowledge, we conducted a study of temporal variability in ED urinary metabolites among New York City (NYC) children. Methods: Thirty Hispanic and Black children (age range: 6-10 years) were recruited from East Harlem, NYC. A maximum of six serial urine samples were collected over a period of six months at the following approximate time intervals: two weeks, one month, two months, three months and six months. At each interview, spot urine samples (∼40 ml) were collected and a brief product-use questionnaire was administered. Urine samples were aliquoted and frozen at –20oC. Frozen samples were analyzed at the National Center for Environmental Health at the Centers for Disease Control and Prevention for ED (9 phthalate metabolites, 9 phenols and 6 phytoestrogens). Results: Preliminary data confirms previous findings of the omni-present exposure to these ED and we find some previously unreported results. The frequencies of detection range from 76% to 100% for phthalates, 63%-100% for the phenols and 53%-100% for phytoestrogens. Across samples analyzed to date, levels range from <1 μg/L (detection limit) to over 3000 μg/L for all three analyte groups. Final data analysis will include an assessment of inter-/intra-individual variability of these ED urinary biomarkers and an estimate of the reproducibility within child, for each biomarker. Discussion: This investigation will establish existing data on temporal variability of ED such as phthalates and will examine the reliability of ED measures such as bisphenol A. If intrapersonal variability is found to be high, results of this study can be used to guide the development of sampling strategies (e.g., pooling multiple samples on each child) for use of ED metabolite levels in epidemiologic studies. Acknowledgements: Supported by grants K01 ES012645, P01 ES009584-07, EPA RD 83171101, U01 ES 012771. We would like to thank Dana Barr, Centers for Disease Control and Prevention. This study could not have been carried out without the work of the dedicated Growing Up Healthy Study staff, Evelyn Cantillo, Ana Mejia, Arkeyris Richiez and Senaka Peter, as well as the participating children and their guardians.

Neighborhood poverty and public policy: A 5-year follow-up of children's educational outcomes in the New York City moving to opportunity demonstration.

Data from the Moving to Opportunity Program, a randomized mobility experiment in which a subset of low-income minority families living in public housing in high-poverty neighborhoods were given vouchers to move to low-poverty neighborhoods, were used to evaluate 1 policy approach for improving children's educational outcomes. Four hundred twenty-five New York City children were seen 2 1/2 and 5 years following relocation (mean age=14.64 years, SD=3.21 years). Analyses examining program effects on 5-year educational outcomes, accounting for 2 1/2-year outcomes, revealed that program effects on adolescent boys' achievement found at 2 1/2 years were not sustained at 5 years. Rather, male and female youths 14-20 years of age in low-poverty neighborhoods reported lower school grades and engagement relative to youths in high-poverty neighborhoods. From a policy standpoint, the complexity of enhancing low-income minority children's educational outcomes is underscored by the multiple dynamics involved--family, neighborhood, housing, and school.

Behavior Problems in New York City's Children After the September 11, 2001, Terrorist Attacks.

Children's behavior was assessed with 3 cross-sectional random-digit-dial telephone surveys conducted 11 months before, 4 months after, and 6 months after September 11, 2001. Parents reported fewer behavior problems in children 4 months after the attacks compared with the pre-September 11 baseline. However, 6 months after the attacks, parents' reporting of behavior problems was comparable to pre-September 11 levels. In the 1st few months after a disaster, the identification of children who need mental health treatment may be complicated by a dampened behavioral response or by a decreased sensitivity of parental assessment to behavioral problems.

Posttraumatic Stress Reactions in New York City Children After the September 11, 2001, Terrorist Attacks

To assess the prevalence of posttraumatic stress reactions (PTSR) in New York City (NYC) children following the September 11, 2001, attacks and determine the key predictors of PTSR. Cross-sectional random digit-dial survey in NYC of parents of children 4-17 years old 4 months after the attacks. PTSR in children was measured using the 20-item Posttraumatic Stress Disorder Reaction Index-Child Revision, with parents as respondents. Overall, 18% of NYC children had "severe" or "very severe" PTSR, and 66% had "moderate" PTSR. In a multivariate model, parental posttraumatic stress disorder (PTSD; odds ratio [OR] = 4.50; P <.01), the parent crying in front of the child (OR = 3.19; P <.001), seeing 3 or more graphic images of the disaster on television (OR = 3.18; P <.01), and living in Manhattan were associated with severe or very severe PTSR in children. A substantial proportion of NYC children had severe or very severe PTSR after September 11, and most children exhibited at least moderate PTSR. These findings suggest an enhanced role for primary care physicians, particularly pediatricians, for screening, treatment, and referral (coupled with appropriate training and reimbursement), especially in light of continued terrorist threats. These findings also have implications for advice that pediatricians can give to parents about limiting disaster-related television exposure and children's need for emotional support.

The effect of lead-based paint hazard remediation on blood lead levels of lead poisoned children in New York City

Despite the widespread use of lead paint hazard control for children with lead poisoning, few controlled studies that estimate the effect of such control on children's blood lead levels have been published. This retrospective follow-up study examined the effects of lead hazard remediation and its timing on the blood lead levels of lead-poisoned children. From the New York City child blood lead registry, 221 children were selected who had an initial blood lead level of 20–44μg/dL between 1 July 1994 and 31 December 1996; were 6 months to 6 years of age; had a report of a follow-up blood lead test between 10 and 14 months after the initial test; had a lead-based paint hazard identified in the primary dwelling unit prior to the 10- to 14-month follow-up blood lead test; had resided or spent time at only one address with an identified lead-based paint hazard; and were not chelated. The decline in geometric mean blood lead levels from baseline to 10–14 months later was compared for children whose homes were remediated and whose homes were not remediated during the follow-up period. Regardless of remediation, geometric mean blood lead levels declined significantly from 24.3μg/dL at the initial diagnosis to 12.3μg/dL at the 10- to 14-month follow-up blood lead test (P<0.01). Among the 146 children whose homes were remediated the geometric mean blood lead levels declined 53% compared to 41% among the 75 children whose homes were not remediated by the follow-up blood lead test, a remediation effect of approximately 20% (P<0.01). After adjusting for potential confounders, the remediation effect was 11%, although it was no longer significant. Race was the only factor that appeared to confound the relationship: Black children had higher follow-up blood lead levels even after controlling for other factors, including the natural logarithm of the initial blood lead level. The effect of remediation appeared to be stronger for younger (10 to <36 months old) than for older (36 to 72 months old) children (P=0.06). While children in homes with earlier remediation (within less than 3 months) appeared to have greater declines in blood lead levels at the follow-up test than children in homes with later remediation (after 3 or more months), this trend was not significant when controlling for confounding factors. The findings of this study suggest that early identification of lead-poisoned children and timely investigation and abatement of hazards contribute to reducing blood lead levels. However, the apparent effect is modest and further research is needed to systematically test and improve the effectiveness of lead hazard controls.

Foster Care and School Mobility

Foster children face numerous obstacles to academic achievement compared to their non-foster peers. In addition to having low educational attainment, they may also suffer from high rates of school mobility and experience long delays when transferring schools. Sources of these transfers and delays include numerous residential movements and a lack of coordination between child welfare and school professionals. Potential solutions currently being explored include reduced residential mobility, better communication between child welfare and school professionals on the frontline, and integrated child welfare and educational databases. There are over one-half million children in foster care homes in the United States. Most children enter foster care because of abuse or neglect, many live in poverty, and a disproportionate percentage are Black (48%) or Hispanic (15%; U.S. Department of Health and Human Services [DHHS], 2002a). The majority of these children also reside in large urban areas, where school systems are often overcrowded and poorly funded (DHHS, 2002b). These disadvantaged backgrounds and troubled schools, combined with the trauma of being removed from home and the stigma of being in foster care, pose significant barriers to educational success for many foster children (Finkelstein, Wamsley, & Miranda, 2002; Jackson, 1994). Research indicates that, compared to the general student population, foster children have lower high school graduation rates, fewer years of schooling, lower levels of participation in college, and higher rates of participation in special education programs (for a review of this literature, see McDonald, Allen, Westerfelt, & Piliavin, 1996).1 FOSTER CARE AND SCHOOL MOBILITY Foster children may also be more likely to transfer schools and experience longer delays during these transfers than their non-foster peers, though there is limited research in this area, in part because many child welfare systems do not systematically monitor the school outcomes of children in care. Departing from this trend, New York City has begun to track the school mobility, attendance rates, and test scores of children involved in the child welfare and school systems. Through a unique data sharing agreement between the commissioners of New York City's child welfare agency, the Administration for Children's Services (ACS), and the Department of Education, ACS has developed a database that contains school information on cohorts of foster care entrants. The latest figures indicate that approximately 57% of children entering foster care between 1995 and 1999 transferred schools for noneducational reasons (other than graduating from the school, for example) in the year following foster care placement (Conger & Rebeck, 2001). This study also revealed differences in the school transfer rates of children according to their experiences in care. School transfers were more likely to occur for children who transferred to new foster care homes, ran away from their foster homes, and remained in care longer than other children. Given the link between residence and school placement2 and foster children's residential instability-leaving home for foster care, moving to new placements while in care, and perhaps returning home upon leaving care-it is not surprising that some foster children experience frequent school transfers. School transfers are problematic for most children, often requiring large adjustments to new classmates, teachers, and curricula, as well as repeated or missed lessons. Yet, there is little agreement on whether these adjustments harm school performance. Most studies indicate that switching schools is associated with lower performance on standardized exams, measures of classroom adjustment, grades, and parent reports of student achievement (e.g., Felner, Primavera, & Cauce, 1981; Hanushek, Kain, & Rivkin, 2001; U.S. General Accounting Office, 1994). A few studies, however, have found positive or no effects of school transfers on performance (e. …

A Survey of Problematic Sexualized Behaviors of Children in the New York City Child Welfare System: Estimates of Problem, Impact on Services, and Need for Training

ABSTRACT Forty-eight of 52 (92%) agencies contracted with the New York City Administration for Children's Services (ACS) responded to a survey about problematic sexualized behaviors (PSB) of children in different levels of care within the child welfare system. Results revealed that almost all agencies reported PSB within their foster boarding home and residential treatment centers. A majority of agencies perceived PSB to be a significant problem for which staff and families were not sufficiently trained. These findings highlight many avenues for advocacy, clinical intervention, and staff development.

Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses

The frequent handwashing and gloving required in high-risk, high-volume patient care areas such as critical care units damages skin of the hands. The purpose of this exploratory study was to compare 2 hand care regimens (traditional antiseptic wash with chlorhexidine-containing detergent versus mild soap wash with subsequent alcohol-based rinse for degerming as necessary) in a neonatal intensive care unit (NICU). Prospective, quasi-experimental, random assignment. One NICU (47 beds) in a New York City children's hospital. Sixteen full-time NICU nurses. Microbial flora and skin condition of hands. Nurses were randomly assigned to one of the 2 hand care regimens. No significant differences in microbial counts or types of organisms from hands of staff were found, but after 2 weeks nurses in the mild soap and alcohol group had significant improvements in their skin condition (P =.005). Use of a mild soap for cleaning and an alcohol-based product for degerming may offer an acceptable alternative to the traditional antiseptic handwash and may reduce skin damage to health care professionals' hands.

Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses

OBJECTIVE: The frequent handwashing and gloving required in high-risk, high-volume patient care areas such as critical care units damages skin of the hands. The purpose of this exploratory study was to compare 2 hand care regimens (traditional antiseptic wash with chlorhexidine-containing detergent versus mild soap wash with subsequent alcohol-based rinse for degerming as necessary) in a neonatal intensive care unit (NICU).DESIGN: Prospective, quasi-experimental, random assignment.SETTING: One NICU (47 beds) in a New York City children's hospital.SUBJECTS: Sixteen full-time NICU nurses.OUTCOME MEASURES: Microbial flora and skin condition of hands.INTERVENTION: Nurses were randomly assigned to one of the 2 hand care regimens.RESULTS: No significant differences in microbial counts or types of organisms from hands of staff were found, but after 2 weeks nurses in the mild soap and alcohol group had significant improvements in their skin condition (P = .005).CONCLUSIONS: Use of a mild soap for cleaning and an alcohol-based product for degerming may offer an acceptable alternative to the traditional antiseptic handwash and may reduce skin damage to health care professionals' hands.

New York City's 1993 child immunization day: planning, costs, and results.

This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. The methodology was designed to (1) document the planning and implementation process, (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2949 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. The differences between inner cities and developing nations have a bearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities.