York City Experience Research Articles

A comprehensive view of adolescent sexual health and family planning from the perspective of Black and Hispanic adolescent mothers in New York city

Black and Hispanic adolescents in New York City experience high rates of pregnancy and sexually transmitted infections. A comprehensive understanding of the complexity of adolescent sexual health and family planning decisions and experiences can provide insights into the sustained disparities and inform practice, policy, and future research. The goal of this study was to explore and analyze this complexity, centering Black and Hispanic adolescent mothers as the experts on sexual and reproductive experiences from pre-pregnancy through parenting. As part of formative research for a human-centered design study, we interviewed 16 Black and Hispanic adolescent mothers living in New York City. Using situational analysis, we mapped relationships, discourse, and social structures to explore the various factors that inform adolescent sexual health decisions, in particular choices about contraception. Situational analysis found that, besides interpersonal factors, organizations and non-human elements like social media and physical birth control devices affected adolescent family planning in three social arenas: home, healthcare, and school. Within and across these arenas, adolescents lacked consistent sexual health education and contraceptive counseling and faced gendered expectations of their behaviors. Participants described parents and healthcare providers as most responsible for providing sexual health counseling yet described parents as uncomfortable or overreactive and healthcare workers as paternalistic and biased. A consideration of the many factors that inform sexual health decision-making and recognition of adolescents’ desire for parents and healthcare providers to be a source of education can address health disparities and promote adolescent sexual health and wellbeing.

Power Relations and Experiential Education: Facilitating Conscientization in the Humanities

This article discusses the value of experiential education in the Humanities as a way to foster conscientization in the classroom. It begins by briefly introducing experiential education and its relationship to critical pedagogy, before detailing one way the author employs experiential learning in the classroom through a semester-long, multi-modal, digital project the author calls, “Power Relations: The New York City Experience.”

Collateral Impacts of the COVID-19 Pandemic: The New York City Experience.

To adapt an existing surveillance system to monitor the collateral impacts of the COVID-19 pandemic on health outcomes in New York City across 6 domains: access to care, chronic disease, sexual/reproductive health, food/economic insecurity, mental/behavioral health, and environmental health. Epidemiologic assessment. Public health surveillance system. New York City. New York City residents. We monitored approximately 30 indicators, compiling data from 2006 to 2022. Sources of data include clinic visits, surveillance surveys, vital statistics, emergency department visits, lead and diabetes registries, Medicaid claims, and public benefit enrollment. We observed disruptions across most indicators including more than 50% decrease in emergency department usage early in the pandemic, which rebounded to prepandemic levels by late 2021, changes in reporting levels of probable anxiety and depression, and worsening birth outcomes for mothers who identified as Asian/Pacific Islander or Black. Data are processed in SAS and analyzed using the R Surveillance package to detect possible inflections. Data are updated monthly to an internal Tableau Dashboard and shared with agency leadership. As the COVID-19 pandemic continues into its third year, public health priorities are returning to addressing non-COVID-19-related diseases and conditions, their collateral impacts, and postpandemic recovery needs. Substantial work is needed to return even to a suboptimal baseline across multiple health topic areas. Our surveillance framework offers a valuable starting place to effectively allocate resources, develop interventions, and issue public communications.

Clinical Outcomes of 2019 COVID-19 Positive Patients Who Underwent Surgery: A New York City Experience

BackgroundThe coronavirus disease 2019 (COVID-19) global pandemic has led to a halt in elective surgeries throughout the United States and many other countries throughout the world. Early reports suggest that COVID-19 patients undergoing surgery have an increased risk of requiring intensive care unit (ICU) admission and overall mortality. Materials and methodsA retrospective review was performed of all COVID-19, positive with polymerase chain reaction confirmation, patients who had surgery between February 17, 2020 and April 26, 2020 at a major New York City hospital. Clinical characteristics and outcomes including ICU admission, ventilator requirement, and mortality were analyzed. ResultsThirty-nine COVID-19 surgical patients were identified. Mean age was 53.9 y, and there were more men than women in the cohort (56.4% versus 43.6%). Twenty-two patients (56.4%) had a confirmed positive COVID-19 test preoperatively, and the remainder tested positive after their procedure. The majority (59%) of patients had an American Society of Anesthesiologists (ASA) class of 3 or higher. Postoperatively, 7 patients (17.9%) required ICU level care with a mean length of stay of 7.7 d. There were 4 deaths (10.3%) in this patient population, all of which occurred in patients who were ASA class 3 or 4. ConclusionsThis study represents the largest study to date, that objectively analyzes the outcomes of COVID-19 positive patients who underwent surgery. Overall, ICU admission rates and mortality are similar to reported rates in the literature for nonsurgical COVID-19 patients. Notably, in COVID-19 patients with ASA 1 or 2, there was a 0% mortality rate in the postoperative period.

Multisystem inflammatory syndrome in children related to COVID-19: A New York City experience.

In December 2019, the 2019, a novel coronavirus disease (COVID‐19) caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as a low risk for severe COVID‐19. However, reports have emerged recently of cases of COVID‐19 in children with a systemic inflammatory disease, with features that overlap with Kawasaki disease (KD). We describe the first 15 cases with the multi‐systeminflammatory syndrome in children (MIS‐C), temporally related to COVID‐19, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and Black/African American ancestry, the distinct cytokine signature across the disease spectrum (IL‐1/IL‐6), and the potential role and pathogenesis of SARS‐CoV‐2 in this new clinical entity.

Clinical Outcomes of COVID-19 Positive Patients Who Underwent Surgery: The New York City Experience

Background: The COVID-19 global pandemic has led to a halt in elective surgeries throughout the United States and many other countries throughout the world. Early reports suggest that COVID-19 patients undergoing surgery have an increased risk of requiring intensive care unit (ICU) admission and overall mortality. Methods: A retrospective review was performed of all COVID-19, positive with PCR confirmation, patients who had surgery between February 17, 2020 and April 26, 2020 at a major New York City hospital. Clinical characteristics and outcomes including ICU admission, ventilator requirement, and mortality were analyzed. Findings: Thirty-nine COVID-19 surgical patients were identified. Mean age was 53.9 years and there were more males than females in the cohort (56.4% vs 43.6%). Twenty-two patients (56.4%) had a confirmed positive COVID-19 test pre-operatively and the remainder tested positive after their procedure. The majority (59%) of patients had an American Society of Anesthesiologists (ASA) class of 3 or higher. Post-operatively, 7 patients (17.9%) required ICU level care with a mean length of stay of 7.7 days. There were 4 deaths (10.3%) in this patient population, all of which occurred in patients who were ASA Class 3 or 4. Interpretation: This study represents the largest study to date, that objectively analyzes the outcomes of COVID-19 positive patients who underwent surgery. Overall, ICU admission rates and mortality are similar to reported rates in the literature for non-surgical COVID-19 patients. Notably, in COVID-19 patients with ASA 1 or 2, there was a 0% mortality rate in the post-operative period. Funding Statement: The authors have no funding sources to report. Declaration of Interests: The authors have no financial interest to declare in relation to the content of this work. Ethics Approval Statement: Institutional review board approval (i20-00644).

The Search for Order in Municipal Administration: Herman A. Metz and the New York City Experience, 1898–1909

ABSTRACTThis paper examines the administrative and accounting reforms coordinated by Herman A. Metz around the turn of the 20th century in New York City. Reform efforts were motivated by deficiencies in administering New York City's finances, including a lack of internal control over monetary resources and operational activities, and opaque financial reports. The activities of Comptroller Metz, who collaborated with institutions such as the New York Bureau of Municipal Research, were paramount in initiating and implementing the administrative and accounting reforms in the city, which contributed to reform efforts across the country. Metz promoted the adoption of functional cost classifications for city departments, developed flowcharts for improved transaction processing, strengthened internal controls, and published the 1909 Manual of Accounting and Business Procedure of the City of New York, which laid the groundwork for transparent financial reports capable of providing vital information about the city's activities and subsidiary units.JEL Classifications: H72, M41, N91.Data Availability: Data are available from the public sources cited in the text.

Adapting Evidence-Based Teen Pregnancy Programs to Be LGBT-Inclusive: Lessons Learned.

Lesbian, gay, bisexual, and transgender (LGBT) youth show higher rates of sexual risk behaviors than heterosexual and cisgender youth; yet, most school-based sexual health education is largely heteronormative and cisnormative and does not recognize the spectrum of sexual and gender identity. New York City's Departments of Health and Education collaborated to create an LGBT-inclusive supplement to the Reducing the Risk curriculum and implement it in 21 South Bronx high schools. Teachers completed an electronic survey to report the number of students reached and an online log to measure curriculum adherence. Students were administered an anonymous 74-item pre- and posttest to measure demographics, sexual health knowledge, and student satisfaction with the curriculum. Chi-square and t tests were used to assess differences in student demographics and changes in knowledge scores. Reducing the Risk was implemented in 21 schools reaching 230 classes and 5,673 students; with 161 classes receiving the supplement. Teachers reported completing an average of 70% of LGBT supplement activities. Students who received the supplement reported higher satisfaction and greater knowledge scores than students who did not. New York City experience shows that being more inclusive of LGBT teens while implementing preexisting evidence-based sexual and reproductive health programs is possible and replicable.

Risky Business: New York City's Experience With Fear-Based Public Health Campaigns.

Fear-based public health campaigns have been the subject of an intense moral and empirical debate. We examined how New York City, under Mayor Michael Bloomberg, used fear-based appeals to confront three challenges to public health: high rates of tobacco use, obesity, and HIV infection. New York City's use of this type of messaging may have set a precedent. Other state and local health departments will have to navigate how and whether to use fear in a context where it is possible to assert that it can serve the interests of public health. But this will not reduce the need to carefully balance efficacy, uncertainty, stigma, marginalization, emotional burdens, justice, community participation, and scientific credibility.

Increasing access to fruits and vegetables: perspectives from the New York City experience.

Broad recognition now exists that price, availability, and other structural factors are meaningful barriers to fruit and vegetable consumption, particularly among low-income adults. Beginning in 2005, the New York City Department of Health and Mental Hygiene used the social-ecological model to develop a multifaceted effort to increase fruit and vegetable access citywide, with emphasis in low-income neighborhoods. Overall, the percentage of New York City adults who reported consuming no fruits and vegetables in the previous day decreased slightly over a 10-year period (2002: 14.3% [95% confidence interval = 13.4%, 15.2%]; 2012: 12.5% [95% confidence interval = 11.4%, 13.6%]; P for trend < .001). Our approach hypothesizes that complementary initiatives, implemented simultaneously, will create a citywide food environment that fuels changes in social norms and cultural preferences, increases consumer demand, and supports sustainable access to affordable produce.

Incorporating research and evaluation into pandemic influenza vaccination preparedness and response.

Incorporating research and evaluation into pandemic influenza vaccination preparedness and response.

Government Leadership in Addressing Public Health Priorities: Strides and Delays in Electronic Laboratory Reporting in the United States

For nearly a decade, interest groups, from politicians to economists to physicians, have touted digitization of the nation's health information. One frequently mentioned benefit is the transmission of information electronically from laboratories to public health personnel, allowing them to rapidly analyze and act on these data. Switching from paper to electronic laboratory reports (ELRs) was thought to solve many public health surveillance issues, including workload, accuracy, and timeliness. However, barriers remain for both laboratories and public health agencies to realize the full benefits of ELRs. The New York City experience highlights several successes and challenges of electronic reporting and is supported by peer-reviewed literature. Lessons learned from ELR systems will benefit efforts to standardize electronic medical records reporting to health departments.

Being Black and Lesbian, Gay, Bisexual or Transgender

This article explores how the experience of being both black and either lesbian, gay, bisexual, or transgender (LGBT) has evolved over time, particularly through the lens of the New York City experience; how the interaction of black LGBT persons with the black community, the white LGBT communities, and the larger society has affected that evolution; and the current crossroad where black LGBT persons and the black community stand today.

Urban environmental challenges and climate change action in New York City

Climate change presents cities with significant challenges such as adaptation to dynamic climate risks and protection of critical infrastructure systems and residents’ livelihoods. City governments and inhabitants must continually respond to a variety of urban environmental risks. Understanding how cities have begun to extend these experiences to the context of climate change adaptation as well as mitigation is crucial for the development and identification of climate action best practices. The focus of this paper will be to document and explore how the city of New York has begun to define and implement a set of climate actions over the past half decade. These actions are presented within a discussion of past and future climate risks and vulnerabilities, and of climate and sustainability programmes that the city government has developed recently. Even as a mature, mega-city in a developed country, lessons from the New York City experience can be transferred to a variety of other urban contexts.

Public Health Detailing of Primary Care Providers: New York City's Experience, 2003–2010

BackgroundGiven evidence of widespread underuse of recommended clinical preventive services and chronic disease management, New York City developed the Public Health Detailing Program, a primary care provider outreach initiative to increase uptake of best practices on public health priorities.PurposeThe goal of the study was to evaluate the effectiveness of the Public Health Detailing Program in helping primary care providers and their staff to improve patient care on public health challenges.MethodsAn analysis was conducted of reported changes in clinical practice or behavior by examining providers' retention and implementation of recommendations for campaigns.ResultsDuring each campaign, 170 to 443 providers and 136 to 221 sites were reached. Among providers who responded to questions on changes in their practice behavior, the following significant increases occurred from baseline to follow-up. Screening for clinical preventive services increased, including routinely screening for intimate partner violence (14%–42%). Clinical management increased, such as prescribing longer-lasting supplies of medicine (29%–42%). Lifestyle modification and behavior change, such as recommending increased physical activity to patients with high cholesterol levels, rose from 52% to 73%. Self-management goal-setting with patients increased, such as using a clinical checkbook to track hemoglobin HbA1c goals (28% to 43%).ConclusionsData suggest that public health detailing can be effective for linking public health agencies and their recommendations to providers and influencing changes in clinical practice behavior. Given evidence of widespread underuse of recommended clinical preventive services and chronic disease management, New York City developed the Public Health Detailing Program, a primary care provider outreach initiative to increase uptake of best practices on public health priorities. The goal of the study was to evaluate the effectiveness of the Public Health Detailing Program in helping primary care providers and their staff to improve patient care on public health challenges. An analysis was conducted of reported changes in clinical practice or behavior by examining providers' retention and implementation of recommendations for campaigns. During each campaign, 170 to 443 providers and 136 to 221 sites were reached. Among providers who responded to questions on changes in their practice behavior, the following significant increases occurred from baseline to follow-up. Screening for clinical preventive services increased, including routinely screening for intimate partner violence (14%–42%). Clinical management increased, such as prescribing longer-lasting supplies of medicine (29%–42%). Lifestyle modification and behavior change, such as recommending increased physical activity to patients with high cholesterol levels, rose from 52% to 73%. Self-management goal-setting with patients increased, such as using a clinical checkbook to track hemoglobin HbA1c goals (28% to 43%). Data suggest that public health detailing can be effective for linking public health agencies and their recommendations to providers and influencing changes in clinical practice behavior.

Safety countermeasures and crash reduction in New York City—Experience and lessons learned

Traffic fatalities and injuries constitute a major global public health problem and the United States has fallen behind other developed countries in traffic safety. Yet, New York City stands out as a traffic safety model in the nation with its low fatality rate and its significant reductions in various types of crashes. This study develops a safety framework that considers three principal axes that affect crashes: why, who, and where. While “why” concerns exposure, conflict, and speed, “who” and “where” consider the unique characteristics of the road users and the surrounding built environment. Grounded in this safety framework, the effectiveness of 13 safety countermeasures and street designs installed in New York City between 1990 and 2008 are evaluated using a two group pretest–posttest design. The potential regression-to-the-mean problem is addressed by applying the ANCOVA regression approach. The results show that signal related countermeasures that are designed to reduce conflicts: split phase timing, signal installations, all pedestrian phase, and increasing pedestrian crossing time, reduce crashes. Traffic calming measures, including road diets, are also found to have significant safety benefits. Countermeasures that are designed to alert drivers’ cognitive attention, such as high visibility crosswalks and posted speed limit reduction signs, appear to have a lesser effect. The various safety countermeasures implemented in New York City considered all three important dimensions in the safety framework: why, who, and where. The study suggests these strategies are likely to contribute to the large reductions in crashes in New York City. We also demonstrate that a rigorous quasi-experimental design can be readily deployed in transportation safety evaluation studies.

Abstract PL05-06: Policy and environmental approaches to cancer prevention: The New York City experience

Abstract Much of the focus on cancer prevention has been on early detection and treatment, but much of the actual progress in reducing cancer mortality has resulted from primary prevention of unhealthy behaviors. Tobacco use, unhealthy diet, and physical inactivity are responsible for a large proportion of cancers in the United States. The New York City Department of Health and Mental Hygiene takes a population-based approach to cancer control, focusing on promoting healthy behaviors by changing the social and built environment. This session will present examples of New York City's environmental approaches to cancer control and data on their effectiveness in a large, diverse urban population. The presenter will discuss the city's use of legislation and counter-advertising to reduce the number of adult and youth smokers, and will describe initiatives to decrease consumption of sugar-sweetened beverages and encourage physical activity. Based on New York City's experience, public health agencies should expect industry opposition to initiatives that may have an impact on consumer behavior. To succeed, cancer prevention programs based on social and environmental change require involvement of state and local governments and benefit from strong public-private partnerships. Researchers interested in cancer prevention should conduct studies of the impact of policies and other population-based approaches to modifying behaviors that increase the risk of cancers. Learning objectives: 1. Identify two environmental approaches to tobacco control. 2. Describe population-based methods to reduce consumption of sugar-sweetened beverages and increase physical activity. 3. Describe research questions relevant to policy approaches to primary prevention of cancer. Citation Information: Cancer Prev Res 2010;3(12 Suppl):PL05-06.

Examining the Effects of New York Experience Corps® Program on Young Readers

There are hundreds of tutoring programs that utilize community volunteers being implemented across the country; however, there are few rigorous efforts to evaluate their effectiveness. This article presents findings on reading achievement from an evaluation of the New York City Experience Corps®, a program that uses older volunteers to work with students in public elementary schools. Two hundred and eighty-eight first- and second-grade students participated in a pre-test/post-test two group design with randomization to assess the impact of the program on their reading abilities. Reading was assessed using the Phonological Awareness Literacy Screening (PALS) and Early Childhood Literary Assessment System (ECLAS). Results indicate that Experience Corps is effective at improving reading scores. This study provides evidence that older volunteers can be successfully utilized to tutor young readers.

Young children's responses to September 11th: The New York City experience.

Although the knowledge base regarding very young children's responses to trauma has been expanding, descriptions of their responses to terrorism remain sparse. Yet, their vulnerability makes this an important group to study. Recent events in the United States (9/11, Hurricane Katrina) make this question highly relevant. This study aims to provide extensive descriptions of how children 5 years or younger on September 11th who were living in close proximity to Ground Zero responded that day and in the following months. Sixty-seven New York City parents (with 104 children) participated in focus groups between November 2001 and May 2002. Focus groups also provided a foundation for an in-depth study examining young children's adaptation following 9/11 and changes in parenting behaviors after the disaster. Findings on children's behavioral and emotional reactions on 9/11 and in the 8 months after as well as their need to return to normalcy are reported. Consistent with current understanding of trauma symptoms in young children, parents reported behaviors including chronic sleep disruptions, fearful reactions, development of new fears, and increased clinginess and separation anxiety following the disaster. On the actual day, children's responses were described as ranging from calm and cooperative to difficult and panicky. Implications for working with parents and young children affected by terrorism or community-level trauma and directions for future research are discussed.

Triage Accuracy at a Multiple Casualty Incident Disaster Drill: The Emergency Medical Service, Fire Department of New York City Experience

We sought to evaluate the accuracy and speed for the triage of multiple patients during a disaster drill by Emergency Medical Service (EMS) personnel. During a disaster drill (train collision with blast injury and chemical release), the accuracy and speed of triage of 130 patient-actors by the Fire Department of New York City (FDNY) EMS personnel was evaluated using the Simple Triage and Rapid Treatment (START) triage system. All EMS personnel had been previously trained in START, but refresher training was not administered before the drill. Overall triage accuracy was 78%. In patients that had additional changes in their status during the triage process (injects), 62% were retriaged appropriately. Because of security and decontamination procedures, triage at the triage/treatment area began 40 minutes after the drill commenced. It took 2 hours and 38 minutes to completely clear the scene of all patients. On average, the time from the start of triage to transport was 1 hour and 2 minutes. Despite the fact that triage is a skill practiced by every EMS system in the country on a daily basis, few studies regarding triage accuracy are available. Limited data suggest that the triage accuracy rates using different triage strategy algorithms are approximately 45% to 55%. During this drill, FDNY-EMS triage accuracy using the START system exceeded these expectations. This study provides insight as to the triage experience of a large urban EMS system operating at a disaster drill.