York City Metropolitan Area Research Articles

Sociodemographic Predictors of Keratoconus (Severity, Treatment, and Progression) in a Tertiary Center in New York City.

To identify sociodemographic factors as predictors of keratoconus severity, progression, disease outcomes, and appropriate management in a tertiary care ophthalmology institute in the New York City metropolitan area. This is a retrospective chart review. Patients with keratoconus presenting at a tertiary eye institute in an urban setting seen between 2015 and 2022 were included. Sociodemographic data including age, sex, race, ethnicity, income derived from zip code, insurance coverage, and preferred language were recorded. These sociodemographic factors were analyzed as possible predictors of keratoconus severity at presentation (Amsler-Krumeich grades III and IV): patients presenting with acute hydrops, patients receiving corneal cross-linking or corneal transplant, patients showing 1 or more diopters of increase of Kmax during their follow-up, and patients having longer time between the provider's recommendation of corneal cross-linking and the time of the procedure. The retrospective review included 634 patients with a clinical diagnosis of keratoconus. Factors associated with severe keratoconus at presentation in the multivariate analysis were non-White (P < 0.001), lowest income (Q1) (P = 0.018), Q2 income (P = 0.012), and having Medicaid/Medicare coverage (P = 0.021). Medicaid/Medicare coverage was the only factor associated with acute hydrops (P < 0.001), and younger age was the only factor associated with disease progression (P < 0.001). Younger patients and patients with commercial insurance coverage were more likely to receive corneal collagen cross-linking (P < 0.001 and P < 0.001, respectively), whereas patients with Medicaid/Medicare coverage, lowest income, and non-White race were more likely to receive corneal transplantation (P = 0.012, P = 0.062, and P = 0.028, respectively). Medicaid/Medicare was the only factor associated with delay in receiving corneal collagen cross-linking (P = 0.013). Our study demonstrates that there are sociodemographic predictors of keratoconus disease severity, progression, and the type and the time of treatment the patients received. This confirms eye health disparities among patients with keratoconus.

Long-term contributions of VOC sources and their link to ozone pollution in Bronx, New York City

Changes in energy and environmental policies along with changes in the energy markets of New York State over the past two decades, have spurred interest in evaluating their impacts on emissions from various energy generation sectors. This study focused on quantifying these effects on VOC (volatile organic compounds) emissions and their subsequent impacts on air quality within the New York City (NYC) metropolitan area. NYC is an EPA nonattainment region for ozone (O3) and likely is a VOC limited region. NYC has a complex coastal topography and meteorology with low-level jets and sea/bay/land breeze circulation associated with heat waves, leading to summertime O3 exceedances and formation of secondary organic aerosol (SOA). To date, no comprehensive source apportionment studies have been done to understand the contributions of local and long-range sources of VOCs in this area. This study applied an improved Positive Matrix Factorization (PMF) methodology designed to incorporate atmospheric dispersion and photochemical reaction losses of VOCs to provide improved apportionment results. Hourly measurements of VOCs were obtained from a Photochemical Assessment Monitoring Station located at an urban site in the Bronx from 2000 to 2021. The study further explores the role of VOC sources in O3 and SOA formation and leverages advanced machine learning tools, XGBoost and SHAP algorithms, to identify synergistic interactions between sources and provided VOC source impacts on ambient O3 concentrations. Isoprene demonstrated a substantial influence in the source contribution of the biogenic factor, emphasizing its role in O3 formation. Notable contributions from anthropogenic emissions, such as fuel evaporation and various industrial processes, along with significant traffic-related sources that likely contribute to SOA formation, underscore the combined impact of natural and human-made sources on O3 pollution. Findings of this study can assist regulatory agencies in developing appropriate policy and management initiatives to control O3 pollution in NYC.

Neighborhood Safety and Neighborhood Police Violence Are Associated with Psychological Distress among English- and Spanish-Speaking Transgender Women of Color in New York City: Finding from the TURNNT Cohort Study.

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC's mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT ("Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color") Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18-55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

Simulating block-scale flood inundation and streamflow using the WRF-Hydro model in the New York City metropolitan area

This study assesses the performance of the Weather Research and Forecasting-Hydrological modeling system (WRF-Hydro) in the simulation of street-scale flood inundation. The case study is the Hackensack River Watershed in New Jersey, US, which is part of the operational Stevens Flood Advisory System (SFAS), a one-way coupled hydrodynamic-hydrologic system that currently uses the Hydrologic Engineering Center's Hydrologic Modeling System (HEC-HMS) to simulate streamflow. The performance of the 50-m gridded WRF-Hydro model was assessed for potential integration into the operational SFAS system. The model was calibrated with the dynamically dimensioned search algorithm using streamflow observations. The model performance was assessed using (i) streamflow observations, (ii) USGS HWMs, and (iii) crowdsourced data on street inundation. Results show that WRF-Hydro outperformed the HEC-HMS model. WRF-Hydro over and underestimated flood inundation extent due to the inaccuracy of the synthetic rating curves and the modeling structure errors. An agreement was noticed between WRF-Hydro and crowdsourced data on flood extent.

Peer social support moderates the impact of ethnoracial discrimination on mental health among young sexual minority men of color

Few studies have examined developmentally relevant sources of resilience, such as peer social support, among young sexual minority men (SMM) of color experiencing discrimination and mental health distress. To address this gap in the literature, we examined the role of peer social support in the association between discrimination and mental health distress in a sample of young SMM of color. Ninety-four cisgender young SMM of color (aged 16–29) were recruited through community-based organizations in the New York City metropolitan area as part of an effectiveness trial of a tailored Motivational Interviewing intervention. Participants completed a baseline survey that included measures of school/workplace ethnoracial discrimination, sexual orientation discrimination, peer social support, and symptoms of anxiety and depression. Results of multivariable models indicated some evidence of the stress-buffering effects of peer social support. School/workplace ethnoracial discrimination was negatively associated with symptoms of anxiety ( B = −0.12, SE = 0.03, p &lt; .001) and depression ( B = 0.44, SE = 0.15, p = .005) among young SMM of color with lower levels of peer social support. Peer social support did not moderate the association between sexual orientation discrimination and either depression or anxiety. Findings provide some evidence of the protective role of peer social support. We discuss the implications of the results for practice with young SMM of color with mental health distress.

“They Are Lost Souls”: Medicare Home Care Nurses’ Perceptions of Medicare’s Inadequate Coverage of Homebound Persons With Alzheimer’s Disease

Alzheimer’s disease is a major and increasing cause of illness and death in the United States, imposing significant social, economic, and psychological burdens on patients and their caregivers. This article explores the perceptions of Medicare home health nurses as to the impact of Medicare home health requirements on their decisions to admit, treat, cope with, and meet patient care needs of Alzheimer’s disease patients. It presents an exploratory study, which resulted from a gap in the literature review that found only 3 studies and 1 article since 1965. The study is based on interviews of a convenience sample of 37 home care nurses from 5 home health agencies in the New York City metropolitan area. Analysis followed the grounded theory 3-stage coding of interview data: open, axial, and selective coding. This research methodology was used because it was developed for interpreting qualitative data in the absence of a pre-existing theory. Five themes emerged from interviews: (1) Most Medicare home health patients have some level of Alzheimer’s disease (AD). Medicare home care regulations: (2) restrict nurses’ admissions of persons with AD and lack a mandatory evidence-based assessment for AD; (3) restrict the care that nurses can order for persons with AD; (4) do not cover evidence-based non-pharmacological interventions for AD patients ; and (5) nurses use 3 coping strategies to deal with the restrictions: most as conformists, others as innovators, some as rebels. Policymakers are urged to consider legislation expanding coverage of home-based, evidence-based non-pharmacological interventions for persons with Alzheimer’s disease; expanding Medicare home care social work services to allow delivery of appropriate services; requiring an evidence-based Alzheimer’s disease assessment at intake and as part of the OASIS; additional reimbursement for home health agencies treating Medicare homebound persons with Alzheimer’s disease.

“¿Y tu novio? Where’s Your Boyfriend?”: A Cultural-Ecological Analysis of Latinas’ Narratives of Teen Dating Experiences

There is a dearth of research examining the dating experiences of Latina teens—a large and rapidly growing population in the U.S. that reports high rates of teen dating violence. The purpose of this qualitative research was to explore Latinas’ teen dating experiences and the familial and sociocultural factors that impact them using a cultural-ecological perspective. Twenty-five first-, second-, and third-generation immigrant Latinas between the ages of 18 and 23 participated in the research. A purposive sample was drawn from the New York City (NYC) metropolitan area. We applied a critical narrative inquiry methodology to conduct in-depth narrative interviews with participants, following protocols approved by the IRB. We employed an inductive and iterative analytic process that combined holistic- and categorical-content approaches to identify themes within and across narratives. We identified the following themes: (1) cultural expectations and norms, (2) parents’ rules and expectations, (3) covert relationships, and (4) violence and control. This study’s findings highlight the importance of considering the cultural-ecological context in examinations of Latina teens’ dating experiences, with particular attention to how gendered power dynamics shape Latina teens’ dating experiences across multiple levels.

A - 181 Test Fairness and True Peer Norms for English Learners: a Validation Study of the Ortiz Picture Vocabulary Acquisition Test.

The Ortiz Picture Vocabulary Acquisition Test (Ortiz PVAT; Ortiz, 2018) incorporates English learners (ELs)' lifetime exposure to English (LEE) in the assessment of ELs' English receptive vocabulary. The current study aimed to examine the validity of the test and to provide support for the use of true peer norms that control for differences in LEE among ELs. An archival community-based dataset (N = 226; ages 2:7 and 18:11) drawn from the New York City metropolitan area was used to assess generalizability of Ortiz PVAT test scores, differences in standard scores obtained via traditional age norms vs. EL norms which account for LEE alongside age, and the predictive value of LEE. No significant differences in Ortiz PVAT performance was found based on gender or home language group membership, suggesting that the test measures receptive vocabulary in English in a fair manner across those demographic groups. Higher LEE was associated with better performance on the Ortiz PVAT. Significant differences in age-based standard scores with a medium effect size was found between monolingual English speakers and ELs with low or moderate LEE but not when LEE is accounted for using the EL norms. Lastly, an additional 18% of variance in Ortiz PVAT raw scores was accounted for by LEE above and beyond age, and LEE was found to exert more influence on test performance compared to age. Results added to the existing fairness evidence for the Ortiz PVAT and supported the use of true peer norms to account for differences in LEE.

Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in the longitudinal trends in mental well-being during the COVID-19 pandemic.

To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time.

The Influence of Synoptic-Scale Wind Patterns on Column-Integrated Nitrogen Dioxide, Ground-Level Ozone, and the Development of Sea-Breeze Circulations in the New York City Metropolitan Area

Abstract The continually changing atmospheric conditions over densely populated coastal urban regions make it challenging to produce models that accurately capture the complex interactions of anthropogenic and environmental emissions, chemical reactions, and unique meteorological processes, such as sea- and land-breeze circulations. The purpose of this study is to determine and identify the influence of synoptic-scale wind patterns on the development of local-scale sea-breeze circulations and air quality over the New York City (NYC), New York, metropolitan area. This study utilizes column-integrated nitrogen dioxide observations made during the Long Island Sound Tropospheric Ozone Study (LISTOS) field campaign, ground-level ozone observations, the HRRR numerical weather prediction model, and trajectory model simulations using the NOAA HYSPLIT model. A cluster analysis within the HYSPLIT modeling system was performed to determine that there were six unique synoptic-scale transport pathways for NYC. Stagnant conditions or weak transport out of the northwest resulted in the worst air quality for NYC. Weak synoptic-scale forcings associated with these conditions allowed for local-scale sea-breeze circulations to develop, resulting in air pollution being able to recirculate and mix with freshly emitted pollutants. Significance Statement The purpose of this work is to understand how synoptic-scale wind patterns influence air quality and sea-breeze circulations in the New York City, New York, metropolitan area. This work shows that clean air can be imported into the region from rural New England and over the Atlantic Ocean, whereas polluted air can be transported into the region from the northwest and southwest. This work also shows the importance of the strength in synoptic-scale forcings in the development of sea-breeze circulations. Weak synoptic-scale winds allow for strong sea-breeze circulations to develop over all coastlines in the New York City region, resulting in air pollutants recirculating and mixing with freshly emitted air pollution and contributing to poor air quality.

Patterns of Aquatic Insect Biodiversity in the Highly Urbanized Bronx River, NY

Aquatic insects are important components of stream food webs and are greatly impacted by anthropogenic disturbances, including urbanization. Successful restoration of urban rivers is contingent on the growth of aquatic insect populations from colonizers from local, less-disturbed streams. However, rivers in highly urbanized watersheds may not have nearby source populations, and therefore must rely only on individuals already surviving in the river. At the regional level, urbanization is a homogenizing process, but the impacts could be heterogeneous at the local level. Therefore, some sites within highly urban rivers might support higher local biodiversity and provide source populations for restoration projects focused on other sites in the river. In this study, we collected aquatic insects from sites within the Bronx River, a highly urbanized river in the New York City metropolitan area, NY, in the summers of 2021 and 2022. We found that while taxonomic richness was similar among sites, insect abundance and dominant taxa, particularly members of Hydropsychidae (Trichoptera), varied significantly among sites. These findings suggest sites within the Bronx River are not homogenous and that some sites within the river harbor larger populations of aquatic insects and may be integral to the success of future conservation projects. This pattern of within-river heterogeneity may exist in other urban rivers and deserves consideration in determining conservation goals and the planning of stream-restoration projects.

The Impact of the Early COVID-19 Pandemic on Registered Nurses' Intent to Stay in Nursing.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

“They Are Measures Without Impact”: Home Care Social Workers Criticize OASIS-E

There is significant literature about the Medicare Outcome and Information Assessment (OASIS). A new OASIS Version E, effective January 2023, makes significant changes in assessing patient mental health. However, a literature review indicates no studies of the anticipated effectiveness of the OASIS-E on improving psychosocial care of Medicare home health beneficiaries. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 36 home care social workers from 5 different home health agencies in the New York City metropolitan area between August 1, 2022, and November 30, 2022. Four themes emerged from the study, namely that social workers believe the OASIS-E revisions: are an improvement over prior OASIS versions; are cumbersome and do not require administration by a social worker; do not impose specific guidance requirements on using new measures scoring results in making care decisions; and do not address coverage of specific interventions that address patients with significant mental health issues. Policymakers are urged to modify the OASIS-E guidance manual to require use of new mental health assessment scores in care planning and to expand coverage of evidence-based treatment interventions for patients with significant assessed mental health conditions.

They Live in an Isolation Chamber: Medicare Fails the Depressed Homebound Elderly

There is significant literature on the existence and adverse effects of social isolation and depression among the elderly, exacerbated by the recent COVID-19 pandemic. A literature review indicates no studies of how the Medicare home health benefit addresses social isolation and depression, including no studies of home care social workers’ perceptions of the nature and consequences of Medicare coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021 and May 31, 2022. Six themes emerged from the study. Social workers believe: (1) extensive social isolation and depression exist among Medicare home health beneficiaries; (2) Medicare home health policy provides no systematic measure to detect or monitor social isolation and a limited measure for depression among the homebound elderly; (3) Medicare home health policy provides no coverage to treat either depression or social isolation; (4) effective interventions are available to prevent and treat depression and social isolation. Social workers also believe that: (5) the lack of social isolation and depression coverage results in additional mental and physical health conditions; (6) lack of social isolation and depression coverage exacerbates existing mental and physical health conditions. Policymakers are urged to modify the Medicare home health benefit to improve detection and monitoring of social isolation and depression as well as coverage of appropriate evidence-based preventative and treatment interventions.

Investigating sensitivity of ozone to emission reductions in the New York City (NYC) metropolitan and downwind areas

Ozone sensitivity to emission changes in urban environments were examined using WRF and CAMx simulations for the New York City metropolitan area (NYC) with data from the 2018 Long Island Sound Tropospheric Ozone Study measurements. The WRF simulation showed large positive biases of windspeed over entire domain, but those were significantly reduced with observational nudging. The base CAMx simulation showed large positive bias for NO2 concentrations in NYC, which was corrected after NOx emission adjustment (22% reduction) based on previous work. The improved modeling platform demonstrated reliable performance skills for regulatory applications. Pollution transport from NYC to the downwind region were well captured by the model. Simulated ozone concentration increases in response to NOx emission reductions within NYC proximity suggested this area to be a VOC-limited ozone formation regime. Reducing anthropogenic emissions by 50% for all pollutants reduced the number of simulated ozone exceedances from 18 to 9 days for NYC. Emission reductions were even more effective for air quality improvements in the downwind region with ozone exceedances decreasing from 20 to 7 days. Source apportionment showed mobile and industrial solvent emission sectors to be contributing more to ozone exceedances than the electrical generating units (EGU) sector in both NYC and the downwind region. The largest air quality improvement appeared to be associated with VOC emission reductions from the industrial solvent sector. All source sectors yielded higher ozone production efficiency when emissions were reduced by 50%, suggesting remaining emissions can be more potent in producing ozone per molecule of NOx.

Nudging Health Care Providers’ Adoption of Clinical Decision Support: Protocol for the User-Centered Development of a Behavioral Economics–Inspired Electronic Health Record Tool

The improvements in care resulting from clinical decision support (CDS) have been significantly limited by consistently low health care provider adoption. Health care provider attitudes toward CDS, specifically psychological and behavioral barriers, are not typically addressed during any stage of CDS development, although they represent an important barrier to adoption. Emerging evidence has shown the surprising power of using insights from the field of behavioral economics to address psychological and behavioral barriers. Nudges are formal applications of behavioral economics, defined as positive reinforcement and indirect suggestions that have a nonforced effect on decision-making. Our goal is to employ a user-centered design process to develop a CDS tool-the pulmonary embolism (PE) risk calculator-for PE risk stratification in the emergency department that incorporates a behavior theory-informed nudge to address identified behavioral barriers to use. All study activities took place at a large academic health system in the New York City metropolitan area. Our study used a user-centered and behavior theory-based approach to achieve the following two aims: (1) use mixed methods to identify health care provider barriers to the use of an active CDS tool for PE risk stratification and (2) develop a new CDS tool-the PE risk calculator-that addresses behavioral barriers to health care providers' adoption of CDS by incorporating nudges into the user interface. These aims were guided by the revised Observational Research Behavioral Information Technology model. A total of 50 clinicians who used the original version of the tool were surveyed with a quantitative instrument that we developed based on a behavior theory framework-the Capability-Opportunity-Motivation-Behavior framework. A semistructured interview guide was developed based on the survey responses. Inductive methods were used to analyze interview session notes and audio recordings from 12 interviews. Revised versions of the tool were developed that incorporated nudges. Functional prototypes were developed by using Axure PRO (Axure Software Solutions) software and usability tested with end users in an iterative agile process (n=10). The tool was redesigned to address 4 identified major barriers to tool use; we included 2 nudges and a default. The 6-month pilot trial for the tool was launched on October 1, 2021. Clinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers, along with conducting traditional usability testing, facilitated the development of a tool with greater potential to transform clinical care. The tool will be tested in a prospective pilot trial. DERR1-10.2196/42653.

Anthropogenic VOCs in the Long Island Sound, NY Airshed and their role in ozone production

Cities like New York and areas downwind have poor air quality due to pollution generated by human activity. Ozone (O3), a harmful pollutant, is produced in the atmosphere from photochemical reactions involving volatile organic compounds (VOCs) and nitrogen oxides (NOx). Aircraft measurements of VOCs obtained during an O3 event in May 2017 over the New York City metropolitan area, Long Island Sound, and Connecticut show concentrations of O3 exceeding 100 ppb between ∼200 and 500 m above the surface. During this campaign, 35 whole air canisters were collected, and 50 VOC species were measured. Biogenic isoprene often dominates VOC reactivity in summer months, but analysis of the chemistry in the middle of the Planetary Boundary Layer (PBL) indicates that primary anthropogenic VOCs such as propylene and isopentane played a major, possibly dominant role in this Spring 2017 O3 event and are suitable targets for control.The most important measured anthropogenic VOCs ranked by OH reactivity were propylene and isopentane, with n-butane and 1-pentene also playing a substantial role. The most important anthropogenic VOCs ranked by Ozone Formation Potential (OFP) were again propylene and isopentane, but aromatic species like toluene were also large contributors. Isoprene ranked tenth in importance for OFP. For VOC species with short lifetimes, like isoprene and propylene, mixing of air parcels throughout the PBL means air above the surface may quickly become depleted of these VOCs, allowing longer-lived, anthropogenic VOCs to have a proportionally greater impact on photochemical O3 production aloft. Our observations indicate that VOC reactivity was much larger in the morning than in the afternoon, suggesting controls of propylene, isopentane, and aromatics overnight may be useful for reducing morning concentrations of VOCs and therefore possibly reduce maximum concentrations of O3 observed in the afternoon. Finally, because formaldehyde (HCHO) was not measured during these flights, and since oxygenates also contribute to O3 formation, we estimate the relative contribution of isoprene and propylene to HCHO formation using a box model. Propylene produces ∼25% and isoprene produces ∼4% of HCHO within the box model.

Employment Quality and Mental and Self-Reported Health Inequities among Latinx Housecleaners: The Safe and Just Cleaners Study.

Precarious employment, such as housecleaning, is one important structural contributor to health inequities. We used an employment quality (EQ) framework to characterize the impact of employment conditions on mental and self-reported ill-health among Latinx housecleaners in the New York City metropolitan area. Using a community-based participatory research approach, we collected cross-sectional survey data from 402 housecleaners between August 2019 and February 2020 to characterize housecleaners' EQ and its association with depression, perceived stress, and self-reported health. We also measured work-related irritant eye, skin, and respiratory symptoms, which have been shown in previous research to be associated with housecleaners' exposure to chemical components of cleaning products. Our housecleaner cohort was largely female and immigrant and most had worked at least five years. Survey items capturing the EQ dimensions of unbalanced interpersonal relations, low material resources, and violations of workers' rights were associated with increased odds of depression, perceived stress, and self-reported ill-health. Work-related irritant eye, skin, and respiratory symptoms were also independently associated with mental and self-reported ill-health and some of the effects of EQ on health were potentially partially mediated through their association with work-related irritant symptoms. Findings can inform directions for community-based educational and policy initiatives to improve housecleaners' employment quality.

Harmful by Design-a Qualitative Study of the Health Impacts of Immigration Detention.

The USA has the largest immigration detention system in the world with over 20,000 individuals imprisoned by Immigration and Customs Enforcement (ICE) daily. Numerous reports have documented human rights abuses in immigration detention, yet little is known about its health impacts. To characterize how the US immigration detention system impacts health from the perspective of people who were recently detained by ICE. Qualitative study using anonymous, semi-structured phone interviews in English or Spanish conducted between July 2020 and February 2021. Adults who had been detained by ICE for at least 30 days in the New York City metropolitan area within the previous 2 years, and that were fluent in English and/or Spanish. We explored participants' health histories and experiences trying to meet physical and mental health needs while in detention and after release. We conducted a reflective thematic analysis using an inductive approach. Of 16 participants, 13 identified as male; five as lesbian, gay, bisexual, or queer; and four as Black; they were from nine countries. Participants had spent a median of 20 years living in the USA and spent a median of 11 months in immigration detention. Four themes emerged from our analysis: (1) poor conditions and inhumane treatment, (2) a pervasive sense of injustice, (3) structural barriers limiting access to care, and (4) negative health impacts of immigration detention. The narratives illustrate how structural features of immigration detention erode health while creating barriers to accessing needed medical care. Clinicians caring for immigrant communities must be cognizant of these health impacts. Community-based alternatives to immigration detention should be prioritized to mitigate health harms.

“What Were They Thinking?”: The Exclusion of Medicare Home Health From Providing Supplemental Social Needs Benefits

There is significant literature on social determinants of health (SDOH) to improve health outcomes. In response, Congress and the Centers for Medicare and Medicaid Services (CMS) have expanded Medicare Advantage Plans’ ability to cover SDOH-related services through supplemental benefits and Special Needs Plans (SNPs). Congress has not authorized Traditional Medicare to cover such services. A literature review indicates no studies of Medicare home health social worker awareness of this dichotomy and their resulting perceptions of the impacts of the lack of such coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021, and May 31, 2022. Results indicate social workers lacked awareness of the dichotomy in coverage of SNPs and supplemental benefits in Medicare Advantage Plans and traditional Medicare. Once made aware of the dichotomy, 4 additional themes emerged from the interviews: documented patient needs were being ignored; the supplemental needs coverage permitted for Medicare Advantage plans should be extended to beneficiaries receiving traditional Medicare; and the lack of such coverage increased the risk of onset of mental and physical health conditions, and revolving door-admissions and costs. Policymakers are urged to consider adding coverage of special needs and supplemental benefits covered in Medicare Advantage to traditional Medicare, through Medicare home health.