York City Public Research Articles

Slipping Through the Cracks: Clinicians' Perspectives on the Gaps in New York City's Public Mental Health System.

Most people who seek mental health treatment cannot access it. Certain groups (e.g., Medicaid enrollees and the uninsured) face particularly severe treatment access barriers along the care continuum. We interviewed 31 clinicians across two studies about their perspectives working in New York City's public mental health system. Because every clinician across both studies reported gaps in the system, we deployed an emergent, "serendipitous finding" approach and qualitatively analyzed the interviews together. Clinicians described three public mental health system gaps. First, many treatment-seekers must wait long periods of time to receive care and some never receive it at all. Second, patients with more serious challenges cannot access longer-term, higher-intensity, or specialized treatment. Third, some patients receiving high-intensity services may benefit from lower-intensity mental health support that is better integrated with medical and social service support. Coordinated and sustained financial investments at every step of the mental healthcare continuum are needed.

T61 - Utilization of Medication for Opioid Use Disorder for Hospitalized Patients at 6 New York City Public Hospitals With an Addiction Consultation Service

T61 - Utilization of Medication for Opioid Use Disorder for Hospitalized Patients at 6 New York City Public Hospitals With an Addiction Consultation Service

Advancing Health Care Equity: A Memory Care Unit in a Large New York City Public Nursing Home

Advancing Health Care Equity: A Memory Care Unit in a Large New York City Public Nursing Home

Who Really Represents Me? The Case of Afro-Latinx Bureaucratic Representation in New York City Public Schools

Who Really Represents Me? The Case of Afro-Latinx Bureaucratic Representation in New York City Public Schools

The origins and growth of the Meatless Monday movement.

Meatless Monday is a global movement that encourages people to reduce meat in their diets for their own health and the health of the planet. We conducted a comprehensive review of primary and secondary sources and archival material documenting the origins, historical roots, and growth of Meatless Monday and simultaneous developments in public health. Sources for the paper included publications of the US Food Administration and articles and media identified using searches of ProQuest Historical Newspapers, Newspapers.com Academic, ProQuest US Newsstream, ProQuest Canadian Newstream, ProQuest International Newsstream databases, and Google.com. Meatless Monday was conceived by the advertising executive and public health advocate Sid Lerner in 2003, inspired by the meatless days observed during World War I and II. Meatless Monday grew steadily from 2003 to 2023 through advocacy by food writers, talk show hosts, and celebrity chefs, and through participation by schools, cities, restaurants, corporations, and institutions worldwide. School systems began to observe Meatless Monday, such as Baltimore City Public Schools in 2009 and New York City Public Schools in 2019. Meat-Free Monday campaign was launched by Paul McCartney and his daughters in 2009 in the United Kingdom. The Humane Society of the United States became an advocate for Meatless Monday and helped institute it in >200 US school systems. From 2003 to 2023, Meatless Monday spread to over 40 countries and was observed in public schools in countries such as Brazil, Ireland, and Belgium. Findings regarding high meat consumption and its adverse effects on health, high greenhouse gas production and environment degradation, and problems with animal welfare under conditions of industrial food animal production emerged during the same period and influenced many to advocate Meatless Monday. Meatless days of World War I and II were driven by patriotic motivations to provide food for the US troops and the Allies in Europe, whereas motivations for observing Meatless Monday were largely related to concerns regarding personal health, the environment, and animal welfare. Meatless Monday grew from relatively humble origins to a highly recognized worldwide movement with wide appeal as a way to begin reducing meat consumption for personal and planetary health.

The longitudinal association between asthma severity and physical fitness by neighborhood factors among New York City public school youth

PurposeThis paper aims to examine the association between asthma severity and one-year lagged fitness in New York City Public school youth by neighborhood opportunity. MethodsUsing the Child Opportunity Index 2.0 and individual-level repeated measures NYC Office of School Health (OSH) fitness surveillance data (2010–2018), we ran multilevel mixed models stratified by neighborhood opportunity, adjusting for sex, race/ethnicity, grade level, poverty status, and time. Asthma severity was based on a physician-completed Asthma Medication Administration Form (MAF) from each school year and drawn from the Automated Student Health Record (ASHR). ResultsAcross all youth in grades 4–12 (n = 939,598; 51.7 % male; 29.9 % non-Hispanic Black, 39.3 % Hispanic; 70.0 % high poverty), lower neighborhood opportunity was associated with lower subsequent fitness. Youth with severe asthma and very low and low neighborhood opportunity had the lowest 1-year lagged fitness z-scores − 0.24 (95 % CI, −0.34 to −0.14) and − 0.26 (95 % CI, −0.32 to −0.20), respectively, relative to youth with no asthma and very high opportunity. ConclusionsAn inverse longitudinal relationship between asthma severity and subsequent fitness was observed. Study findings have implications for public health practitioners to promote physical activity and improved health equity for youth with asthma, taking neighborhood factors into account.

Associations Between Neighborhood Opportunity and Indicators of Physical Fitness for New York City Public School Youth.

Background: Fewer than 1/4th of US children and adolescents meet physical activity (PA) guidelines, leading to health disparities that track into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to improve fitness attainment and reduce these disparities. We drew data from the Child Opportunity Index to examine associations between neighborhood indicators of opportunity for PA and multiple fitness indicators among New York City public school youth. Methods: Multilevel generalized linear mixed models were used to estimate the overall and sex-stratified associations between neighborhood indicators (green space, healthy food, walkability, commute time) and indicators for physical fitness [curl-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER), sit-and-reach] using the New York City FITNESSGRAM data set. Results: The analytic sample [n = 299,839; median (interquartile range) age = 16 (12-17)] was 50.1% female, 37.5% Hispanic, 26.2% non-Hispanic Black, and most (69.5%) qualified for free/reduced price school meals. Neighborhood indicators were positively associated with higher values of indicators for physical fitness. The strongest associations were observed between walkability and both BMI and PACER, and commute time with BMI, push-ups, and PACER. For example, walkability had the greatest magnitude of effects for BMI and muscular strength and endurance (BMI: β: -0.75, 95% confidence interval, CI: -1.01 to -0.49; PACER: β: 1.98, 95% CI: 1.59 to 2.37), and particularly for girls compared with boys (BMI, girls: β: -0.91, 95% CI: -1.22 to -0.66); BMI, boys: β: -0.56, 95% CI: -0.86 to -0.25); PACER, girls: β: 2.11, 95% CI: 1.68 to 2.54; push-ups, boys: β: 1.71, 95% CI: 1.31 to 2.12). Conclusion: Neighborhood indicators were associated with multiple measures of youth fitness. Continued research on neighborhood opportunity and youth fitness may better inform place-based public health interventions to reduce disparities.

The Billion Oyster Project and Curriculum and Community Enterprise for Restoration Science Curriculum: ITEST Program Impacts on NYC School Student Scientific Identity

The Billion Oyster Project and Curriculum and Community Enterprise for the Restoration of New York Harbor with New York City Public Schools (BOP-CCERS) program is a National Science Foundation (NSF) supported initiative that involves multiple stakeholder collaborations and is led by Pace University. Within Pace, the initiative crosses over three different schools and colleges and across multiple departments. Pace University’s NSF project of focus in this article is the Innovative Technology Experiences for Students and Teachers (ITEST) program. The purpose is to increase student motivation and preparation for pursuing STEM careers. This article presents results of programming to increase student scientific identity. Findings revealed that students in the 11th grade had the highest level of scientific identity compared to other high school grades. These findings indicate that 11th grade may be an ideal timeframe for interventions to improve scientific identity. Moreover, project participants had higher levels of engagement in STEM-related activities, were more likely to watch videos made by scientists, and read articles written by scientists than those in the control group.

The Billion Oyster Project and Curriculum and Community Enterprise for Restoration Science Curriculum: STEM+C Summer Institute Experiential Learning

The Billion Oyster Project and Curriculum and Community Enterprise for the Restoration of New York Harbor with New York City Public Schools (BOP-CCERS) program is a National Science Foundation (NSF) supported initiative and collaboration led by Pace University. One of Pace University’s NSF projects is STEM+C (Science, Technology, Engineering, and Mathematics plus Computing) designed to work with teachers and students in New York City public schools. This article presents results of a study conducted on the STEM Summer Institute at Pace University in Summer 2022. The purpose was to engage both teachers and students in harbor restoration and experiential learning in New York City including learning about vital ecology projects related to New York’s harbor such as oyster restoration, which is critical to cleaning pollutants in the New York Harbor. Findings revealed that students indicated improved oyster knowledge and restoration skills, scientific skills, collecting and analyzing data, and knowledge about STEM careers. Participating teachers indicated a positive impact on their knowledge of content and harbor restoration, pedagogical knowledge used to engage students in hands-on scientific learning, and methods of engaging and motivating their own students. Moreover, teachers indicated a positive outcome for exposing their students to STEM career options.

A Chance at the Arts: Assessment of NYC Department of Education’s ArtsCount as a Violation of Title VI Implementing Regulation

A Chance at the Arts: Assessment of NYC Department of Education’s ArtsCount as a Violation of Title VI Implementing Regulation

Longitudinal associations between neighborhood child opportunity and physical fitness for New York City public school youth.

Neighborhood environments can support fitness-promoting behavior; yet, little is known about their influence on youth physical fitness outcomes over time. We examined longitudinal associations between neighborhood opportunity and youth physical fitness among NYC public school youth. The Child Opportunity Index (COI), a composite index of 29 indicators measuring neighborhood opportunity at the census tract-level, along with scores on four selected COI indicators were linked to NYC FITNESSGRAM youth at baseline. Fitness outcomes (measured annually, 2011 - 2018) included BMI, curl-ups, push-ups, and PACER laps. Unstratified and age-stratified adjusted three-level generalized liner mixed models, nested by census tract and time, estimated the association between COI and fitness outcomes. The analytic sample (n=204,939) lived in very low (41%) or low (30%) opportunity neighborhoods. Unstratified models indicate that overall COI is modestly associated with improved youth physical fitness outcomes. The strongest opportunity-fitness associations were observed for PACER. Stratified models show differences in associations across younger vs. older youth. We find that neighborhood factors are associated with youth fitness outcomes over time, with the strength of the associations dependent on age. Future implications include better informed place-based interventions tailored to specific life stages to promote youth health.

Pulling Back the Curtain on School-Level Expenditures: A Quantitative Examination of Budget Choices in New York City Public Schools

Pulling Back the Curtain on School-Level Expenditures: A Quantitative Examination of Budget Choices in New York City Public Schools

Health Care Provider Decisions to Initiate Oral HIV Preexposure Prophylaxis in New York City Public Sexual Health Clinics.

Oral HIV preexposure prophylaxis (PrEP) is safe and effective but underutilized. Health care providers' beliefs about PrEP and attitudes toward people who could benefit may affect PrEP access. This mixed-methods study (2016-2018) was conducted in 8 New York City public sexual health clinics that implemented a PrEP program. Data included 32 in-depth qualitative interviews with clinicians, quantitatively coded to reflect their PrEP beliefs; a provider questionnaire; and 6 months of medical record visit data for these providers. Among patients with a PrEP indication, we examined the odds of a patient being initiated on PrEP associated with providers' PrEP beliefs and demographic characteristics, and patient characteristics. Providers reported strong support for offering PrEP to eligible patients. The majority denied concerns about possible development of drug-resistant viral strains, giving PrEP to people who might not benefit, and PrEP toxicity. Nevertheless, about one-third agreed with each of these concerns, and 55% thought PrEP use might limit condom use. Of 2176 patients with a PrEP indication, 20% were initiated. Providers with more restrictive PrEP beliefs did not have lower odds of initiating patients on PrEP. Women as well as Black and Latinx patients were less likely to be initiated on PrEP. Contrary to our hypotheses, providers' negative PrEP beliefs did not seem to reduce initiation of PrEP for eligible patients. This may be attributable to clear clinical protocols, strong staff support, and training on implementing PrEP in this setting. Racial and gender disparities in PrEP uptake urgently require attention.

Abstract 10298: Suboptimal Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation for Pulmonary Embolism in a New York City Public Hospital

Introduction: Computed tomography with pulmonary angiography (CTPA) is the gold standard for diagnosis of pulmonary embolism (PE). A nearly five-fold increase in the use of CTPA was observed from 2004 to 2016 in the United States. Hypothesis: Suboptimal utilization of validated diagnostic predictive tools with D-dimer might have led to excessive use of CTPA in a large public hospital in Bronx, New York. Methods: We conducted a retrospective review of patients who underwent CTPA from January to October 2021. Two independent reviewers, blinded to each other and to the CTPA and D-dimer results, estimated the clinical probability for PE using the Well’s criteria, YEARS criteria, and the revised Geneva score. Patients were classified based on the presence or absence of PE in the CTPA. Chi-square and Fischer's exact test were used to compare discrete variables. Results: 504 patients were included in the analysis (median age: 56 years, female: 59.1%). The clinical probability for PE was considered to be low by both independent reviewers in 303 (60.2%), 250 (49.7%), and 108 (21.5%) patients based on Well’s criteria, YEARS criteria, and the revised Geneva score, respectively. D-dimer testing was conducted in less than half of patients with low clinical probability [Well’s:(43.2%), YEARS:(49.7%), Geneva:(46.3%)]. Based on Well’s criteria, of 69/131 patients (52.7%) with a D-dimer < 500 ng/ml, 3/69 (4.3%) were diagnosed with PE. As per YEARS criteria, of 51/100 patients (51%) with a D-dimer < 500 ng/ml, 3/51 (5.9%) were diagnosed with PE. Based on the revised Geneva score, of 26/50 (52%) patients with a D-dimer of < 500 ng/ml, 1/26 (3.8%) patient was diagnosed with PE. All PEs were subsegmental. Conclusion: Many patients underwent CTPA despite having a low probability of PE due to suboptimal utilization of validated diagnostic predictive tools with D-dimer. Using a D-dimer cut-off of <500 ng/ml in patients with a low probability of PE would have missed only a small number of subsegmental PE.

The Billion Oyster Project and Curriculum and Community Enterprise for Restoration Science Curriculum: The Digital Platform and Student Symposium Presentations

The Billion Oyster Project and Curriculum and Community Enterprise for the Restoration of New York Harbor (BOP-CCERS) program is a National Science Foundation (NSF) supported initiative and collaboration of multiple institutions and organizations led by Pace University and is in collaboration with New York City Public Schools. This large-scale project, Innovative Technology Experiences for Students and Teachers (ITEST), generated a large amount of data through programming that engaged both teachers and students. This article presents the third part to the study with focus on the Digital Platform and results from the student Symposium presentations. Part 1 focused on Underrepresented Minority (URM) student interest in STEM as motivated by the original project. Part 2 focused on URM student engagement with teachers to support students in teaching science through experiential learning and lessons that connect science to the real world, particularly through science in the New York Harbor. Moreover, the second part of the study focused on teacher engagement in the program, and what the researchers had learned in the process. The third aspect of the study, and primary focus on this paper, had found additional positive results cited by the teachers in the study both using the Digital Platform and after the project outcomes from the student Symposium presentations.

Sensitivity of Medicaid Claims Data for Identifying Opioid Use Disorder in Patients Admitted to 6 New York City Public Hospitals.

Behavioral health diagnoses are frequently underreported in administrative health data. For a pragmatic trial of a hospital addiction consult program, we sought to determine the sensitivity of Medicaid claims data for identifying patients with opioid use disorder (OUD). A structured review of electronic health record (EHR) data was conducted to identify patients with OUD in 6 New York City public hospitals. Cases selected for review were adults admitted to medical/surgical inpatient units who received methadone or sublingual buprenorphine in the hospital. For cases with OUD based on EHR review, we searched for the hospitalization in Medicaid claims data and examined International Classification of Diseases, Tenth Revision discharge diagnosis codes to identify opioid diagnoses (OUD, opioid poisoning, or opioid-related adverse events). Sensitivity of Medicaid claims data for capturing OUD hospitalizations was calculated using EHR review findings as the reference standard measure. Among 552 cases with OUD based on EHR review, 465 (84.2%) were found in the Medicaid claims data, of which 418 (89.9%) had an opioid discharge diagnosis. Opioid diagnoses were the primary diagnosis in 49 cases (11.7%), whereas in the remainder, they were secondary diagnoses. In this sample of hospitalized patients receiving OUD medications, Medicaid claims seem to have good sensitivity for capturing opioid diagnoses. Although the sensitivity of claims data may vary, it can potentially be a valuable source of information about OUD patients.

Can reading practitioners and researchers improve intensive reading support systems in a large urban school system?

One way to provide intensive intervention for students with severe and persistent reading difficulties is to use a systematic data‐based decision‐making process called data‐based individualisation (DBI). DBI is a process for identifying needs and aligning them with specialist support. Meta‐analyses of DBI studies by university‐based researchers have shown positive effects, but university research studies do not involve many of the implementation science‐related factors that affect success. This study addresses the dearth of data from practice‐based studies that incorporate DBI and was done as a researcher–practitioner collaboration, developed with based on the theory that the collaborators' combined knowledge and skills could produce positive outcomes. Mixed methods were used to examine whether there was evidence of success in implementation DBI conducted through a researcher–practitioner partnership in New York City Public Schools, the largest public school system in the United States. Specifically, data were collected concerning the quality of DBI implementation and changes in teachers' and administrators' perspectives about the value of implementing intensive intervention. Results indicated that district‐level implementation met many criteria for effective DBI, that school teams (N = 6) implemented DBI with an overall high level of fidelity (mean score of 4.1 on a 5‐point scale) and that teachers and school administrators changed their thinking about intensive intervention as a result of participation in DBI. Stakeholder interview data indicated a high level of social acceptability for DBI implementation. Features of the research–practice partnership thought to have contributed to the success of the project are discussed.

COVID-19 Transmission Due to Delta Variant in New York City Public Schools From October to December 2021

This cohort study assesses COVID-19 prevention measures against the Delta variant by measuring the secondary attack rate for cases in students, teachers, and staff of New York City public schools from October to December 2021 and analyzing the likely direction of transmission for secondary cases.

The Billion Oyster Project and Curriculum and Community Enterprise for Restoration Science Curriculum Impact on Teacher Engagement

The Billion Oyster Project and Curriculum and Community Enterprise for the Restoration of New York Harbor with New York City Public Schools (BOP-CCERS) program is a National Science Foundation (NSF) supported initiative and collaboration of multiple institutions and organizations led by Pace University. The NSF project, Innovative Technology Experiences for Students and Teachers (ITEST), had generated a large amount of data through engagement with teachers and students throughout New York City public schools. This article presents the second part to a large data collection study with focus on Underrepresented Minority (URM) student interest in STEM and engagement with teachers to support them in teaching science through experiential learning and lessons that connect science to the real world, particularly through science in the New York Harbor. The first component of the study focused on URM student interest in STEM. This second component of the study focuses on teacher engagement in the program, and what the researchers had learned in the process. Overall, teachers reported very favorable options on the impact of the BOP-CCERS activities as ways to generate student interest in STEM majors and careers. Teacher participants were generally positive about the amount of support and resources they received as members of the project, as well as the oyster-related knowledge and practices they learned to use with their own students in oyster field research. Data from the study provided evidence that the teacher activities were successful and met the project’s goals to provide support and resources for teachers to engage students in oyster restoration research.

Statin Use in Hospitalized Patients with COVID-19: A Comprehensive Analysis of the New York City Public Hospital System

IntroductionStatins have been commonly used for primary and secondary cardiovascular prevention. We hypothesized that statins may improve in-hospital outcomes for hospitalized patients with Coronavirus disease 2019 (COVID-19) due to its known anti-inflammatory effects. MethodsWe conducted a retrospective study at the largest municipal health care system in the United States, including adult patients who were hospitalized for COVID-19 between March 1 and December 1, 2020. The primary endpoint was in-hospital death. Propensity score matching was conducted to balance possible confounding variables between patients receiving statins during hospitalization (statin group) and those not receiving statins (non-statin group). Multivariate logistic regression was used to evaluate the association of statin use and other variables with in-hospital outcomes. ResultsThere were 8897 patients eligible for study enrollment, with 3359 patients in the statin group and 5538 patients in the non-statin group. After propensity score matching, both the statin and non-statin groups included 2817 patients. Multivariate logistic regression analysis showed that the statin group had a significantly lower risk of in-hospital mortality (odds ratio 0.71; 95% confidence interval, 0.63-0.80; P < .001) and mechanical ventilation (OR 0.80; 95% confidence interval, 0.71-0.90; P < .001) compared with the non-statin group. ConclusionStatin use was associated with lower likelihood of in-hospital mortality and invasive mechanical ventilation in hospitalized patients with COVID-19.