York County Research Articles

Hounded Women: The IPV Protocol and the Autonomy of Abuse Victims

Abstract In the early 90s, many jurisdictions adopted a special protocol in an effort to stop and punish intimate partner abuse. This article focuses on the particular form this policy has taken in the New York County jurisdiction, as it is a source of deep disagreement among feminists. In this article, I explore this disagreement in order to demonstrate two things. First, that like many other contentious issues, this controversy revolves around the question of how oppressed individuals’ autonomy should be conceived. Second, that a structural understanding of autonomy, such as the one pioneered by the philosopher Joseph Raz, can be of great use to resolve disagreements on this protocol. I offer an interpretation of his account which enables us to acknowledge the agency of ‘hounded women’ while legitimizing interventions aimed at eradicating the coercion they are victims of.

Local Governance and Redistributive Policy: Explaining Local Funding for Public Defense

In many American states, public defense is provided at the county rather than state level (Langton & Farole 2009). Local governments have discretion over implementing and funding the right to counsel, resulting in considerable variability in programs and funding levels. Placing this issue in the theoretical context of redistributive policies and politics, we investigate decisions on funding this service across upstate New York counties. Using as a point of departure Paul Peterson's classic explication of community politics, we first model variation in funding as a function of counties' fiscal capacity, need for services, and costs of supplying legal representation. We also test Peterson's prediction that local political factors will play little if any role in budget decisions. Second, through interviews with program administrators we explore the characters of twelve defender programs in which expenditures departed from the model's predictions. We find that three factors—which we term “influence,” “infrastructure,” and “ideas”—also vary directly with levels of funding. We conclude with a discussion of the implications of these findings for theoretical thinking about due process policies and local politics, and for policy debate over how best to ensure adequate counsel in criminal court.

Low Income Suburban Residents Perceive a Greater Lack of Specialty But not Primary Care Physicians than Those with Higher Incomes.

As the number of low income residents in suburban areas increases, they may present new healthcare delivery challenges. We compared residents' perceptions of access to primary care (PCP) and specialty (SCP) physicians by income categories in two adjacent counties of New York, which differ in physician density and public healthcare delivery models. Telephone interviews of 812 residents of Nassau (NC, 6.9 physicians/1000) and Suffolk (SC, 3.5 physicians/1000) counties were conducted, assessing perceptions of whether there were "too few," or "about the right number" of PCPs and SCPs. Counties were compared using bivariate analysis; multivariate analyses examined the association of perceptions of PCP and SCP access with demographic variables, including income. Twice as many SC respondents perceived too few SCPs compared to NC (35.31 vs. 18.27%, p = .001) and 50% more perceived too few PCPs (32.56 vs. 23.85%, p = .06). Thus, physician access was a perceived problem for many in SC despite a supply greater than the national average. For both counties combined, those with household incomes less than $35,000/year were twice as likely to perceive too few SCPs (p = .05), while in SC, this group was more than three times as likely to perceive too few SCPs (p = .02). There were no significant associations between income and perception of PCP availability. Thus, both counties have eliminated income-related differences in perceived access to PCPs. However, this is not the case for SCPs, especially in SC, which, unlike NC, has no publically supported specialty care. As the number of low income suburban residents increases, access to specialty care presents an important challenge for some areas.

Lack of Preventive Health Behaviors in the Early Forties: The Role of Earlier Trajectories of Cigarette Smoking From Adolescence to Adulthood

ABSTRACTObjective: To study the degree to which individuals in different trajectories of cigarette smoking from adolescence to the early forties are similar or different in terms of lack of preventive health behaviors (e.g., underuse of preventive health services, unhealthy eating habits) in early midlife. Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from adolescence to early midlife (mean age = 43 years, standard deviation [SD] = 2.8) at seven time points. Using growth mixture modeling, we statistically identified the number of smoking trajectories. Logistic regression analysis was used to study the relationship between the probabilities of participants' smoking trajectory group membership and lack of preventive behaviors in early midlife. Results: Five trajectory groups of cigarette smokers were identified. With controls, as compared with the nonsmoker trajectory group, higher probabilities of belonging to the heavy/continuous smoker trajectory group and the late starter trajectory groups were significantly associated with a higher likelihood of lack of preventive health behaviors (adjusted odds ratio [AOR] = 3.49 and 4.02 respectively). In addition, as compared to the quitter/decreaser trajectory group, higher probabilities of belonging to the heavy/continuous smoker trajectory group and the late starter trajectory group were also significantly associated with a higher likelihood of lack of preventive health behaviors (AOR = 3.51 and 4.04 respectively). Conclusions: Intervention programs may consider focusing on heavy/continuous smokers and late starters in programs designed to promote adequate use of preventive health services and healthy general lifestyles in early midlife.

Psychosocial Factors Related to the Intergenerational Transmission of Externalizing Behaviors in Early Midlife

ABSTRACTBackground: To study the intergenerational transmission of externalizing behaviors. Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from mothers at mean age 40 and from their children from adolescence (mean age = 14, SD = 2.8) to early midlife (mean age = 43, SD = 2.8) at seven time points. Structural equation modeling (SEM) was used to study the psychosocial factors as related to externalizing behaviors in early midlife. Results: First, maternal externalizing behaviors were indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's smoking patterns, and the offspring's marital conflict. Second, maternal cigarette smoking was indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's cigarette smoking, and the offspring's marital conflict. Third, maternal marital conflict had an indirect effect on the offspring's externalizing behaviors, mediated by offspring marital conflict. Conclusions: The finding that externalizing behaviors can be transmitted from parent to child informs the need for family-based interventions that are appropriate to adolescents.

Improving Retention in HIV Care Through New York's Expanded Partner Services Data-to-Care Pilot.

Data to Care (DTC) represents a public health strategy using HIV surveillance data to link persons living with diagnosed HIV infection (PLWDHI) to HIV-related medical care. To investigate the feasibility of the DTC approach applied to a Partner Services program serving a geographically diffuse area of New York State. Disease intervention specialists received training to function as Expanded Partner Services (ExPS) advocates. HIV surveillance data identified PLWDHI presumed to be out of care (OOC). ExPS advocates attempted to locate and reengage OOC individuals in HIV-related care. The pilot ran from September 1, 2013, to August 31, 2014. Four upstate New York counties, home to one-third of all PLWDHI in upstate New York. A total of 1155 PLWDHI presumed to be OOC. Linked to HIV medical care-cases verified as attending 1 or more HIV medical appointments subsequent to case assignment; reengaging in HIV care-any HIV laboratory test in the 6 months following case closure; and retention in HIV care-2 or more HIV laboratory tests in the 6 months following case closure. The majority of assigned cases (85.3%) were located; 23.7% (n = 233) of located cases confirmed as OOC; and 71.2% of OOC cases (n = 166) were successfully relinked into care. Relinkage success did not differ by gender, transmission risk, or major race/ethnicity categories; however, there was a direct relationship between age and successful relinkage (P < .001). Ninety-five percent of relinked cases reengaged in medical care, and 63.3% were retained in care. Individuals relinked by ExPS advocates were more likely to reengage in care (95%) than individuals interviewed but not relinked to care by advocates (53.7%) and individuals ineligible for the ExPS intervention (34.2%). DTC can be effective when conducted outside large metropolitan areas and/or closed health care systems. It can also be effectively incorporated into existing Partner Services programs; however, the relative priority of DTC work must be established in this context.

Compulsive buying and quality of life: An estimate of the monetary cost of compulsive buying among adults in early midlife

The aims of this study were to examine the associations between compulsive buying and quality of life and to estimate the monetary cost of compulsive buying for a cohort of men and women at mean age 43. Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. Linear regression analyses showed that compulsive buying was significantly associated with quality of life, despite controlling for relevant demographic and psychosocial factors. The estimated monetary cost of compulsive buying for this cohort was significant. The fact that the monetary cost of CB is not trivial suggests that individuals are both consciously and unconsciously plagued by their CB. The findings are important for interventionists and clinicians for cost-effective intervention and treatment programs.

New York Amish: Life in the Plain Communities of the Empire State

New York Amish: Life in the Plain Communities of the Empire State

New applications of near‐infrared spectroscopy in crop and soil analysis

New applications of near‐infrared spectroscopy in crop and soil analysis

Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care.

Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

Differences in Polio Mortality by Socioeconomic Status in Two Southern Ontario Counties, 1900–1937

The collective polio literature of the mid-twentieth century developed a model centered on age at infection. In this model, known as the hygiene hypothesis, risk of severe polio increased with socioeconomic status (SES) because higher SES was associated with older age at infection. Rural residence was also linked to increased polio risk due to older age at infection. Crowding and larger family size were associated with earlier age at infection and thus reduced the risk of severe polio. In contrast, according to the intensive-exposure hypothesis proposed by Nielsen and colleagues (2001, 2002), exposure to the poliovirus within the home was linked to increased severity of infection, making larger family size and crowding important risk factors. Data for polio deaths in Wentworth and York counties, including the cities of Hamilton and Toronto, from 1900 to 1937 were gathered from a variety of archival sources and socioeconomic class was coded using the five-point composite score scale from Hauser (1982). The results provide support for the intensive-exposure hypothesis as an addition to the traditional polio model. Age at death increased with status score during the earlier 1900–1929 period, but not in the 1930–1937 period. The overall proportions of polio deaths in the various status scores were stable over both periods and disproportionately prevalent in status score three (skilled blue collar). This analysis of polio mortality provides a more nuanced picture of the disease and its relation to SES in a time of rapidly changing socioecological conditions.

Birds in New York State Have Altered Their Migration Timing and Are Experiencing Different Thermal Regimes While Breeding or on Stopover from 2010 to 2015

Migration represents a significant physiological challenge for birds, and increasing ambient temperatures due to global climate change may add to birds’ physiological burden during migration. We analyzed migration timing in a central New York county and two counties in the Adirondack region by using data from the citizen science network, eBird, and correlating it with historical temperature data. Species of birds sighted in Central NY (N=195) and the Adirondack region (N=199) were categorized into year-round residents and one- and two-stopover groupings based on eBird observations. Using linear regressions, we looked at various relationships between temperature and variables relating to birds’ migration across 2010–2015. Of the total 195 species used within this data in Central NY, 35 species showed some alteration in their migration timing or in the temperature regime they experienced while breeding or on migration stopover. In the Adirondack region, of the total 199 species used within this dataset, 43 species showed some alteration in their migration timing or experienced significantly colder or warmer temperatures while breeding or on migration stopover during 2010–2015. Additionally, many of the bird species affected by temperature changes in the state of New York and those that altered migration timing tended to be long-distance migrants.

Our Stories Transforming Our Libraries: The York County Library System

These narratives chronicle the authors’ journeys to collaborate and discover the transformative impact that stories have on library culture and library staff. This study describes a research collaboration between York County Libraries and Penn State York. In Phase I, we collected stories from library staff as the library system was being challenged to reimage public libraries for the future. The major themes and types of organizational stories identified in the initial narrative project were presented during a county-wide all-staff in-service training. The library District Consultant (first author) and the Penn State professor (second author) then facilitated a workshop designed to lead staff in their exploration of these topics and generate a written record of their storytelling/discussions. This data became the basis for Phase II of the project and allowed the system to strategically assess its evolving culture and identity.

Combining Inverse and Transport Modeling to Estimate Bacterial Loading and Transport in a Tidal Embayment

Poquoson River is a tidal coastal embayment located along the Western Shore of the Chesapeake Bay about 4 km south of the York River mouth in the City of Poquoson and in York County, Virginia. Its drainage area has diversified land uses, including high densities of residence, agricultural, salt marsh land uses, as well as a National Wildlife Refuge. This embayment experiences elevated bacterial concentration due to excess bacterial inputs from storm water runoff, nonpoint sources, and wash off from marshes due to tide and wind-induced set-up and set-down. Bacteria can also grow in the marsh and small tributaries. It is difficult to use a traditional watershed model to simulate bacterial loading, especially in this low-lying marsh area with abundant wildlife, while runoff is not solely driven by precipitation. An inverse approach is introduced to estimate loading from unknown sources based on observations in the embayment. The estimated loadings were combined with loadings estimated from different sources (human, wildlife, agriculture, pets, etc.) and input to the watershed model. The watershed model simulated long-term flow and bacterial loading and discharged to a three-dimensional transport model driven by tide, wind, and freshwater discharge. The transport model efficiently simulates the transport and fate of the bacterial concentration in the embayment and is capable of determining the loading reduction needed to improve the water quality condition of the embayment. Combining inverse, watershed, and transport models is a sound approach for simulating bacterial transport correctly in the coastal embayment with complex unknown bacterial sources, which are not solely driven by precipitation.

Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitioners.

BackgroundWidespread dissatisfaction among United States (U.S.) clinicians could endanger ongoing reforms. Practitioners in rural/underserved areas withstand stressors that are unique to or accentuated in those settings. Medical professionals employed by integrating delivery systems are often distressed by the cacophony of organizational change(s) that such consolidation portends. We investigated the factors associated with dis/satisfaction with rural practice among doctors/non-physician practitioners employed by an integrated healthcare delivery network serving 9 counties of upstate New York, during a time of organizational transition.MethodsWe linked administrative data about practice units with cross-sectional data from a self-administered multi-dimensional questionnaire that contained practitioner demographics plus valid scales assessing autonomy/relatedness needs, risk aversion, tolerance for uncertainty/ambiguity, meaningfulness of patient care, and workload. We targeted medical professionals on the institutional payroll for inclusion. We excluded those who retired, resigned or were fired during the study launch, plus members of the advisory board and research team. Fixed-effects beta regressions were performed to test univariate associations between each factor and the percent of time a provider was dis/satisfied. Factors that manifested significant fixed effects were entered into multivariate, inflated beta regression models of the proportion of time that practitioners were dis/satisfied, incorporating clustering by practice unit as a random effect.ResultsOf the 473 eligible participants. 308 (65.1 %) completed the questionnaire. 59.1 % of respondents were doctoral-level; 40.9 % mid-level practitioners. Practitioners with heavier workloads and/or greater uncertainty intolerance were less likely to enjoy top-quintile satisfaction; those deriving greater meaning from practice were more likely. Higher meaningfulness and gratified relational needs increased one’s likelihood of being in the lowest quintile of dissatisfaction; heavier workload and greater intolerance of uncertainty reduced that likelihood. Practitioner demographics and most practice unit characteristics did not manifest any independent effect.ConclusionsMutable factors, such as workload, work meaningfulness, relational needs, uncertainty/ambiguity tolerance, and risk-taking attitudes displayed the strongest association with practitioner satisfaction/dissatisfaction, independent of demographics and practice unit characteristics. Organizational efforts should be dedicated to a redesign of group-employment models, including more equitable division of clinical labor, building supportive peer networks, and uncertainty/risk tolerance coaching, to improve the quality of work life among rural practitioners.

Surveying Local Health Departments and County Emergency Management Offices on Cooling Centers as a Heat Adaptation Resource in New York State.

Local agencies in New York State (NYS) set up cooling centers to provide relief from summer-time heat especially for people with limited access to air-conditioning. We aimed to determine cooling center locations in NYS, and explore county agencies' involvement in organizing and promoting utilization of cooling centers. We conducted a survey among county health and emergency preparedness offices in NYS (excluding NYC) and explored official county websites. We identified 377 cooling centers, mostly in metropolitan areas of NYS. Although 47% of counties listed locations online, only 29% reported locations via survey. Radio (90%) and internet (84%) were popular for information dissemination. Air-conditioning was available at all indoor cooling center facilities. Cooling centers in 13% of the counties were accessible by either public transportation or shuttles arranged by the facility. About 38% counties do not consider cooling centers important in their region or promote informal cooling centers. More than a third of New York counties had neither cooling centers nor plans to establish a cooling center as extreme heat was not perceived as a threat in their region.

Reimaging Public Libraries as Learning Communities: What Library Stories Can Tell Us

ABSTRACTThis article describes a study conducted in York County, Pennsylvania, on its countywide library system framed within the context of the statewide “Reimaging Libraries” Get Storied initiative, developed and marketed by organizational story consultant, Michael Margolis. Understood as an essential aspect of culture re-imaging and change, narratives were collected from library personnel by undergraduate students at Pennsylvania State University-York as part of a service-learning initiative (directed by the first author). Working closely with the library district consultant (second author), we assess the success of the initiative and make some recommendations for culture reimaging through the practice of storytelling.

Associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder among men and women

ABSTRACTThe objective of this study was to examine the associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder at the mean age of 43. Participants came from a community-based random sample of residents in 2 New York counties in 1975 (N = 548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (standard deviation = 2.8). Of the participants, 55% were females. Over 90% of the participants were Caucasian. The prevalence of substance dependence/abuse, major depressive episodes, and generalized anxiety disorder (during the past 5 years before the interviews) was 6.6, 13.7, and 11.5%, respectively. Logistic regression analyses showed that compulsive buying was significantly associated with substance dependence/abuse (adjusted odds ratio = 1.60), major depressive episodes (adjusted odds ratio = 1.70), and generalized anxiety disorder (adjusted odds ratio = 1.63), despite controlling for substance dependence/abuse, major depressive episodes, and generalized anxiety disorder, respectively, at the mean age of 37, and demographic factors. Since the study sample is limited to predominantly Caucasian participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, major depressive episodes, and generalized anxiety disorder consider the role of compulsive buying.

Estimating the Population Sizes of Men Who Have Sex With Men in US States and Counties Using Data From the American Community Survey.

BackgroundIn the United States, male-to-male sexual transmission accounts for the greatest number of new human immunodeficiency virus (HIV) diagnoses and a substantial number of sexually transmitted infections (STI) annually. However, the prevalence and annual incidence of HIV and other STIs among men who have sex with men (MSM) cannot be estimated in local contexts because demographic data on sexual behavior, particularly same-sex behavior, are not routinely collected by large-scale surveys that allow analysis at state, county, or finer levels, such as the US decennial census or the American Community Survey (ACS). Therefore, techniques for indirectly estimating population sizes of MSM are necessary to supply denominators for rates at various geographic levels.ObjectiveOur objectives were to indirectly estimate MSM population sizes at the county level to incorporate recent data estimates and to aggregate county-level estimates to states and core-based statistical areas (CBSAs).MethodsWe used data from the ACS to calculate a weight for each county in the United States based on its relative proportion of households that were headed by a male who lived with a male partner, compared with the overall proportion among counties at the same level of urbanicity (ie, large central metropolitan county, large fringe metropolitan county, medium/small metropolitan county, or nonmetropolitan county). We then used this weight to adjust the urbanicity-stratified percentage of adult men who had sex with a man in the past year, according to estimates derived from the National Health and Nutrition Examination Survey (NHANES), for each county. We multiplied the weighted percentages by the number of adult men in each county to estimate its number of MSM, summing county-level estimates to create state- and CBSA-level estimates. Finally, we scaled our estimated MSM population sizes to a meta-analytic estimate of the percentage of US MSM in the past 5 years (3.9%).ResultsWe found that the percentage of MSM among adult men ranged from 1.5% (Wyoming) to 6.0% (Rhode Island) among states. Over one-quarter of MSM in the United States resided in 1 of 13 counties. Among counties with over 300,000 residents, the five highest county-level percentages of MSM were San Francisco County, California at 18.5% (66,586/359,566); New York County, New York at 13.8% (87,556/635,847); Denver County, Colorado at 10.5% (25,465/243,002); Multnomah County, Oregon at 9.9% (28,949/292,450); and Suffolk County, Massachusetts at 9.1% (26,338/289,634). Although California (n=792,750) and Los Angeles County (n=251,521) had the largest MSM populations of states and counties, respectively, the New York City-Newark-Jersey City CBSA had the most MSM of all CBSAs (n=397,399).ConclusionsWe used a new method to generate small-area estimates of MSM populations, incorporating prior work, recent data, and urbanicity-specific parameters. We also used an imputation approach to estimate MSM in rural areas, where same-sex sexual behavior may be underreported. Our approach yielded estimates of MSM population sizes within states, counties, and metropolitan areas in the United States, which provide denominators for calculation of HIV and STI prevalence and incidence at those geographic levels.

Medical Mondays: ED Utilization for Medicaid Recipients Depends on the Day of the Week, Season, and Holidays

The purpose of this study is to describe and explain the temporal and seasonal trends in ED utilization for a low-income population. A retrospective analysis of 66,487 ED Medicaid-insured health care claims in 2009 was conducted for 2 Western New York Counties using time-series analysis with autoregressive moving average (ARMA) models. The final ARMA (2,0) model indicated an autoregressive structure with up to a 2-day lag. ED volume is lower on weekends than on weekdays, and the highest volumes are on Mondays. Summer and fall seasons demonstrated higher volumes, whereas lower volume outliers were associated with holidays. Day of the week was an influential predictor of ED utilization in low-income persons. Season and holidays are also predictors of ED utilization. These calendar-based patterns support the need for ongoing and future emergency leaders' collaborations in community-based care system redesign to meet the health care access needs of low-income persons.