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Examine the association between neighborhood segregation and 6-year incident metabolic syndrome (MetSyn) in the Hispanic Community Health Study/Study of Latinos.Prospective cohort of adults residing in Miami, Chicago, the Bronx, and San Diego. The analytic sample included 6,710 participants who did not have MetSyn at baseline. The evenness and exposure dimensions of neighborhood segregation, based on the Gini and Isolation indices, respectively, were categorized into quintiles (Q). Racialized economic concentration was measured with the Index of Concentration at the Extremes (continuously and Q).Exposure, but not evenness, was associated with higher disease odds (Q1 (lower segregation) vs. Q4, OR = 1.53, 95% CI = 1.082.17; Q5, OR = 2.29, 95% CI = 1.493.52). Economic concentrationprivilege (continuous OR = 0.87, 95% CI = 0.770.98), racial concentrationracialized privilege (Q1 (greater concentration) vs. Q2 OR = 0.75, 95% CI = 0.541.04; Q3 OR = 0.68, 95% CI = 0.441.05; Q4 OR = 0.68, 95% CI = 0.451.01; Q5 OR = 0.64, 95% CI = 0.420.98)(continuous OR = 0.93, 95% CI = 0.821.04), and racialized economic concentrationprivilege (i.e., higher SES non-Hispanic White, continuous OR = 0.86, 95% CI = 0.760.98) were associated with lower disease odds.Hispanics/Latino adults residing in neighborhoods with high segregation had higher risk of incident MetSyn compared to those residing in neighborhoods with low segregation. Research is needed to identify the mechanisms that link segregation to poor metabolic health.

OBJECTIVE We investigated associations of living in a doubled-up household (i.e., adults living with adult children, other related adults, or other unrelated adults) with diabetes self-management behaviors, occurrence of diabetes preventive care services, and hospital use by Hispanic/Latino adults with diabetes. RESEARCH DESIGN AND METHODS We analyzed data from the second clinical visit (2014–2017) through subsequent annual follow-up interviews completed through January 2020 of all participants with diabetes in the Hispanic Community Health Study/Study of Latinos. Multivariable regression was used to test associations between doubled-up status with diabetes self-management behaviors (i.e., checking blood glucose level, checking feet for sores), diabetes preventive care services done by a doctor (i.e., dilated-eye examination, feet checked, hemoglobin A1c measured, urine analysis for kidney function), and hospital use (i.e., emergency department [ED] visits and hospitalizations). RESULTS Hispanic/Latino adults living doubled up were less likely to have their urine checked by a doctor for kidney disease compared with adults not in doubled-up households. Doubled-up status was not associated with diabetes self-management behaviors. Adults living doubled up in a household with other related adults had a 33% increased risk of ED visits compared with adults living doubled up in a household with adult children. CONCLUSIONS Health care settings where Hispanic/Latino adults with diabetes receive trusted care should add housing characteristics such as doubled-up status to social-needs screening to identify residents in need of connecting with housing or social services and more targeted diabetes management services.

Introduction This study examines the associations of neighborhood environments with BMI, HbA1c, and diabetes across 6 years in Hispanic/Latino adults. Methods Participants from the Hispanic Community Health Study/Study of Latinos San Diego site (n=3,851, mean age=39.4 years, 53.3% women, 94.0% Mexican heritage) underwent assessment of metabolic risk factors and diabetes status (categorized as normoglycemia, prediabetes, and diabetes) at baseline (2008–2011) and approximately 6 years later (2014–2017). In the Study of Latinos Community and Surrounding Areas Study ancillary study (2015–2020), participant baseline addresses were geocoded, and neighborhoods were defined using 800-meter circular buffers. Neighborhood variables representing socioeconomic deprivation, residential stability, social disorder, walkability, and greenness were created using Census and other public databases. Analyses were conducted in 2020–2021. Results Complex survey regression analyses revealed that greater neighborhood socioeconomic deprivation was associated with higher BMI (β=0.14, p

Health care organizations are increasingly incorporating social care programs into medical care delivery models. Recent studies have identified burnout as a potential unintended consequence of this expansion. Successful implementation of these programs requires investment in the health care team, although understanding the impact of this expansion on nonphysician team members remains limited. Utilizing a theory-informed model for organizational behavior change, the authors aim to characterize the perceived elements of capacity to address patients' social needs within a heterogenous group of health care workers, and to examine the association of these behavioral conditions with burnout. A cross-sectional analysis was conducted of a survey of ∼1900 health care staff from 46 organizations in a large delivery system. Exploratory factor analysis identified factors contributing to the "Perceived Capacity to Address Social Needs" domain; Motivation, Organizational Reinforcement, and 3 task-specific capacities (Identification of social needs, Providing care for patients with social needs, and Linkage to social needs resources). Logistic regression found both a lower sense of motivation (OR 0.71, 95% CI 0.59-0.86), and organizational reinforcement (OR 0.51, 95% CI 0.42-0.62) associated with a higher rate of burnout. These associations with burnout differed by organizational role, suggesting role-specific relationships between these behavioral conditions. As health care has evolved into team-based interventions, staff across the care spectrum are now tasked with addressing larger social issues that affect their patients. A systems approach, aligning organizational priorities and staff motivations, in addition to task-specific skill sets is likely necessary to prevent burnout in this setting.

Menthol in cigarettes increases nicotine dependence and decreases the chances of successful smoking cessation. In New York City (NYC), nearly half of current smokers usually smoke menthol cigarettes. Female and non-Latino Black individuals were more likely to smoke menthol-flavored cigarettes compared to males and other races and ethnicities. Although the US Food and Drug Administration recently announced that it will ban menthol cigarettes, it is unclear how the policy would affect population health and health disparities in NYC. To inform potential policymaking, we used a microsimulation model of cardiovascular disease (CVD) to project the long-term health and economic impact of a potential menthol ban in NYC. Our model projected that there could be 57,232 (95% CI: 51,967–62,497) myocardial infarction (MI) cases and 52,195 (95% CI: 47,446–56,945) stroke cases per 1 million adult smokers in NYC over a 20-year period without the menthol ban policy. With the menthol ban policy, 2,862 MI cases and 1,983 stroke cases per 1 million adults could be averted over a 20-year period. The model also projected that an average of $1,836 in healthcare costs per person, or $1.62 billion among all adult smokers, could be saved over a 20-year period due to the implementation of a menthol ban policy. Results from subgroup analyses showed that women, particularly Black women, would have more reductions in adverse CVD outcomes from the potential implementation of the menthol ban policy compared to males and other racial and ethnic subgroups, which implies that the policy could reduce sex and racial and ethnic CVD disparities. Findings from our study provide policymakers with evidence to support policies that limit access to menthol cigarettes and potentially address racial and ethnic disparities in smoking-related disease burden.

Compared to previous studies that have typically used a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to characterize the magnitude and variability of area-level factors with the potential to modify the health effects of environmental pollutants. Using the Toxicological Prioritization Index framework and data from the 2015-2019 U.S. Census American Community Survey and the 2020 CDC PLACES Project, we quantified census tract-level vulnerability overall and in 4 primary domains (demographic, economic, residential, and health status), 24 subdomains, and 54 distinct area-level features for New York City (NYC). Overall and domain-specific indices were calculated by summing standardized feature values within the subdomains and then aggregating and weighting subdomains within equally-weighted primary domains. In citywide comparisons, NEVI was correlated with both the Neighborhood Deprivation Index (r = 0.91) and the Social Vulnerability Index (r = 0.87) but provided additional information on features contributing to vulnerability. Vulnerability varied spatially across NYC, and hierarchical cluster analysis using subdomain scores revealed six patterns of vulnerability across domains: 1) low in all, 2) primarily low except residential, 3) medium in all, 4) high demographic, economic, and residential 5) high economic, residential, and health status, and 6) high demographic, economic and health status. Created using a tool that offers flexibility for theory-based construction, NEVI provided detailed metrics of vulnerability across domains that can inform targeted research and public health interventions aimed at reducing the health impacts from environmental exposures across an urban center.

Using a tool integrated into the electronic health record, we determined prevalence of 10 social needs among 377 people with HIV (PWH) and 27,833 patients without HIV receiving care in the Montefiore Health System. PWH (median age 53) were 55% women, 41% Black, 44% Hispanic. 33% of PWH reported at least one social need vs. 18% among patients without HIV, with healthcare transportation and housing needs significantly higher in PWH in adjusted analyses. PWH reporting transportation needs were 27% less likely to be virologically suppressed (

Using a tool integrated into the electronic health record, we determined prevalence of 10 social needs among 377 people with HIV (PWH) and 27,833 patients without HIV receiving care in the Montefiore Health System. PWH (median age 53) were 55% women, 41% Black, 44% Hispanic. 33% of PWH reported at least one social need vs. 18% among patients without HIV, with healthcare transportation and housing needs significantly higher among PWH in adjusted analyses. PWH reporting transportation needs were 27% less likely to be virologically suppressed ( 200 copies/mL, adjusted prevalence ratio 0.73, 95% CI 0.55-0.96) compared with PWH without transportation needs.Por medio del uso de encuestas integradas en el registro electrónico de salud, determinamos la prevalencia de 10 necesidades sociales entre 377 personas con VIH (PCV) y 27 833 pacientes sin VIH que reciben atención en el Montefiore Health System. PCV (edad mediana de 53 años) fueron 55% mujeres, 41% negras, 44% hispanas. 33% de PCV reportó al menos una necesidad social vs. 18% de los pacientes sin VIH, siendo las necesidades de transporte a cuidados de salud y de vivienda significativamente mayores en PCV en análisis multivariable ajustado. PCV con necesidades de transportación fueron 27% menos probables de tener supresión viral ( 200 copias/ml, razón de prevalencias ajustada 0.73, IC 95% 0.55–0.96) comparada con PCV sin necesidades de transportación.

There is growing evidence on the effect of face mask use in controlling the spread of COVID-19. However, few studies have examined the effect of local face mask policies on the pandemic. In this study, we developed a dynamic compartmental model of COVID-19 transmission in New York City (NYC), which was the epicenter of the COVID-19 pandemic in the USA. We used data on daily and cumulative COVID-19 infections and deaths from the NYC Department of Health and Mental Hygiene to calibrate and validate our model. We then used the model to assess the effect of the executive order on face mask use on infections and deaths due to COVID-19 in NYC. Our results showed that the executive order on face mask use was estimated to avert 99,517 (95% CIs 72,723–126,312) COVID-19 infections and 7978 (5692–10,265) deaths in NYC. If the executive order was implemented 1 week earlier (on April 10), the averted infections and deaths would be 111,475 (81,593–141,356) and 9017 (6446–11,589), respectively. If the executive order was implemented 2 weeks earlier (on April 3 when the Centers for Disease Control and Prevention recommended face mask use), the averted infections and deaths would be 128,598 (94,373–162,824) and 10,515 (7540–13,489), respectively. Our study provides public health practitioners and policymakers with evidence on the importance of implementing face mask policies in local areas as early as possible to control the spread of COVID-19 and reduce mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00517-2.

INTRODUCTION: Health systems are increasingly interested in addressing the social determinants of health via social risk screening. The objective of this study is to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system. METHODS: Between April and December 2018, a total of 24,633 primary care patients completed a 10-item screener across 19 ambulatory sites within a health system in the Bronx, NY. The prevalence of any social risk and specific social risks was estimated overall and for population subgroups. Wald tests were used to determine statistically significant differences by subgroup. Data were analyzed in winter/spring 2019. RESULTS: Twenty percent of patients presented with at least 1 social risk. The most frequently reported risks included housing quality (6.5%) and food insecurity (6.1%). Middle-aged (30–59 years) respondents (24.7%, 95% CI=23.6%, 25.7%) compared with those aged 18–29 years (17.7%, 95% CI=16.4%, 19.2%, p

OBJECTIVES: The objective of this study was to examine the association between volunteerism and favorable cardiovascular health (CVH) among Hispanics/Latinos living in the US. METHODS: Data from the Hispanic Community Health Study/Study of Latinos (2008-2011) Sociocultural Ancillary Study were used (N = 4,926; ages 18-74 years). Favorable CVH was defined as positive profiles of all major CVD risk factors: low total serum cholesterol, blood pressure, and body mass index; not having diabetes; and not smoking. Survey-weighted logistic regression models were adjusted for sociodemographic, lifestyle, and psychological factors. In secondary analyses, we tested whether the volunteerism-CVH association was modified by sex, age, or years lived in the US (

OBJECTIVE Equations for predicting body surface area (BSA) produce flawed estimates, especially for individuals with obesity. This study aimed to compare BSA measured by a three-dimensional photonic scanner (3DPS) with BSA predicted by six commonly cited prediction equations and to develop new prediction equations if warranted. METHODS The 3DPS was validated against manual measurements by breadth caliper for body thicknesses measured at three anatomical sites on a mannequin. BSA was derived from 3DPS whole-body scans of 67 males and 201 females, aged 18 to 83 years, with BMI between 17.8 and 77.8 kg/m2 and varied races/ethnicities. RESULTS Width and depth measurements by 3DPS and caliper were within 1%, except for hip, with an error of 1.8%. BSA3DPS differed from BSA predicted by each equation (P

We examined associations of micro-scale environment attributes (e.g., sidewalks, street crossings) with three physical activity (PA) measures among Hispanic/Latino adults (n = 1776) living in San Diego County, CA. Systematic observation was used to quantify micro-scale environment attributes near each participant's home. Total PA was assessed with accelerometers, and PA for transportation and recreation were assessed by validated self-report. Although several statistically significant interactions between individual and neighborhood characteristics were identified, there was little evidence micro-scale attributes were related to PA. An important limitation was restricted environmental variability for this sample which lived in a small area of a single county.

Neighborhood-level socioeconomic deprivation can increase risk for higher blood pressure or hypertension, while greater neighborhood safety and walkability may protect against hypertension. Large-scale prospective research, particularly among Hispanics/Latinos, is lacking. We examined cross-sectional and prospective associations between neighborhood environments and blood pressure and hypertension among 3851 Hispanic/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos San Diego, CA cohort. Addresses from Visit 1 (2008-2011) were geocoded and neighborhood characteristics were determined as part of the SOL CASAS ancillary study. Home addresses were geocoded and home areas created using 800m circular radial buffers. Neighborhood indices socioeconomic deprivation, residential stability, and social disorder were created using Census and other publicly available data. Walkability was computed as density of intersections, retail spaces, and residences. Greenness was measured via satellite imagery using the Normalized Difference Vegetation Index. Visit 1 and Visit 2 (2014-2017) clinical outcomes included systolic (SBP) and diastolic (DBP) blood pressure, as well as prevalent and 6-year incident hypertension, defined as SBP/DBP ≥140/90mmHg or antihypertensive medication use. Complex survey regression models adjusted for covariates revealed cross-sectional associations between greater walkability and lower SBP (B=-0.05; 95% CI: -0.09, -0.003). In prospective analyses, greater neighborhood social disorder was related to increasing SBP (B=0.05; 95% CI: 0.01, 0.09) and DBP (B=0.07; 95% CI: 0.02, 0.12) over time. Greater socioeconomic deprivation (OR=1.47; 95% CI: 1.06, 2.04) and greater social disorder (OR=1.25; 95% CI: 1.02, 1.54) were associated with higher odds of incident hypertension. All other associations were not significant. Beyond individual-level characteristics, greater neighborhood social disorder and socioeconomic deprivation were related to adverse changes in blood pressure over 6 years among Hispanics/Latinos. Neighborhood social environment may help identify, or be an area for future intervention for, cardiovascular risk among Hispanics/Latinos.

Hispanic/Latino populations may experience significant neighborhood disadvantage, but limited research has explored whether these factors affect their health behaviors. Associations between perceived neighborhood factors at Visit 1 and health behaviors and related outcomes at Visit 2 in the Hispanic Community Health Study/Study of Latinos were evaluated. Multivariable logistic regression assessed cross-sectional and longitudinal relationships between perceived neighborhood social cohesion (NSC, 5 items), and neighborhood problems (NP, 7 items), with cancer screening, current smoking, excessive/binge drinking, hypertension, obesity, physical activity, and poor diet by gender and birthplace. NSC and NP scores were converted into quartiles. Mean age of participants was 42.5 years and 62.1% were women. Perceived NP, but not perceived NSC, differed by gender (p 0.001). In unstratified models, no significant associations were observed between perceived NSC and any health behavior, whereas greater perceived NP was associated with less adherence to colon cancer screening (moderate level: aOR = 0.68, 95% CI = 0.51, 090) and more physical activity (very high level: aOR = 1.34, 95% CI = 1.06, 1.69) compared to low perceived NP. Women with moderate perceived NP, versus low NP, had a lower odds of colon cancer screening at Visit 1 (aOR = 0.62, 95% CI = 0.43, 0.91) and higher odds of mammogram adherence at Visit 2 (aOR = 2.86, 95% CI = 1.44, 5.68). Men with high perceived NP had a higher odds of excessive or binge drinking at Visit 2 (aOR = 1.99, 95% CI = 1.19, 3.31). We conclude that perceived NP were significantly related to health behaviors among HCHS/SOL individuals. Perceptions of neighborhood environment may be considered modifiable factors of structural neighborhood environment interventions.

ObjectivesThere has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network.SettingAcademic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA).ParticipantsThis retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices.MethodsWe organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices.ResultsBetween April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient.ConclusionsThese findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.

In 1999, BC Hydro installed optical fibers in the fluid channel of 525 kV self-contained fluid-filled submarine cables originally installed in the 1980s that connect substations in the Vancouver area of British Columbia, Canada, for the purposes of monitoring temperatures. In combination with this work, a real-time monitoring was used to collect load data and measured temperatures in an effort to optimize the ratings of the cables. The dynamic thermal circuit rating system developed by the Electric Power Research Institute was applied to the 525 kV cables as part of a project to modify the system for support of the unique characteristics of the cable system installation. Specifically, the submarine cables utilize a parallel pipe water cooling system for the shore zones. This paper describes the software modifications that were implemented to enhance the dynamic rating system to model the unique characteristics of the 525 kV cable system and discusses how recorded data collected over several seasons were used to verify and refine the cable rating model. The resulting evaluation showed good agreement of the dynamic rating system calculations with measured results and helped the utility better understand the ratings on these circuits and permitted the utility to perform simulations to evaluate various loading conditions.

Background: Residential segregation has been associated with cancer incidence and mortality. Hispanic/Latinos (HL) experience moderate to high residential segregation. Purpose: This study investigates levels of racial and ethnic residential segregation and racialized economic concentrations at the extremes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: We used baseline data from 16,415 HL adults enrolled in the Hispanic Community Health Study/Study of Latinos between 2008-2011 from the Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA. Segregation measures were calculated from census tract-level (2006-2010 American Community Survey and 2010 decennial census). We measured residential segregation using the % HL Gini coefficient, to capture variability of HL residents within the census tract, and the isolation index, to capture the probability that HL residents come into contact with other members of the same minority group. We measured racialized economic (race/ethnicity + income) concentration using the Index of Concentration at the Extremes (ICE), to capture spatial social polarization at the extremes. We compared means of HCHS/SOL population characteristics using linear regression and adjusted Wald tests for continuous, binary, and categorical variables, respectively, calculated from weighted complex samples analyses. Results: On average, overall segregation was moderate to high (M±SE): Gini (0.39 ± 0.00); Isolation (0.76 ± 0.01); ICE (race: -0.64 ± 0.01; income: -0.29 ± 0.01; race + income: -0.26 ± 0.01). HL adults who were older (> 65 y: 0.80 ± 0.01; 45-65 y: 0.77 ± 0.008; 18-44 y: 0.75 ± 0.75, p = .000) and foreign/territory-born residing in US =10 years: 0.76 ± 0.01; vs. US born: 0.70 ± 0.01) and preferred Spanish (0.79 ± 0.01; p = .000 vs. English: 0.69 ± 0.007) experienced higher racial/ethnic segregation as measured by the Isolation index. HL of Cuban (0.42 ± 0.006, p = 0.049) vs. all other heritage experienced the as measured by the % HL Gini index. We found higher levels of racialized economic segregation among foreign/territory-born residing in US = 10 years (-0.26 ± .01) and US born (-0.21 ± 0.01; p = 0.000); individuals that preferred Spanish (-0.28 ± 0.01) vs. English (-0.21 ± .01; p = 0.000); and self-reported Cuban heritage (-0.42 ± 0.01; p = .000) vs all other heritage. Conclusion: Using multiple, measures of segregation, we found that HL adults who were older, foreign born, and preferred Spanish experienced moderate and high levels of segregation. It is important for future work to examine the impact of racial/ethnic and economic segregation on social determinants of cancer disparities within segregated environments among diverse HL. Citation Format: Catherine M. Pichardo, Jesse J. Plascak, Lisa A. Sanchez-Johnsen, Amber Pirzada, Amanda L. Roy, Margaret S. Pichardo, Earle C. Chambers, Sheila F. Castañeda, Ramon A. Durazo-Arvizu, Krista M. Perreira, Tanya P. Garcia, Matthew Allison, Jordan Carlson, Martha L. Daviglus, Gregory A. Talavera, Linda C. Gallo. Patterns of segregation among diverse Hispanic/Latino adults- implications for cancer prevention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 32.

Introduction/Objectives: Uncontrolled diabetes can lead to major health complications, and significantly contributes to diabetes-related morbidity, mortality, and healthcare costs. Few studies have examined the relationship between unmet social needs and diabetes control among predominantly Black and Hispanic patient populations. Methods: In a large urban hospital system in the Bronx, NY, 5846 unique patients with diabetes seen at a primary care visit between April 2018 and December 2019 completed a social needs screener. Measures included diabetes control (categorized as Hemoglobin (Hb) A1c Results: Twenty-two percent (22%) of the patient sample had at least 1 unmet social need, and the most prevalent unmet social needs were housing issues (including housing quality and insecurity), food insecurity, and lack of healthcare transportation. Logistic regression analysis showed a significant relationship between social needs and uncontrolled diabetes, with more social needs indicating a greater likelihood of uncontrolled diabetes (Adjusted Odds Ratio (AOR) for ≥3 needs: 1.59, 95% CI: 1.26, 2.00). Of the patients with most frequently occurring unmet social needs, lack of healthcare transportation (AOR: 1.54, 95% CI: 1.22, 1.95) and food insecurity (AOR: 1.50, 95% CI: 1.19, 1.89) had the greatest likelihood of having uncontrolled diabetes, after adjusting for covariates. Conclusion: Unmet social needs appear to be linked to a greater likelihood of uncontrolled diabetes. Implications for healthcare systems to screen and address social needs for patients with diabetes are discussed.

BackgroundNew York City (NYC) was the epicenter of the COVID-19 pandemic in the United States. On April 17, 2020, the State of New York implemented an Executive Order that requires all people in New York to wear a face mask or covering in public settings where social distancing cannot be maintained. It is unclear how this Executive Order has affected the spread of COVID-19 in NYC.MethodsA dynamic compartmental model of COVID-19 transmission among NYC residents was developed to assess the effect of the Executive Order on face mask use on infections and deaths due to COVID-19 in NYC. Data on daily and cumulative COVID-19 infections and deaths were obtained from the NYC Department of Health and Mental Hygiene.ResultsThe Executive Order on face mask use is estimated to avert 99,517 (95% CIs: 72,723-126,312) COVID-19 infections and 7,978 (5,692-10,265) deaths in NYC. If the Executive Order was implemented one week earlier (on April 10), the averted infections and deaths would be 111,475 (81,593-141,356) and 9,017 (6,446-11,589), respectively. If the Executive Order was implemented two weeks earlier (on April 3 when the Centers for Disease Control and Prevention recommended face mask use), the averted infections and deaths would be 128,598 (94,373-162,824) and 10,515 (7,540-13,489), respectively.ConclusionsNew York’s Executive Order on face mask use is projected to have significantly reduced the spread of COVID-19 in NYC. Implementing the Executive Order at an earlier date would avert even more COVID-19 infections and deaths.

There is consensus that social needs influence health outcomes, but less is known about the relationships between certain needs and chronic health conditions in large, diverse populations. This study sought to understand the association between social needs and specific chronic conditions using social needs screening and clinical data from Electronic Health Records. Between April 2018-December 2019, 33,550 adult (≥18y) patients completed a 10-item social needs screener during primary care visits in Bronx and Westchester counties, NY. Generalized linear models were used to estimate prevalence ratios for eight outcomes by number and type of needs with analyses completed in Summer 2020. There was a positive, cumulative association between social needs and each of the outcomes. The relationship was strongest for elevated PHQ-2, depression, alcohol/drug use disorder, and smoking. Those with ≥3 social needs were 3.90 times more likely to have an elevated PHQ-2 than those without needs (95% CI: 3.66, 4.16). Challenges with healthcare transportation was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. For example, those with transportation needs were 84% more likely to have an alcohol/drug use disorder diagnosis (95% CI: 1.59, 2.13) and 41% more likely to smoke (95% CI: 1.25, 1.58). Specific social needs may influence clinical issues in distinct ways. These findings suggest that health systems need to develop strategies that address unmet social need in order to optimize health outcomes, particularly in communities with a dual burden of poverty and chronic disease.

A North American utility has extensive pipe-type cable on their system. While reliable, utilities recognize that long-term industry trends are to use extruded dielectric cables exclusively as pipe-type manufacturing capabilities and qualified contractors are diminishing in the industry. Extensive infrastructure for pipe-type cables is already present at many utilities, which would be costly to replace, so one utility considered a project that would use extruded cable installed in a pipe to evaluate practical aspects of retrofit applications while gaining operational experience. This paper discusses and identifies the challenges encountered by the utility's design team, describes the selected cable system, and summarizes the project details.

Background: News reports and hate crime data suggest that anti-Hispanic/Latino immigrant sentiment was expressed by some sectors of the U.S. public during the 2016 Presidential campaign and election. The purpose of this study was to examine the association between this period and cardiovascular disease (CVD) risk factors thought to be responsive to acute stress exposure among Hispanic/Latino adults in the US. Methods: Data were from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective cohort study of Hispanic/Latino adults living in the US. The analytic sample was limited to non-pregnant adults, 35 to 74 years old, who participated in Visit 1 (2008-2011) and Visit 2 (2014-2017). The exposed were defined as participants who completed Visit 2 in 2016 and the unexposed were defined as participants who completed Visit 2 in 2014 or 2015. Cardiovascular disease risk factors included elevated depressive symptoms (CESD-10 score: 10+), current smoking, and at-risk levels of alcohol consumption (women: 7+ drinks/week; men: 14+ drinks/week). Current alcohol use (i.e., any current alcohol use) was also examined as a potential stress-related outcome. Predicted marginal risk ratio models were used to estimate incident Visit 2 outcomes as a function of exposure to the year 2016 among individuals who did not have those outcomes at Visit 1. Models were adjusted for age and insurance status at Visit 1. A priori interactions with nativity status, duration of residence in the US, and Hispanic/Latino background group were examined. Results: No statistically significant association between 2016 exposure and elevated depressive symptoms was observed in the main model, but additive interaction by Hispanic/Latino background group was observed ( p = 0.03) (Mexican and Central American background: RR adjusted : 1.28 (0.94, 1.76); Hispanics/Latinos of other background groups: RR adjusted : 0.85 (0.66, 1.09)). No association between 2016 exposure and incident smoking or incident at-risk alcohol consumption was observed and tests for interaction were not statistically significant. For incident current alcohol use, borderline trends in the main model suggested an association with the exposure (RR adjusted : 1.11 (0.99, 1.26)). Further, statistically significant additive interaction by nativity status was observed (Foreign-born: RR adjusted : 1.20 (1.06, 1.37); US/Puerto Rico-born: RR adjusted : 0.78 (0.55, 1.09)). Conclusions: Trends from study findings suggest an association between exposure to anti-Hispanic/Latino immigrant sentiment in 2016 and current alcohol use among foreign-born Hispanic/Latino adults. Given limitations of using time as a proxy for exposure to anti-Hispanic/Latino immigrant sentiment, future studies should explore more specific measurements of sentiment during this time and explore short and long-term effects of this sentiment.

OBJECTIVE: Equations for predicting Body Surface Area (BSA) produce flawed estimates, especially for individuals with obesity. We aimed to compare BSA measured by a 3-dimensional photonic scanner (BSA(3DPS)) to BSA predicted by six commonly cited prediction equations, and to develop new prediction equations if warranted. METHODS: We validated the 3DPS against manual measurements by breadth caliper for body thicknesses measured at three anatomical sites on a mannequin. BSA was derived from 3DPS whole body scans of 67 males and 201 females, ages 18-83; BMIs 17.8-77.8 kg/m(2), and varied race/ethnicities. RESULTS: Width and depth measurements by 3DPS and caliper were within 1%, except for hip, error 1.8%. BSA(3DPS) differed from BSA predicted by each equation (p

Highlights • Associations between acculturation and physical activity varied across measurements. • Higher social acculturation was positively associated with self-reported physical activity. • Language acculturation, but not language preference, was positively associated with leisure-time physical activity. • Language acculturation, but not language preference, was negatively associated with occupational physical activity. • Among workers, greater acculturation was associated with lower occupational physical activity. • Longer residency in the US was associated with higher accelerometer-assessed moderate-to-vigorous physical activity. • Most acculturation measures were positively associated with self-report, but not accelerometer-assessed sedentary behavior., The adoption of US culture among immigrants has been associated with higher leisure-time physical activity and sedentary behavior. However, most research to date assesses this association using single measures of acculturation and physical activity. Our objective was to describe the cross-sectional association between acculturation and both physical activity and sedentary behavior among US Hispanic/Latino adults. Participants included Hispanic/Latinos 18–74 years living in four US locations enrolled in the Hispanic Community Health Study/Study of Latinos from 2008 to 2011. Acculturation was measured using acculturation scales (language and social), years in the US, language preference, and age at immigration. Physical activity and sedentary behavior were measured using the Global Physical Activity Questionnaire (N = 15,355) and Actical accelerometer (N = 11,954). Poisson, logistic, and linear regression were used, accounting for complex design and sampling weights. English-language preference was positively associated with self-reported leisure-time and transportation physical activity and accelerometer-assessed moderate-to-vigorous physical activity (MVPA). Social acculturation was positively associated with self-reported leisure-time and transportation physical activity and MVPA. Years in the US and age at immigration were positively associated with accelerometer-assessed MVPA. Language acculturation, years in the US, and age at immigration were associated with occupational physical activity among those who reported employment. Most acculturation measures were associated with self-reported sitting but not with accelerometer-assessed sedentary behavior. Different measures of acculturation, capturing various domains acculturation, were associated with physical activity and sedentary behavior. However, the direction of the association was dependent on the measures of acculturation physical activity/sedentary behavior, highlighting the complexity of these relationships.

Purpose The purpose of this study was to identify patient and program delivery characteristics associated with engagement and weight loss in a Diabetes Prevention Program (DPP) implemented in an urban hospital system. Methods Patient and program delivery data were collected between July 2015 and December 2017. DPP eligibility was determined based on age, body mass index (BMI), and hemoglobin A1C data via the electronic health record. Engagement was measured at 3 levels: ≤3 sessions, 4 to 8 sessions, and ≥9 sessions. Weight was measured at each DPP session. Results Among the eligible patients (N = 31 524), referrals and engagement were lower in men than women, in Spanish speakers than English speakers, in younger (18-34 years) and middle-aged (35-54 years) than older adults, and in patients receiving Medicaid than other patients. Referral and engagement were higher in patients with higher BMIs and those prescribed ≥5 medications. Current smokers were less frequently engaged. Prior health care provider contact was associated with higher engagement. Overall, 28% of DPP participants achieved ≥5% weight loss; younger and middle-aged patients and those who gained weight in the prior 2 years were less likely to lose weight. Conclusion This assessment identified characteristics of patients with lower levels of referral and engagement. The DPP staff may need to increase outreach to address barriers to referral and during all points of engagement among men, younger patients, and Spanish speakers. Future research is needed to increase understanding with regard to why referrals and engagement are lower among these groups.

Objective: Housing status is a primary social determinant of health that is not typically not collected in clinical settings. Residential address data collected during clinical visits can identify patients at high-risk for cardio­metabolic disease (CMD) residing in public housing. Design: This study examined CMD and related risk factors among patients living in public housing and a comparison group not living in public housing. Setting: All patients (n=173,568) were receiving primary care in a large hospital system in the Bronx, New York between January 1, 2016 and December 31, 2017. Results: Patients in public housing were more likely to be women, to be Black or Hispanic, and to be on Medicaid compared with patients not living in public housing. Women in public housing were more likely than men to have had a higher prevalence of CMD and related risk factors. Conclusion: The burden of CMD among public housing residents shows sex disparities where women have a higher prevalence of CMD and related risk factors than men. Ethn Dis. 2019;29(3):463-468; doi:10.18865/ed.29.3.463

Background The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods HCHS/SOL participants were age 18–74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). Results Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. Conclusion Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

This study compared the prevalence of chronic pediatric health conditions for youth in public housing with youth not in public housing using clinical electronic health record (EHR) and housing data. Youth (ages 2-17 years) in a large urban health system were identified and categorized into two housing types—public housing (n = 10 770) and not in public housing (n = 84 883) by age (young childhood, middle childhood, young adolescence). The prevalence of some pediatric conditions was higher in public housing but varied by age. Disparities in health conditions among youth in public housing were more common in early adolescence: asthma (26.4 vs 18.6; P < .001); obesity (28.5 vs 24.6; P < .001); depression/anxiety (19.2 vs 17.3; P = .008); behavioral disorders (8.1 vs 5.3; P < .001). These results show that chronic pediatric conditions like asthma and obesity that lead to significant morbidity into adulthood are more common among youth living in public housing. However, this pattern is not consistent across all chronic conditions.

Purpose Limited research has examined maternal experiences of racial/ethnic discrimination in relation to child cardiometabolic health. In this study, we investigated whether maternal experiences of ethnic discrimination were associated with cardiometabolic risk in Hispanic/Latino youth several years later. Methods Our sample included 1146 youth (8–16 years) from the Study of Latino Youth (2012–2014), who were children of the Hispanic Community Health Study/Study of Latinos participants (2008–2011). We used regression models to examine the prospective associations between maternal report of ethnic discrimination in relation to her child's body mass index (BMI) z-score, metabolic syndrome score (MetS), and high sensitivity C-reactive protein (hsCRP) levels 2 years later. Results Maternal ethnic discrimination was associated with youth hsCRP, but not BMI or MetS (P-values >.05). Adjusting for age, nativity, and national background, maternal ethnic discrimination was associated with higher (log) hsCRP levels (β = 0.18, 95% CI = 0.04 to 0.32) in children. This association was robust to adjustment for maternal and household characteristics (β = 0.17, 95% CI = 0.04 to 0.31), as well as maternal depression and maternal BMI. Conclusions Maternal ethnic discrimination is associated with inflammation among Hispanic/Latino youth, and not BMI z-score or MetS. Studies are needed to address temporality and pathways.

Introduction: Sedentary behavior (SED) is associated with higher obesity and cardiometabolic risk in youth, independent of physical activity. Studies showing the association between screen time and SED among Hispanics/Latinos, have primarily focused on Mexican-origin Hispanics. Additional research is needed to examine other socio-environmental factors that can influence SED among diverse Hispanics/Latinos. This cross-sectional study examined the home-, neighborhood-, and school- environment to identify factors associated with total sedentary time among youth. Methods: Data from 1,104 youth ages 8-16 years and 728 caregivers (mean age 43.1 ± 8.2 years) from four U.S. cities, who participated in the Study of Latino Youth (2012-2014), were examined. Associations between socio-environmental factors (measured by self-report) and total sedentary time (measured by one-week Actical accelerometry) were examined in linear regression models that included MVPA minutes/day, demographic covariates, and accounted for the complex survey design and sampling weights. Results: Mean sedentary time was 10.1 ± 1.8 hours/day. Home environment factors, such as electronics in the bedroom and parent limit setting, were not associated with total sedentary time. Presence of barriers to physical activity in the neighborhood (e.g., muggings, gangs) was associated with 13.4 more minutes of sedentary time per day. Attending a school that never/rarely compared to sometimes offered after school physical activity opportunities was associated with more sedentary time (B=38.0 minutes/day; 95% Confidence Interval: 13.5-62.4). Conclusions: The study findings highlight the need for future research to investigate other sources of sedentary behavior in the home for interventionist to focus on specific SED-based strategies to decrease sedentary time among youth. Minimizing barriers by identifying safe places to be active in participant’s neighborhoods may also support youth to spend less time indoors where sedentary time is prevalent.

In this study of low-income Hispanic/Latino adults living in 291 individual apartments in the Bronx, New York, the apartment layout was significantly associated with the odds of depressive symptomology. Women living in apartments in which the most central rooms were the living, dining, or kitchen (i.e., rooms commonly used for communal activities) were less likely to have depressive symptomology (OR = 0.44, 95% CI = 0.22–0.86) than women in apartments where the central rooms were lobbies or corridors, adjusting for demographics, health conditions, and housing and neighborhood characteristics. No statistically significant association was observed in men. We present the logic underlying the use of layout variables in this study and discuss the implications it may have for understanding the role of the home environment on psychological distress among inhabitants. The results of this study show how space syntax analysis can be used to better understanding disparities in the risk of depression and offer an additional opportunity for public health stakeholders to identify those most at risk for depression.

Comparative effectiveness research trials in real-world settings may require participants to choose between preferred intervention options. A randomized clinical trial with parallel experimental and control arms is straightforward and regarded as a gold standard design, but by design it forces and anticipates the participants to comply with a randomly assigned intervention regardless of their preference. Therefore, the randomized clinical trial may impose impractical limitations when planning comparative effectiveness research trials. To accommodate participants’ preference if they are expressed, and to maintain randomization, we propose an alternative design that allows participants’ preference after randomization, which we call a “preference option randomized design (PORD)”. In contrast to other preference designs, which ask whether or not participants consent to the assigned intervention after randomization, the crucial feature of preference option randomized design is its unique informed consent process before randomization. Specifically, the preference option randomized design consent process informs participants that they can opt out and switch to the other intervention only if after randomization they actively express the desire to do so. Participants who do not independently express explicit alternate preference or assent to the randomly assigned intervention are considered to not have an alternate preference. In sum, preference option randomized design intends to maximize retention, minimize possibility of forced assignment for any participants, and to maintain randomization by allowing participants with no or equal preference to represent random assignments. This design scheme enables to define five effects that are interconnected with each other through common design parameters—comparative, preference, selection, intent-to-treat, and overall/as-treated—to collectively guide decision making between interventions. Statistical power functions for testing all these effects are derived, and simulations verified the validity of the power functions under normal and binomial distributions.

Excessive sedentary behavior is associated with negative health outcomes independent of physical activity. Objective estimates of time spent in sedentary behaviors are lacking among adults from diverse Hispanic/Latino backgrounds. The objective of this study was to describe accelerometer-assessed sedentary time in a large, representative sample of Hispanic/Latino adults living in the United States, and compare sedentary estimates by Hispanic/Latino background, sociodemographic characteristics and weight categories. This study utilized baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) that included adults aged 18–74 years from four metropolitan areas (N = 16,415). Measured with the Actical accelerometer over 6 days, 76.9% (n = 12,631) of participants had > 10 h/day and > 3 days of data. Participants spent 11.9 h/day (SD 3.0), or 74% of their monitored time in sedentary behaviors. Adjusting for differences in wear time, adults of Mexican background were the least (11.6 h/day), whereas adults of Dominican background were the most (12.3 h/day), sedentary. Women were more sedentary than men, and older adults were more sedentary than younger adults. Household income was positively associated, whereas employment was negatively associated, with sedentary time. There were no differences in sedentary time by weight categories, marital status, or proxies of acculturation. To reduce sedentariness among these populations, future research should examine how the accumulation of various sedentary behaviors differs by background and region, and which sedentary behaviors are amenable to intervention., Graphical abstract, Highlights • We present accelerometer-assessed sedentary time in a representative sample of Hispanic/Latino adults living in the U.S. • We compare sedentary estimates by heritage and other socio-demographic variables such as education. • Adults of Mexican background were the least whereas adults of Dominican background were the most sedentary.

Introduction: Volunteering - a social capital indicator - has been associated with a lower burden of CVD risk factors in middle-aged and older adults . The prevalence of volunteering and its association with favorable cardiovascular health (i.e., low CV risk, LR ) has not been examined among diverse Hispanic/Latino adults. Hypothesis: Volunteering is positively associated with LR independent of sociodemographic and lifestyle factors; this association is modified by acculturation. Methods: Our analysis included 4,385 participants, ages 18-74 years, from the HCHS/SOL Sociocultural Ancillary Study (2010-2011), a population-based cohort of US Hispanics/Latinos. Multivariate logistic regression (survey weighted) was used to examine cross-sectional associations of self-reported current regular volunteering (yes vs. no) with LR (definition in Table). We tested whether these associations varied by acculturation (assessed as language preference [English vs. Spanish] and length of residence in the US [ Results: The prevalence of regular volunteering was 15.4%. Volunteers were more likely to be English speakers, have lived in the US ≥10 years, and had higher income and education than non-volunteers.Association of volunteering with LR varied by length of residence in the US but not with language preference (P for interactions=0.06 and 0.77, respectively). Among persons with ≥10 years of residence in the US, volunteering was associated with more than 2 times higher odds of being at LR vs. non-volunteering in the fully adjusted model (Table). No association of volunteering with LR was observed among those living in the US Conclusions: Volunteering was associated with LR among Hispanic/Latino adults who have lived in the US for ≥10 years independent of sociodemographic and lifestyle factors. Future research should examine the mechanisms underlying this association, as well as the longitudinal associations of volunteering with incidence of CVD risk factors to assess reverse causality.

Introduction The reach of the New York State YMCA's Diabetes Prevention Program (DPP) to at-risk populations may be increased through integration with primary care settings. Although considerable effort has been made in the referral and retention of patients, little is known about the factors associated with the placement of potential participants into YMCA's DPP. Methods Among Montefiore Health System (MHS) patients referred to YMCA's DPP (n = 1,249) from July 10, 2010, through November 11, 2015, we identified demographic factors (eg, age, preferred language) and primary care practice-level factors (eg, time between referral and start of session, session season) associated with placement into a session and subsequent drop-out. We also evaluated factors associated with weight loss. Results Patients were predominantly female (71%) and aged 45 years or older (71%). Patients preferring sessions in Spanish were less often placed in sessions. Patients aged 18 to 44 years were less often placed (P = .01) and enrolled (P = .001) than patients aged 60 years or older. Sessions conducted in the summer and spring had higher enrollment than fall and winter months. Patients who started the YMCA's DPP within 2 months of their referral date were more often enrolled (54.4%) than patients who waited 4 or more months (21.6%) to start their sessions. Patients aged 45 to 59 years lost marginally less weight than those aged 60 years or older (-3.1% vs -3.8%; P = .07). Conclusion Although this evaluation gives some insight into the barriers to placement and enrollment in YMCA's DPP, challenges remain. Efforts are under way to increase referral of patients to community-based DPPs.

Studies have shown that households subsidized with vouchers live in higher quality units and exhibit fewer physical, mental, and social problems than do their peers living in public housing. However, none of these studies have included cardiovascular outcomes. The objective of this study was to assess if use/type of rental assistance is independently associated with poor cardiovascular health among Latino adults (ages ≥ 18) who are eligible for federal low-income rental assistance and living in the Bronx, NY. Data from the cross-sectional, Affordable Housing as an Obesity Mediating Environment study, collected over 18 months (January 2011 to August 2012) were used. The prevalence of cardiovascular disease (CVD) outcomes was determined by measured high blood pressure and self-reported heart attack and/or stroke. Type of housing status was defined as: public housing units, units subsidized by section 8 vouchers, and units unassisted by either federal program. Statistical techniques used were analysis of variance and multivariate logistic regression. The prevalence of CVD was significantly higher among public housing residents than unassisted participants even in the presence of all individual level covariates. Public housing residents also have higher levels of CVD than do section 8 participants. The prevalence of CVD was similar for unassisted and section 8 participants. These findings point to the potential for health benefits arising from housing voucher use even within a fairly delimited geographic area.

From February through December 2012, we examined responses to health behavior questions integrated into the electronic medical record of primary care centers in the Bronx, New York in the context of New York City Community Health Survey data. We saw a higher proportion of unhealthy behaviors among patients than among the neighborhood population. Analyzing clinical data in the neighborhood context can better target at-risk populations.

The routes of underground cable projects sometimes include challenging obstacles that do not permit construction using conventional open-cut trenching methods. The size of the obstacles may range from a few tens of meters (e.g., roadway crossing) to a couple of kilometers (major highway or body of water) where specialized civil construction methods that avoid open-cut trenching can be beneficial. Because of the heat-producing nature of power cables, combining trenchless methods with electric power cables presents unique challenges that must be carefully considered. This paper highlights these design challenges in an effort to better assure successful power cable projects using trenchless technology.

we report amphibian and reptile distribution records based on recent biodiversity surveys conducted at the Angat watershed Reservation, Bulacan Province, Luzon Island, Philippines. This watershed constitutes the principal water source for Manila, the Philippines' largest metropolitan area. As virtually nothing is known of the herpetological diversity of the immediate area and the surrounding Bulacan Province, all species recorded as part of our surveys constitute major geographical records and/or significant range extensions. Our data result in a total of 63 new records of amphibian (19 frogs) and reptile (22 lizards, 2 turtles, and 20 snakes) species for this protected area (and immediate vicinity) that serves as a watershed for the major metropolitan area of Manila and surrounding cities. Together with the few previous literature records, our new records bring the total number of amphibian and reptile species for Bulacan Province to 68. we discuss several strategies for future survey work (focusing on habitat type, seasonal variation, and elevational variability) that we anticipate will result in increased knowledge of diversity within the Angat wa tershed Reserve. The impressive level of herpetological diversity within such a small area, so close to Metro Manila, emphasizes that the diversity and distribution patterns of amphibians and reptiles from Luzon are still poorly known and in need of further study.