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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.

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 (

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

The study examined whether characteristics of the urban physical environment are associated with child and maternal body mass index (BMI) in a sample of 3 year-old children and their mothers from 18 US cities (N=1997 dyads). BMI was determined based on measured height and weight. Characteristics of the interior and exterior physical environment, assessed and rated by trained interviewers, were related to child BMI at age 3 and to their mother's BMI. Negative aspects of the physical environment were more strongly related to maternal BMI among whites than among African-Americans or Hispanics.

Fragile Families and Wellbeing Study (FFS) data were analyzed to examine the relationships between obesity, household instability, and area poverty in urban mothers and their children (N=1,449). The FFS was conducted in 20 U.S. cities between 2001 and 2004. Household instability was defined as a tenuous home environment where certain psychosocial and economic constraints are present. Area poverty was determined according to the 2000 U.S. Census. Relative weight increased with level of household instability in mothers but not in children. Mothers with the highest level of household instability within areas of low poverty (i.e., relatively little poverty) were more likely than others to be obese (Odds Ratio=1.8, 95% CI 1.2-2.6). Household instability was not associated with overweight in children. These results suggest that home stability should be considered as a possible risk factor for obesity in mothers with infant children, particularly those residing in low poverty areas.

Introduction The Diabetes Prevention Program has been translated to community settings with varying success. Although primary care referrals are used for identifying and enrolling eligible patients in the Diabetes Prevention Program, little is known about the effects of strategies to facilitate and sustain eligible patient referrals using electronic health record systems. Methods To facilitate and sustain patient referrals, a modification to the electronic health record system was made and combined with provider education in 6 federally qualified health centers in the Bronx, New York. Referral data from April 2012 through November 2014 were analyzed using segmented regression analysis. Results Patient referrals increased significantly after the modification of the electronic health record system and implementation of the provider education intervention. Before the electronic system modification, 0 to 2 patients were referred per month. During the following year (September 2013 through August 2014), which included the provider education intervention, referrals increased to 1 to 9 per month and continued to increase to 5 to 11 per month from September through November 2014. Conclusions Modification of an electronic health record system coupled with a provider education intervention shows promise as a strategy to identify and refer eligible patients to community-based Diabetes Prevention Programs. Further refinement of the electronic system for facilitating referrals and follow-up of eligible patients should be explored.

Studies show that those residing in households subsidized with federal housing vouchers exhibit fewer mental health problems than residents of public housing. The role of housing conditions and neighborhood quality in this relationship is unclear. This study investigated the relationship between rental assistance, housing and neighborhood conditions, and the risk of depressive symptomology and hostile affect among low-income Latino adults living in the Bronx, NY. Latino adults participating in the Affordable Housing as an Obesity Mediating Environment (AHOME) study were used for analysis. All AHOME participants were eligible for federal low-income housing rental assistance (n = 385) and living in the Bronx, New York (2010–2012). Housing (crowding and structural deficiencies) and neighborhood (physical disorder and social cohesion) were measured by questionnaire during in-home interview. Depressive symptomology was measured using the Center for Epidemiologic Studies Depression Scale Short Form, CES-D 10 (score ≥10). Hostile affect was measured using items from the Cook-Medley Hostility Scale (score ≥ 4). Results suggest residents of Section 8 housing have similar levels of depressive symptomology and hostility compared to residents in public housing or those receiving no federal housing assistance. However, depressive symptomology was significantly associated with maintenance deficiencies [OR = 1.17; CI 1.02, 1.35] and social cohesion [OR = 0.71; CI 0.55, 0.93]. Hostility was significantly associated with perceived crowding [OR = 1.18; CI 1.16, 2.85], neighborhood physical disorder [OR = 1.94; CI 1.12, 3.40], and social cohesion [OR = 0.70; CI 0.50, 0.98]. Low-income housing assistance did not have an independent effect on mental health outcomes. However, characteristics of the housing and neighborhood environments were associated with depressive symptomology and hostility.

To examine the relationship between serum iron and body composition in a multiracial adult cohort.The analysis consisted of 670 participants on whom blood analysis and anthropometric data were available. The participants were recruited as part of the Rosetta Study (1990-2000), which was designed to assess body composition in a multiethnic cohort of healthy adults. Fasting iron level was measured as part of a biochemistry panel. Dual x-ray absorptiometry was used to assess fat mass. Anthropometric measures included waist circumference and body mass index (BMI; calculated as kg/m(2)) as an index of abdominal adiposity and overall body fatness, respectively.In the study cohort the mean age was 54+/-17 years and 60.9% were overweight or obese (BMIor =25). Men had higher serum iron levels (94.91+/-34.52 microg/dL [16.99+/-6.18 micromol/L] vs 82.17+/-32.62 microg/dL [14.71+/-5.84 micromol/L]) and larger waist circumference (91.98+/-11.87 cm vs 85.24+/-12.37 cm) compared with women (P0.001). Iron was inversely correlated with BMI (r=-0.23, P0.001), waist circumference (r=-0.19, P0.05), and fat mass (r=-0.19, P0.05) among Hispanic women but not among African-American, white, or Asian women or in men of any race/ethnic group.The results of this study show an inverse association of measures of body fat distribution and total fat mass with serum iron level in Hispanic women. Studies designed to explore how micronutrients are used by the body at varying degrees of body fatness could provide useful information on the micronutrient-related comorbidities of obesity.

Purpose Metabolic syndrome (MetS), the clustering of several risk factors for cardiovascular disease, is highly prevalent in Hispanics/Latinos. We tested whether all components significantly loaded on the syndrome in Hispanics/Latinos and whether their contribution differed by sex and Hispanic ancestry. We also examined associations of MetS with prevalent diabetes and coronary heart disease in Hispanics/Latinos. Methods Data were obtained from a population-based cohort of n = 15,823 participants in the HCHS/SOL study who self-identified as being of Central American, Cuban, Dominican, Mexican American, Puerto Rican, or South American ancestry and were aged 18 to 74 years at screening. Results A latent variable model of waist circumference, systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting glucose fit the data in men and women, but the contribution of HDL-C was weak. No difference in the latent model of MetS was detected across Hispanic/Latino ancestry groups. MetS was significantly associated with diabetes and coronary heart disease. Conclusions Our results indicate that similar criteria for MetS may be applied across Hispanic/Latino ancestry groups but call into question the role of HDL-C in classifying the MetS in Hispanics/Latinos.

Although multiple social and behavioral risk factors associated with obesity co-occur among young children, most studies have examined them separately. The purpose of this study was to examine the relationship between social risk factors, behavioral problems, health behaviors, and obesity among preschoolers in the Fragile Families and Child Wellbeing Study (N = 1589).A cumulative social risk score was created by summing maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father's incarceration, obtained when the child was 3 years old. Mothers reported on the child's internalizing and externalizing behaviors with the Child Behavior Checklist at age 5 years. Mothers also reported on hours the child spent watching television and sleeping as well as servings of soda or juice drinks the child consumed per day. Child height and weight were measured at age 5 years. Obesity was defined as body mass index ≥ 95th percentile.In regression analyses adjusted for health behaviors, behavioral problems, and sociodemographic factors, cumulative social risk was associated with obesity among girls. Externalizing behavioral problems were associated with obesity among girls (prevalence ratios [PRs], 1.5; 95% confidence interval [CI], 1.2-1.7) and boys (PR, 1.3; 95% CI, 1.1-1.6). Short sleep duration was also associated with obesity among girls (PR, 1.2; 95% CI, 1.0-1.4) and boys (PR, 1.3; 95% CI, 1.1-1.5) even after adjusting for behavioral problems and social risk factors. Watching more than 2 hours of television per day was associated with obesity among boys (PR 1.5; 95% CI, 1.2 to 1.9) but not girls.Co-occurring social and behavioral risk factors are associated with obesity among 5-year-old children.

Objective: The objective of this review is to determine what size congenital melanocytic nevi (CMN) increases the risk of malignant melanoma in affected patients.Background: Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes apparent at birth or in the first postnatal weeks. The Kopf system classifies nevi based on size: small

OBJECTIVES: The goal of this study was to examine the relationship between cumulative social adversity and childhood obesity among preschool-aged children (N = 1605) in the Fragile Families and Child Wellbeing Study. METHODS: Maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father’s incarceration were obtained when the child was 1 and 3 years of age. Two cumulative social risk scores were created by summing the 6 factors assessed at ages 1 and 3 years. Child height and weight were measured at 5 years of age. Logistic regression models stratified according to gender were used to estimate the association between cumulative social risk and obesity, adjusting for sociodemographic factors. RESULTS: Seventeen percent of children were obese at age 5 years, and 57% had at least 1 social risk factor. Adjusting for sociodemographic factors, girls experiencing high cumulative social risk (≥2 factors) at age 1 year only (odds ratio [OR]: 2.1 [95% confidence interval [CI]: 1.1–4.1]) or at 3 years only (OR: 2.2 [95% CI: 1.2–4.2]) were at increased odds of being obese compared with girls with no risk factors at either time point. Those experiencing high cumulative risk at age 1 and 3 years were not at statistically significant odds of being obese (OR: 1.9 [95% CI: 0.9–4.0]). No significant associations were noted among boys. CONCLUSIONS: There seems to be gender differences in the effects of cumulative social risk factors on the prevalence of obesity at 5 years of age. Understanding the social context of families could make for more effective preventive efforts to combat childhood obesity.

Objective To examine whether the relationship between obesity and asthma in young girls and boys can be explained by social and physical characteristics of the home environment. Study design We examined the relationship between asthma and obesity in children in the Fragile Families and Child Wellbeing Study (n = 1815). Asthma was determined through maternal report of asthma diagnosis by a doctor (active in past 12 months). Weight and height of child was measured during an in-home visit. Data on home social (maternal depression, intimate partner violence) and physical environmental factors (housing quality, tobacco exposure) were collected via questionnaire. Results Ten percent of children had active asthma, 19% of children were overweight, and 17% of children were obese. In fully adjusted models, obese children had twice the odds of having asthma (OR, 2.3; 95% CI, 1.5-3.3) compared with children of normal body weight. In stratified analyses, overweight boys, but not overweight girls, had increased of odds of asthma. Obese boys and girls had increased odds of asthma compared with boys and girls of normal body weight. Conclusion The relationship between asthma and obesity is present in boys and girls as young as 3 years of age; a relationship between being overweight and asthma is only present among boys. This relationship is not attributable to shared social and environmental factors of the children's home.

The increase in adiposity associated with aging is a concern in older adults, especially as it relates to the risk for ventilatory complications. Therefore, the specific aim of this study was to determine the association of various measures of abdominal adiposity with lung function in a sample of older healthy Black women. Participants (n = 27) had no history of diabetes or respiratory disease. The mean age was 67 years. Lung function was measured by spirometry using percent of predicted values for forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Body fat was measured using a three-dimensional photonic scanner and dual energy X-ray absorptiometry (DXA). Correlation analyses show that percent body fat in the trunk (%TF) is significantly associated with percent predicted FVC (r = −0.38; p < 0.05). No association was observed between anthropometric indices of truncal adiposity and lung function. Results of this study show that truncal fat mass measured by DXA is more strongly associated with lung function than anthropometric indices of truncal adiposity in this sample of women.

The aim of this study was to examine the relationship of serum Mg with stage of diabetes measured by fasting serum glucose in a cohort of 485 African American and Hispanic adults.The cross sectional Rosetta study was designed to assess body composition in a multi-racial cohort of healthy adults living in New York City. The data utilized for the current analyses were collected during the years 1990 to 2000. Serum Mg and glucose were measured after a 10-12 hour fast. Dual-energy x-ray absorptiometry was used to measure fat mass (FM) and fat free mass (FFM).The mean age of the cohort was 53 +/- 16 years. Hispanics had significantly lower (p0.05) mean serum Mg levels (0.82 +/- 0.07 mmol/L vs. 0.85 +/- 0.07 mmol/L) and FFM (48.8 +/- 10.9 kg vs. 50.9 +/- 10.3 kg) compared to African Americans. In both race/ethnic groups, individuals classified as having diabetes had significantly (p0.001) lower serum concentrations of Mg (0.80 +/- 0.07 mmol/L) compared to the normal group (0.84 +/- 0.07 mmol/L).These results show that in African American and Hispanic adults, those with diabetes have lower serum Mg levels compared to those classified as pre-diabetic or those with normal fasting glucose levels.

To the Editor: The recent supplement to the American Journal of Preventive Medicine—Addressing Latino Childhood Obesity Through Research and Policy: Findings from the Salud America! Experience1—was exciting and interesting to read. It is a constant reminder of the racial and ethnic disparities that exist in health outcomes that can be seen early in life. It has become clear that treating obesity requires a multifactorial approach. It is also becoming more apparent, and suggested by many of the reports in this supplement, that obesity can be difficult to treat and requires an approach with many different points of contact, including medical providers, parents, and community. We would like to highlight an additional concern in the treatment of obesity not often considered among obese youth but potentially important to treatment. Concomitant unhealthy behaviors can create barriers to treating obesity. Risky sexual behavior and its related health-compromising outcomes—for example, sexually transmitted infections (STIs), unintended pregnancy—greatly affect Latino youth,2,3 presumably many of the same youth who are affected by obesity. Risky sexual behavior has been defined most commonly in the literature as unprotected sexual acts that have a high probability of leading to unintended pregnancy; acquisition of an STI, including HIV/AIDS; or other negative outcomes. In our recent review of the literature on the relationship between risky sexual behavior and obesity among sexually active youth there were only two studies that we found4,5 addressing this issue and they suggest that obesity increases the likelihood of engaging in risky sexual behaviors such as using alcohol and drugs and not using a condom. According to the CDC, 47.4% of high school students nationwide have ever had sexual intercourse, and 33.7% report having had sex with at least one person in the 3 months prior to the survey.2 Adolescents who are obese and participating in risky sexual behavior add another layer of complexity to obesity treatment campaigns since both pregnancy and STIs can add additional complications to successful weight management. Excessive weight gain during pregnancy is common6 and weight loss post-partum is difficult for new mothers.7 Further, research suggests that HIV infection can make obesity-related complications difficult to treat.8 Despite the prevalence of obesity and sexual risk behavior among adolescents, there are few studies that investigate how these conditions may be related. Obese adolescents are a vulnerable population that can benefit from an integrated approach to intervention and treatment. As suggested by many of the studies of this supplement,1 it is important to pay attention to the whole child in the context of the many environments in which they live—including family, school, and community—when designing interventions that have the potential for sustainable success.

Calculations are presented which correlate the risk of carcinogenesis with various diagnostic radiological procedures. Even though "worst case" conditions are assumed, such as a linear non-threshold dose-response relationship, most of the radiographic procedures appeared to be quite conservative in terms of carcinogenic risk. This was not true, however, for mammography of younger women.

1. Off-type Russet Burkank potatoes, smooth-skinned and shaped like Rurals, transmitted the original varietal characteristics when grown in a normal soil. 2. Russet Burbank potatoes of certified seed stock, when grown in soils of high saline content, produced off-type potatoes with smooth skins. 3. Soils from the same locality, upon which good potatoes were growing, produced similar off-type potatoes when treated with equivalent amounts of sodium sulfate and chloride salts.

A Coulter-orifice pulse-height analyzer system was used to measure volume spectra of mammalian cells in suspension at different times after the addition of an equal volume of water. In appropriate hypotonic medium, cultured mammalian cells rapidly increase in volume and then shrink, more slowly, approaching their initial volumes within 20 to 30 minutes at 37.5°C. The shrinking phase was found to be reversibly inhibited by ouabain and inhibited in both K+-free and Na+-free solutions; neither choline+ nor Li+ could substitute for extracellular Na+ in supporting the shrinking phenomenon but Rb+ and Cs+ were fairly good substitutes for K+. Under conditions similar to those with which the shrinking phenomenon was observed with cultured cells, it was not found with either human or mouse red blood cells. Two methods were used to determine intracellular Na+ and K+ content in osmotically shocked cells and in unshocked controls. An isotope equilibration method was employed with L5178-Y mouse lymphoblasts and a chemical determination by flame photometry was used with Ehrlich ascites tumor cells. The K+ content was significantly reduced and the Na+ content was unchanged or somewhat increased in cells which had returned to their original volumes in hypotonic medium. The K+ content was even more reduced but the Na+ content was greatly increased in cells which were osmotically shocked in the presence of ouabain.