Gretchen Van Wye

Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes

OBJECTIVES We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. METHODS We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. RESULTS Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract-level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. CONCLUSIONS The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation.

Evaluation of the New York City Breakfast in the Classroom Program

OBJECTIVES We determined the impact of Breakfast in the Classroom (BIC) on the percentage of children going without morning food, number of locations where food was consumed, and estimated calories consumed per child. METHODS We used a cross-sectional survey of morning food consumed among elementary school students offered BIC and not offered BIC in geographically matched high-poverty-neighborhood elementary schools. RESULTS Students offered BIC (n = 1044) were less likely to report not eating in the morning (8.7%) than were students not offered BIC (n = 1245; 15.0%) and were more likely to report eating in 2 or more locations during the morning (51.1% vs 30%). Overall, students offered BIC reported consuming an estimated 95 more calories per morning than did students not offered BIC. CONCLUSIONS For every student for whom BIC resolved the problem of starting school with nothing to eat, more than 3 students ate in more than 1 location. Offering BIC reduced the percentage of students not eating in the morning but may contribute to excess calorie intake. More evaluation of BICs impact on overweight and obesity is needed before more widespread implementation.

Reducing Sugary Drink Consumption: New York City’s Approach

Studies have linked the consumption of sugary drinks to weight gain, obesity, and type 2 diabetes. Since 2006, New York City has taken several actions to reduce consumption. Nutrition standards limited sugary drinks served by city agencies. Mass media campaigns educated New Yorkers on the added sugars in sugary drinks and their health impact. Policy proposals included an excise tax, a restriction on use of Supplemental Nutrition Assistance Program benefits, and a cap on sugary drink portion sizes in food service establishments. These initiatives were accompanied by a 35% decrease in the number of New York City adults consuming one or more sugary drinks a day and a 27% decrease in public high school students doing so from 2007 to 2013.

Estimating Potential Reductions in Premature Mortality in New York City From Raising the Minimum Wage to

OBJECTIVES To assess potential reductions in premature mortality that could have been achieved in 2008 to 2012 if the minimum wage had been

15

15 per hour in New York City. METHODS Using the 2008 to 2012 American Community Survey, we performed simulations to assess how the proportion of low-income residents in each neighborhood might change with a hypothetical

Profiling risk of fear of an intimate partner among men and women

15 minimum wage under alternative assumptions of labor market dynamics. We developed an ecological model of premature death to determine the differences between the levels of premature mortality as predicted by the actual proportions of low-income residents in 2008 to 2012 and the levels predicted by the proportions of low-income residents under a hypothetical

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990–2011

15 minimum wage. RESULTS A

Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 August 2017

15 minimum wage could have averted 2800 to 5500 premature deaths between 2008 and 2012 in New York City, representing 4% to 8% of total premature deaths in that period. Most of these avertable deaths would be realized in lower-income communities, in which residents are predominantly people of color. CONCLUSIONS A higher minimum wage may have substantial positive effects on health and should be considered as an instrument to address health disparities.

Institution-to-institution mentoring to build capacity in 24 local US health departments: best practices and lessons learned.

OBJECTIVE Fear of a partner, a component of intimate partner violence (IPV), can be used in clinical IPV assessment. This study examines correlates of fear in a population-based, urban sample to inform a gender-specific health care response to IPV. METHODS This study used pooled data on 9687 men and 13,903 women collected in 2002, 2004 and 2005 through three random-digit-dial surveys of New York City adults. Bivariate and multivariable analyses were used to examine associations between fear and sociodemographic and health-related factors. RESULTS There was no significant difference in age-adjusted prevalence of reported fear of a partner between women (2.7%) and men (2.2%). In multivariable analysis, fear was correlated with being female, younger age, divorced or separated marital status, poor self-reported health status, and multiple sex partners. The most striking gender difference was in the stronger association with multiple sex partners among women (adjusted Odds Ratio [aOR]=6.2; p<0.01). Binge drinking was correlated with fear only among low-income adults (aOR=2.8; p<0.01). CONCLUSION IPV is a health concern for both men and women, and a risk profile for fear can guide IPV assessment in health care. Physicians should consider multiple sex partners in women and alcohol misuse in low-income patients as potential markers for IPV.

Demographic and Behavioral Factors Associated with Daily Sugar-sweetened Soda Consumption in New York City Adults

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.