Jenna Mandel-Ricci

Prevalence and Control of Diabetes and Impaired Fasting Glucose in New York City

OBJECTIVE—To determine the prevalence of diabetes and impaired fasting glucose (IFG) and to assess clinical management indicators among adults with diabetes in a representative sample of New York City adults. RESEARCH DESIGN AND METHODS—In 2004, New York City implemented the first community-level Health and Nutrition Examination Survey (NYC HANES), modeled after the National Health and Nutrition Examination Survey (NHANES). We used an interview to determine previously diagnosed diabetes and measured fasting plasma glucose to determine undiagnosed diabetes and IFG in a probability sample of 1,336 New York City adults. We assessed glycemic control and other clinical indicators using standardized NHANES protocols. RESULTS—The prevalence of diabetes among New York City adults was 12.5% (95% CI 10.3–15.1): 8.7% diagnosed and 3.8% undiagnosed. Nearly one-fourth (23.5%) of adults had IFG. Asians had the highest prevalence of impaired glucose metabolism (diabetes 16.1%, IFG 32.4%) but were significantly less likely to be obese. Among adults with diagnosed diabetes, less than one-half (45%) had A1C levels <7%; one-half (50%) had elevated blood pressure measures at interview, 43% of whom were not on antihypertensive medications; nearly two-thirds (66%) had elevated LDL levels, and only 10% had their glucose, blood pressure, and cholesterol all at or below recommended levels. Most adults (84%) with diagnosed diabetes were on medication, but only 12% were receiving insulin. CONCLUSIONS—In New York City, diabetes and IFG are widespread. Policies and structural interventions to promote physical activity and healthy eating should be prioritized. Improved disease management systems are needed for people with diabetes.

Making It Harder to Smoke and Easier to Quit: The Effect of 10 Years of Tobacco Control in New York City

In 2002, New York City implemented a comprehensive tobacco control plan that discouraged smoking through excise taxes and smoke-free air laws and facilitated quitting through population-wide cessation services and hard-hitting media campaigns. Following the implementation of these activities through a well-funded and politically supported program, the adult smoking rate declined by 28% from 2002 to 2012, and the youth smoking rate declined by 52% from 2001 to 2011. These improvements indicate that local jurisdictions can have a significant positive effect on tobacco control.

Public opinions on tax and retail-based tobacco control strategies

Background While tobacco taxes and smoke-free air regulations have significantly decreased tobacco use, tobacco-related illness accounts for hundreds of thousands of annual deaths. Experts are considering additional strategies to further reduce tobacco consumption. Methods We investigated smokers’ (n=2118) and non-smokers’ (n=2210) opinions on existing and theoretical strategies, including tax and retailer-based strategies in New York City, across three cross-sectional surveys. Results Compared with smokers, non-smokers were significantly more likely (p<0.05) to favour all tobacco control strategies. Overall, 25% of smokers surveyed favoured increasing taxes on cigarettes, climbing to 60% if taxes were used to fund healthcare programmes. Among non-smokers, 72% favoured raising taxes, increasing to 83% if taxes were used to fund healthcare programmes. 54% of non-smoking New Yorkers favoured limiting the number of tobacco retail licences, as did 30% of smokers. The most popular retail-based strategies were raising the minimum age to purchase cigarettes from 18 to 21, with 60% of smokers and 69% of non-smokers in favour, and prohibiting retailers near schools from selling tobacco, with 51% of smokers and 69% of non-smokers in favour. Keeping tobacco products out of customers’ view, prohibiting tobacco companies from paying retailers to display or advertise tobacco products and prohibiting price promotions were favoured by more than half of non-smokers surveyed, and almost half of smokers. Conclusions While the support level varied between smokers and non-smokers, price and retail-based tobacco control strategies were consistently supported by the public, providing useful information for jurisdictions examining emerging tobacco control strategies.

Designing a Quality Improvement Program With Electronic Health Records New York City’s Health eQuits

Despite clear recommendations for identifying and intervening with smokers, clinical preventive practice is inconsistent in primary care. Use of electronic health records could facilitate improvement. Community health centers treating low-income and Medicaid recipients with greater smoking prevalence than the general population were recruited for a pilot program. Key design elements used to engage centers’ participation include designating a project champion at each organization, confirming ability to transmit data for reporting and participation, and offering money to facilitate initial engagement; however, financial incentives did not motivate all organizations. Other methods to elicit participation and to motivate practice change included building on centers’ previous experiences with similar programs, utilizing existing relationships with state cessation centers, and harnessing the “competitive” spirit—sharing both good news and areas for improvement to stimulate action. These experiences and observations may assist others in designing programs to improve clinical interventions with smokers.

Public Support for Smoke-Free Air Strategies Among Smokers and Nonsmokers, New York City, 2010–2012

Introduction From 2010 through 2012, the New York City Department of Health and Mental Hygiene engaged in multiple smoke-free-air activities in collaboration with community, institution, and government partners. These included implementing a law prohibiting smoking in all parks and beaches as well as working to increase compliance with existing Smoke-free Air Act provisions. Methods We investigated trends in awareness of existing smoke-free rules publicized with new signage and public support for new smoke-free air strategies by using 3 waves of survey data from population-based samples of smoking and nonsmoking adults in New York City (2010–2012). Analyses adjusted for the influence of sociodemographic characteristics. Results Among both smokers and nonsmokers, we observed increased awareness of smoke-free regulations in outdoor areas around hospital entrances and grounds and in lines in outdoor waiting areas for buses and taxis. Regardless of smoking status, women, racial/ethnic minorities, and adults aged 25 to 44 years were more likely than men, non-Hispanic whites, and adults aged 65 years or older to support smoke-free air strategies. Conclusion New signage was successful in increasing population-wide awareness of rules. Our analysis of the association between demographic characteristics and support for tobacco control over time provide important contextual information for community education efforts on secondhand smoke and smoke-free air strategies.

Going Tobacco-Free on 24 New York City University Campuses: A Public Health Agency's Partnership with a Large Urban Public University System.

ABSTRACT The New York City Department of Health and Mental Hygiene partnered with the nations largest university system, the City University of New York (CUNY), to provide technical assistance and resources to support the development and implementation of a system-wide tobacco-free policy. This effort formed one component of Healthy CUNY—a larger initiative to support health promotion and disease prevention across the university system and resulted in the successful introduction of a system-wide tobacco-free policy on all CUNY campuses. Glassman et al (J Am Coll Health. 2011;59:764–768) published a blueprint for action related to tobacco policies that informed our work. This paper describes the policy development and implementation process and presents lessons learned from the perspective of the Health Department, as a practical case study to inform and support other health departments who may be supporting colleges and universities to become tobacco-free.

Training mental health professionals to treat tobacco dependence.

To the Editor: Compared with the general population, individuals with serious mental illness are heavier smokers and have higher levels of nicotine dependence and higher relapse rates after quitting (1). Smoking rates among adults in New York City declined 31% between 2002 (21.5%) and 2011 (14.8%) (2); yet rates among persons with serious mental illness remain high. A 2010 New York City Department of Health and Mental Hygiene (DOHMH) survey of supportive housing program clients, including many with mental illness, found that 66% smoked (DOHMH, unpublished data, 2010). Evidence suggests that training health care professionals on smoking cessation has an impact on patient behavior (3). Thus the Communities Putting Prevention to Work initiative of the Centers for Disease Control and Prevention (4), which was implemented by DOHMH, focused on integrating tobacco dependence treatment into behavioral health services by implementing a train-the-trainer program for clinical and lay staff serving adults with serious mental illness. Between May 2010 and January 2011, ten train-the-trainer sessions were conducted for 44 assertive community treatment (ACT) teams and 160 supportive housing programs under contract with DOHMH and serving 7,500 clients annually. Duration was 18 hours (over three days). The curriculum focused on increasing understanding of tobacco addiction and its health impacts and training participants in use of quit-smoking medications and provision of cessation counseling based on motivational interviewing techniques. Participants were educated about smoking cessation benefits provided by New York State (NYS) Medicaid, the NYS Smokers’ Quitline, and community-level cessation services. Pairs of participants were expected to train colleagues within four months of their training session. Evaluation of the initiative was conducted by using Survey Monkey software for baseline and follow-up assessments of ACT team leaders and supportive housing program directors. Results indicated statistically significant improvements among staff in knowledge and attitudes about tobacco dependence treatment, including counseling techniques (67% increase in knowledge among ACT staff and 115% increase among housing program staff) and medications and cessation resources (80% and 29%, respectively, among housing program staff). The proportion of supportive housing programs that provided individual counseling increased significantly by 25%. All ACT teams and 90% of supportive housing programs implemented turnkey trainings, completing most modules. DOHMH successfully trained hundreds of providers serving thousands of clients with serious mental illness. Program directors and staff from ACT and supportive housing programs reported gains in knowledge and attitudinal changes. The only significant programmatic change reported was an increase in the number of housing programs offering individual counseling; however, this finding was not surprising, because evidence suggests that provider behavior change is more difficult to achieve than changes in awareness and knowledge (5). Research should examine incorporation of tobacco dependence treatment into daily practice by providers and its impact on client smoking rates. Exploration of remote training modalities is also needed. This program implementation was a successful first step to increasing tobacco dependence treatment for adults with serious mental illness, a population disproportionately affected by tobacco use. We encourage other jurisdictions to explore ways of adapting this program to the needs of their professional communities. Jenna Mandel-Ricci, M.P.A., M.P.H. Marie Bresnahan, M.P.H. Rachel Sacks, M.P.H. Shannon M. Farley, M.P.H.

Trends in smoking among adults with serious psychological distress during comprehensive tobacco control in New York City, 2003–2012

Adults with mental illness in the USA suffer excess smoking-related morbidity and mortality.1 Recent studies examining trends from 2001–2005 and 2004–2011 have shown consistently higher smoking prevalence and less successful quitting among those with mental illness, across an array of diagnoses.2 ,3 However, national data may mask changes in jurisdictions such as New York City (NYC), where comprehensive tobacco control (CTC) including taxation, legislation, education and access to cessation medications has operated for a decade (see Kilgore et al for details).4 We analysed data from the NYC Community Health Survey (CHS),5 to assess whether declines in the citywide smoking prevalence between 2003 and 20124 extend to those with serious psychological distress (SPD), measured using the …