Renu K. Garg

A biomonitoring study of lead, cadmium, and mercury in the blood of New York city adults.

Objectives We assessed the extent of exposure to lead, cadmium, and mercury in the New York City (NYC) adult population. Methods We measured blood metal concentrations in a representative sample of 1,811 NYC residents as part of the NYC Health and Nutrition Examination Survey, 2004. Results The geometric mean blood mercury concentration was 2.73 μg/L [95% confidence interval (CI), 2.58–2.89]; blood lead concentration was 1.79 μg/dL (95% CI, 1.73–1.86); and blood cadmium concentration was 0.77 μg/L (95% CI, 0.75–0.80). Mercury levels were more than three times that of national levels. An estimated 24.8% (95% CI, 22.2–27.7%) of the NYC adult population had blood mercury concentration at or above the 5 μg/L New York State reportable level. Across racial/ethnic groups, the NYC Asian population, and the foreign-born Chinese in particular, had the highest concentrations of all three metals. Mercury levels were elevated 39% in the highest relative to the lowest income group (95% CI, 21–58%). Blood mercury concentrations in adults who reported consuming fish or shellfish 20 times or more in the last 30 days were 3.7 times the levels in those who reported no consumption (95% CI, 3.0–4.6); frequency of consumption explained some of the elevation in Asians and other subgroups. Conclusions Higher than national blood mercury exposure in NYC adults indicates a need to educate New Yorkers about how to choose fish and seafood to maximize health benefits while minimizing potential risks from exposure to mercury. Local biomonitoring can provide valuable information about environmental exposures.

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.

Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City

Background—Hypertension-related risk in urban areas may vary from national estimates; however, objective data on prevalence and treatment in local areas are scarce. We assessed hypertension prevalence, awareness, treatment, and control among New York City (NYC) adults. Methods and Results—The NYC Health And Nutrition Examination Survey (HANES), modeled on the national HANES, was conducted in 2004 with a representative sample of noninstitutionalized NYC residents ≥20 years of age. Hypertension outcomes were examined with interview and examination data (n=1975). Multiple logistic regression was used to assess factors associated with control among adults with hypertension. We found that 25.6% of NYC adults had hypertension. Blacks had a higher prevalence than whites (32.8% versus 21.1%, P<0.001), as did Hispanics (26.5% versus 21.1%, P<0.05). Foreign-born residents who had lived in the United States for <10 years had lower rates than those who had lived in the United States longer (20.0% versus 27.5%, P<0.05). Among adults with hypertension, 83.0% were diagnosed, 72.7% were treated, and 47.1% had hypertension controlled. Of those treated, 64.8% had hypertension controlled. After adjustment for sociodemographic variables among all adults with treated hypertension, lack of a routine place of medical care was most strongly associated with poor control levels (adjusted odds ratio 0.21, 95% confidence interval 0.07 to 0.66). Among nonelderly adults with treated hypertension, blacks had 4-fold lower odds than whites of having hypertension controlled (adjusted odds ratio 0.24, 95% confidence interval 0.06 to 0.92). Conclusions—In NYC, hypertension is common and frequently uncontrolled. Low levels of control are associated with poor access to care. Racial disparities in prevalence and control are evident among nonelderly adults.

Molecular Epidemiology of Tuberculosis in a Rural Area of High Prevalence in South India: Implications for Disease Control and Prevention

ABSTRACT Molecular and conventional epidemiologic techniques were used to study the mechanisms and risk factors for tuberculosis transmission in a rural area with high prevalence in south India. Restriction fragment length polymorphism analysis with IS6110 and direct repeat probes was performed with 378 Mycobacterium tuberculosis isolates from patients. Forty-one percent of M. tuberculosis isolates harbored a single copy of IS6110. Of 378 patients, 236 had distinct strains; 142 (38%) shared a strain with other patients, indicating recent infection. Older patients, those detected by a house-to-house community survey, and those hospitalized in a sanatorium were more likely to have had a recent infection. These findings suggest that the majority of the tuberculosis cases in south India were due to reactivation; therefore, efforts to control tuberculosis should be sustained.

Secondhand smoke exposure among nonsmokers nationally and in New York City.

INTRODUCTION We describe smoking prevalence and secondhand smoke (SHS) exposure among adult nonsmokers in New York City (NYC) across key demographic strata and compare exposure estimates with those found nationally. METHODS We used serum cotinine data from the 2004 NYC Health and Nutrition Examination Survey (n = 1,767 adults aged 20 years or older) and the 2003-2004 National Health and Nutrition Examination Survey (n = 4,476 adults aged 20 years or older) to assess and compare smoking prevalence and the prevalence of elevated cotinine levels (> or =0.05 ng/ml) among nonsmokers. We conducted multivariate logistic regression to assess independent predictors of elevated cotinine levels in NYC. RESULTS Although the smoking prevalence in NYC was lower than that found nationally (23.3% vs. 29.7%, p < .05), the proportion of nonsmoking adults in NYC with elevated cotinine levels was greater than the national average overall (56.7% vs. 44.9%, p < .05) and was higher for most demographic subgroups. In NYC, the highest cotinine levels among nonsmokers were among adults aged 20-39 years, males, and Asians. DISCUSSION Although NYC enacted comprehensive smoke-free workplace legislation in 2003, findings suggest that exposure to SHS remains a significant public health issue, especially among certain subgroups. The finding of a higher prevalence of SHS exposure in NYC despite lower smoking rates is puzzling but suggests that SHS exposure in dense, urban settings may pose a particular challenge.

Evaluation of the Phenol Ammonium Sulfate Sedimentation Smear Microscopy Method for Diagnosis of Pulmonary Tuberculosis

ABSTRACT We compared the sensitivity and specificity of the phenol ammonium sulfate (PhAS) sediment smear microscopy method for detection of acid-fast bacilli with those of direct smear microscopy, using culture results for Mycobacterium tuberculosis as the “gold standard.” The sensitivities of the PhAS and direct smear methods were 85% (465 of 547) and 83% (454 of 547), respectively, and the specificity of each method was 97%. The PhAS method was better accepted by the laboratory technicians and safer but necessitates an overnight sedimentation, which delays reporting of results until 1 day after sputum collection.

Seroprevalence of herpes simplex virus type 2 and characteristics associated with undiagnosed infection: New York City, 2004.

Background: Herpes simplex virus type 2 (HSV-2) infection is associated with substantial morbidity and increased risk for human immunodeficiency virus acquisition. We describe HSV-2 seroprevalence in adult New Yorkers, and examine the relationship between select characteristics, infection, and diagnosis. Methods: HSV-2 seroprevalence and risk factors were measured using the 2004 New York City Health and Nutrition Examination Survey, a population-based cross-sectional survey of adults. HSV-2 seroprevalence and corresponding 95% confidence intervals were computed for select characteristics. Associations between proposed risk factors and HSV-2 infection and diagnosis were estimated using unadjusted and adjusted odds ratios. Results: Nearly 28% of adults were infected with HSV-2; 88.4% of HSV-2 positive persons were undiagnosed. Black women had the highest seroprevalence (59.7%) of any sex or race/ethnicity group. Women, non-Hispanic blacks, and Hispanics (vs. non-Hispanic whites), and men who have sex with men were at greater odds of HSV-2 infection. Among HSV-2 infected individuals, non-Hispanic blacks (vs. non-Hispanic whites), uncircumcised men, and those with no routine place of care were less likely to be diagnosed. Conclusions: HSV-2 is highly prevalent and largely undiagnosed in New York City; seroprevalence varies by subgroup. Targeted HSV-2 screening, counseling and treatment may help reduce transmission of HSV-2 and human immunodeficiency virus.

Contributions of a Local Health Examination Survey to the Surveillance of Chronic and Infectious Diseases in New York City

OBJECTIVES We sought to evaluate the contribution of the New York City Health and Nutrition Examination Survey (NYC-HANES) to local public health surveillance. METHODS Examination-diagnosed estimates of key health conditions from the 2004 NYC-HANES were compared with the National Health and Nutrition Examination Survey (NHANES) 2003-2004 national estimates. Findings were also compared with self-reported estimates from the Community Health Survey (CHS), an annually conducted local telephone survey. RESULTS NYC-HANES estimated that among NYC adults, 25.6% had hypertension, 25.4% had hypercholesterolemia, 12.5% had diabetes, and 25.6% were obese. Compared with US adults, NYC residents had less hypertension and obesity but more herpes simplex 2 and environmental exposures (P<.05). Obesity was higher and hypertension was lower than CHS self-report estimates (P<.05). NYC-HANES and CHS self-reported diabetes estimates were similar (9.7% vs 8.7%). CONCLUSIONS NYC-HANES and national estimates differed for key chronic, infectious, and environmental indicators, suggesting the need for local data. Examination surveys may provide more accurate information for underreported conditions than local telephone surveys. Community-level health and nutrition examination surveys complement existing data, providing critical information for targeting local interventions.

Prevalence of Hepatitis C Infection in New York City, 2004

Hepatitis C virus (HCV) is the leading cause of chronic liver disease in the United States. Accurate hepatitis C prevalence estimates are important to guide local public health programs but are usually unavailable to local health jurisdictions. National surveys may not reflect local variation, a particular challenge for urban settings with disproportionately large numbers of residents in high-risk population groups. In 2004, the New York City Department of Health and Mental Hygiene conducted the NYC Health and Nutrition Examination Survey, a population-based household survey of non-institutionalized NYC residents ages 20 and older. Study participants were interviewed and blood specimens were tested for antibody to HCV (anti-HCV); positive participants were re-contacted to ascertain awareness of infection and to provide service referrals. Of 1,786 participants with valid anti-HCV results, 35 were positive for anti-HCV, for a weighted prevalence of 2.2% (95% confidence interval [CI] 1.5% to 3.3%). Anti-HCV prevalence was high among participants with a lifetime history of injection drug use (64.5%, 95% CI 39.2% to 83.7%) or a lifetime history of incarceration as an adult (8.4%, 95% CI 4.3% to 15.7%). There was a strong correlation with age; among participants born between 1945 and 1954, the anti-HCV prevalence was 5.8% (95% CI 3.3% to 10.0%). Of anti-HCV positive participants contacted (51%), 28% (n = 5) first learned of their HCV status from this survey. Continued efforts to prevent new infections in known risk behavior groups are essential, along with expansion of HCV screening and activities to prevent disease progression in people with chronic HCV.