Thomas D. Matte

Purchasing behavior and calorie information at fast-food chains in New York City, 2007.

We surveyed 7318 customers from 275 randomly selected restaurants of 11 fast food chains. Participants purchased a mean of 827 calories, with 34% purchasing 1000 calories or more. Unlike other chains, Subway posted calorie information at point of purchase and its patrons more often reported seeing calorie information than patrons of other chains (32% vs 4%; P<.001); Subway patrons who saw calorie information purchased 52 fewer calories than did other Subway patrons (P<.01). Fast-food chains should display calorie information prominently at point of purchase, where it can be seen and used to inform purchases.

Lead-contaminated house dust and urban children's blood lead levels.

OBJECTIVESnThis study assessed the relationship between lead-contaminated house dust and urban childrens blood lead levels.nnnMETHODSnA random-sample survey was used to identify and enroll 205 children, 12 to 31 months of age, who had resided in the same house since at least 6 months of age. Childrens blood and household dust, water, soil, and paint were analyzed for lead, and interviews were conducted to ascertain risk factors for elevated blood lead (> or = 10 micrograms/dL).nnnRESULTSnChildrens mean blood lead level was 7.7 micrograms/dL. In addition to dust lead loading (micrograms of lead per square foot), independent predictors of childrens blood lead were Black race, soil lead levels, ingestion of soil or dirt, lead content and condition of painted surfaces, and water lead levels. For dust lead standards of 5 micrograms/sq ft, 20 micrograms/sq ft, and 40 micrograms/sq ft on noncarpeted floors, the estimated percentages of children having blood lead levels at or above 10 micrograms/dL were 4%, 15%, and 20%, respectively, after adjusting for other significant covariates.nnnCONCLUSIONSnLead-contaminated house dust is a significant contributor to lead intake among urban children who have low-level elevations in blood lead. A substantial proportion of children may have blood lead levels of at least 10 micrograms/dL at dust lead levels considerably lower than current standards.

Trends and Racial/Ethnic Disparities in Gestational Diabetes Among Pregnant Women in New York City, 1990–2001

We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using information obtained from birth certificates. Gestational diabetes diagnoses among women who delivered babies increased 46%, from 2.6% (95% confidence interval [CI]=2.5, 2.7) to 3.8% (95% CI=3.7, 3.9) of births. Prevalence was highest among South and Central Asian women (11%). Given risks for adverse fetal outcomes and maternal chronic diabetes, prompt screening is critical. Metabolic control should be maintained during pregnancy and assessed postpartum for women with gestational diabetes.

Public Health Detailing: A Strategy to Improve the Delivery of Clinical Preventive Services in New York City

To promote use of essential clinical preventive services, the New York City Department of Health and Mental Hygiene developed the Public Health Detailing Program, a primary care provider outreach initiative modeled on pharmaceutical detailing. Department representatives conducted topical campaigns, making unscheduled visits to health care practices and meeting with providers and office staff members. Representatives distributed “action kits” containing practice tools, provider information, and patient education materials; nicotine replacement therapy was distributed during the smoking cessation campaign. More than 2,500 interactions with practice staff members were completed by six health department representatives at approximately 200 sites. Physician visits lasted 10 minutes or longer, and by provider self-report, use of office systems for prevention and adherence to recommended practices increased. Public health detailing is an effective method of reaching providers to deliver key prevention messages, feasible for public health agencies and acceptable to practices. The effectiveness of this intervention in improving clinical prevention services requires further evaluation.

Do medical students know enough about smoking to help their future patients? Assessment of New York City fourth-year medical students' knowledge of tobacco cessation and treatment for nicotine addiction.

Purpose Practicing physicians underutilize U.S. Department of Health and Human Services evidence-based approaches to nicotine addiction and treatment. Few studies have assessed medical student knowledge in this area. This study examined New York City fourth-year medical students’ knowledge of tobacco cessation and treatment of nicotine addiction. Method The authors conducted a Web-based survey, comprising 27 closed- and open-ended questions, of six of seven New York City medical schools in the spring of 2004. They drew questions from international, national, and local surveys on tobacco and health, U.S. Department of Health and Human Services tobacco treatment guidelines, and prior studies. Primary outcome measures were knowledge of the epidemiology of smoking, benefits of cessation and treatment of nicotine addiction, clinical cessation practices, and students’ use of tobacco and intentions to stop smoking. Results Of 943 fourth-year medical students, 469 (50%) completed an online survey. Students had good knowledge of the epidemiology of smoking, including its prevalence and health effects, with most responding correctly to relevant questions (mean correct response 79%; SD = 9.4). Students demonstrated a fair understanding of the benefits of cessation (mean correct response, 67%; SD = 19.2) and treatment of nicotine addiction (mean correct response, 61%; SD = 13.2). Three hundred students (64%) rated their own preparation to assist patients to quit as less than adequate. Conclusions Fourth-year medical students at the participating schools in New York City understood the harms of smoking but needed more information on the benefits of stopping smoking and treatment of nicotine addiction.

Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012

OBJECTIVESnWe evaluated the use of New York Citys (NYCs) electronic death registration system (EDRS) to conduct mortality surveillance during and after Hurricane Sandy.nnnMETHODSnWe used Centers for Disease Control and Prevention guidelines for surveillance system evaluation to gather evidence on usefulness, flexibility, stability, timeliness, and quality. We assessed system components, interviewed NYC Health Department staff, and analyzed 2010 to 2012 death records.nnnRESULTSnDespite widespread disruptions, NYCs EDRS was stable and collected timely mortality data that were adapted to provide storm surveillance with minimal additional resources. Direct-injury fatalities and trends in excess all-cause mortality were rapidly identified, providing useful information for response; however, the time and burden of establishing reports, adapting the system, and identifying indirect deaths limited surveillance.nnnCONCLUSIONSnThe NYC Health Department successfully adapted its EDRS for near real-time disaster-related mortality surveillance. Retrospective assessment of deaths, advanced methods for case identification and analysis, standardized reports, and system enhancements will further improve surveillance. Local, state, and federal partners would benefit from partnering with vital records to develop EDRSs for surveillance and to promote ongoing evaluation.