Faculty Bibliography

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.

OBJECTIVE:To evaluate the acceptability of a community health worker (CHW) intervention designed to improve the oral health of low-income, urban Chinese immigrant adults. BACKGROUND:Given that both dental caries and periodontitis are behaviourally mediated, biofilm-based diseases that are largely preventable with attention to regular oral hygiene practices and preventive dental visits, strategies to arrest or even heal carious lesions and high-quality maintenance care and plaque control without the need to resort to aerosol-generating surgical approaches are evidence-based best practices. Older immigrants have poorer oral health than older US-born natives, motivating the need for delivery of more effective and affordable services to this vulnerable population. MATERIALS AND METHODS/METHODS:CHWs were trained by the NYU College of Dentistry dental hygienist faculty members using dental models and flip charts to instruct patients on proper brushing and flossing techniques. In addition, they discussed the presented oral health promotion information one-on-one with patients, addressed any expressed concerns and encouraged prevention of oral conditions through regular dental visits and brushing with fluoride toothpaste. RESULTS:More than 98% of the 74 older Chinese adult participants strongly agreed/agreed that the CHWs helped them to improve how they take care of their health, the CHWs answered their questions and concerns, the information and topics were informative, and the in-person demonstrations were helpful in improving oral health. CONCLUSION/CONCLUSIONS:The health of all communities depends on access to comprehensive care, including oral health care, in the wake of COVID-19. CHW interventions are acceptable to and may reach marginalised and immigrant communities.

BACKGROUND:The COVID-19 pandemic has significantly disrupted the food retail environment. However, its impact on fresh fruit and vegetable vendors remains unclear; these are often smaller, more community centered, and may lack the financial infrastructure to withstand supply and demand changes induced by such crises. OBJECTIVE:This study documents the methodology used to assess fresh fruit and vegetable vendor closures in New York City (NYC) following the start of the COVID-19 pandemic by using Google Street View, the new Apple Look Around database, and in-person checks. METHODS:In total, 6 NYC neighborhoods (in Manhattan and Brooklyn) were selected for analysis; these included two socioeconomically advantaged neighborhoods (Upper East Side, Park Slope), two socioeconomically disadvantaged neighborhoods (East Harlem, Brownsville), and two Chinese ethnic neighborhoods (Chinatown, Sunset Park). For each neighborhood, Google Street View was used to virtually walk down each street and identify vendors (stores, storefronts, street vendors, or wholesalers) that were open and active in 2019 (ie, both produce and vendor personnel were present at a location). Past vendor surveillance (when available) was used to guide these virtual walks. Each identified vendor was geotagged as a Google Maps pinpoint that research assistants then physically visited. Using the "notes" feature of Google Maps as a data collection tool, notes were made on which of three categories best described each vendor: (1) open, (2) open with a more limited setup (eg, certain sections of the vendor unit that were open and active in 2019 were missing or closed during in-person checks), or (3) closed/absent. RESULTS:Of the 135 open vendors identified in 2019 imagery data, 35% (n=47) were absent/closed and 10% (n=13) were open with more limited setups following the beginning of the COVID-19 pandemic. When comparing boroughs, 35% (28/80) of vendors in Manhattan were absent/closed, as were 35% (19/55) of vendors in Brooklyn. Although Google Street View was able to provide 2019 street view imagery data for most neighborhoods, Apple Look Around was required for 2019 imagery data for some areas of Park Slope. Past surveillance data helped to identify 3 additional established vendors in Chinatown that had been missed in street view imagery. The Google Maps "notes" feature was used by multiple research assistants simultaneously to rapidly collect observational data on mobile devices. CONCLUSIONS:The methodology employed enabled the identification of closures in the fresh fruit and vegetable retail environment and can be used to assess closures in other contexts. The use of past baseline surveillance data to aid vendor identification was valuable for identifying vendors that may have been absent or visually obstructed in the street view imagery data. Data collection using Google Maps likewise has the potential to enhance the efficiency of fieldwork in future studies.

Social and built environments may influence physical activity (PA). However, evidence for South Asian Americans (SAA), a group with low PA levels and high cardiometabolic risk, is lacking. We assessed the association between five neighborhood factors and PA behaviors in a community-based cohort of SAA. Data were from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study 2010-2013 (n = 906). Adjusted multivariable models stratified by sex regressing PA behaviors on neighborhood factors were run. Higher neighborhood social cohesion was associated with 17% more PA MET minutes/week in men (p < 0.01), but not in women. Having a park/playground near home was associated with meeting PA guidelines (odds ratio (95% CI): men: 3.14 (1.20-8.24); women: 3.67 (1.17-11.52). Neighborhood factors were associated with favorable PA behaviors in SAA. PA interventions for SAA that increase neighborhood social cohesion or focus on linking individuals with local resources may be effective.

PURPOSE OF REVIEW:To outline intervention efforts focused on reducing hypertension disparities in immigrant communities in the U.S. and to identify areas in the design, implementation, and evaluation of these interventions that warrant further exploration guided by an implementation science framework. RECENT FINDINGS:Studies examined (n = 11) included immigrant populations of African, Hispanic, and Asian origin. Men were underrepresented in most studies. Culturally tailored group-based educational sessions in religious or community spaces were common. Intervention agents included research assistants, registered nurses, community health workers, and faith-based organization volunteers. Community stakeholders were engaged in most studies, although most commonly for recruitment efforts. Surveys/interviews were used for intervention evaluation, and documentation of intervention activities and trainings was used to assess fidelity. Identified pathways for further intervention innovation included gender or migration-status-based targeting, diversifying intervention agents, enhancing mixed-method process evaluations, and tailoring to emerging needs during the COVID-19 pandemic.

Purpose: Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), the leading cause of morbidity, mortality, and disability in the United States. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers-often working with limited resources-need to compare the population health impacts of different food policies and programs to determine priorities, build capacity, and maximize resources. Numerous reports, reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that "real-world" settings are complex, multifaceted and dynamic. Methods: A narrative review was conducted of currently recommended evidence-based approaches to improving dietary behaviors, to describe and characterize applied and practical factors for consideration when adopting and implementing these dietary policies and programs across diverse settings. Results: From the narrative review, six key considerations emerged to guide community-based organizations, public health practitioners, and policymakers on moving from the evidence base, toward implementation in local and community settings. Conclusions: Considerations of "real-world" contextual factors are necessary and important when adopting and selecting evidence-based policies and programs to improve dietary behaviors and ultimately improve CVD outcomes. Promising approaches include those that apply community-partnered research and systems science to examine the equitable implementation of evidence-based dietary policies and programs.

Introduction/UNASSIGNED:The US Asian American (AA) population is projected to double by 2050, reaching ~43 million, and currently resides primarily in urban areas. Despite this, the geographic distribution of AA subgroup populations in US cities is not well-characterized, and social determinants of health (SDH) and health measures in places with significant AA/AA subgroup populations have not been described. Our research aimed to: 1) map the geographic distribution of AAs and AA subgroups at the city- and neighborhood- (census tract) level in 500 large US cities (population ≥66,000); 2) characterize SDH and health outcomes in places with significant AA or AA subgroup populations; and 3) compare SDH and health outcomes in places with significant AA or AA subgroup populations to SDH and health outcomes in places with significant non-Hispanic White (NHW) populations. Methods/UNASSIGNED:Maps were generated using 2019 Census 5-year estimates. SDH and health outcome data were obtained from the City Health Dashboard, a free online data platform providing more than 35 measures of health and health drivers at the city and neighborhood level. T-tests compared SDH (unemployment, high-school completion, childhood poverty, income inequality, racial/ethnic segregation, racial/ethnic diversity, percent uninsured) and health outcomes (obesity, frequent mental distress, cardiovascular disease mortality, life expectancy) in cities/neighborhoods with significant AA/AA subgroup populations to SDH and health outcomes in cities/neighborhoods with significant NHW populations (significant was defined as top population proportion quintile). We analyzed AA subgroups including Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other AA. Results/UNASSIGNED:The count and proportion of AA/AA subgroup populations varied substantially across and within cities. When comparing cities with significant AA/AA subgroup populations vs NHW populations, there were few meaningful differences in SDH and health outcomes. However, when comparing neighborhoods within cities, areas with significant AA/AA subgroup vs NHW populations had less favorable SDH and health outcomes. Conclusion/UNASSIGNED:When comparing places with significant AA vs NHW populations, city-level data obscured substantial variation in neighborhood-level SDH and health outcome measures. Our findings emphasize the dual importance of granular spatial and AA subgroup data in assessing the influence of SDH in AA populations.

Social media has been crucial for seeking and communicating COVID-19 information. However, social media has also promulgated misinformation, which is particularly concerning among Asian Americans who may rely on in-language information and utilize social media platforms to connect to Asia-based networks. There is limited literature examining social media use for COVID-19 information and the subsequent impact of misinformation on health behaviors among Asian Americans. This perspective reviews recent research, news, and gray literature to examine the dissemination of COVID-19 misinformation on social media platforms to Chinese, Korean, Vietnamese, and South Asian Americans. We discuss the linkage of COVID-19 misinformation to health behaviors, with emphasis on COVID-19 vaccine misinformation and vaccine decision-making in Asian American communities. We then discuss community- and research-driven responses to investigate misinformation during the pandemic. Lastly, we propose recommendations to mitigate misinformation and address the COVID-19 infodemic among Asian Americans.

Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.