Faculty Bibliography

OBJECTIVES: We determined the demographic characteristics, behaviors, injuries, and outcomes of commercial bicyclists who were injured while navigating New York City's (NYC's) central business district. METHODS: Our study involved a secondary analysis of prospectively collected data from a level 1 regional trauma center in 2008 to 2014 of bicyclists struck by motor vehicles. We performed univariable and multivariable logistic regression analyses. RESULTS: Of 819 injured bicyclists, 284 (34.7%) were working. Commercial bicyclists included 24.4% to 45.1% of injured bicyclists annually. Injured commercial bicyclists were more likely Latino (56.7%; 95% confidence interval [CI] = 50.7, 62.8 vs 22.7%; 95% CI = 19.2, 26.5). Commercial bicyclists were less likely to be distracted by electronic devices (5.0%; 95% CI = 2.7, 8.2 vs 12.7%; 95% CI = 9.9, 15.9) or to have consumed alcohol (0.7%; 95% CI = 0.9, 2.5 vs 9.5%; 95% CI = 7.2, 12.3). Commercial and noncommercial bicyclists did not differ in helmet use (38.4%; 95% CI = 32.7, 44.4 vs 30.8%; 95% CI = 26.9, 34.9). Injury severity scores were less severe in commercial bicyclists (odds ratio = 0.412; 95% CI = 0.235, 0.723). CONCLUSIONS: Commercial bicyclists represent a unique cohort of vulnerable roadway users. In NYC, minorities, especially Latinos, should be targeted for safety education programs. (Am J Public Health. Published online ahead of print August 13, 2015: e1-e6. doi:10.2105/AJPH.2015.302738).

Study Objectives: New York City (NYC) recently expanded its bicycle routes by demarcating bike lanes with paint and constructing 30 miles of protected paths that physically separate automobile traffic from bicyclists to address increases in bicyclist fatalities. Our objective was to determine whether bike lanes and protected paths result in safety benefits for bicyclists in NYC. We hypothesized that bike lanes would be associated with reduced injury severity among bicyclists colliding with motor vehicles and that protected paths would be associated with an even greater safety benefit. Methods: We performed a secondary analysis of bicyclist injury data collected from December 2008 to August 2014 at a Level 1 Trauma Center in NYC. We evaluated the association of protected paths and bike lanes on injury severity while controlling for potential confounders including patient demographics, scene-related and environmental information, helmet use, traffic law compliance, street characteristics, and injury mechanism. Data were obtained from patient interviews and medical records. Injury severity score (ISS) was categorized according to National Trauma Data Bank (NT

CONTEXT/BACKGROUND:Vitamin D binding protein (DBP) is an important determinant of bioavailable vitamin D (BAVD) and may provide clues to racial variation in osteoporosis and atherosclerosis. OBJECTIVE:The objective was to assess relationships between DBP, BAVD, 25-hydroxyvitamin D (25OHD), and 1,25 di-hydroxyvitamin D (1,25OH2D) with kidney, bone, adipose, and atherosclerosis phenotypes in African Americans with type 2 diabetes. DESIGN/METHODS:Cross-sectional (N = 545) and longitudinal (N = 288; mean 5.1 ± 0.9-year follow-up) relationships between vitamin D concentrations with renal phenotypes, vertebral bone mineral density, aorto-iliac, coronary artery, and carotid artery calcified plaque (CP), and adipose tissue volumes were studied. SETTING/METHODS:African American-Diabetes Heart Study. PATIENTS/METHODS:Participants were 56.7% female with mean ± standard deviation (sd) age 55.6 ± 9.6 years, diabetes duration 10.3 ± 8.2 years, and eGFR 90.9 ± 22.1 ml/min/1.73 m(2). INTERVENTIONS/METHODS:None. MAIN OUTCOMES AND MEASURES/METHODS:Associations tested between vitamin D and the previously mentioned phenotypes adjusting for age, sex, African ancestry proportion, diabetes duration, statins, smoking, changes in estimated glomerular filtration rate, body mass index, hemoglobin A1c, and blood pressure. RESULTS:1,25OH2D was inversely associated with change in coronary artery CP (parameter estimate [β] -0.005, standard error [SE] 0.002; P = .037), with a trend for change in carotid artery CP (β -0.007, SE 0.004; P = .074). Further adjustment for renin-aldosterone-system blockade revealed inverse association between 1,25OH2D and change in albuminuria (β -0.004, SE 0.002; P = .037). DBP, BAVD, and 25OHD did not associate significantly with changes in albuminuria, CP, or bone mineral density. BAVD was inversely associated with visceral, subcutaneous, intermuscular, and pericardial adipose volumes. CONCLUSIONS:In contrast to BAVD and 25OHD, only 1,25OH2D levels were significantly and inversely associated with changes in subclinical atherosclerosis and albuminuria in African Americans, suggesting potential beneficial effects.

OBJECTIVE: To assess the impact of a new government-subsidized supermarket in a high-need area on household food availability and dietary habits in children. DESIGN: A difference-in-difference study design was utilized. SETTING: Two neighbourhoods in the Bronx, New York City. Outcomes were collected in Morrisania, the target community where the new supermarket was opened, and Highbridge, the comparison community. SUBJECTS: Parents/caregivers of a child aged 3-10 years residing in Morrisania or Highbridge. Participants were recruited via street intercept at baseline (pre-supermarket opening) and at two follow-up periods (five weeks and one year post-supermarket opening). RESULTS: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls from a sample of predominantly low-income minorities. While there were small, inconsistent changes over the time periods, there were no appreciable differences in availability of healthful or unhealthful foods at home, or in children's dietary intake as a result of the supermarket. CONCLUSIONS: The introduction of a government-subsidized supermarket into an underserved neighbourhood in the Bronx did not result in significant changes in household food availability or children's dietary intake. Given the lack of healthful food options in underserved neighbourhoods and need for programmes that promote access, further research is needed to determine whether healthy food retail expansion, alone or with other strategies, can improve food choices of children and their families.

OBJECTIVE: To determine whether early social-emotional problems are associated with child feeding practices, maternal-child feeding styles, and child obesity at age 5 years, in the context of a primary care-based brief general parenting intervention led by an integrated behavioral health specialist to offer developmental monitoring, on-site intervention, and/or referrals. METHODS: A retrospective cohort study was conducted of mothers with 5-year-old children previously screened using the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) during the first 3 years of life. ASQ:SE scores were dichotomized "not at risk" versus "at risk." "At risk" subjects were further classified as participating or not participating in the intervention. Regression analyses were performed to determine relationships between social-emotional problems and feeding practices, feeding styles, and weight status at age 5 years based on participation, controlling for potential confounders and using "not at risk" as a reference group. RESULTS: Compared with children "not at risk," children "at risk-no participation" were more likely to be obese at age 5 years (adjusted odds ratio, 3.12; 95% confidence interval, 1.03 to 9.45). Their mothers were less likely to exhibit restriction and limit setting and more likely to pressure to eat than mothers in the "not at risk" group. Children "at risk-participation" did not demonstrate differences in weight status compared with children "not at risk." CONCLUSION: Early social-emotional problems, unmitigated by intervention, were related to several feeding styles and to obesity at age 5 years. Further study is needed to understand how a general parenting intervention may be protective against obesity.

Study Objectives: Previously, we built machine-learned models to automatically identify Tweets indicating alcohol use from 34,563 labeled Tweets collected over 24 hours during New Year's Day. The models demonstrated an estimated area under the receiver operating curve (AUROC) of 0.94 for identifying alcohol use Tweets. In this study, we validated our alcohol use model in an independently collected dataset - the Electric Zoo music festival on New York City's Randall's Island. This event attracted over 130,000 people in 2013 and resulted in two substance-associated deaths. Methods: The initial dataset contained all Tweets and Instagrams geo-tagged within 5 miles of Randall's Island, covering all event days from August 29-31, 2014. Two authors independently reviewed Tweets for drug- or alcohol-related content. 10% of the Tweets were randomly selected for dual independent review to determine agreement using a weighted Cohen's kappa. Identified Tweets were then jointly reviewed to determine those indicative of alcohol use according to previous definitions. Tweets and Instagrams were considered indicators of alcohol use if they referred to: intention to drink, the act of drinking, location at a bar or liquor store, mention of a specific brand, drinking paraphernalia (eg, flask), consequences from drinking (eg, drunk, wasted, tipsy), or alcohol-related hashtags. Our Bayesian logistic regression machine learned model, which had been derived only from Tweets, was applied to a restricted dataset excluding Instagrams. Results: The complete geo-located collection included 11,071 Tweets and Instagrams. The restricted dataset containing only Tweets consisted of 2,928 elements, of which 82 Tweets were classified as drug- or alcohol-related (weighted kappa = 0.92). Of these, 23 Tweets explicitly referenced alcohol use (eg, "Wine at Zoo is the right play. Instadrunk;" "Wow. I am not sober;" "#clskipfridays #livesummer #Ezoo #were dumb #and drunk"). The model achieved an AUROC of 0.87 when applied to this independent Tweet validation set. Conclusion: Our machine-learned model automatically identified alcohol use at Electric Zoo with high discriminatory power. Differences between the previous estimated AUROC performance and the validated AUROC performance are likely due to language variations between the two groups. An in-depth error analysis may identify approaches to improve model performance. The ability to automate social media geosurveillance of substance behavior at events could be coupled with real-time data feeds. Model automation would allow these real-time data feeds to be analyzed for potential public health interventions (including messaging, Tweet geodensity dependent medical presence, or other measures) to further reduce harm

BACKGROUND: Inorganic arsenic exposure has been related to the risk of increased blood pressure based largely on cross-sectional studies, conducted in highly exposed populations. Pregnancy is a period of particular vulnerability to environmental insults. However, little is known about the cardiovascular impacts of arsenic exposure during pregnancy. OBJECTIVES: To evaluate the association between prenatal arsenic exposure and maternal blood pressure over the course of pregnancy in a US population. METHODS: The New Hampshire Birth Cohort Study is an ongoing prospective cohort study, in which over 10% of participant household wells exceed the arsenic maximum contaminant level of 10 mug/L established by the US EPA. Total urinary arsenic measured at 24-28 weeks gestation was measured in 514 pregnant women, ages 18-45, who used a private well in their household and used as a biomarker of exposure during pregnancy. Outcomes were repeated blood pressure measurements (systolic, diastolic and pulse pressure) recorded during pregnancy. RESULTS: Using linear mixed effects models, we estimated that, on average, each 5 microg/L increase in urinary As was associated with a 0.15 mmHg (95% CI: 0.02, 0.29, p = 0.022) increase in systolic blood pressure per month and a 0.14 mmHg (95% CI: 0.02, 0.25; p=0.021) increase in pulse pressure per month over the course of pregnancy. CONCLUSIONS: In our US cohort of pregnant women, arsenic exposure was associated with greater increases in blood pressure over the course of pregnancy. These findings may have important implications as even modest increases in blood pressure impact cardiovascular disease risk.

The World Trade Center (WTC) destruction released dust and fumes into the environment. Although many community members developed respiratory symptoms, screening spirometry was usually normal. We hypothesised that forced oscillation testing would identify functional abnormalities undetected by spirometry and that symptom severity would relate to magnitude of abnormalities measured by oscillometry. A symptomatic cohort (n=848) from the Bellevue Hospital WTC Environmental Health Center was evaluated and compared to an asymptomatic cohort (n=475) from the New York City Department of Health WTC Health Registry. Spirometry and oscillometry were performed. Oscillometry measurements included resistance (R5) and frequency dependence of resistance (R5-20). Spirometry was normal for the majority of subjects (73.2% symptomatic versus 87.6% asymptomatic, p<0.0001). In subjects with normal spirometry, R5 and R5-20 were higher in symptomatic versus asymptomatic subjects (median (interquartile range) R5 0.436 (0.206) versus 0.314 (0.129) kPa.L-1.s-1, p<0.001; R5-20 0.075 (0.085) versus 0.004 (0.042) kPa.L-1.s-1, p<0.0001). In symptomatic subjects, R5 and R5-20 increased with increasing severity and frequency of wheeze (p<0.05). Measurement of R5-20 correlated with the presence and severity of symptoms even when spirometry was within normal limits. These findings are in accord with small airway abnormalities as a potential explanation of the respiratory symptoms.