Faculty Bibliography

New York City (NYC) jails are the epicenter of an epidemic that overwhelmingly affects Black and Hispanic men and offer a significant opportunity for public health intervention. The NYC Department of Health and Mental Hygiene instituted population based approaches to identify the HIV-infected, initiate discharge planning at jail admission, and facilitate post-release linkages to primary care. Using a caring and supportive 'warm transitions' approach, transitional care services are integral to continuity of care. Since 2010, over three-quarters of known HIV-infected inmates admitted to jails received discharge plans; 74 % of those released were linked to primary care. The EnhanceLink initiative's new Health Liaison, a lynchpin role, facilitated 250 court-led placements in medical alternatives to incarceration. Transitional care coordination programs are critical to facilitate continuity of care for people with chronic health conditions including the HIV-infected returning home from jail and for the public health of the communities to which they return.

Correctional health systems represent some of the largest health systems in the United States, caring for patients with high rates of morbidity and mortality. The poorly understood realm of correctional health care represents a missed opportunity to integrate care for these patients with care provided by community health providers. Three aims are integral to effective correctional health: patient safety, population health, and human rights. Patient safety and population health are well-defined aims in community health care systems and emerging in correctional settings. Dual loyalty and other unique challenges in correctional settings make the human rights aim absolutely essential for promoting correctional health.

OBJECTIVES: Sexually transmitted infections (STIs) are an important cause of morbidity among incarcerated women and female sex workers (FSW). Little is known about FSW incarcerated in New York City (NYC) jails. We reviewed jail health records to identify the STI and HIV prevalence among newly incarcerated FSW in NYC jails. We also examined the relationship of demographics and self-reported clinical and risk behaviour history with FSW status and compared FSW with non-FSW incarcerated women to identify FSW predictors and, guide NYC jail programme planning and policy. METHODS: We retrospectively reviewed routinely collected jail health record data to identify the prevalence of chlamydia (Ct), gonorrhoea (Ng) and HIV infection among women newly incarcerated in NYC jails in 2009-2010 (study period) and studied the relationship of STIs, demographics and self-reported clinical and risk behaviour history with FSW status. RESULTS: During the study period, 10 828 women were newly incarcerated in NYC jails. Of these, 10 115 (93%) women were tested for Ct and Ng; positivity was 6.2% (95% CI 5.7% to 6.7%) and 1.7% (95% CI 1.4% to 1.9%), respectively. Nine percent had HIV infection. Seven hundred (6.5%) were defined as FSW. FSW were more likely to have Ct (adjusted OR (AOR): 1.55; 95% CI 1.17 to 2.05; p<0.0001) but not Ng or HIV. FSW were more likely to report age 20-24 years, reside in boroughs other than Manhattan, >/=6 prior incarcerations, >/=2 incarcerations during the study period, condom use with current sex partners, multiple sex partners and current drug use. CONCLUSIONS: Women incarcerated in NYC jails had high rates of Ct, Ng, and HIV infection. FSW were at higher risk for Ct than non-FSW incarcerated women. These findings are being used to design targeted interventions to identify FSW, provide clinical and preventive services in jail and coordinate care with community partners.

Approximately 90,000 inmates are admitted annually to the New York City jail system, many of whom require a high level of medical or mental health services. According to our analysis of deaths in custody from 2001 to 2009, crude death rates have dropped significantly despite the increasing age of the population. Falling HIV-related mortality appears to contribute to this change. Other observations include low rates of suicide across all 9 years and increasing age of the population in recent years.

Rationale: The prevalence of obesity continues to increase, and obesity has been associated with increased risk of new incident asthma in children. Ambient air pollution has also been associated with increases in asthma incidence and morbidity. Since asthma and obesity are both inflammatory states it is possible that the adverse effects of air pollution may be enhanced among children with obesity. This potential effect modification of obesity on the association between air pollution and increased asthma morbidity merits further investigation. Methods: We studied the effects of ambient ozone exposure on pulmonary function in a cohort of 2,239 children with asthma, ages 6 to 18, in New York State. Pulmonary function testing occurred over a 4 year period from January 2006 to May 2012. Body mass index (BMI) percentiles were calculated for each child. Those with a BMI from the 85th up to the 95th percentile were considered overweight and those at the 95th percentile or greater were considered obese. Eight-hour maximum ozone levels were obtained from U.S. Environmental Protection Agency's local area monitoring stations on day of and 1, 2 and 3 days (lag 0- to 3-day) prior to the day of testing for each subject. Generalized estimating equations were used to assess the effect of ozone exposures (average lag-0 to lag-3, 8-hour maximum) on pulmonary function as well as to determine whether obesity status modified these effects. Results: The mean age of the study population was 10.5 +/- 3.3 (SD); 53% of subjects were male; 18.7% of subjects were overweight and 22.4% were obese. Average pulmonary function measures for children with normal BMI and for the combination of overweight and obese subjects are shown in Table 1. Conclusions: Acute exposures to ambient ozone were associated with changes in pulmonary function among children with asthma. Increased obstruction following acute exposures to ambient ozone is positively modified by weight status. These results indicate that overweight or obese children may have increased sensitivity to the adverse pulmonary effects of air pollution exposure. (Figure Presented)

RATIONALE: Epidemiological studies indicate that exposure to fine particulate matter air pollution mass (PM_2.5) is associated with an increased risk of mortality; Pope et al., noted elevated total and cardiovascular mortality risks of long-term PM_2.5 in the U.S. nationwide American Cancer Society CP-II cohort (2002,2004). However, it is desirable to test these results in another large cohort that addresses participant mobility and estimates pollution exposures on a finer geographic scale. This research seeks to address these issues in the NIH-AARP Diet and Health Cohort. METHODS: The NIH-AARP cohort is an ongoing prospective mortality study of more than a half million people from locations across the U.S. It was begun in 1995-1996, when questionnaires eliciting information on demographic and health related behaviors were mailed to 3.5 million AARP members aged 50 to 71 years residing in 6 U.S. States (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and 2 metropolitan areas (Atlanta, GA; and Detroit, MI). Subject residence data were available at the census tract level at study entry. Subjects were censored from the analysis if they changed residence. Using available central site data to interpolate exposures on a census tract level, we fitted the Cox proportional hazard model to estimate hazard ratios and 95% confidence intervals for pollution and mortality using time-dependent exposure of PM_2.5, one-year prior. For this analysis, follow-up began January 1, 2000 and extended to 2006. The individual subject variables included in the model were age, sex, BMI, smoking status, race, alcohol consumption, education level, marital status, and residence region (6 States and 2 metropolitan areas). RESULTS: During the study period, more than 50,000 deaths occurred, including more than 15,000 from cardiovascular disease. Univariate analyses showed weak correlations (R2 < .05) between (log) PM_2.5 and the individual subject covariates of age, race, gender, education, marital status, tobacco use and BMI. Contextual spatial-related variables based on census tract data were not strongly correlated with PM_2.5 (household income, education, income diversity), with the exception of region of residence (R2 < .40). After inclusion of above-noted potential confounders, excess risks (p < .05) were found with increasing PM_2.5 exposure for all-cause and cardiovascular mortality. CONCLUSION: An analysis of mortality among US residents of the NIH-AARP cohort confirms excess total and cardiovascular mortality risks to be associated with long-term exposure to PM_2.5 air pollution

Feedback on game performance can be provided in many ways (e.g., cumulative points on game achievements, points on selected aspects of game play, biofeedback, brief statements offered during gameplay on choices made, verbal feedback at end of gameplay on overall performance, etc.). Feedback could be used motivationally to maintain player interest and involvement, informationally to guide the player in more effective choices, to build player confidence, and for a variety of other purposes. Although diverse feedback types and purposes are possible, some are more likely to be useful and effective. We have contacted several accomplished game designers and game researchers to obtain their insights into issues in feedback in Games for Health Journal.

OBJECTIVES: To analyse emergency department-based data on paediatric traumatic brain injury (TBI). METHODS: This study constructed a retrospective cohort of 493,890 children who were born in New York City between 1999-2007 and who were enrolled in the New York Medicaid programme at the time of their birth and followed these children from birth to the end of 2007. RESULTS: There were 62,089 injury-related emergency department visits, of which 1290 had ICD-9 codes consistent with TBI. Children with TBI were more likely to be male (59.4% vs 51.4%) and Hispanic (43.9% vs 26.3%) than those in the underlying birth cohort and were more than twice as likely to be admitted to the hospital for inpatient care (RR = 2.4, 95% CI = 2.2, 2.6). The most commonly listed cause of injury was falls (58.3%). Spatially-smoothed risk estimates indicated that some areas of the city are associated with a greater risk of paediatric TBI than others. CONCLUSIONS: Emergency department data can be used to describe paediatric TBI in ways not easily available through more routinely collected administrative health data. This information can be used to target prevention and control efforts.