Background: Utility services for electricity, gas, heat, and hot water are necessities for everyday activities (e.g., lighting, cooking, and thermal safety). Utility outages can threaten health; however, information is limited on the prevalence of electricity, gas, heat, and hot water outages in representative studies. We characterized infrastructure-related electricity, gas, heat, and hot water outages in New York City (NYC) and within subgroups. Methods: Using a representative 2022 survey of NYC adults (18+), we assessed the prevalence for 6+ hour utility outages and compared across building, demographic, and health subgroups. Building characteristics included age, number of floors, rental type, and owner/rental status. Demographics included household poverty, neighborhood poverty, and race/ethnicity. For health, we focused on cognitive impairment, electricity-dependent medical equipment use, and mental health conditions. Results: Outages impacted 20% of NYC residents. Heat outages were nearly 3× and 2× more common in mid-rise and high-rise buildings respectively, vs. low-rise buildings. Similarly, hot water outages were 5× and over 6× more prevalent in mid-rise and high-rise residences. Renters faced 2× more heat and hot water outages compared with owners. Compared with low-poverty households, high-poverty households faced 2× more hot water outages. Residents with mental health conditions experienced more electricity (11% vs. 5%), heat (15% vs. 7%), and hot water (16% vs. 8%) outages compared with those without. Conclusions: NYC utility outage prevalence varied by type with heat and hot water being most common. Disparities across building, sociodemographic, and health characteristics were also larger and more frequent for heat and hot water outages.

Adoption of electric stoves and rooftop solar can reduce fossil-fuel reliance and improve health by decreasing indoor air pollution and alleviating energy insecurity. This study assessed prevalence and perceptions of these clean-energy technologies to increase adoption in New York City (NYC). A representative survey of 1950 NYC adults was conducted from February 28 to April 1, 2022. Fourteen percent of people had an electric stove; 86% had gas stoves. Black, Latino/a, and lower-income residents were more likely to have electric stoves than White and higher-income residents. Only 14% of residents were interested in switching from gas to electric stoves. Of the 71% with gas stoves uninterested in switching, nearly half (45%) preferred gas cooking, particularly among White and higher-income residents, indicating a large opportunity to shift preferences. About 5% used solar for their home or building; another 77% were interested in solar. Of the 18% uninterested in solar, reasons included lack of agency, confusion about operation, and costs. Education about health and cost benefits, induction technology, how to transition, available subsidies, and other efforts to reduce adoption barriers can support clean technology uptake. Residential clean energy metrics should be tracked regularly to ensure that technology adoption proceeds equitably.

CONTEXT:Public health agencies routinely publish data in hopes that data influence public health policy and practice. However, data websites can often be difficult to use, posing barriers to people trying to access, understand, and use data. Working to make data websites easier to use can add value to public health data communication work. PROGRAM:The New York City Department of Health and Mental Hygiene (DOHMH) redesigned its Environment and Health Data Portal, a website used to communicate environmental health data, with the goal of making data more accessible and understandable to a broader audience. The DOHMH used Civic Service Design methods to establish priorities and strategies for the redesign work, to build a data communication website that emphasizes a high level of usability, and content that explains data. IMPLEMENTATION:By following a Civic Service Design process, the DOHMH synthesized findings from health communications, data visualization and communication, and web usability to create an easy-to-use website with explanations of data and findings alongside datasets. On the new site, automated dataset visualizations are supplemented with narrative content, explanatory content, and custom interactive applications designed to explain data and findings. EVALUATION:Web analytics showed that, in its first year of operation, the site's web traffic grew substantially, with the last 12 weeks recording weekly page views 150% higher than the first 12 weeks of operation (7185 average weekly page views compared with 2866 average weekly page views). Two-thirds (66.3%) of page views include recorded user engagement. Additional evaluations to measure specific aspects of usability compared with the previous version of the site are planned. DISCUSSION:By following a Civic Service Design process, the DOHMH redesigned a vital data communication platform to increase its usability and saw significant increase in engagement in its first year of operations. By designing data material with usability in mind, public health departments have the potential to improve public health data communication work.

The remnants from Hurricane Ida in September 2021 caused unprecedented rainfall and inland flooding in New York City (NYC) and resulted in many immediate deaths. We reviewed death records (electronic death certificates and medical examiner reports) to systematically document the circumstances of death and demographics of decedents to inform injury prevention and climate adaptation actions for future extreme precipitation events. There were 14 Ida-related injury deaths in NYC, of which 13 (93%) were directly caused by Ida, and 1 (7%) was indirectly related. Most decedents were Asian (71%) and foreign-born (71%). The most common circumstance of death was drowning in unregulated basement apartments (71%). Themes that emerged from the death records review included the suddenness of flooding, inadequate exits, nighttime risks, and multiple household members were sometimes affected. These deaths reflect interacting housing and climate crises, and their disproportionate impact on disadvantaged populations needing safe and affordable housing. Climate adaptation actions, such as improving stormwater management infrastructure, informing residents about flood risk, implementing Federal Emergency Management Agency recommendations to make basements safer, and expanding emergency notification measures can mitigate risk. As climate change increases extreme precipitation events, multi-layered efforts are needed to keep residents safe.

Energy insecurity, defined as the inability to meet household energy needs, has multiple economic, physical, and coping dimensions that affect health. We conducted the first citywide representative survey of energy insecurity and health in a sample of 1,950 New York City residents in 2022. We compiled ten indicators that characterize energy insecurity as experienced in New York City housing settings and then examined associations between number and types of indicators and health conditions. Nearly 30 percent of residents experienced three or more indicators, with significantly higher levels among Black non-Latino/a and Latino/a residents compared with White non-Latino/a residents, renters compared with owners, recent immigrants compared with those living in the United States for longer, and those in households with children compared with those with no children. Residents with three or more indicators of energy insecurity had higher odds of respiratory, mental health, and cardiovascular conditions and electric medical device dependence than residents with no indicators. Our study demonstrates that broadening the understanding of energy insecurity with context-specific metrics can help guide interventions and policies that address disparities relevant to health and energy equity.

In summer 2020, New York City (NYC) implemented a free air conditioner (AC) distribution program in response to the threats of extreme heat and COVID-19. The program distributed and installed ACs in the homes of nearly 73,000 older, low-income residents of public and private housing. To evaluate the program's impact, survey data were collected from October 2020 to February 2021 via mail and online from 1447 program participants and 902 non-participating low-income NYC adults without AC as a comparison group. Data were examined by calculating frequencies, proportions, and logistic regression models. Participants were 3 times more likely to report staying home during hot weather in summer 2020 compared to non-participants (adjusted odds ratio [AOR] = 3.0, 95% confidence interval [CI] = 2.2, 4.1), with no difference between groups in summer 2019 (AOR = 1.0, CI = 0.8, 1.3). Participants were less likely to report that 2020 hot weather made them feel sick in their homes compared to non-participants (AOR = 0.2, CI = 0.2, 0.3). The program helped participants-low-income residents and primarily people of color-stay home safely during hot weather. These results are relevant for climate change health-adaptation efforts and heat-health interventions.

Electrical power outages are of increasing interest to US urban scholars, government officials and stakeholders, as they have increased in number and duration with significant health and economic, among other, impacts. This analysis examines reports of power outages in New York City in relation to socioeconomic and health characteristics of neighborhoods. Using the city's 311-call database we examine complaint calls for power outages from 2014 to 2022. While 311-calls for power outages occur all year long, volume trended higher during the warmer months (June, July and August), and as minimum daily temperatures exceeded 20 degrees C (68 degrees F), the number of calls increased dramatically. Spatial clusters of high call areas were in Census tracts with high energy burdens, lower-income households, and high percentages of people of color. Furthermore, we found the higher call areas were associated with higher vulnerability to heat-exacerbated deaths. As climate change is expected to raise temperatures and increase the frequency and intensity of heat waves around the world, and as power outages are becoming more common, these findings will help to provide guidance for adaptation and energy reliability policies in New York City and have implications for other cities globally.

BACKGROUND AND AIM Recent studies suggest an association between daily variation in ambient temperature during pregnancy and preterm birth (PTB). Our objective is to examine the short-term effects of heat and cold on PTB risk from 2008 to 2016 in New York City (NYC). METHODS We applied quasi-Poisson regression with distributed lag nonlinear models to estimate the cumulative relative risk (CRR) of daily counts of spontaneous PTB (<37 weeks gestation) and outdoor temperature, and to estimate the fraction of PTBs attributable to temperature, by season, using NYC Vital Statistics birth records and National Weather Service daily temperature data at LaGuardia airport. Models were adjusted for within-season trends and daily number of pregnant people at risk for preterm delivery. Heat and cold were defined as the 95th versus 50th percentile of maximum temperature during the warm season and 5th versus 50th percentile of minimum temperature during the cold season, respectively. Maternal race/ethnicity was assessed for effect modification. RESULTS Our analysis consisted of 38,593 spontaneous PTBs. Heat was not associated with PTB during the warm season [CRR: 0.98 (95% CI: 0.92, 1.05)]. There was a nonlinear association between cold and PTB. During the cold season, the CRR was 1.08 (0.99, 1.17) for cold up to three days before delivery (lag 0-3). The estimated fraction of PTBs attributable to cold was 9.3% (-0.6%, 17.4%), which corresponded to 81 (-2, 154) cold-attributable PTBs over the 9-year study period. Among non-Hispanic Blacks, the CRR was 1.20 (1.04, 1.39) for cold over lag 0-3 days, and an estimated 23.2% (10.3%, 34.3%) of non-Hispanic Black PTBs, equivalent to 69 (29, 105) PTBs, were attributable to cold. CONCLUSIONS Heat had no measurable impact. Cold potentially increased risk of PTB. Our finding for the impact of cold on non-Hispanic Black PTBs warrants additional research. KEYWORDS Preterm birth Temperature

BACKGROUND AND AIM: Rising temperatures threaten the safety of at-risk populations in cities. The threat of COVID-19 introduced new risks. METHODS: In May 2020, New York City (NYC) initiated the Get Cool NYC program, which addressed indoor heat exposure during the summer by distributing 74,000 air conditioners (ACs) to low-income seniors (60+) in private and public housing. In the fall, a survey to assess whether the ACs helped those who wished to stay home do so safely was distributed to: (1) program participants living in privately-owned housing (3,800) and (2) a group of non-eligible New Yorkers (12,029). The comparison group included section 8 tenants (55-59 years) living in private housing (NYC Department of Housing and Preservation and Development), NYC Department for the Aging clients and ineligible Get Cool applicants younger than 60. Difference in prevalence estimates across program participants and comparison respondents without AC, and within groups across years, were compared with Rao-Scott Chi-Square tests. RESULTS:The American Association for Public Opinion Research response rate 2 among program participants and non-participants was 22.2% (845 complete) and 13.5% (1,126 complete), respectively. About 35% (395) of the non-participant group did not have an AC in 2020. While COVID-19 influenced both groups, within the participant group, respondents were more likely to stay home during summer 2020 than summer 2019 (90%, CI: 88, 92 vs. 71%, 95% CI: 67, 74). In contrast, we observed no difference in the non-participant group (67% in 2019 versus 68% in 2020). Both groups took similar advantage of other city-implemented mitigation strategies, such as green space and cooling centers. CONCLUSIONS:Our findings demonstrate the need for heat intervention strategies to decrease barriers to thermal safety, providing people with a range of choices but focusing on the ability to stay home safely and in comfort for populations most impacted. KEYWORDS: Extreme Heat, Covid-19, Policy, mitigation, adaptation

Objectives: To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation. Study design: In a randomized controlled trial of 384 children aged 5-12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use. Results: The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma (p = 0.04) and larger declines that fell short of statistical significance in asthma symptom days (p = 0.22), severe symptoms (p = 0.16), missed school (p = 0.27) and rescue medication use (p = 0.27). Both roach (p = 0.001) and mice (p = 0.11) infestations decreased much more in the IPM group than the UC group. Conclusions: After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma.

BACKGROUND AND AIM: Heat mitigation planning requires careful characterization of the adverse impacts of temperature on health outcomes. New York City (NYC) has used observed temperature-mortality relationships to revise the city's heat advisory trigger threshold, but such assessment must be ongoing as temperatures rise. METHODS: We analyzed 5-year rolling periods of weather and mortality data for May-September, 1997-2017 in NYC to estimate changes in cumulative relative risks (CRR) with up to 3-day lag and attributable deaths over time using both the extreme heat event (EHE) day indicator (0/1) for NYC's heat advisory threshold (=35°C for two days or =38°C for any duration) and a continuous daily maximum heat index (or maximum temperature when heat index was unavailable), or MAX, using quasi-Poisson distributed lag non-linear models. For MAX, we used the median for the entire period (28°C) as reference, estimated CRRs at 37°C (median temperature of days above 35°C), compared to EHE CRR, and estimated attributable deaths for all days above 28°C. RESULTS:CRRs for both EHE and MAX have been comparable and stable (~1.08) in the recent decade and lower than in earlier periods (~1.10). The number of EHE days were stable over the study period (~10 days/year), while non-EHE summer days (28°C to less than 35°C) have been increasing (57 days in 1997-2001 vs. 74 days in 2013-2017). The estimated attributable deaths for MAX mirror the warming climate, increasing since 1997, and surpassing those for EHE in recent years (267 MAX vs 94 EHE for 2013-2017). CONCLUSIONS:Estimated excess deaths due to non-EHE days are larger than those for EHE days and increasing. In NYC, where the overall air conditioning prevalence is greater than 90%, near-term heat mitigation should focus on addressing inequities in air conditioning and energy insecurity in the most-impacted communities along with other structural heat mitigation strategies beyond emergency response. KEYWORDS: temperature, mortality, extreme heat, attributable deaths, heat mitigation

Noise can be harmful to health. One effect of noise is disrupted sleep and poorer daytime cognitive performance. New York City (NYC) adults were surveyed to examine the frequency and sources of ambient noise that cause sleep disturbance, physical (e.g., wearing earplugs) or medical (e.g., using sleep medications) measures taken to reduce noise exposure, and effect on concentration due to poor sleep. The data were obtained from a 2017 automated telephone survey using a Redirected Inbound Call Sampling method. Participants were screened to be 18 years and older and live in a NYC borough. Imputation was used for missing demographic variables and missing or “prefer not to answer” responses of key noise questions. SAS was used to calculate frequencies and perform logistic regression. An estimated 2,650,000 NYC adults reported being disturbed from sleep by noise at least once per week. Of them, 78% were disturbed three or more nights per week. Traffic caused 53% of sleep disturbances of three or more nights per week, with sources consisting of subways (7%), buses (9%), sirens (15%), garbage trucks (11%), and other traffic (12%). 75% of New Yorkers with noise-disrupted sleep three or more nights per week reported difficulty concentrating due to poor sleep at least once per week. Regression analysis showed that significant associations of having noise-disrupted sleep at least once per week were: sleep disturbed by light (OR 2.9, 95% CI 1.9–4.3, p<0.0001), use of physical (OR 7.4, 95% CI 5.2–10.4, p<0.0001) or medical (OR 2.1, 95% CI 1.4–3.1, p=0.0004) interventions to mitigate outside noise, and race/ethnicity when compared to White Non-Hispanic (Hispanic OR 1.9, 95% CI 1.3–2.8, p=0.001; Other OR 1.8, 95% CI 1.1–3.0, p=0.0145). Associations with having difficulty concentrating due to poor sleep at least once per week included having sleep disturbed by light (OR 3.9, 95% CI 2.6–5.8, p<0.0001), sleep disturbed by noise (OR 1.8, 95% CI 1.4–2.4, p<0.0001), and use of physical(OR 2.3, 95% CI 1.6–3.1, p<0.0001) or medical interventions (OR 2.8, 95% CI 1.9–4.2, p<0.0001). Noise pollution, frequently due to traffic, is common in urban environments. It has detrimental effects on sleep, leading to perceived concentration difficulty, even with attempts to reduce it. Additionally, in NYC, there are disparities in noise exposure by race/ethnicity, possibly related to inequities in the concentration of non-white residents in under-resourced neighborhoods. Although NYC has a noise code that sets decibel limits and quiet times, additional ways to reduce noise pollution are needed to complement the regulatory approach.

“Heat illness is preventable.” So begins our public health messaging on heat risk at the New York City Department of Health and Mental Hygiene (hereafter, the Health Department). But as we go through emergency response operations for extreme heat events every summer, “heat illness is preventable” sometimes feels like an existential mantra, reminding us how much more we need to do. On behalf of our many colleagues, we share here our collective experiences and primary challenges in using applied health research findings to describe and mitigate the adverse health impacts of heat in the past decade. One of the first questions we examined was whether the threshold for triggering a heat emergency response was appropriate. In most U.S. cities, local National Weather Service offices issue heat advisories in advance of forecast heat events. In New York City, these advisories activate the heat emergency plan. However, advisory guidelines were not derived from epidemiologic analysis of heat-dependent health effects. We found nonlinear lagged impacts of temperature on natural cause deaths at heat index levels below the threshold at the time (41°C for any duration) in a retrospective time-series analysis.1 Our agency approached the City’s Emergency Management agency and the National Weather Service to recommend lowering the threshold for triggering a heat advisory and emergency plan; in 2008 the threshold was changed to the forecast maximum heat index of 35°–37°C for at least 2 consecutive days or at least 38°C for 1 day or more. In response to a heat emergency, New York City Emergency Management coordinates activities of over 20 city and state agencies, utility companies, and transit authorities before and during heat events based on continuing National Weather Service forecast updates. Throughout the summer season (May-September), the Health Department runs prediction models of daily syndromic surveillance of emergency department visits (based on chief complaint) and emergency medical service calls for heat-related illness with the maximum heat index and several temporal variables as predictors. We contribute synopses of the result of the observed versus predicted values to the City’s emergency response, providing situational awareness and a basis for ramping up alert messaging during severe heat waves, as needed. From a retrospective analysis2 we know that increases in heat-illness syndrome indicators predict increased heat-related, excess, nonexternal cause deaths (hereafter, excess deaths). Being able to provide situational awareness during an emergency, however, is limited in effect. We know the weather is the best predictor of health impacts,1 heat waves occur almost every year, and climate change is projected to make these events more severe and frequent in the city.3 Clearly intervention needs to occur before heat emergencies happen. Who is dying of heat stroke and where? Following the 2006 heat wave, the Health Department developed a protocol with the Office of Chief Medical Examiner to review, after severe heat waves, heat stroke (hyperthermia) death records, which contain information beyond standard vital statistics data on circumstances surrounding deaths (e.g., presence of air conditioning). Of the 48 heat-stroke deaths that occurred between 2008 and 2011, 41 (85%) had onset at home. Of 26 heat-stroke deaths with information available on home air conditioning, none had a working air conditioner.4 Although the average number of heat-stroke deaths per year in New York City is low, the estimated average annual number of excess deaths associated with extreme heat events is nearly 10 times greater (~115 deaths).5 To determine individual- and neighborhood-level risk factors associated with excess deaths, we worked with academic researchers on a case-only analysis of heat-wave impacts. We identified individual-level modifiers of being non-Latinx Black, having congestive heart failure as underlying cause of death, dying at home, and neighborhood (census tract) risk factors of percent public assistance, percent green space (negatively associated), and surface temperature.6 To visualize neighborhood variation in heat risk, we created a Heat Vulnerability Index (Figure A), publicly available through the Health Department’s Environment and Health Data Portal.7 The City recently used this index to develop its Cool Neighborhoods initiative, which includes planting street trees in the most vulnerable neighborhoods and a pilot community resilience project.8FIGURE.: A, Heat vulnerability index computed at community district level from: percent non-Latinx Black, percent public assistance, surface temperature, and tree cover, based on the analysis by Madrigano et al.6 B, Lack of air conditioning, from 2014 New York City Housing and Vacancy Survey.10 Both figures available from New York City Department of Health Environmental and Health Data Portal.7 Figure is available in color online.With neighborhood percent of residents receiving public assistance and of non-Latinx Black residents as two of the four components for the heat vulnerability index, the resulting spatial pattern of heat vulnerability mirrors the spatial pattern of other adverse health outcomes associated with the City’s pattern of residential racial segregation.9 Tracking with high poverty levels, these neighborhoods also have a lower prevalence of air conditioners (Figure B).10 An ecologic analysis in New York City found that several characteristics, including lower rates of air conditioning access, percent below poverty, and surface temperature were associated with higher mortality rates on hot days and that percent of non-Latinx Black population and household poverty were strong negative predictors of seniors’ air conditioning access.11 Similarly, an analysis of four U.S. cities reported that disproportionate mortality impacts of heat on Black residents were explained in part by the lower prevalence of air conditioning.12 Given that air conditioning reduces or eliminates indoor heat exposures, increasing air conditioning prevalence in heat-vulnerable neighborhoods is the most effective intervention to reduce heat-related morbidity and mortality. Yet even if we could universally provide air conditioners, we might not be able to eliminate heat-related mortality. A 2011 telephone survey of a representative sample of New York City adults found that some seniors or those in fair or poor health never/rarely used it on hot days. Disliking air conditioning and not feeling hot were identified as major reasons for not using air conditioners, in addition to the cost of running them.13 Air-conditioning access must be coupled with outreach to those unaware of the danger of high indoor temperatures to increase use of the intervention. Indoor temperatures without air conditioning can be substantially higher (e.g., > 10°C) than outdoors.14 Further, a recent New York City study found that indoor temperatures in non–air conditioned residences remained high for days after a heat wave, even at night, due to buildings’ thermal inertia.15 As the Health Department has presented evidence supporting equitable access to air conditioning for those whose health depends on it, we have faced some resistance. At scientific and public health meetings, colleagues ask about resulting energy demand that could increase the chance of power outages; chemical refrigerants that contribute to global warming; increased air pollution from generating additional energy to power air conditioners that can contribute to climate change; and the waste heat that could further contribute to the urban heat island problem. Although all these concerns are valid in isolation, we have realized that many professionals in public health and climate science are unaware that people are dying today—cooking to death in their own homes—from the lack of air conditioning. “Adaptation” to heat as the climate changes may be discussed in the abstract, but there is a concrete biologic limit to how much heat humans can tolerate.16 Skeptics of air conditioning also must consider implementation realities and scale when estimating potential negative environmental impacts. Energy load, air pollution and waste heat would be substantial issues should any municipality double the air conditioning prevalence—that is, 50–100%—in the short-term. But the air conditioning prevalence is already nearly 90% in many U.S. cities17—88% in New York City in 2014.10 However, inequities persist, with 30% of residents without air conditioning in the highest poverty neighborhoods versus 1% in the lowest. Given the racial and economic disparity in adverse health impacts from heat, closing this relatively narrow gap across neighborhoods in New York City (and other U.S. cities) is paramount juxtaposed against the associated, incremental increase in energy usage. Increases in energy use also can be somewhat offset by reductions in wasteful air conditioner (AC) use to super-cool businesses and office buildings, and new air conditioning technologies can reduce greenhouse gasses.18 The global perspective is more daunting. According to a recent report by the International Energy Agency, only 8% of the 2.8 billion people living in the hottest parts of the world possess air conditioners, and the energy needed for space cooling is expected to triple by 2050,19 highlighting the need to develop highly energy-efficient societies. The U.S. took five decades to increase air conditioning prevalence from 10% (before 1960) to current levels. An analysis of the heat impacts on New York City mortality from 1900 to 2006 found a substantial decline in risk from the 1970s to 2000s,20 and the increase in air conditioning explained substantial declines in mortality impacts of extreme heat between 1900 and 1959 and 1960 and 2004 in a nationwide study.21 Another U.S. study of 105 cities from 1987 to 2005 also observed a decline in heat impacts on deaths, which was not materially explained by the incremental increase in air conditioning prevalence during the period.22 However, before the study period, air conditioning prevalence was already over 60% nationwide and higher in warmer cities. The U.S. story provides evidence of potential global gains in reducing excess deaths owing to heat by increasing air conditioning access in hot areas as quickly as feasible. Extending widespread access to cooling in other countries will likely present different challenges and require alternative solutions than in the U.S. For instance, countries without reliable electric grids could consider investment in solar technologies.23 But solutions must be found: People in some areas of the world are projected to be exposed to intolerable temperatures within this century under high-emission scenarios.24 Equitable coverage worldwide also requires the U.S. and other countries with higher air conditioning prevalence to prioritize responsible energy use and efficiency across sectors, and financial investment, to compensate for this life-saving adaptation to climate change. The Health Department’s application of epidemiologic research led us to a lower heat advisory threshold, development of heat illness syndromic surveillance, and identification of individual- and neighborhood-level risk factors associated with adverse heat impacts. But most importantly, we have identified areas of intervention for local government that can tangibly minimize the adverse health impacts of heat in the near future: In collaboration with community organizations, we must reach out to vulnerable populations to (1) facilitate access to and financing to pay for using air conditioning; and (2) educate on the danger of heat and life-saving need for air conditioning in hot temperatures. Federal, state and local public assistance to counteract energy insecurity25 through need-based benefits (i.e., Home Energy Assistance Program in the U.S.) must be optimally balanced to reflect the changing climate between heating costs in the winter and cooling costs in the summer. In addition, local governments need to evaluate gaps in coverage and distribution barriers for cooling benefits and their impact on high-risk residents. Epidemiologic research, and return-on-investment analyses for health care payers, can identify highest risk patients for whom air conditioners should be considered life-sustaining medical equipment, providing evidence to support air conditioning and energy cost coverage through federal insurance programs (e.g., U.S. Medicaid) for low-income people. Responsible energy use must become the culture. We need to raise awareness about inequitable energy use and access to safe temperatures at home across race and social class. It must become unacceptable for indoor temperatures to be set low so some can wear suits at work, while others are dying in overheated homes in part due to energy usage concern. We can encourage—and model—setting thermostats in public spaces in the upper range of normal comfort zone during warm months (e.g., 26°C26) to minimize the energy impact of space cooling. Equitable access to air conditioning should also become a part of larger conversations around sustainability, factoring in the need for this adaptation as efficiency measures are developed, ranging from smart thermostats to development of better air conditioning technologies, such as solar-thermal chillers,24 to setting criteria for green buildings. Pursuing these solutions will stretch the traditional capacity and scope of health departments and epidemiologists, but complex problems require interdisciplinary efforts. Healthy indoor temperatures should not be a privilege that excludes vulnerable and low-income populations, especially when its consequence is illness and death.

Characteristics of an urban setting such as New York City (NYC), including readily available putrescible waste and ample underground infrastructure, make it highly attractive to the Norway rat (Rattus norvegicus). To identify property and neighborhood characteristics associated with rat presence, recent inspectional results were analyzed from over 77,000 properties in the Bronx and Manhattan. Variables capturing the location and density of factors believed to promote rat populations were tested individually and in combination in models predicting rat activity. We found that property-specific characteristics typically associated with high garbage volume, including large numbers of residential units, public ownership, and open-space designation (parks, outdoor recreation, or vacant land) were the most important factors in explaining increased rat presence across neighborhoods in NYC. Interventions that involved improved garbage management and street sanitation within a designated area reduced the likelihood of finding rats, especially in medium- and high-poverty neighborhoods. Neighborhood characteristics, such as being near a railroad or subway line, having a school nearby, the presence of numerous restaurants, or having older infrastructure, also contributed to the increased likelihood of rats. Our results support the use of built environment data to target community-level interventions and capture emerging rat infestations.

Drowning is an important cause of preventable injury and mortality, ranking fifth among leading causes of unintentional injury death in the United States. In 2011, two healthy young men died in a drowning incident at a New York City (NYC)-regulated swimming facility. The men became unconscious underwater after performing intentional hyperventilation before submersion. The phenomenon of healthy swimmers becoming unconscious underwater has been described elsewhere as hypoxic blackout. Prompted by this incident, the NYC Department of Health and Mental Hygiene (DOHMH) in collaboration with the New York State Department of Health (SDOH) conducted a case review of New York state fatal and nonfatal drownings reported during 1988-2011 to investigate similar behaviors in other incidents. DOHMH identified 16 cases, three in NYC, with a consistent set of voluntary behaviors associated with unintentional drowning and designated this class of behaviors as "dangerous underwater breath-holding behaviors" (DUBBs). For this small sample, the frequency of different DUBBs varied by age and swimming level, and practicing more than one DUBB increased the risk for fatality. This research contributes to the literature on drowning by focusing on contributing behaviors rather than drowning outcomes. NYC recently enacted public health education and regulations that discourage DUBBs; these interventions have the potential to effectively reduce unintentional drowning related to these behaviors and could be considered by other municipalities and jurisdictions.

Despite agreement among stakeholders that senior centers can promote physical and mental health, research on senior center use in urban populations is limited. Our objective was to describe demographic and health factors associated with senior center use among urban, low-income older adults in order to inform programming and outreach efforts. We used data from a 2009 telephone survey of 1036 adults randomly selected from rosters of New York City public housing residents aged 65 and older. We analyzed senior center use by race/ethnicity, age, gender, health, housing type, and income, and used a forward selection approach to build best-fit models predicting senior center use. Older adults of all ages and of both genders reported substantial use of senior centers, with nearly one third (31.3%) reporting use. Older adults living alone, at risk of depression, or living in specialized senior housing had the greatest use of centers. Senior center use varied by race/ethnicity, and English-speaking Hispanics had a higher prevalence of use than Spanish-speaking Hispanics (adjusted prevalence ratio [PR]=1.69, 95% CI: 1.11-2.59). Spanish-speaking communities and older adults living in non-senior congregate housing are appropriate targets for increased senior center outreach efforts.

OBJECTIVES:In 2003, in response to low colonoscopy screening rates and significant sociodemographic disparities in colonoscopy screening in New York City (NYC), the NYC Department of Health and Mental Hygiene, together with the Citywide Colon Cancer Control Coalition, launched a multifaceted campaign to increase screening. We evaluated colonoscopy trends among adult New Yorkers aged 50 years and older between 2003 and 2007, the first five years of this campaign.METHODS:Data were analyzed from the NYC Community Health Survey, an annual, population-based surveillance of New Yorkers. Annual prevalence estimates of adults who reported a timely colonoscopy, one within the past 10 years, were calculated. Multivariate models were used to analyze changes over time in associations between colonoscopy screening and sociodemographic characteristics.RESULTS:Overall, from 2003 to 2007 the proportion of New Yorkers aged 50 years and older who reported timely colonoscopy screening increased from 41.7% to 61.7%. Racial/ethnic and sex disparities observed in 2003 were eliminated by 2007: prevalence of timely colonoscopy was similar among non-Hispanic whites, non-Hispanic blacks, Hispanics, men, and women. However, Asians, the uninsured, and those with lower education and income continued to lag in receipt of timely colonoscopies.CONCLUSIONS:The increased screening colonoscopy rate and reduction of racial/ethnic disparities observed in NYC suggest that multifaceted, coordinated urban campaigns can improve low utilization of clinical preventive health services and reduce public-health disparities.