We examined internal and external determinants of state's adoption of imp... more We examined internal and external determinants of state's adoption of impaired driving laws. Data included 7 state-level, evidence-based public health laws collected from 1980 to 2010. We used event history analyses to identify predictors of first-time law adoption and subsequent adoption between state pairs. The independent variables were internal state factors, including the political environment, legislative professionalism, government capacity, state resources, legislative history, and policy-specific risk factors. The external factors were neighboring states' history of law adoption and changes in federal law. We found a strong secular trend toward an increased number of laws over time. The proportion of younger drivers and the presence of a neighboring state with similar laws were the strongest predictors of first-time law adoption. The predictors of subsequent law adoption included neighbor state adoption and previous legislative action. Alcohol laws were negatively associated with first-time adoption of impaired driving laws, suggesting substitution effects among policy choices. Organizations seeking to stimulate state policy changes may need to craft strategies that engage external actors, such as neighboring states, in addition to mobilizing within-state constituencies.
This study uses data from a nationally representative household survey (the 2013 National Health ... more This study uses data from a nationally representative household survey (the 2013 National Health Survey, n = 62,986) to describe patterns of alcohol consumption and related behaviors among Brazilian adults. Analyses include descriptive and multivariable Poisson regression for self-reports in the past 30 days of: drinking any alcohol, binge drinking, binge drinking 4 or more times, and driving after drinking (DD); as well as age of alcohol consumption initiation. Results show that current drinking prevalence was 26%, with an average age of initiation of 18.7 years. Binge drinking was reported by 51% of drinkers, 43% of whom reported binge drinking 4 or more times. Drinking and driving was reported by nearly one quarter of those who drive a car/motorcycle. Current drinking was more likely among males, ages 25-34, single, urban, and those with more education. Binge drinking was more likely among males, older age groups, and people who started drinking before 18. Drinking and driving was higher among males, those with more education, and rural residents. Those who binge-drink were nearly 70% more likely to report DD. All behaviors varied significantly among Brazilian states. Given their potential health consequences, the levels of injurious alcohol behaviors observed here warrant increased attention from Brazilian policymakers and civil society.
Objective: Fatalities from motor vehicle crashes remain a leading cause of death and vary up to 5... more Objective: Fatalities from motor vehicle crashes remain a leading cause of death and vary up to 5-fold among different states. This study examines state adoption of 25 evidence-based public policies focused on protecting occupant and driver safety, reducing underage and excessive drinking, penalizing drunk driving, and reducing other unsafe driving practices from 1982-1998 and quantifies the combined impact of these policies on traffic fatalities. Methods: Ecological time series/cross-sectional design, employing fixed effects negative binomial regression models of state-level traffic fatalities per 100 million vehicle miles traveled. State policy comprehensiveness is measured by the proportion of the 25 evidence-based policies states have adopted at each year. Models control for state-level demographics, resources, and additional risk factors. Results: States vary substantially in the extent to which they have adopted a comprehensive package of the 25 policies examined here. A more ...
Background: Studies that typically estimate epidemiologic trends as long-term change between two ... more Background: Studies that typically estimate epidemiologic trends as long-term change between two time periods ignore short-term changes in trends occurring during the study period. This study describes long- and short-term trends in motor vehicle (MV) traffic fatalities between 1968 and 2010 using a method typically employed in cancer epidemiologic trend analyses. Methods: Long-term and short-term (linear piecewise segments) trends in age-specific MV fatalities were compared for males and females using the Joinpoint Regression Program. Data for the study were from the Compressed Mortality Files of death certificates filed in all 50 states and DC. Results: All age-sex groups, except women 25-34 and 35-44 years, experienced significant long-term declines in MV fatalities between 1968 and 2010. Distinct short-term trends were observed during this time period. After a period of initial decline until the mid-1970s in both males and females, short-term trends in fatalities differed for wo...
Death due to motor vehicle collisions (MVCs) remains a leading cause of death in the US and alcoh... more Death due to motor vehicle collisions (MVCs) remains a leading cause of death in the US and alcohol plays a prominent role in a large proportion of these fatalities nationwide. Rates for these incidents vary widely among states and over time. Here, we explore the extent to which driving volume, alcohol consumption, legislation, political ideology, and geographical factors influence MVC deaths across states and time. We specify structural equation models for extracting associations between the factors and outcomes for MVC deaths and compute correlation functions of states' relative geographic and political positions to elucidate the relative contribution of these factors. We find evidence that state-level variation in MVC deaths is associated with time-varying driving volume, alcohol consumption, and legislation. These relationships are modulated by state spatial proximity, whereby neighboring states are found to share similar MVC death rates over the thirty-year observation peri...
To achieve its national public health goals, the US must improve the health of low-income urban p... more To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, H1V infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. 444 FREUDENBERG ET AL.
New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014... more New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014. The new law is intended to decrease current smoking rates and smoking initiation among the city's youth. Assessment of compliance with existing cigarette sales and tax laws could aid in determining what may be needed for successful implementation of the city's new law. To assess compliance with minimum sales price and purchase age laws in NYC, before change in law. Ten trained field investigators purchased cigarettes from different types of retailers throughout all five NYC boroughs, resulting in 421 purchases. Investigators noted whether they were asked for identification and the price of their purchase. Multivariable logistic and Ordinary Least Squares regression techniques were used to assess predictors of retailer compliance with sales price and minimum purchase age laws. In 29% of purchases, investigators did not have to produce identification (p<0.05) to purchase cigarettes. Only 3.1% of sales were at prices lower than the minimum sales price. City borough was significantly associated with purchase without identification (p<0.001) and mean sales price (p<0.024). Vendor type (independent vs chain) was significantly related to investigators being able to purchase cigarettes without identification (p<0.001). Variation in compliance with existing laws suggests that more active monitoring of compliance with the new minimum legal purchase age will be required in order to realise the new law's public health potential.
Although substantive declines in motor vehicle fatalities in 1980-2010 have been observed, declin... more Although substantive declines in motor vehicle fatalities in 1980-2010 have been observed, declines by position in the vehicle and alcohol involvement have not been well elucidated. Analyses of FARS data use the Intrinsic Estimator (IE) to produce estimates of all age, period, and cohort effects simultaneously by position in the car and by alcohol involvement. Declines in MVC deaths by position in the car vary for men and women by age and cohort over time. Cohorts born before 1970 had higher risks than those born later. Analyses using proxy indicators of alcohol involvement found the highest risks for those aged 16-24. By period, these risks declined more rapidly than non- alcohol related traffic fatalities. Changes in risk patterns are consistent with evidence regarding the contributions of new technologies and public policy efforts to reduce fatalities, but gains have not been shared evenly by sex or position in the car. Greater attention is needed in reducing deaths among older drivers and pedestrians. Gender differences should be addressed in prevention efforts aimed at reducing MVCs due to alcohol involvement.
ABSTRACT The disparity between US blacks and whites in avoidable mortality (AM, usually operation... more ABSTRACT The disparity between US blacks and whites in avoidable mortality (AM, usually operationalized as mortality before age 65) has been well documented, but little is known about the associations of AM with geography, urbanicity, or city-level economic distress. We investigated rates of all-cause AM, and differences in AM rates, for blacks and whites in the 70 largest U.S. cities. In these cities, blacks had 94% higher AM rates than whites (IRR 95% CI = 1.78 2.12). This disparity was especially pronounced among women, where the AM rate was 3 times higher among blacks than whites (IRR 95% CI = 2.76 3.32). City-level economic distress (defined by poverty, labor force participation, income distribution, and other economic variables) was also significantly related to AM. Controlling for race and gender, AM rates were 29% higher in distressed than in non-distressed cities (IRR 95% CI = 1.07-1.55). When components of economic distress were disaggregated and interacted with race, we found that blacks and whites did not benefit equally from the economic health of cities. As labor force participation and the proportion of households earning greater than $75k/year each increased, AM rates decreased for whites, but remained the same for blacks. These associations were not mediated by access to care (operationalized as the proportion of city residents without health insurance), which was not significantly associated with AM rates in any of our models. Distressed cities face a higher burden of AM overall, but black/white disparities in AM are higher in economically better off cities.
ABSTRACT Background: New York City has been a leader in aggressively regulating smoking, yet prog... more ABSTRACT Background: New York City has been a leader in aggressively regulating smoking, yet progress in reducing smoking over the last five years has stalled. Currently, about 8% of New York City young people under the age of 18 are smokers, a rate that has stayed steady since 2007. In October 2013, The New York City Council passed legislation to raise the age for cigarette purchase from 18 to 21, effective May 2014. However, while “sting” operations have been used to prosecute vendors who have been identified as failing to comply with the law, regular systematic monitoring of compliance through observing sales not been undertaken. In advance of the change in the law, this study tests how consistently young people are asked for ID at time of purchase. Methods: Youthfully dressed adult female investigators 18-20 years old were deployed February-March 2014 to purchase cigarettes from 500 randomly selected vendors thoroughout NYC, stratified by borough. When purchasing, investigators observed whether vendors requested ID prior to the sale. Results: Results from multivariable logistic regression analyses will estimate the relative likelihood of request for ID across New York City. Independent variables include neighborhood income, type of vendor, and proximity to local public and private high schools. Qualitative information regarding sales will be used to further interpret results. Conclusion: This study provides essential information for policymakers seeking to use changes to minimum age of purchase laws to reduce smoking among young people by assessing general compliance with tobacco sales laws.
We compared cause-specific mortality and birth rates for children and youths aged younger than 18... more We compared cause-specific mortality and birth rates for children and youths aged younger than 18 years in 100 US cities from 1992 through 2002. We used 5 census indicators to categorize the 100 most populous US cities in 1990 as economically distressed or nondistressed. We used Poisson regression to calculate rate ratios for cause-specific mortality and birth rates, comparing distressed cities to nondistressed cities overall and by race/ethnicity from 1992 through 2002. We also calculated rates of change in these variables within each city over this period. Despite improvements in health for the study population in all cities, disparities between city groups held steady or widened over the study period. Gaps in outcomes between Whites and Blacks persisted across all cities. Living in a distressed city compounded the disparities in poor outcomes for Black children and youths. A strong national economy during the study period may have facilitated improvements in health outcomes for c...
ABSTRACT Telephone-survey data were gathered from parents and youth in five of America's ... more ABSTRACT Telephone-survey data were gathered from parents and youth in five of America's largest and most distressed cities to estimate unmet demand for after-school programs. Unmet demand was conceptualized as a function of low utilization and dissatisfaction with one's current arrangement; furthermore, the authors argue that dissatisfaction must stem from something that can be addressed through changes in policy or programs. Large numbers of parents of children who infrequently use after-school programs were found to indicate that they would increase utilization if there were improvements in the quality, access, or types of programming. However, large numbers of parents whose children do not participate or participate infrequently in after-school programs were also found to express satisfaction with their arrangement and indicated that they do not wish to change it. Expanding services with the assumption that children from these families will participate may be misguided. (Contains 9 tables.)
This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-tim... more This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.
Many social programs, funded by government or philanthropy, begin with efforts to improve local c... more Many social programs, funded by government or philanthropy, begin with efforts to improve local conditions with strategic planning. Mandated by funders, these processes aim to include the views of community residents and those with technical expertise. Program leaders are left to reconcile public and expert opinions in determining how to shape their programs. The experience of the Robert Wood Johnson Foundation's Urban Health Initiative suggests that although consultation with experts and the public failed to reveal a clear assessment of the community's problems or their solutions, it did assist in engaging diverse groups. Despite this engagement, howevel; core leaders wielded substantial power in selecting the agenda.
To achieve its national public health goals, the US must improve the health of low-income urban p... more To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, H1V infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. 444 FREUDENBERG ET AL.
Journal of Public Administration Research and Theory, 2010
... Caitlyn Brazill. New York University; Office of Financial Empowerment, New York City Departme... more ... Caitlyn Brazill. New York University; Office of Financial Empowerment, New York City Department of Consumer Affairs; New York University. Beth C. Weitzman. ... Detroit's Mayor Kwame Kilpatrick was elected in 2002 with a Kids, Cops, Clean campaign slogan. ...
Playgrounds are assumed to be an important resource for physical activity. This study investigate... more Playgrounds are assumed to be an important resource for physical activity. This study investigates seasonal utilization, user preferences, and perceptions of safety and upkeep of public playgrounds in New York City. A cross-sectional survey was conducted from May 2010 to January 2011 across 10 playgrounds in low/middle income neighborhoods in each of the five boroughs in New York City. A total of 1,396 adults accompanying children were surveyed. Outcomes included playground as main place of outdoor play, and perceptions of playground upkeep and safety. Covariates included socio-demographics and other characteristics of playground users. Multivariable logistic regression with playground/season fixed effects were used. Utilization varied substantially across the four seasons. Blacks had higher odds of reporting the playground as the main place of outdoor play (AOR 1.78, 95 % CI 1.13-2.80, p < .05). High income users had lower odds of reporting the playground as the main place of outdoor play ($60-$80,000: AOR 0.47, 95 % CI 0.29-0.76, p < .01, $80,000+: AOR 0.47, 95 % CI 0.28-0.79, p < .01). Racial differences in perceived upkeep and safety were not significant once playground/season fixed effects were included, highlighting the importance of neighborhood conditions. Women were more likely to report feeling unsafe within playgrounds (AOR 1.51, 95 % CI 1.12-2.02, p < .01). While some playground utilization is driven by individual characteristics, perceptions of public resources influences utilization and cannot be separated from neighborhood conditions. Increasing access to opportunities for physical activity for children requires new strategies beyond playground improvements.
This study offers a new evaluation methodology for peer-education programs. Peer educators&#3... more This study offers a new evaluation methodology for peer-education programs. Peer educators' knowledge, self-esteem, peer pressure, and the number of friends, neighbors, and relatives given HIV/AIDS information were compared before and after training using self-administered questionnaires. Significant changes were observed in knowledge, peer pressure, self-efficacy, numbers of people given condoms, number of formal and informal HIV/AIDS presentations, and numbers of HIV/AIDS discussions with friends and neighbors.
We examined internal and external determinants of state's adoption of imp... more We examined internal and external determinants of state's adoption of impaired driving laws. Data included 7 state-level, evidence-based public health laws collected from 1980 to 2010. We used event history analyses to identify predictors of first-time law adoption and subsequent adoption between state pairs. The independent variables were internal state factors, including the political environment, legislative professionalism, government capacity, state resources, legislative history, and policy-specific risk factors. The external factors were neighboring states' history of law adoption and changes in federal law. We found a strong secular trend toward an increased number of laws over time. The proportion of younger drivers and the presence of a neighboring state with similar laws were the strongest predictors of first-time law adoption. The predictors of subsequent law adoption included neighbor state adoption and previous legislative action. Alcohol laws were negatively associated with first-time adoption of impaired driving laws, suggesting substitution effects among policy choices. Organizations seeking to stimulate state policy changes may need to craft strategies that engage external actors, such as neighboring states, in addition to mobilizing within-state constituencies.
This study uses data from a nationally representative household survey (the 2013 National Health ... more This study uses data from a nationally representative household survey (the 2013 National Health Survey, n = 62,986) to describe patterns of alcohol consumption and related behaviors among Brazilian adults. Analyses include descriptive and multivariable Poisson regression for self-reports in the past 30 days of: drinking any alcohol, binge drinking, binge drinking 4 or more times, and driving after drinking (DD); as well as age of alcohol consumption initiation. Results show that current drinking prevalence was 26%, with an average age of initiation of 18.7 years. Binge drinking was reported by 51% of drinkers, 43% of whom reported binge drinking 4 or more times. Drinking and driving was reported by nearly one quarter of those who drive a car/motorcycle. Current drinking was more likely among males, ages 25-34, single, urban, and those with more education. Binge drinking was more likely among males, older age groups, and people who started drinking before 18. Drinking and driving was higher among males, those with more education, and rural residents. Those who binge-drink were nearly 70% more likely to report DD. All behaviors varied significantly among Brazilian states. Given their potential health consequences, the levels of injurious alcohol behaviors observed here warrant increased attention from Brazilian policymakers and civil society.
Objective: Fatalities from motor vehicle crashes remain a leading cause of death and vary up to 5... more Objective: Fatalities from motor vehicle crashes remain a leading cause of death and vary up to 5-fold among different states. This study examines state adoption of 25 evidence-based public policies focused on protecting occupant and driver safety, reducing underage and excessive drinking, penalizing drunk driving, and reducing other unsafe driving practices from 1982-1998 and quantifies the combined impact of these policies on traffic fatalities. Methods: Ecological time series/cross-sectional design, employing fixed effects negative binomial regression models of state-level traffic fatalities per 100 million vehicle miles traveled. State policy comprehensiveness is measured by the proportion of the 25 evidence-based policies states have adopted at each year. Models control for state-level demographics, resources, and additional risk factors. Results: States vary substantially in the extent to which they have adopted a comprehensive package of the 25 policies examined here. A more ...
Background: Studies that typically estimate epidemiologic trends as long-term change between two ... more Background: Studies that typically estimate epidemiologic trends as long-term change between two time periods ignore short-term changes in trends occurring during the study period. This study describes long- and short-term trends in motor vehicle (MV) traffic fatalities between 1968 and 2010 using a method typically employed in cancer epidemiologic trend analyses. Methods: Long-term and short-term (linear piecewise segments) trends in age-specific MV fatalities were compared for males and females using the Joinpoint Regression Program. Data for the study were from the Compressed Mortality Files of death certificates filed in all 50 states and DC. Results: All age-sex groups, except women 25-34 and 35-44 years, experienced significant long-term declines in MV fatalities between 1968 and 2010. Distinct short-term trends were observed during this time period. After a period of initial decline until the mid-1970s in both males and females, short-term trends in fatalities differed for wo...
Death due to motor vehicle collisions (MVCs) remains a leading cause of death in the US and alcoh... more Death due to motor vehicle collisions (MVCs) remains a leading cause of death in the US and alcohol plays a prominent role in a large proportion of these fatalities nationwide. Rates for these incidents vary widely among states and over time. Here, we explore the extent to which driving volume, alcohol consumption, legislation, political ideology, and geographical factors influence MVC deaths across states and time. We specify structural equation models for extracting associations between the factors and outcomes for MVC deaths and compute correlation functions of states' relative geographic and political positions to elucidate the relative contribution of these factors. We find evidence that state-level variation in MVC deaths is associated with time-varying driving volume, alcohol consumption, and legislation. These relationships are modulated by state spatial proximity, whereby neighboring states are found to share similar MVC death rates over the thirty-year observation peri...
To achieve its national public health goals, the US must improve the health of low-income urban p... more To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, H1V infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. 444 FREUDENBERG ET AL.
New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014... more New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014. The new law is intended to decrease current smoking rates and smoking initiation among the city's youth. Assessment of compliance with existing cigarette sales and tax laws could aid in determining what may be needed for successful implementation of the city's new law. To assess compliance with minimum sales price and purchase age laws in NYC, before change in law. Ten trained field investigators purchased cigarettes from different types of retailers throughout all five NYC boroughs, resulting in 421 purchases. Investigators noted whether they were asked for identification and the price of their purchase. Multivariable logistic and Ordinary Least Squares regression techniques were used to assess predictors of retailer compliance with sales price and minimum purchase age laws. In 29% of purchases, investigators did not have to produce identification (p<0.05) to purchase cigarettes. Only 3.1% of sales were at prices lower than the minimum sales price. City borough was significantly associated with purchase without identification (p<0.001) and mean sales price (p<0.024). Vendor type (independent vs chain) was significantly related to investigators being able to purchase cigarettes without identification (p<0.001). Variation in compliance with existing laws suggests that more active monitoring of compliance with the new minimum legal purchase age will be required in order to realise the new law's public health potential.
Although substantive declines in motor vehicle fatalities in 1980-2010 have been observed, declin... more Although substantive declines in motor vehicle fatalities in 1980-2010 have been observed, declines by position in the vehicle and alcohol involvement have not been well elucidated. Analyses of FARS data use the Intrinsic Estimator (IE) to produce estimates of all age, period, and cohort effects simultaneously by position in the car and by alcohol involvement. Declines in MVC deaths by position in the car vary for men and women by age and cohort over time. Cohorts born before 1970 had higher risks than those born later. Analyses using proxy indicators of alcohol involvement found the highest risks for those aged 16-24. By period, these risks declined more rapidly than non- alcohol related traffic fatalities. Changes in risk patterns are consistent with evidence regarding the contributions of new technologies and public policy efforts to reduce fatalities, but gains have not been shared evenly by sex or position in the car. Greater attention is needed in reducing deaths among older drivers and pedestrians. Gender differences should be addressed in prevention efforts aimed at reducing MVCs due to alcohol involvement.
ABSTRACT The disparity between US blacks and whites in avoidable mortality (AM, usually operation... more ABSTRACT The disparity between US blacks and whites in avoidable mortality (AM, usually operationalized as mortality before age 65) has been well documented, but little is known about the associations of AM with geography, urbanicity, or city-level economic distress. We investigated rates of all-cause AM, and differences in AM rates, for blacks and whites in the 70 largest U.S. cities. In these cities, blacks had 94% higher AM rates than whites (IRR 95% CI = 1.78 2.12). This disparity was especially pronounced among women, where the AM rate was 3 times higher among blacks than whites (IRR 95% CI = 2.76 3.32). City-level economic distress (defined by poverty, labor force participation, income distribution, and other economic variables) was also significantly related to AM. Controlling for race and gender, AM rates were 29% higher in distressed than in non-distressed cities (IRR 95% CI = 1.07-1.55). When components of economic distress were disaggregated and interacted with race, we found that blacks and whites did not benefit equally from the economic health of cities. As labor force participation and the proportion of households earning greater than $75k/year each increased, AM rates decreased for whites, but remained the same for blacks. These associations were not mediated by access to care (operationalized as the proportion of city residents without health insurance), which was not significantly associated with AM rates in any of our models. Distressed cities face a higher burden of AM overall, but black/white disparities in AM are higher in economically better off cities.
ABSTRACT Background: New York City has been a leader in aggressively regulating smoking, yet prog... more ABSTRACT Background: New York City has been a leader in aggressively regulating smoking, yet progress in reducing smoking over the last five years has stalled. Currently, about 8% of New York City young people under the age of 18 are smokers, a rate that has stayed steady since 2007. In October 2013, The New York City Council passed legislation to raise the age for cigarette purchase from 18 to 21, effective May 2014. However, while “sting” operations have been used to prosecute vendors who have been identified as failing to comply with the law, regular systematic monitoring of compliance through observing sales not been undertaken. In advance of the change in the law, this study tests how consistently young people are asked for ID at time of purchase. Methods: Youthfully dressed adult female investigators 18-20 years old were deployed February-March 2014 to purchase cigarettes from 500 randomly selected vendors thoroughout NYC, stratified by borough. When purchasing, investigators observed whether vendors requested ID prior to the sale. Results: Results from multivariable logistic regression analyses will estimate the relative likelihood of request for ID across New York City. Independent variables include neighborhood income, type of vendor, and proximity to local public and private high schools. Qualitative information regarding sales will be used to further interpret results. Conclusion: This study provides essential information for policymakers seeking to use changes to minimum age of purchase laws to reduce smoking among young people by assessing general compliance with tobacco sales laws.
We compared cause-specific mortality and birth rates for children and youths aged younger than 18... more We compared cause-specific mortality and birth rates for children and youths aged younger than 18 years in 100 US cities from 1992 through 2002. We used 5 census indicators to categorize the 100 most populous US cities in 1990 as economically distressed or nondistressed. We used Poisson regression to calculate rate ratios for cause-specific mortality and birth rates, comparing distressed cities to nondistressed cities overall and by race/ethnicity from 1992 through 2002. We also calculated rates of change in these variables within each city over this period. Despite improvements in health for the study population in all cities, disparities between city groups held steady or widened over the study period. Gaps in outcomes between Whites and Blacks persisted across all cities. Living in a distressed city compounded the disparities in poor outcomes for Black children and youths. A strong national economy during the study period may have facilitated improvements in health outcomes for c...
ABSTRACT Telephone-survey data were gathered from parents and youth in five of America's ... more ABSTRACT Telephone-survey data were gathered from parents and youth in five of America's largest and most distressed cities to estimate unmet demand for after-school programs. Unmet demand was conceptualized as a function of low utilization and dissatisfaction with one's current arrangement; furthermore, the authors argue that dissatisfaction must stem from something that can be addressed through changes in policy or programs. Large numbers of parents of children who infrequently use after-school programs were found to indicate that they would increase utilization if there were improvements in the quality, access, or types of programming. However, large numbers of parents whose children do not participate or participate infrequently in after-school programs were also found to express satisfaction with their arrangement and indicated that they do not wish to change it. Expanding services with the assumption that children from these families will participate may be misguided. (Contains 9 tables.)
This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-tim... more This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.
Many social programs, funded by government or philanthropy, begin with efforts to improve local c... more Many social programs, funded by government or philanthropy, begin with efforts to improve local conditions with strategic planning. Mandated by funders, these processes aim to include the views of community residents and those with technical expertise. Program leaders are left to reconcile public and expert opinions in determining how to shape their programs. The experience of the Robert Wood Johnson Foundation's Urban Health Initiative suggests that although consultation with experts and the public failed to reveal a clear assessment of the community's problems or their solutions, it did assist in engaging diverse groups. Despite this engagement, howevel; core leaders wielded substantial power in selecting the agenda.
To achieve its national public health goals, the US must improve the health of low-income urban p... more To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, H1V infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. 444 FREUDENBERG ET AL.
Journal of Public Administration Research and Theory, 2010
... Caitlyn Brazill. New York University; Office of Financial Empowerment, New York City Departme... more ... Caitlyn Brazill. New York University; Office of Financial Empowerment, New York City Department of Consumer Affairs; New York University. Beth C. Weitzman. ... Detroit's Mayor Kwame Kilpatrick was elected in 2002 with a Kids, Cops, Clean campaign slogan. ...
Playgrounds are assumed to be an important resource for physical activity. This study investigate... more Playgrounds are assumed to be an important resource for physical activity. This study investigates seasonal utilization, user preferences, and perceptions of safety and upkeep of public playgrounds in New York City. A cross-sectional survey was conducted from May 2010 to January 2011 across 10 playgrounds in low/middle income neighborhoods in each of the five boroughs in New York City. A total of 1,396 adults accompanying children were surveyed. Outcomes included playground as main place of outdoor play, and perceptions of playground upkeep and safety. Covariates included socio-demographics and other characteristics of playground users. Multivariable logistic regression with playground/season fixed effects were used. Utilization varied substantially across the four seasons. Blacks had higher odds of reporting the playground as the main place of outdoor play (AOR 1.78, 95 % CI 1.13-2.80, p < .05). High income users had lower odds of reporting the playground as the main place of outdoor play ($60-$80,000: AOR 0.47, 95 % CI 0.29-0.76, p < .01, $80,000+: AOR 0.47, 95 % CI 0.28-0.79, p < .01). Racial differences in perceived upkeep and safety were not significant once playground/season fixed effects were included, highlighting the importance of neighborhood conditions. Women were more likely to report feeling unsafe within playgrounds (AOR 1.51, 95 % CI 1.12-2.02, p < .01). While some playground utilization is driven by individual characteristics, perceptions of public resources influences utilization and cannot be separated from neighborhood conditions. Increasing access to opportunities for physical activity for children requires new strategies beyond playground improvements.
This study offers a new evaluation methodology for peer-education programs. Peer educators&#3... more This study offers a new evaluation methodology for peer-education programs. Peer educators' knowledge, self-esteem, peer pressure, and the number of friends, neighbors, and relatives given HIV/AIDS information were compared before and after training using self-administered questionnaires. Significant changes were observed in knowledge, peer pressure, self-efficacy, numbers of people given condoms, number of formal and informal HIV/AIDS presentations, and numbers of HIV/AIDS discussions with friends and neighbors.
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Papers by Diana Silver