Emerging Roles of Health Care Providers to Mitigate Climate Change Impacts: A Perspective from East Harlem, New York

Professional associations of health care workers are issuing policy statements on climate change and health with greater frequency, calling on their members to act in their duty to protect and fulfill the right to health. These health care providers’ perceptions of their roles in the intersection of climate and health, however, have not been well-studied. This article presents results from a qualitative study using focus groups conducted with health care providers serving the low-income, ethnic minority population in East Harlem, New York. The focus groups sought to identify and explore providers’ perceived health threats of climate change, as well as their perceived role as frontline disseminators of information and detectors of disease for their patients. Extreme heat events were used to frame the discussion in each group. Three major themes emerged: 1) environmental awareness, 2) an “ecohealth” lens, and 3) heat and health vulnerability. The participants demonstrated their interest in playing a role in climate change adaptation by identifying at-risk patients and helping to tailor clinical care to better serve these individuals

Chronic Conditions and Pediatric Healthcare Utilization during Warm Weather Days in New York City

Background: While literature on the overall health burden of high temperature exposures on children continues to grow, little is known about whether children with chronic diseases are particularly vulnerable to the adverse health impacts of extreme heat. Methods: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to emergency department and hospitals during the warm months (May-September) from 2005 to 2011. We identified children with specific chronic diseases or conditions that plausibly enhance susceptibility to heat (i.e., asthma, obesity, cerebral palsy, cystic fibrosis, sickle cell disease, sickle cell trait, and mental health disorders). We also identified children with a complex chronic condition (CCC) defined using the Feudtner classification scheme. We used a time-stratified, case-crossover design and conditional logistic regression models, adjusted for mean daily relative humidity, to derive estimates of excess risk of pediatric admissions associated with daily maximum temperature (Tmax). Results: There were 2,480,556 pediatric cases in New York City during the study period; 90.8% (n = 2,252,550) occurred in emergency departments; chronic conditions appeared in 0.1% (sickle cell trait) up to 8.3% (asthma). The average Tmax was 80.3F (range 50F-104F). While we found an increase in overall pediatric admissions associated with Tmax, we found decreased risks among children with some specific categories of chronic conditions, including asthma, obesity, and mental health disorders. For children with CCC, temperature was associated with increased admissions when considering only the summer months. Conclusions: We found that children with chronic conditions show a complex pattern of risk of healthcare utilization. With further replication, our findings can help inform preparedness of the health system for prevention measures

Health Impact Assessments for Environmental Restoration: The Case of Caño Martín Peña

Background: Health Impact Assessment (HIA) is a methodology for predicting the effects of a proposed policy or plan on health. A proposed environmental restoration and development plan presented an opportunity for an HIA in an environmental justice community surrounding the Martín Peña channel in San Juan, Puerto Rico. The HIA focused on the dredging of the channel, debris removal, road, sewer, and storm water infrastructure improvements, housing demolition, and resident relocation. Objective: The aim of this study was to determine the potential effects of the proposed plan on the community's health to inform the funding decision by the Puerto Rican legislature. As the first HIA in Puerto Rico, a secondary objective was to build HIA capacity in Puerto Rico. Methods: This HIA used community training, literature reviews, existing local studies, focus groups, interviews, and disease surveillance data to assess baseline health, determine expected effects, and build capacity. Findings: The Martín Peña community is experiencing deteriorating environmental conditions. Flooding and negative environmental exposures, such as mold, limits to physical activity, stress, chemical toxicants, pathogenic bacteria, and pests, are worsening. The higher rates of diseases, such as asthma and diarrhea, in the community compared with elsewhere in Puerto Rico appear to be largely attributable to these factors. Overall, the proposed plan is expected to improve many of these health disparities but the successful implementation depends on continued community acceptance and participation, particularly with the relocation process. Recommendations are for full financing and several mitigation efforts to avoid negative and preserve beneficial health consequences. Conclusions: As the first HIA in Puerto Rico, this assessment provided specific recommendations to benefit the health of the community affected by an environmental restoration and development plan and also capacity building for a larger audience in Puerto Rico. This approach could be generalized to other Latino environmental justice communities in Puerto Rico and abroad

Temperature and mental health–related emergency department and hospital encounters among children, adolescents and young adults

Abstract Aims We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults. Methods This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June–August) in New York City from 2005 to 2011 from patients of three age groups (6–11, 12–17 and 18–25 years). Using a distributed lag non-linear model over 0–5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations. Results In New York City, there were 82,982 mental health–related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health–related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13–1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09–1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04–1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature. Conclusions We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood

The Association of Tree Pollen Concentration Peaks and Allergy Medication Sales in New York City: 2003–2008

The impact of pollen exposure on population allergic illness is poorly characterized. We explore the association of tree pollen and over-the-counter daily allergy medication sales in the New York City metropolitan area. Dates of peak tree pollen (maple, oak, and birch) concentrations were identified from 2003 to 2008. Daily allergy medication sales reported to the city health department were analyzed as a function of the same-day and lagged tree pollen peak indicators, adjusting for season, year, temperature, and day of week. Significant associations were found between tree pollen peaks and allergy medication sales, with the strongest association at 2-day lag (excess sales of 28.7% (95% CI: 17.4–41.2) over the average sales during the study period). The cumulative effect over the 7-day period on and after the tree pollen peak dates was estimated to be 141.1% (95% CI: 79.4–224.1). In conclusion, tree pollen concentration peaks were followed by large increases in over-the-counter allergy medication sales

Increasing atmospheric [CO2] from glacial through future levels affects drought tolerance via impacts on leaves, xylem and their integrated function

This is the peer reviewed version of the following article: Medeiros, J. S. and Ward, J. K. (2013), Increasing atmospheric [CO2] from glacial to future concentrations affects drought tolerance via impacts on leaves, xylem and their integrated function. New Phytol, 199: 738–748. doi:10.1111/nph.12318, which has been published in final form at http://doi.org/10.1111/nph.12318. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Changes in atmospheric carbon dioxide concentration ([CO2]) affect plant carbon/water trade-offs, with implications for drought tolerance. Leaf-level studies often indicate that drought tolerance may increase with rising [CO2], but integrated leaf and xylem responses are not well understood in this respect. In addition, the influence of low [CO2] of the last glacial period on drought tolerance and xylem properties is not well understood. We investigated the interactive effects of a broad range of [CO2] and plant water potentials on leaf function, xylem structure and function and the integration of leaf and xylem function in Phaseolus vulgaris. Elevated [CO2] decreased vessel implosion strength, reduced conduit specific hydraulic conductance, and compromised leaf specific xylem hydraulic conductance under moderate drought. By contrast, at glacial [CO2], transpiration was maintained under moderate drought via greater conduit specific and leaf specific hydraulic conductance in association with increased vessel implosion strength. Our study involving the integration of leaf and xylem responses suggests that increasing [CO2] does not improve drought tolerance. We show that under glacial conditions changes in leaf and xylem properties could increase drought tolerance, while under future conditions greater productivity may only occur when higher water use can be accommodated

Gender ‘hostility’, rape, and the hate crime paradigm

This article examines whether crimes motivated by, or which demonstrate, gender ‘hostility’ should be included within the current framework of hate crime legislation in England and Wales. The article uses the example of rape to explore the parallels (both conceptual and evidential) between gender‐motivated violence and other ‘archetypal’ forms of hate crime. It is asserted that where there is clear evidence of gender hostility during the commission of an offence, a defendant should be pursued in law additionally as a hate crime offender. In particular it is argued that by focusing on the hate‐motivation of many sexual violence offenders, the criminal justice system can begin to move away from its current focus on the ‘sexual’ motivations of offenders and begin to more effectively challenge the gendered prejudices that are frequently causal to such crimes