NPCC4: Concepts and tools for envisioning New York City's futures.

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report discusses the many intersecting social, ecological, and technological-infrastructure dimensions of New York City (NYC) and their interactions that are critical to address in order to transition to and secure a climate-adapted future for all New Yorkers. The authors provide an assessment of current approaches to "future visioning and scenarios" across community and city-level initiatives and examine diverse dimensions of the NYC urban system to reduce risk and vulnerability and enable a future-adapted NYC. Methods for the integration of community and stakeholder ideas about what would make NYC thrive with scientific and technical information on the possibilities presented by different policies and actions are discussed.

NPCC4: Climate change, energy, and energy insecurity in New York City.

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report provides an overview of energy trends in New York City and the State of New York, as well as accompanying challenges and barriers to the energy transition-with implications for human health and wellbeing. The link between energy trends and their impact on health and wellbeing is brought to the fore by the concept of "energy insecurity," an important addition to the NPCC4 assessment.

Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown.

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)-albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits. We focused on fine particulate matter (PM) and modeled potential future health benefits to children and adults.

Building Healthy Community Environments: A Public Health Approach.

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs.

Awareness, Risk Perception, and Protective Behaviors for Extreme Heat and Climate Change in New York City.

Preventing heat-related illness and death requires an understanding of who is at risk and why, and options for intervention. We sought to understand the drivers of socioeconomic disparities in heat-related vulnerability in New York City (NYC), the perceived risk of heat exposure and climate change, and barriers to protective behaviors. A random digit dial telephone survey of 801 NYC adults aged 18 and older was conducted from 22 September⁻1 October, 2015.

Health Impacts of Citywide and Localized Power Outages in New York City.

Background: Previous studies investigated potential health effects of large-scale power outages, including the massive power failure that affected the northeastern United States and Ontario, Canada, in August 2003, and outages associated with major storms. However, information on localized outages is limited.

Objective: The study sought to examine potential health impacts of citywide and localized outages in New York City (NYC).

Burden and Risk Factors for Cold-Related Illness and Death in New York City.

Exposure to cold weather can cause cold-related illness and death, which are preventable. To understand the current burden, risk factors, and circumstances of exposure for illness and death directly attributed to cold, we examined hospital discharge, death certificate, and medical examiner data during the cold season from 2005 to 2014 in New York City (NYC), the largest city in the United States. On average each year, there were 180 treat-and-release emergency department visits (average annual rate of 21.

Real-time surveillance of heat-related morbidity: Relation to excess mortality associated with extreme heat.

The impact of heat on mortality is well documented but deaths tend to occur after (or lag) extreme heat events, and mortality data is generally not available for timely surveillance during extreme heat events. Recently, systems for near-real time surveillance of heat illness have been reported but have not been validated as predictors of non-external cause of deaths associated with extreme heat events. We analyzed associations between daily weather conditions, emergency medical system (EMS) calls flagged as heat-related by EMS dispatchers, emergency department (ED) visits classified as heat-related based on chief complaint text, and excess non-external cause mortality in New York City.

Levels and determinants of tree pollen in New York City.

Exposure to allergenic tree pollen is a risk factor for multiple allergic disease outcomes. Little is known about how tree pollen levels vary within cities and whether such variation affects the development or exacerbation of allergic disease. Accordingly, we collected integrated pollen samples at uniform height at 45 sites across New York City during the 2013 pollen season.

The contribution of motor vehicle emissions to ambient fine particulate matter public health impacts in New York City: a health burden assessment.

Background: On-road vehicles are an important source of fine particulate matter (PM2.5) in cities, but spatially varying traffic emissions and vulnerable populations make it difficult to assess impacts to inform policy and the public.

Methods: We estimated PM2.

Intraurban Variation of Fine Particle Elemental Concentrations in New York City.

Few past studies have collected and analyzed within-city variation of fine particulate matter (PM2.5) elements. We developed land-use regression (LUR) models to characterize spatial variation of 15 PM2.

Excess Mortality Attributable to Extreme Heat in New York City, 1997-2013.

Extreme heat event excess mortality has been estimated statistically to assess impacts, evaluate heat emergency response, and project climate change risks. We estimated annual excess non-external-cause deaths associated with extreme heat events in New York City (NYC). Extreme heat events were defined as days meeting current National Weather Service forecast criteria for issuing heat advisories in NYC based on observed maximum daily heat index values from LaGuardia Airport.

Ambient Fine Particulate Matter, Nitrogen Dioxide, and Preterm Birth in New York City.

Background: Recent studies have suggested associations between air pollution and various birth outcomes, but the evidence for preterm birth is mixed.

Objective: We aimed to assess the relationship between air pollution and preterm birth using 2008-2010 New York City (NYC) birth certificates linked to hospital records.

Methods: We analyzed 258,294 singleton births with 22-42 completed weeks gestation to nonsmoking mothers.

Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012.

Objectives: We evaluated the use of New York City's (NYC's) electronic death registration system (EDRS) to conduct mortality surveillance during and after Hurricane Sandy.

Methods: We used Centers for Disease Control and Prevention guidelines for surveillance system evaluation to gather evidence on usefulness, flexibility, stability, timeliness, and quality. We assessed system components, interviewed NYC Health Department staff, and analyzed 2010 to 2012 death records.

Area-level socioeconomic deprivation, nitrogen dioxide exposure, and term birth weight in New York City.

Numerous studies have linked air pollution with adverse birth outcomes, but relatively few have examined differential associations across the socioeconomic gradient. To evaluate interaction effects of gestational nitrogen dioxide (NO2) and area-level socioeconomic deprivation on fetal growth, we used: (1) highly spatially-resolved air pollution data from the New York City Community Air Survey (NYCCAS); and (2) spatially-stratified principle component analysis of census variables previously associated with birth outcomes to define area-level deprivation. New York City (NYC) hospital birth records for years 2008-2010 were restricted to full-term, singleton births to non-smoking mothers (n=243,853).

The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012.

Background: Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits.

Methods: Nine clinically-relevant spring tree pollen genera (elm, poplar, maple, birch, beech, ash, sycamore/London planetree, oak, and hickory) measured in Armonk, NY, were analyzed for their associations with over-the-counter allergy medication sales and daily asthma syndrome ED visits from patients' chief complaints or diagnosis codes in New York City during March 1st through June 10th, 2002-2012.

Ambient Fine Particulate Matter, Nitrogen Dioxide, and Hypertensive Disorders of Pregnancy in New York City.

Background: Previous studies suggested a possible association between fine particulate matter air pollution (PM2.5) and nitrogen dioxide (NO2) and the development of hypertensive disorders of pregnancy, but effect sizes have been small and methodologic weaknesses preclude firm conclusions.

Methods: We linked birth certificates in New York City in 2008-2010 to hospital discharge diagnoses and estimated air pollution exposure based on maternal address.

Drinking water turbidity and emergency department visits for gastrointestinal illness in New York City, 2002-2009.

Background: Studies have examined whether there is a relationship between drinking water turbidity and gastrointestinal (GI) illness indicators, and results have varied possibly due to differences in methods and study settings.

Objectives: As part of a water security improvement project we conducted a retrospective analysis of the relationship between drinking water turbidity and GI illness in New York City (NYC) based on emergency department chief complaint syndromic data that are available in near-real-time.

Methods: We used a Poisson time-series model to estimate the relationship of turbidity measured at distribution system and source water sites to diarrhea emergency department (ED) visits in NYC during 2002-2009.

A Case-Only Study of Vulnerability to Heat Wave-Related Mortality in New York City (2000-2011).

Background: As a result of climate change, the frequency of extreme temperature events is expected to increase, and such events are associated with increased morbidity and mortality. Vulnerability patterns, and corresponding adaptation strategies, are most usefully conceptualized at a local level.

Methods: We used a case-only analysis to examine subject and neighborhood characteristics that modified the association between heat waves and mortality.

Using tracking infrastructure to support public health programs, policies, and emergency response in New York City.

Objective: To describe how the New York City (NYC) Tracking Program has used nationally mandated Secure Portal infrastructure and staff analytical expertise to support programs and inform policy.

Setting: The NYC Health Department assesses, investigates, and acts on a wide range of environmental concerns to protect the health of New Yorkers.

Design: Specific examples of highly effective policies or initiatives that relied on the NYC Tracking Program are described, including restaurant sanitary grade posting, rat indexing, converting boilers to cleaner-burning fuels, reducing exposure to mercury from fish and contaminated products, and responding to Superstorm Sandy.