1. The State of the Health of Children in NYC and the Bronx Jane Bedell, MD Assistant Commissioner Bronx District Public Health Office NYC Dept of Health & Mental Hygiene

2. Today’s talk What we know from the data Where you can get more information What the DOHMH is doing in response to this data What else could be done Questions, comments

3. Information Sources Health Department Website:  To get to the DOHMH website, type into your search engine: NYC Dept of Health & Mental Hygiene  Click on “My Community’s Health”

5. Demographics

6. Oversimplification of Bronx demographics Big (1.3 million residents), but not the biggest borough Non-white (approx 85% people of color) Low-income (contains poorest congressional district in continental US) Marked inequities in health outcomes (health disparities) On the move: significant changes in last 20 – 30 years…

7. Source: Census 2000. www.census.gov Total Population by Race and Hispanic Origin, Bronx, 2000

8. Number of Bronx Children (ages 0 – 18 yo) 397,372 Source: US Census

9. ~ 25% of New Yorkers are Under 18 77% of NYC Kids are Members of a Racial/Ethnic “Minority” NYC Pop. = 8,008,278 NYC Pop. <18 = 1,940,269 Source: Census 2000 NYC:

10. ~33% Bronx Residents Are Under 18 93% of BX Kids are Members of a Racial/Ethnic “Minority” BX Pop. = 1,332,650 BX Pop. <18 = 397,372 Source: Census 2000 BRONX:

11. Bronx Children Living in Poverty Surpass Both the National and NYC Rates US Children NYC Children Bronx Children Source: Census 2000

12. Key DOHMH Pediatric Health Priorities **Neonatal and infant care Lead poisoning prevention **Obesity Mental health Drugs and alcohol **Teen Sexual Health Smoking School Health Take Care New York

13. Neonatal and infant care SIDS prevention Breastfeeding

14. SIDS Prevention Although fewer infants are dying of SIDS, it is still the leading cause of death for infants between 1 month and 1 year Proper sleeping arrangements Maintain smoke-free environment around infants

15. SIDS Rates: NYC and U.S. 1993-2002 Source: NYC DOHMH Bureau of Vital Statistics, NCHS Final Mortality Data

16. Breastfeeding Healthy People 2010 Breastfeeding Objectives 40% exclusively breastfeed 75% Initiate breastfeeding 50% Breastfeed 17% Exclusively breastfeed 25% breastfeed Birth3 Months6 Months1 Year US Department of Health and Human Services. Healthy People 2010: Conference Edition—Volumes I and II.

17. Women in the Bronx are as likely to breastfeed than women citywide Source: NYC PRAMS, 2007

18. What DOHMH is doing.. SIDS: Surveillance Community education Breastfeeding: Baby Friendly designation for NYC hospitals (only 1 hospital in NYC thus far) Perinatal consortium Newborn Home Visiting Program Nurse-Family Partnership Worksite changes for BF mothers Surveillance/data other

19. What pediatricians can do… SIDS education, including smoking cessation (offer NRT) Breastfeeding education, esp anticipatory guidance Care of the breastfeeding mother AAP recommendations

20. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention **Obesity Mental health Drugs and alcohol **Teen Sexual Health Smoking School Health Take Care New York

21. Lead Poisoning Rates Among NYC’s Children Have Steadily Declined Blood-Lead Levels ≥ 10 μg/dL, Rate per 1,000 Children Age 0 Months-18 Years, 1995-2007 # of New Cases w/BLL ≥ 10 μg/dL Rate per 1,000 Tested

23. Bronx children less likely to have elevated led levels than children citywide

24. Not Enough Children Are Being Tested for Lead Poisoning 1 in 10 children has not had a lead test % of Children Data are for NYC children born in 2003 Source: Report to NYC Council on Progress in Preventing Childhood Lead Poisoning in NYC, 2006.

25. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention **Obesity Mental health Drugs and alcohol **Teen Sexual Health Smoking School Health Take Care New York

26. Between 39% and 47% of Children in the South Bronx are Either Overweight or Obese Head Start data from physical exams; Elementary school data from 2005 DOHMH Height and Weight survey

27. There are No Significant Childhood Obesity Differences Between the S Bronx, the Bx and the City Head Start data from physical exams; Elementary school data from 2005 DOHMH Height and Weight survey

28. Public High School students in the South Bronx are more likely to be obese than their NYC peers Source: 2007 YRBS Obese = BMI at or above 95 th percentile; Overweight = BMI from 85 th but below 95 th percentile

29. Overweight Prevalence in NYC H.S. Students, by Gender and Ethnicity, 2007 Source: 2007 YRBS

30. Poor Diet Among NYC Teens H.S. Students Reporting NOT Eating 5+ Servings of Fruits/ Vegetables Each Day for the Past Week, by Gender and Ethnicity, 2005 Source: 2005 YRBS

31. Many South Bronx Adolescents Do Not Get Enough Exercise, More than Half Watch Too Much TV, and Many Consume No Fruits or Vegetables Source: 2007 YRBS

32. South Bronx Public High School Students Attend Fewer PE Classes *The South Bronx does not contribute to Bronx and NYC proportions Source: 2007 YRBS

33. What the DOHMH is doing…. Daycare settings – over 1100 staff trained in fitness curriculum Change in daycare regulations Starting classroom phys ed training this year Improved nutrition standards for school food and “competitive” foods Water availability Farmers mkts, HealthBucks, bodegas Hard-hitting ads (“pouring on the pounds”) other

35. What pediatricians can do….

36. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention Obesity Mental health Drugs and alcohol **Teen Sexual Health Smoking School Health Take Care New York

37. Mental Health Among NYC Teens, 2007 % of NYC H.S. Students 75,400 NYC H.S. students report symptoms of depression 15,500 NYC H.S. students attempted suicide in the past 12 months 29,800 NYC H.S. students seriously considered suicide in the past 12 months Source: 2007 YRBS

38. NYC H.S. Students as Likely to Be “Depressed” as U.S. Teens almost every day for >2 weeks in a row that stopped them from doing usual activities Source: 2007 YRBS

39. Attempted Youth Suicide % of H.S. Students Reporting 1 or More Suicide Attempts in Past 12 Months, by Ethnicity and Gender, 2007 Source: 2007 YRBS

40. What the DOHMH is doing…. Special targeted campaign for teen Latinas School system changes to increase access to care

41. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention Obesity Mental health Drugs and alcohol **Teen Sexual Health Smoking School Health Take Care New York

42. Binge Drinking by NYC Teens % of H.S. Students Reporting “Binge” Drinking (>5 drinks on a single occasion), by Ethnicity and Age, 2007 Source: 2007 YRBS

43. NYC H.S. Students Less Likely to Use Drugs than U.S. Teens Source: 2007 YRBS

44. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention Obesity Mental health Drugs and alcohol **Teen Sexual Health Smoking School Health Take Care New York

45. Consequences of teen risky sexual behavior Almost 3,000 births/year in NYC to females under age 18 Over 6,000 terminations in NYC to females under age 18 Sexually transmitted infection rates average over 7% in high school females who are screened HIV infection

46. CHLAMYDIA RATES AMONG TEENAGE FEMALES ARE HIGHEST IN THE BRONX

47. NYC Teen Pregnancy Rates 1996-2007, by Year & Borough of Residence

48. 2007 Teen Pregnancy Rates, per 1,000 Population* Source: Vital Statistics, Rates calculated by BMIRH National Rate (2004) = 72 per 1,000 South Bronx UHF areas = Crotona-Tremont, High Bridge- Morrisania and Hunts Point- Mott Haven; Harlem UHF areas = East Harlem & Central Harlem-Morningside Heights; Brooklyn UHF areas = Bedford-Stuyvesant-Crown Heights, East New York & Williamsburg-Bushwick

49. Percent of Teens Who Have Ever Had Sex Source: 2007 YRBS

50. Percent of Teens Who Have Had Sex in the Past 3 Months Source: 2007 YRBS

51. Percent of Teens Who Had Sex for the First Time Before Age 13 Source: 2007 YRBS

52. Percent of Teens Who Have Had 4 or More Sex Partners in their Lifetimes Source: 2007 YRBS

53. Among Sexually Active Teens, What Percent Used a Condom at Last Sex? Source: 2007 YRBS

54. Among Sexually Active Teens, What Percent Used Birth Control Pills at Last Sex? Source: 2007 YRBS

55. What the DOHMH is doing…. Increase the number and improve the quality of care at School-Based Health Centers School-linked Health Services Healthy Teens initiative targetting medical practices Access to emergency contraception other

56. What pediatricians can do… All pediatricians should ask about sexual history starting at an early age of the patient All pediatricians in general practice should be able to prescribe hormonal forms of birth control All medical practices that see teens should have teen-friendly spaces All medical practices that see teens should be able to conform to NYS law protecting confidentiality More…..

57. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention Obesity Mental health Drugs and alcohol Teen Sexual Health Smoking School Health Take Care New York

58. NYC Adult Smoking Prevalence 1993-2006 Nearly 250,000 Fewer Smokers More than 75,000 Premature Deaths Prevented % of adults City and State tax increases Smoke-free workplaces Free patch programs 3-yr average Media campaign

59. Smoking Issues for Teens 85-90% of adult smokers start before age 18 Starting to smoke during adolescence is associated with:  Higher daily cigarette consumption  Lower probability of quitting as an adult

60. Teen Smoking in NYC Down 64% in 10 Years YRBS % of H.S. Students

61. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention Obesity Mental health Drugs and alcohol Teen Sexual Health Smoking School Health Take Care New York

62. DOHMH School Health School Health Program has provided public health services in the schools for 100 years Promotes health of 1.2 million schoolchildren enrolled in 1,400 schools (public and non-public) throughout NYC  Adjunct to health care from regular family physician

63. School Health Programs Vision screening Dental sealant application School-based health centers Special initiatives (e.g., asthma, chlamydia screening and treatment, H1N1 vaccination) Joint programs with Dept. of Education  Physical activity, nutrition, health and sexuality education

64. Increased Fitness Correlates with Higher Test Scores in All Grades Test Score Percentile Average of Reading and Math Scores

65. Improved School Nutrition Guidelines Smaller portions, standard serving sizes All meals lower in fat  <30% of calories from fat at each meal Vegetables and fruits at all meals  Fresh or frozen rather than canned Increased use of wheat/whole wheat breads, fish, soy proteins – no trans fats Beverages limited to 100% juice, milk, water Fewer mayonnaise-based salads, highly processed foods

66. Asthma

67. Asthma Hospitalization Rates per 1,000 among Children ages 0 – 14, 1995-2006 Source: SPARCS data

69. Asthma hospitalization rates among teens have declined in all 5 boroughs over the past decade Source: SPARCS data

70. Hospitalization rates for children in South Bronx (ages 0-14) have gone down over the past 10 years 38.8% decrease37.1% decrease48.5% decrease41.6% decrease

71. Key DOHMH Pediatric Health Priorities Neonatal and infant care Lead poisoning prevention Obesity Mental health Drugs and alcohol Teen Sexual Health Smoking School Health Take Care New York

72. Seasonal flu and H1N1 For info & current data, go to nyc.gov/flu H1N1 is here (again) We’ve learned a lot since the spring H1N1 causes mild flu and there is no evidence of mutation in the virus at this point Epi data suggests older age is protective Vaccine plans are in place Surveillance strategies are in place Hygiene measures work (wash your hands and cover your cough)

74. Information Sources Health Department Website:  To get to the DOHMH website, type into your search engine: NYC Dept of Health & Mental Hygiene  Click on “My Community’s Health”

75. THANKS. www.health.nyc.gov Jane Bedell, MD Assistant Commissioner & Medical Director 1826 Arthur Avenue Bronx, NY 10457 718466-9178 jbedell@health.nyc.gov