Public Release: 

Smoking, growing private hospital care for poor and US flu vaccine policies

Research in New York Academy of Medicine's Journal of Urban Health

New York Academy of Medicine

NEW YORK CITY, May 14 -- Bans on smoking at home may have greater influence on health status than those at work, according to a first-study-of-its kind study published in the May/June 2007 issue of The Journal of Urban Health (JUH), a bi-monthly publication of The New York Academy of Medicine. Also, a community's ethnic diversity can influence on a woman's decision to smoke during pregnancy, according to another study in this JUH issue, which also includes reports on how private hospitals have surpassed public hospitals in caring for Medicaid patients, as well as on the effect of 2004-2005 influenza vaccine shortage on minority groups.

Below are summaries of the four studies. Access to the full table of contents and the 11 peer-reviewed articles within can be found on the JUH web site at"SGWID=4-40467-70-79373664-0.

Influenza Vaccine Shortage Did Not Results in Racial Disparities in Inner City Health Centers

Despite fears that the 50 percent reduction in available flu vaccines in 2004-2005 would leave those with the greatest flu risk unprotected, that did not happen, according to an analysis by researchers from the University of Pittsburgh's School of Medicine and Graduate School of Public Health. In fact, the researchers conclude, the priority vaccination groups established by the Centers for Disease Control and Prevention (CDC) could serve as a model for establishing future priority vaccine groups in anticipation of a possible flu pandemic. The 2004-2005 flu shortage resulted when the U.S. Food and Drug Administration and British authorities suspended the license of one of only two manufacturers that provided the U.S. supply of inactivated influenza vaccine. The CDC stepped in and recommended that adults older than 65 and those with chronic health conditions, among other groups, should receive priority vaccination. In an analysis of vaccination rates among 288 patients 50 years old and older who used four inner city health centers, researchers found that the majority of patients (73 percent) between the ages of 50 and 64 and in good health did not get the vaccine during the shortage, while 64 percent of those age 65 and older were vaccinated. Furthermore, no racial discrimination in vaccination distribution resulted.

"Impact of the 2004 Influenza Vaccine Shortage on Patients from Inner City Health Centers," Richard K. Zimmerman, et al

Better Health More Than Twice as Likely for Nonsmokers who Live and Work with Smoking Restrictions

Nonsmokers who live under both a total household and total workplace smoking ban are 2.61 times more likely to report better health status than those facing no smoking bans at work or home, according to first-of-its-kind study, which surveyed 1,472 Chinese American adults living in New York City. Even those with just a smoking ban at home fared better and were 1.90 times more likely to report better health status than those under no smoking bans. Before the New York City Clean Indoor Air Act, second-hand smoke exposure among this immigrant Chinese population at home and work was high, note the researchers. More private apartment buildings are enforcing smoking bans and public housing is considering adopting them. ¡§Although these policies raise difficult ethical issues, this study provides additional support for aggressively promoting smoke free homes,¡¨ said lead author Donna Shelley of the Department of Sociomedical Sciences at Columbia University¡¦s Mailman School of Public Health. In the new report, 43 percent of respondents report a total smoking ban at home and the workplace, 20 percent at work only, 22 percent at home only, and 15 percent report no smoking restriction at home or work.

"The Relative Effect of Household and Workplace Smoking Restriction on Health Status among Chinese Americans Living in New York City," Donna Shelley, et al

Racial Diversity of Neighborhood Influences Decision to Smoke During Pregnancy for African-American Women

African-American women are 30 to 40 percent more likely to smoke during pregnancy if they live in areas of high segregation or low segregation compared to areas that are moderately segregated, according to researchers at the University of Washington. In highly segregated residential areas, the authors suggest, the higher smoking rates among pregnant black women may reflect less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products or limited access to smoking cessation treatment.

In contrast, the higher smoking rates in highly integrated areas may reflect how exposure to harmful behaviors of the majority population can dilute the normally salutatory no-smoking habits of the African Americans. While just 10 percent of African American women smoke during pregnancy, compared to 16 percent of white women, this rate is well above the 1 percent goal for pregnant smokers put forward in the U.S. health agenda, Healthy People 2010. ¡§Effective interventions to promote smoking cessation during pregnancy may require new approaches that consider the social environment,¡¨ said lead author Janice Bell, PhD, post-doctoral Fellow in the School of Public Health and Community Medicine at the University of Washington. The analysis linked measures of segregation to birth certificates and 2000 U.S. census data in a sample of more than 400,000 African American women in 216 U.S. metro areas.

"Associations between Residential Segregation and Smoking during Pregnancy among Urban African-American Women," Janice F. Bell, et al

Private Urban Hospitals Surpass Public Hospitals in Caring for Medicaid Patients

Private, for-profit urban hospitals far surpassed public hospitals in caring for patients on Medicaid, the federal-state insurance program for the poor, between 1996 and 2002, investigators from Drexel University School of Public Health discovered. During those years, hospital closures were highest in the poorest suburban areas.

Medicaid admissions in city for-profit and non-profit hospitals rose 39 percent and 17 percent respectively over these years, while falling by more than 21 percent in public hospitals, researchers found. They also found that as the number of hospitals decline, there are growing disparities between hospitals in rich and poor suburbs, with hospitals in richer areas receiving a highly disproportionate share of basic and high-tech services. Usage and availability of PET scans for residents in the wealthiest suburbs, for example, were generally double that for residents living in the poorest suburbs.

"The Changing Landscape of Hospital Capacity in Large Cities and Suburbs: Implications for the Safety Net in Metropolitan America," Dennis P. Andrulis and Lisa M. Duchon


About the Journal of Urban Health

The Journal of Urban Health is a bimonthly peer-reviewed publication of The New York Academy of Medicine and focuses on the emerging fields of urban health and epidemiology. Published since 1847, the JUH addresses health issues such as substance abuse, teenage pregnancy, HIV, tuberculosis, and violence from both clinical and policy perspectives, filling a neglected niche in medical and health literature. The JUH is edited by David Vlahov, Ph.D., director of the Academy¡¦s Center for Urban Epidemiologic Studies.

About The New York Academy of Medicine

Founded in 1847, The New York Academy of Medicine is an independent, non-partisan, non-profit institution whose mission is to enhance the health of the public. Our research, education, community engagement, and evidence-based advocacy seeks to improve the health of people living in cities, especially disadvantaged and vulnerable populations. The impact of these initiatives reaches into neighborhoods in New York City, across the country, and around the world. We work with community based organizations, academic institutions, corporations, the media, and government to catalyze and contribute to changes that promote health. Visit us online at

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