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Asthma In the Bronx
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Written By:
Eubie Chance
Melissa Falcon
Newton Mignott
Thomas Saw Aung
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Contents
Health Conditions
(Thomas Saw Aung)
Specified Population
(Thomas Saw Aung)
Setting
(Eubie Chance)
Intervention Strategy
Recommendations
Green Roof Intervention
(Melissa Falcon)
Smoking Cessation Intervention
(Newton Mignott)
References
Asthma: The Plight of New York City Children
The air we breathe is vital to the development and maintenance of life. An average person takes about 16 breathes/minute. In total, that accounts for about 23,040 breathes a day, not including exercise rates. Assuming that the average person breathes in 500mL of air per breathe adding up to a total of 11,520L of air daily. However, those suffering from asthma have this breathing volume cut drastically during sudden attacks. The rapid decrease in breathing volume is a result of inflammation of the body’s airways, which obstructs airflow in and out of the lungs. Asthma attacks leave the individual coughing, wheezing, and gagging as they attempt to inhale air into their clogged airways.
The causes behind the development of asthma are varied and complex. Genetic or prior respiratory infections are believed to play some role. However, the primary cause of asthma is allergies, similar to food allergies. Certain molecules or substances called, “allergens” trigger a person’s mast cells and basophils (Allergies, 2011). These cells are part of the body’s immune system and release chemicals such as histamines and cytokines causing a whole list of uncomfortable or severe symptoms ranging from redness to suffocation.
It is unfortunate that a significant percentage of asthma cases during childhood. Early adolescence is a period for children to grow and explore their environment. Tragically, asthma impedes a youth’s ability to function in public. The allergens that trigger asthma are so varied that a lot of time is spent trying to figure out and avoid the triggers. A few examples of possible triggers for asthma are aerosols, second-hand smoke, perfumes, paints, cockroaches, cold air, exercise, mold, smog, animal dander, and industrial chemicals. With such a long list, those suffering from asthma go throughout the day like a minesweeper through a minefield; one wrong move and their health will go up in flames. Their only solution in the event of a terrible allergic reaction is to use the emergency inhaler with corticosteroids or bronchodilators. In 2015, 7% (91,000) of children ages 0 through 12 years in New York City had an asthma attack (New York City Department of Health, 2015). Among the boroughs, the Bronx has the worst rates of asthma.
The Bronx borough has significantly higher asthma rates compared to the rest of the city. The New York City Childhood Asthma Initiative, a study produced by Renu Garg, Adam Karpati, Jessica Leighton, Mary Perrin and Mona Shah from New York City Department of Health and Mental Hygiene in May 2003, reported in 1999 than 30.8% of all child asthma cases from the age of four through five were from the Bronx. Despite the percentage being less than Brooklyn’s 30.9%, the Bronx has a higher prevalence owing to its disproportionate percentage of four to five-year-olds. The Bronx only has 18.3% of total 4-5 year olds in the city. In addition to prevalence, the Bronx’s morbid statistics continue with the highest child asthma hospitalizations in the city. Since 1990, the Bronx has had the highest borough-wide incidence of asthma hospitalization for children from 0-14 years old with 16.98 per 1000 population in 1993 and 9.16 per 1000 population in 2000.
More than a decade later, the asthma rates in the Bronx still remain higher than the rest of the city. From 2009 – 2011 the Bronx had the highest asthma hospitalization, discharge, and mortality rates (New York State Department of Health Public Health Information Group, 2013). In 2014 it was reported that about 25% of Bronx children have physician-diagnosed asthma (Reznik, Bauman, Okelo & Jill S. Halterman, 2014). That same year the Bronx had 100.3 asthma hospitalizations per 10,000 residents (NYC DoH, 2014). On the other hand, New York City saw an overall decrease in asthma hospitalizations for children from 51.3 per 10,000 to 31.4 per 10,000 in 2016. In the Bronx the situation still remains grim. In 2015 the Department of Health Community Health Report listed the Bronx as the borough with the top three asthma hospitalizations per 10,000 neighborhood residents (DOHMH, 2015).
Bronx – Public School Children Reported with Asthma (NYC Automated School Health Records)
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Year
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Prevalence of Asthma
% of total NYC cases
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Incidence of Hospitalization (5-14)
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2010-2011
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27.9%
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75.8 per 1000
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2011-2012
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28.2%
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90.8 per 1000
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2012-2013
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28.7%
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97.4 per 1000
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2013-2014
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29.1%
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102.5 per 1000
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New York City – Children Asthma Hospitalization (SPARCS - Deidentified Hospital Discharge Data)
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Year
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Incidence of Hospitalization
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1993
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51.3 per 10000
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1994
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46.2 per 10000
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1995
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46.5 per 10000
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1996
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47.0 per 10000
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1997
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44.1 per 10000
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1998
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37.7 per 10000
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1999
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41.9 per 10000
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2000
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41.7 per 10000
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2001
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41.1 per 10000
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2003
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50.2 per 10000
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2004
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46.8 per 10000
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2005
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41.4 per 10000
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2006
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41.1 per 10000
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2007
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38.5 per 10000
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2008
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36.2 per 10000
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2009
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38.9 per 10000
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2010
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33.1 per 10000
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2011
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33.8 per 10000
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2012
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36.3 per 10000
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2013
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35.9 per 10000
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2014
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38.6 per 10000
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2015
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33.2 per 10000
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2016
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31.4 per 10000
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Asthma in Bronx Public Housing in Morrisania and Williamsbridge
Our asthma intervention is in Bronx public housing, specifically the Daniel Webster Houses, Bronx, NY 10456. The Gun Hill Houses, Bronx, NY 10467 will serve as our control group. The Webster Houses are in the neighborhood of Morrisania (zip code 10456). The 94,667 residents of the neighborhood are predominantly Hispanic (59%) with Blacks being the second largest race (39%). The remaining 3% of the population is White, Asian, and other (New York City Department of Health and Mental Hygiene DOHMH, 2015). Age distribution of the population skews towards the youth with 69% of the neighborhood being younger than 44 years old, and the median age being 30.5 years old. The gender of the population is estimated to be 46% male and 54% female. While this may be demographically similar to other neighborhoods in Queens, Manhattan, and Brooklyn, the socioeconomic status is a complete aberration.
Morrisania suffers from a whole slew of socioeconomic factors ranging from high poverty levels to high rates of illegal drug use. The US 2013-2017 Community Survey reports that 40.4% of individuals in Morrisania live below the poverty level. With a median household income of $26,724, it is no wonder that 61% of the residents spend more than 30% of their income on rent and that 62.9% of children in the neighborhood live in households receiving government assistance. Intertwined with the low incomes is high unemployment at 20% (NYC DOHMH, 2015). The reality on the ground is even worse with 43.7% of neighborhood population not in the labor force. Since these individuals do not participate in the labor force they are not counted towards unemployment, masking the real “unemployment” (US Census, 2013-2017). With statistics like these, it is clear why the neighborhood is labeled as one of New York City’s poorest neighborhoods.
The health of Morrisania correlates with its socioeconomic plight. About 74% of the homes in the neighborhood have maintenance defects in comparison to the rest of the city. The poor quality of the homes combines with air pollution, recorded at 9.4µg pollutants/m3, and a 20% smoker population to play a vital role in asthma development. The issue is further compounded by the fact that there are many teen moms (43.1 per 1000 girls) that are giving birth to premature babies (11.1%) (NYC DOHMH, 2015). Premature babies without fully functioning lungs are getting exposed to the poor Bronx air quality increasing risk of asthma later on. The outcomes of such increased asthma risk are evident from the neighborhood’s high asthma hospitalization rate at 89 per 10,000 for children and 769 per 10,000 for adults, placing it at second highest in New York City.
Morrisania suffers from a whole slew of socioeconomic factors ranging from high poverty levels to high rates of illegal drug use. The US 2013-2017 Community Survey reports that 40.4% of individuals in Morrisania live below the poverty level. With a median household income of $26,724, it is no wonder that 61% of the residents spend more than 30% of their income on rent and that 62.9% of children in the neighborhood live in households receiving government assistance. Intertwined with the low incomes is high unemployment at 20% (NYC DOHMH, 2015). The reality on the ground is even worse with 43.7% of neighborhood population not in the labor force. Since these individuals do not participate in the labor force they are not counted towards unemployment, masking the real “unemployment” (US Census, 2013-2017). With statistics like these, it is clear why the neighborhood is labeled as one of New York City’s poorest neighborhoods.
The health of Morrisania correlates with its socioeconomic plight. About 74% of the homes in the neighborhood have maintenance defects in comparison to the rest of the city. The poor quality of the homes combines with air pollution, recorded at 9.4µg pollutants/m3, and a 20% smoker population to play a vital role in asthma development. The issue is further compounded by the fact that there are many teen moms (43.1 per 1000 girls) that are giving birth to premature babies (11.1%) (NYC DOHMH, 2015). Premature babies without fully functioning lungs are getting exposed to the poor Bronx air quality increasing risk of asthma later on. The outcomes of such increased asthma risk are evident from the neighborhood’s high asthma hospitalization rate at 89 per 10,000 for children and 769 per 10,000 for adults, placing it at second highest in New York City.
Further north of Morrisania in the neighborhood of Williamsbridge where the Gun Hill Houses are located. The socioeconomic situation shifts for the better the more distant from the South Bronx a neighborhood is. Here the population is predominantly Black (65%) with Hispanics being the second largest race (24%). Whites (7%), Asians (2%), and other races (2%) still remain the minority (DOHMH, 2015). The median age is 33.9 with an age distribution that leans more towards adults instead of youth (US Census, 2017). In this 102,718 people neighborhood, the females (52%) as usual outnumber the males (48%). The demographic makeup differs from Morrisania and the socioeconomic situation is better as well.
Williamsbridge lies close to the outer borders of the Bronx and has a better economic situation. For starters, the median household income is $35,381 putting it almost $10,000 higher than the median income of Morrisania, which is $26,724 (US Census, 2013-2017). The percentage of children living in households relying on government assistance is lower at 51.1%, but remains quite high due to the city’s high cost of living. The slightly higher salaries coincide with a lower number of individuals below the poverty level, 29.9%, but unemployment still rest at 16% (10th in the city). However, Williamsbridge’s asthma situation is dire like Morrisania.
Despite being further up north, the Williamsbridge still suffers from high asthma rates. In 2012-2013 the neighborhood had 74 child asthma hospitalizations per 10,000, just slightly higher than the Bronx average rate of 72 child asthma hospitalizations per 10,000. This continual asthma presence is quite peculiar considering that Williamsbridge has less housing maintenance defects (65% compared to the Bronx’s 69% of housing) as well as lower air pollution at 8.7µg pollutants/m3 close to the city average of 8.6µg pollutants/m3. The expectation would be that asthma rates would go significantly down. Yet the adult asthma hospitalization rates for Williamsbridge at 501 per 100,000 residents is lower than the Bronx average of 508 adults hospitalizations per 100,000 residents. This significant difference can be contributed to missing polluting factors or additional environmental stressors. The comparable child asthma rate between one of the city’s worst districts, Morrisania, and Williamsbridge and different adult asthma hospitalization rates make the two neighborhoods a great measuring stick to measure the impact of structural interventions.
Setting Section: The Gun Hill and Webster Houses
Gun Hill Road and Webster Avenue meet at the eastern gateway to Montefiore’s Moses Campus, integrated into the fabric of the Norwood neighborhood and its different housing structure of century-old Tudor-style homes and multi-family buildings. This intersection is on the rise, especially with attention from the more than 200-member Jerome-Gun Hill Business Improvement District. The Bronx River Parkway and Williams Bridge Metro-North station connect the area to the adjacent expressway, Manhattan, and Westchester County. This is according to The New York City Economic Development Corporation (NYCEDC).
Asthma has been and remains a prevalent problem for many residents of the Bronx, New York City and the state. Asthma imposes, proportionally, a large burden on New York’s healthcare system and affects numerous Bronx residents, especially its children. Thus, the importance of asthma prevention and management cannot be stressed enough. Mere treatment of acute asthma events and its symptoms, while important for those necessary times when asthma puts lives at risk, is not taking the proper holistic approach to the issue. Therefore, intervention, prevention and management are better tools to restrict the adverse effects of asthma as prevention leads to a better overall quality of life and leads to improvements in other areas of health such as preventing obesity.
There are a few advantages and disadvantages in these settings. Firstly, public housing provides housing options for Low-Income Families, safety and property maintenance. Many of the families that take advantage of public housing options are unable to afford other living situations. This population is diverse and may consist of senior citizens, low-income families and students attending a college or university. In fact, according to the Department of Housing and Urban Development, Development, "There are about 1.2 million families living in public housing units, handled by some 3,300 home agencies"(2017).
However, it comes with disadvantages even though public-housing has many great benefits. Some of the disadvantages are poor housing quality, mismanagement of funds and lower property value. For example, resources are stretched to more individuals, leaving less monies per individual, on the other hand, the rents may also affect the nearby community negatively. According to David Stanowski in his article entitled "The basics about public Housing" Stanowski stated "Town authorities view it as a liability because the assets required to guide public-housing much surpass the taxation that public-housing residents spend to the town plus national subsidies"(2010). There are other disadvantages in public housing. These units are generally in blighted neighborhoods and can be a magnet for criminals engaging in all sorts of illegal activity. Public Housing relies heavily on monies received from government therefore cutbacks in programs and services sometimes cause public housing units to fall into disrepair. Moreover, there is a stigma associated with public housing, which may cause those that live in NYCHA housing units to feel a sense of shame because of their living conditions. According to Blake and Kellerson exposure to smoke and mold in homes is responsible for children emergency room visit for asthma (2007).
Unfortunately, according to Lehman College Geographic Information Sciences research team, which conducted a study in the Bronx, stated “there is a definite link between asthma hospitalization and air pollution in the Bronx. The South Bronx is home to major truck routes, several expressways, more than a dozen waste-transfer stations, the busiest meat, and fish wholesale market and a junk-treatment plant”. The Bronx has one of the highest asthma hospitalization rates in the United States according to the Centers for Disease Control and Prevention.
Intervention Strategy Section
Comparison of Current City Level Interventions:
The two structural interventions we chose to compare studied improvements in physical, psychological and dietary health among children in urban communities which are key factors in the improvement of asthma-related illnesses. A haven of green space was a pilot program targeting school children between the ages of 9-15 years of age who were experiencing behavioral, emotional, and social difficulties in a city in North West England. The Children from haven of green space had monthly sessions within the timeframe of 6 months where they worked with horticulturalists and a Child and Adolescent Mental Health Service psychotherapist to design a green space. The aim of the intervention was to promote positive mental, emotional, and physical wellbeing. Qualitative and quantitative data were used to collect their data both pre and post intervention. Mental wellbeing impact assessments were used to collect qualitative data and a mental wellbeing scale was used to collect quantitative data. Mental health assessments of the 36 participants showed improvement in the children’s emotional wellbeing and self-help. However, results from wellbeing check cards showed worsening scores. Limitations included the fact this was a pilot program and the challenge of adapting evaluation methods suitable to context and age appropriateness. In conclusion the studied showed the correlation between socially interactive horticultural activities facilitated by a trained therapist and the positive emotional and well-being of a child experiencing behavioral, emotional and social challenges (Chiumento et alt., 2018).
“LA Sprouts” was also a pilot program targeting 104 children ages 9-11, predominantly Latino. 34 of the students participated in the intervention, majority were overweight, and 77 volunteered to be a part of the control group. The focus of the intervention was to use a garden-based approach to educate the children in healthy nutrition which will hopefully improve on their nutrition habits. The impact on behavior associated with dietary intake and psychosocial factors was studied as well. This is similar to the psychosocial impact of gardens on children studied in the haven of green space intervention. Quantitative date was collected 1 week before and 1 week after the intervention in the form of a questionnaire pertaining to their demographic, habits and interest, motivation for healthy eating, and school performance. Interactive cooking and nutritional information were taught during 90-minute sessions for 12 weeks. Results of the study showed participants preferred fruits and vegetables (F/V) from the garden as opposed to those sold in grocery stores. Participants felt self-sufficient as a result of the cooking classes and preference to F/V led to weight loss. Participants preferred to eat fruits and vegetables as opposed to the control group. Psychosocial impact could not be fully studied due to small sample group. Limitations included the fact this was a pilot program and study was limited due to the small number of participants. Focus on Latino youth limit generalizability to other groups and the questioners needed to be evaluated more thoroughly. In conclusion, programs in an in garden based setting may lead to an increase influence in cooking with and eating more fresh fruits and vegetables and promote healthy eating habits (Gatto et alt, 2012).
Recommendation section:
Recognizing the significantly high asthma rates in the Bronx, specifically in low income communities, we have decided to introduce a Green Roof Intervention. Environmental factors are key contributors to high asthma rates within urban communities. Exposure to traffic related air pollutants, fungal spores, and pollen have shown to exacerbate asthma related symptoms (Lambert, et al., 2017). In addition to environmental factors poor dietary practices can be prevalent in asthma related symptoms. Green Roofs can help alleviate the problem cities create by, “bringing air filtration properties that vegetated landscapes provide to the urban environment” (Benefits and Challenges of Green Roofs, 2011). Studies have shown that fresh fruits, vegetable and fish were associated with a lower prevalence of wheeze amongst asthma patients. Diets high in fruits and vegetables help promote anti-inflammatory properties while diets that are high in sodium and processed foods promote pro-inflammatory properties. Consumption of fresh fruits and vegetables are also associated with lowering airway inflammation and reducing neutrophils (a type of white blood cell) in asthmatics (Guilleminault et al., 2017). Stress has also been linked to asthma. Children from lower socioeconomic statuses experienced such stressors as chronic family stress, chronic home stress, and threat interpretations. This showed a significant connection to socioeconomic status and eosinophil count associated with asthma (Chen et alt., 2006). Green Roofs help improve air quality, promote urban agriculture, and improve on the aesthetics and quality of life within an urban community (Benefits and Challenges of Green Roofs, 2011). A haven for green space and LA Sprouts aided in our research of how community gardens increased physical activity and psychological stress relief and increase access to fresh fruits and vegetables, all aiding in factors that have proven to improve on asthma and respiratory illnesses (Buenemann, 2017). Although community gardens have been shown to benefit urban communities in ways that promote public health, we chose to install Green Roofs due to minimal fertile land available within NYCHA housing.
Our target population will be children living in the NYCHA Webster Houses between the ages of 0-17 years old. Our control group will be children between the ages of 0-17 living in the NYCHA Gun Hill houses. We plan on building an Extensive Green Roof which is relatively inexpensive to install and may not need irrigation (Benefits and Challenges of Green Roofs, 2011). We plan on reaching out to the public sector and developing a private/public partnership in order to acquire the funding for our intervention. The children will participate in the installation of the Green Roof. We believe this will give them a sense of ownership and pride and will play a large role in the acceptance of this intervention within the community. We also believe this will encourage community building and promote friendships amongst the children aiding in their psychosocial health as discussed in the haven of green space intervention. Fruits and fresh vegetation will be planted once the Green Roof has been installed. As a continued benefit of the Green Roofs, the fruits and vegetables will be offered free of charge to the residents of the Webster Houses. In the event there is produce left over, we plan on collaborating with Grow NYC to create an opportunity for the community to purchase Fresh Food Boxes. Fresh Food Boxes offer fresh produce at a noticeably lower cost, they also accept SNAP/EBT and Health Bucks (How Fresh Food Box Works, 2018). We hope this will promote healthy dietary habits that will result in a high preference for fresh fruits and vegetables as discussed in the LA Sprouts intervention.
Measures:
We used a quantitative method to collect our date in the form of a questionnaire. The questionnaire was distributed to 250 residents who had children within the ages of 0-17 years of age. The questions were as follows: Has your child been diagnosed with asthma within the last 12 months? If so, has your child had an asthma attack or visited an ER for an attack in the last 12 months? Has your child been prescribed asthma medication within the last 12 months? Has your child missed school within the past 12 months due to an asthma attack or asthma related illness?
Anticipated Results:
We wish to study our chosen population for two years. Within the first six months of our intervention, we anticipate lower ER visits for the majority of our participants and a decrease in asthma related absences from school. We also anticipate a decrease in asthma medication prescriptions. Within a year we anticipate seeing a significant decrease in childhood asthma related illnesses.
Results Meaning:
Asthmatic children living in Webster Houses with Green Roofs were less likely to experience asthma symptoms, asthma attacks, ER visits due to asthma related illness, and asthma-related absences from school. Results reflect that being exposed to green spaces can improve on one’s overall health by improving on air quality, access to fresh fruits and vegetables, which offer anti-inflammatory properties, also improve on a child’s mental wellbeing and stress management; stress has been known to exacerbate asthma related illnesses. Asthma contributes to $56 billion in healthcare and societal cost in this country (Colton et al., 2015). Incorporation of Green Roofs within NYCHA will greatly reduce this cost.
Limitations:
We did not find information on current interventions relating to green roofs and its direct effect on asthma related illnesses, therefore the success of our intervention is speculative. Green Roofs cost more to install than traditional black or tar roofs, they also cost more to maintain (Benefits and Challenges of Green Roofs, 2011). More time may be needed to observe the children of the Webster Houses. In addition, pesticides and certain plants may cause additional allergies to the children. This must be considered when caring for and planting certain flowers, fruits and vegetables.
Smoking Cessation Intervention Strategy Section
The New York City Department of Health and Mental Hygiene’s Tobacco Control Program, implemented in 2002 sought out to help in the area of public health. This strategy was to decrease smoking among city residents, which would also reduce the exposure of secondhand smoke to the urban population. This is expected to be accomplished with five components: taxation, legislation, cessation, public education and evaluation. Taxation was used by increasing the excise tax on cigarettes to deter individuals from purchasing them. Legislation was using by the implementation of the Smoke-Free Air Act (SFAA) of 2002. This made all workplaces, restaurants, and bars smoke free areas. Cessation was rolled out in 2003 with the distribution of nicotine replacement therapy (NRT) to assist New Yorkers with quitting smoking. The public was educated by testimonial advertisements done by dying or severely sick smokers. The Health Department also aired striking and vivid anti-smoking educational ads showing the physical health risks of smoking. The public evaluations were done by an annual Community Health Survey, (by phone; 10,000 adults) and a bi-annual Youth Risk Behavior Survey, (written survey; 5,000 high school students). According to (NYC.gov, 2011), the five-point plan resulted in adult smoking down 27% since 2002 and youth smoking down 64% in the past twelve years. This strategy would serve well in our targeted area of Gun Hill and Webster Houses. The implementation of the strategy was successful and we anticipate similar results to assist the residence with their smoking habits.
Smoke Related Issues
With such a dense population the urban community in the Gun Hill and Webster Houses areas, residence experience the unfortunate affects that smoking causes. According to the World Health Organization (2011), smoking can cause serious health problems for the urban New York City population. Smoking causes strokes, cardiovascular disease, lung disease and a number of other chronic illnesses. The WHO (2011), went on to say that most smokers truly do not realize the harmful dangers that exist, attributable to smoking and half of those smokers will die as a result of smoke-related illnesses. They provided a gender breakdown as well as a total yearly death toll based on smoke related diseases. Those figures were (CDC, 2011), approximately 443,000 annual deaths. Within those annual deaths 269,655 were men and 173,940 were women. Our team’s direction aims to change those avoidable deaths with our health focused initiatives.
According to the New York City government website (2008), an effort by Major Michael R. Bloomberg was also made on May 28, 2008 – “NYC Quit Day.” The campaign tried to motivate individuals to quit smoking without threats of pending diseases or illnesses. This intervention honed in on what smokers could gain by redirecting funds that were used for smoking to other desirable amenities. We will use the similar campaign of smoking cessation for Bronx residents. NYC.gov (2008) had a focus to engage smokers in a manner that would peak their interest in wanting to quit smoking. The notion of presenting what a smoker is missing out on due to spending money on cigarettes was venerated. Otherwise called creating a fear of missing out. This intervention would take on a smoker’s habit psychologically. The goal would be to assist the residence in the targeted area with choosing healthier lifestyle choices that would benefit the community as a whole.
Recommendations Section
The problem of smoking has been identified and a number of preventative methods have been established to decrease the crisis. The interventions of having green rooftops will enhance the overall quality of the air in the Gun Hill and Webster Houses. The likely results would be decreased rates of smoke related illnesses, which would be a direct result of the effectiveness of smoking cessation initiatives. The interventions of smoking cessation coupled with providing smoke free centered education, access, and resources to smokers and non-smokers will make the difference.
The decrease in the number of smokers in the urban community and better quality of the air in our targeted neighborhoods create an improvement in the overall health of the Bronx urban population. The Centers for Disease Control and Prevention (2005) produces these findings: there was a reduction from 21.6% to 19.2% (approximately 140,000 fewer smokers) in NYC smokers due to the laws, and initiatives taken toward prevention. Since it is better to prevent than to cure, preventative methods to smoking will produce a community that is healthier and free from smoke related diseases. Smoking cessation intervention will produce better air quality for Bronx Residents. Empowering residences of the Bronx that care and are willing to take the necessary actions to keep their community thriving for optimal health is our goal. We will use proven methods that produced empirical results.
Initiative Results
The policies and initiatives taken to deter smoking were implemented to foster better health and lifestyle choices for the community. The decline in smokers that are educated and supported produced tangible quantitative data. The largest network of hospitals in the US, Health and Hospitals Corporation (HHC) produced facts to give smokers reasons to change the smoking habit. The cost of funding the smoking habit with real figures that are monthly and yearly created an eye-opening reality to smokers. Harlem Hospital, part of HHC has a successful Quit Smoking Clinic. They network with banks to promote and inform smokers at tables in the banks to quit. Based on HHC statistics many smokers are getting the assistance they need to quit. “Over the past three years, we have helped more than 25,000 patients to quit smoking successfully” said HHC former President and CEO Alan D. Aviles. “Research suggests that at least one third of these patients, or about 8,000 former smokers, will avoid smoking-related disease and premature death as a result.” With these types of proven results, the Bronx population is expected to have residence that are healthier. Those residence will have less smoke related illnesses as well as less deaths caused by smoking or secondhand smoke exposure.
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