The Future of Health in NYC: Combating Obesity, HIV/AIDS, and Smoking
By Abraham Chabbott, Fradah Gold, Fred Gong, Anna Gugeshashvili
The great medical leaders like Hippocrates, Pasteur, and Jenner have left their marks by using knowledge of past medical findings combined with insights into the future to renovate healthcare into the image it holds today. We, as young leaders, can take the unspoken advice from these healers of the past and use them to improve our current society. Obesity, HIV, and smoking have plagued our society for decades. Halting these health problems will improve individual lives as well as our city as a whole. With the understanding of these diseases at its core and continued government and resident efforts, we can raise awareness for the consequences of obesity, HIV, and smoking, and craft innovative plans to curb these issues for future generations.
The Obesity Epidemic
In New York City, obesity is epidemic: more than half of adult New Yorkers are either overweight (34%) or obese (22%). Statistics show that obesity begins early in life: nearly half of all elementary school children and Head Start children are not a healthy weight. In New York City, one in five kindergarten students, and one in four Head Start children, is obese.[1] Obesity is a medical condition that is characterized by general excessive body fat and a body mass index (BMI) of over 30. Beyond superficial concern and societal stigmatization, obesity places an individual at risk for many other health problems, including Type II diabetes, heart disease, arthritis, depression, and cancer.[2]
Society-Based Explanations
- Meal content: A traditional American meal consists of red meat, refined grains, unhealthy fats, and sugary drinks, with few fruits, vegetables, whole grains, and nuts.
- Meal size: The average restaurant meal is now four times larger than it was in the 1950s, with sugary drinks increasing the most (from 7 ounces on average in the 1950s to 42 ounces on average today).
- Lifestyle: New York City provides a very fast-paced, high convenience, and instant gratification lifestyle. An abundance of New Yorkers find it difficult to stay healthy because of the:
Biological Explanations
The body’s regulation of food consumption is a highly complex biological system. At its basics, our bodies try to maintain balance (homeostasis) in all areas.
- When you eat, signals tell the brain that you are full and to cease eating. In some people, these signals do not function properly.
- Another system, the reward system, promotes food intake. The sight or smell of appealing food may trigger a desire to eat, even when you are not hungry.[5] Also, people have an unconscious drive to eat whatever comes in their vicinity as a form of survival, regardless of portion size and nutritional value.[6]
- Once you start losing weight, lowered blood sugar levels and other factors play a role in magnifying the body’s appetite, making it more difficult to maintain the weight Recent studies have shown that obese individuals possess less ability to resist food cues.[7]
Overview of the Solutions to the Obesity Epidemic
The most important thing cities can do is foster communities that support healthy eating and active living.[8] Solutions include:
- Increase the consumption of fruits and vegetables; decrease the consumption of sweetened beverages, nutrient poor foods, portion sizes, and the number of non-homemade meals.
- Reduce stress and increase sleep in daily life.
- Decrease daily “screen time” on computers, phones, television, etc.
- Decrease the marketing of unhealthy foods that specifically target children, and increase promotions of the adverse impacts of junk food and/or the value of healthier items.
- Create more biking facilities, promote exercise programs in parks, and develop open spaces for physical recreation.
- Open farmers markets, increase access to supermarkets, and discourage unhealthy food retailers in public venues, especially densely packed together in a given area.[9]
What Local Governments Can Do
Local governments can be an important part of the solution. Policies that affect people’s health are determined by a variety of local government entities such as school districts, zoning boards, and city planning departments. In New York City, the Board of Health plays a key role.
- Zoning boards and planning departments can create more biking facilities, mixed use developments, and safe public areas for physical activity.
- Local community officials and leaders can:
- establish joint use agreements with school districts to open up school recreation facilities and resources for public use.[10]
- improve access to outdoor recreational facilities, enhance infrastructure supporting biking and walking.
- improve public safety for physical activity by reducing traffic in areas where people are likely to be physically active.
- Public schools can open up their gymnasiums, swimming pools, athletic fields, and tennis courts to the public during after-school hours, weekends, and non-school days.
- The New York City Department of Education can:
- require physical education for students and increase the amount of physical activity required in these programs.
- provide more opportunities for exercise by increasing the number and availability of physical extracurricular activities.
City governments need to foster communities that support healthy eating and active living. Leaders and residents need to partner with agencies, businesses, and schools to raise a community that not only reduces obesity now but also paves the way to healthier lifestyles for future generations. Government officials and community residents need to understand that their short-term goals can become long-term plans for the future.
What the Board of Health Can Do
- Ban trans fats, limit sodium usage, and reduce soda consumption, enforcing warning labels and age-restrictions on these items (as currently done on cigarette packaging).[11]
- Implement clearer calorie displays[12] across all restaurants (not just fast-food chains) and supermarkets, holding restaurants accountable for designing healthier meals.[13]
- Increase the availability of low-fat or nonfat milk for children, make water readily obtainable throughout the day for everyone in day care facilities and schools, and place limits on beverages served in licensed day care facilities and public venues.
What Marketing Companies Can Do
Unhealthy food items have become advertised more across multiple platforms, including television commercials, in-movie priming, and short messages on websites. Marketing companies can:
- Use media marketing to increase the promotion of healthy options instead of junk food[14], especially to children watching television shows and playing video games. In 2006, food, beverage, and quick-serve restaurant companies spent more than $1.6 billion to promote their products to young people.
- Increase counter-advertising, including pop-up advertisements[15], that display cautionary messages for unhealthy lifestyles, since anti-smoking advertisements of this kind have been found to reduce smoking in New York City.[16]
- Alter impulse marketing, replacing candy and chips with fruits and vegetables near registers.[17]
Increase Funding
As in other sectors, funding plays a major role in the reduction of the obesity epidemic, so ways to increase funding include:
- Remove the current tax treatment of junk food advertising as a business expense that the government subsidizes, reallocating these newly made available funds to other programs[18] (ex: “HealthBucks” that currently give NYC residents the chance to buy fresh fruit and vegetables at farmers’ markets).
- Tax sugary beverages to influence residents to cut down in consumption of such items and use this tax to fund other public health programs, such as the Department of Transportation’s “Urban Cycling” initiative that is creating 250 bike lanes across the city.[19]
Promote Physical Activity
In addition to an improper diet, physical inactivity, a societal factor, is another major cause of obesity.
- Make bicycle rentals available throughout New York City[20], collecting donated bikes in addition to the Citi Bike program to make this option accessible to a greater range of people.
- Develop exercise programs in public parks, and increase worksite moving initiatives to get more people to experience physical activity while having sedentary jobs (exercise breaks, walking paths, or on-site gyms).[21]
- Encourage entertainment venues and broadcasting stations to introduce short exercise breaks, as people need reminders and cues to get up and move.[22]
Change Psychological Influences and Lifestyles
Unlike other epidemics that can be eradicated by a vaccine, obesity reduction and prevention requires lifestyle and behavioral changes.
- Promote supermarket systems that give people a few points for every purchase of a healthy food item (determined by calorie, saturated fat, cholesterol, sodium, and sugar content), allowing those points to be redeemed for free fruit/vegetables and healthy snacks.
- Stores should help customers choose healthier options by tracking which locations lead to greater sales and placing the healthier items there, using the limitation of human nature to buy the first things we see as an advantage for improving diets.[23]
- Restaurants can offer night or weekend cooking classes to encourage more residents to cook their own meals, reducing take-out expenditures and also choosing better ingredients. Additionally, business and restaurant owners can offer a “happy hour” for healthy food choices, a “healthy hour” if you will.
Currently, the New York State Department of Health projects that obesity may soon become the leading cause of premature death and will result in a shorter life expectancy by up to fourteen years.[24] As a result, it is imperative to generate a stronger battle against obesity in New York City, altering current legislation to work towards improving the health of all New York City residents and upcoming generations.
Hindering HIV/AIDS Transmission
Battling Stigma Through High School Education
Many people who are considered high-risk for contracting the Human Immunodeficiency Virus (HIV) are personally discouraged from being tested. They fear being discriminated against if their results are positive.[25] “In 35% of countries with available data, over 50% of men and women report having discriminatory attitudes towards people living with HIV”.[26] Even if the patient does not disclose a positive status to others, he or she may develop an internal stigma towards having the virus. Sexual education teachers are expected to prevent discrimination and stigma within their classes by teaching their students accurate information.[27]
Although the city mandates middle and high schools to teach sexual education to students, city officials claim that many schools do not abide to this law.[28] Consequently, the stigma of having HIV is not being removed from the minds of adolescents and, thus, potentially becomes the reason students do not get tested. Organizations, such as the “Women’s City Club of New York”, are in support of a law that would require tracking and evaluating sexual education in New York public schools.[29] This law would be an adequate tool for ensuring that the public schools are teaching sexual education that is both appropriate and effective:
- Encourage the Department of Education to pass a law requiring city representatives to attend lessons in public schools across the city.
- Have the lessons evaluated to see if the school is adhering to the mandate.
- If it has been decided that the lessons are not up to par, penalize the school and have the school evaluated again in a month.
How The Pornography Industry Can Support Safe Sex
In 2016, “Pornhub,” a popular pornography website, had over 23 billion visits. The United States accounted for 40% of those visits.[30] Given that there are countless other websites for pornography, the amount of pornography being viewed is inevitably much higher. A study conducted at Columbia University’s Mailman School of Public Health demonstrates that men who have sex with men (MSM) and watch pornography featuring condom use are more likely to use a condom in their own sexual endeavors.[31] Many of the viewers are under the age of 18 and are very impressionable. As a large amount of underage viewers do not have personal experience, internet pornography unintentionally molds their views about appropriate sexual behavior. Measure B, also known as the County of Los Angeles Safer Sex in the Adult Film Industry Act, requires, by law, that actors in Los Angeles County, California performing in pornographic productions wear condoms when engaging in vaginal or anal sex. Originally, Measure B was meant to protect the performers in these productions from sexually transmitted diseases and infections, such as HIV.[32] Passing a law similar to Measure B in New York City can:
- Make condom use more acceptable among the productions’ viewers.
- Prevent the transmission of infections among the performers in the porn industry.
- Protect NYC tax dollars from going to treatment for cases of HIV that could be prevented.
Database of Preferred Contact Information
Partner Services is a free program provided by New York State that helps notify people about a past sexual partner who has been diagnosed with HIV without releasing any information about the patient. This is a great approach for informing sexual partners that they are at risk and should be tested.[33] Unfortunately, it presents the problem of changed phone numbers and addresses. A voluntary database that is updated whenever there is a change in contact information can ensure that all parties will be informed before the infection of anybody else.
- Doctors can ask patients if they would like to enter their contact information in the database.
- If the patient agrees, he or she can be given login information to the database and update it as needed.
The Smoking Crisis
Enforcement
Legal enforcement of smoking laws has been poor in New York City. Despite initiatives set up to decrease smoking in public areas, they are usually unenforced, rendering them useless. To make use of the proactive anti-smoking laws established in the city, police officers must be trained to strictly enforce them.
- Smokers are a price sensitive population[34], therefore, heavily fining for violations will discourage many smokers from smoking and violating laws.
- 50% of New York cigarettes are smuggled[35], defeating the purpose of implementing the highest cigarette tax rates in the country.
- Tightening enforcement on smuggled cigarettes will high taxation to make its full impact on price-sensitive smokers.
Creative Commons, Flickr
- Tightening enforcement on smuggled cigarettes will high taxation to make its full impact on price-sensitive smokers.
- Only 440 summonses were issued from 2011 to 2014 under Mayor Bloomberg’s ban of smoking in parks.[36]
- In 2016, the federal government banned smoking in public housing.[37]
- The measure will be wasted in New York City if it is as rarely enforced as the ban on smoking in parks.
- Littering of cigarette butts is a daily occurrence that is never regulated.
- To solve the issue of littering, legislation must treat disposal of cigarette butts with the same severity as littering of garbage. Government must fine littering heavily to discourage both smoking and littering.
Media
Media campaigns to halt smoking have been very successful. In 2013, the CDC’s anti-smoking ad campaign influenced 100,000 to quit smoking and 1.6 million to attempt to quit smoking.[38] In addition, one-third of former smokers cite anti-smoking ads as the reason they stopped.[39]
- Given the overwhelming evidence that anti-smoking ads are a success, more money needs to be put into these campaigns in New York City.
- Media should target the smoking population.
- 70% of smokers wish to quit, but only 2% of them actually quit.[40] The gap in the two numbers shows that those wishing to change must receive the appropriate support, either in the form of nicotine patches or therapy.
- Demographic-targeted advertising must be an additional priority.
- A disproportionate number of smokers are uneducated and poor[41], therefore advertising must target the population that is most vulnerable to the habit.
- Smoking is a symptom of the larger disease of unequal education in America. The poor and uneducated must be better educated on the negatives of smoking through specific population-targeted advertising.
Location
The location of cigarette vendors must be regulated in order to help the anti-smoking cause. Poorer districts have three times the amount of cigarette vendors per 1000 people than do the rich districts in New York City, exemplifying the demographic disparity among smokers.[42] Furthermore, children must be a priority when combating second-hand smoke and negative influence on the youth.
- There should be a limit on the number of cigarette vendors per community district so that the poor are not targeted for cigarette sales. Limiting the vendors in poorer neighborhoods will make smoking less convenient and discourage it.
- Schools must be a safe-zone against smoking.
- Cigarette vendors must be restricted from a 300 feet radius from all schools to discourage smoking in the youth population.
- Smoking within 50 feet from a school will result in a severe fine because it introduces harmful second-hand and sidestream smoke to students.
Mayor
Former Mayor Bloomberg put in much more money and effort to decrease the smoking rate by almost 20% during his first four years in office.[43] The hard work will be negated unless the government and society make a pact to fight smoking by increasing funding for the anti-smoking movement, initiating new smoking bans, and enforcing current ones.
- Historic relevance: in the 1960s, tuberculosis was seen as a problem that had been solved, so funding and resources were significantly reduced, leading to a revival of the deadly disease in the 1990s.[44] Therefore, attention and money for the anti-smoking agenda cannot be cut off because we have already witnessed the negatives of stopping an effort just short of the end goal. Anti-smoking campaigns must receive the necessary funds and anti-smoking laws must be enforced so smoking does not become an epidemic once again.
- April 29, 2017: Mayor de Blasio has proposed an initiative to raise the minimum cigarette pack price to $13.[45] This is a huge step in the right direction because cigarette smokers are price sensitive so raising the cigarette price drastically will discourage many to stop smoking.
Closing Statement
Awareness is the first step toward a brighter future. Through education, New Yorkers will understand the past and present crises that surround their society. Informing youth of healthy lifestyle habits is imperative for the next generation following in their footsteps, thereby slowly building populations that lack problems of their ancestors. Through law enforcement, resident involvement, and the enactment of new policies, New York City will progress towards the eradication of a variety of health problems. The city’s efforts can eliminate the popularization of smoking, decrease HIV contraction, and lower the obesity rate. With increased efforts by the New York City government and its residents, future health crises may be averted by adopting the aforementioned suggestions.
[1] “Understanding the American Obesity Epidemic”, American Heart Association, March 9, 2016, http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/U nderstanding-the-American-Obesity-Epidemic_UCM_461650_Article.jsp#.WKSIeLYrJ- V.
[2] “Obesity Prevention,” Department of Health, January 2017, accessed February 15, 2017, https://www.health.ny.gov/prevention/obesity/.
[3] Michael J. Gonzalez-Campoy, “Obesity in America: A Growing Concern”, EndocrineWeb,
April 14, 2016), https://www.endocrineweb.com/conditions/obesity/obesity-america growing-concern.
[4] Deborah A. Cohen, Cohen, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic
and How We Can End It, (Nation Books, 2013), 93-95. E-Book.
[5] Gonzalez-Campoy, “Obesity in America: A Growing Concern”.
[6] Cohen, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic and How We Can End It, 83-87. E-Book.
[7] Gonzalez-Campoy, “Obesity in America: A Growing Concern”.
[8] Laura Khan, PhD, Kathleen Sobush, MS, Dana Keener, PhD, Kenneth Goodman, MA, Amy Lowry, MPA, Jakub Kakietek, MPH, and Susan Zaro, Recommended Community Strategies and Measurements to Prevent Obesity in the United States.
[9] Cohen, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic and How We Can End It, 105. E-Book.
[10] Center for Disease Control. Recommended Community Strategies and Measurements to Prevent Obesity in the United States.
[11] Tom Farley, Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives, (New York City: W.W. Norton & Company, 2015), 39-53, 67-91, 101- 130, 203-218.
[12] “Supersize the Label: The Effect of Prominent Calorie Labeling on Sales,” Nutrition (Burbank, Los Angeles County, Calif.), December 7, 2016, Accessed March 5, 2017, https://www.ncbi.nlm.nih.gov/pubmed/28241977.
[13] Tom Farley, Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives, (New York City: W.W. Norton & Company, 2015), 39-53.
[14] Jennifer L. Harris, “The Relationship between Television Viewing and Unhealthy Eating:
Implications for Children and Media Interventions,” Health Communication, October
2009, accessed March 05, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829711/.
[15] Juli Durante, “Do Pop-up Ads Actually Work? Here’s the Data You Need,” Inbound Marketing Agency, June 10, 2016, accessed March 10, 2017, https://www.smartbugmedia.com/blog/do-pop-up-ads-actually-work-heres-the-data-you- need.
[16] “Frequently Asked Questions About the Tips Campaign,” Centers for Disease Control and Prevention, May 13, 2016, accessed March 10, 2017, https://www.cdc.gov/tobacco/campaign/tips/about/faq.html.
[17] Cohen, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic and How We Can End It, 105-106. E-Book.
[18] Kendrin R. Sonneville, “BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth,” Choices Project, July 2015, accessed March 4, 2017.
[19] “Reversing the Epidemic: The New York City Task Force Plan to Prevent and Control Obesity,” NYC.GOV, May 31, 2012, accessed February 16, 2017, http://www.nyc.gov/html/om/pdf/2012/otf_report.pdf.
[20] “Citi Bike: Unlock a Bike, Unlock New York,” Citi Bike NYC, accessed March 5, 2017, https://member.citibikenyc.com/map/.
[21] “Worksite Obesity Prevention Recommendations: Complete List,” Obesity Prevention, April 13, 2016, accessed March 9, 2017, https://www.hsph.harvard.edu/obesity- prevention-source/obesity-prevention/worksites/worksites-obesity-prevention- recommendations-complete-list/#ref8.
[22] Cohen, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic and How We Can
End It, 206-207. E-Book.
[23] Cohen, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic and How We Can
End It, 181. E-Book.
[24] “NIH Study Finds Extreme Obesity May Shorten Life Expectancy up to 14 years,” National Institutes of Health, July 18, 2015, accessed February 17, 2017, https://www.nih.gov/news-events/news-releases/nih-study-finds-extreme-obesity-may- shorten-life-expectancy-14-years.
[25] Chandler Burr, “The AIDS Exception: Privacy vs. Public Health,” The Atlantic, June 01,
1997, accessed March 30, 2017,
https://www.theatlantic.com/magazine/archive/1997/06/the-aids-exception-privacy-vs-
public-health/308779/.
[26] “On the Fast-Track to end AIDS by 2030: Focus on Location and Population,” UNAIDS,
accessed March 28, 2017,
http://www.unaids.org/en/resources/documents/2015/FocusLocationPopulation.
[27] Bruce Berg, Healing Gotham: New York City’s Public Health Policies for the Twenty-First
Century, (Baltimore, Johns Hopkins University Press, 2015), 109-161.
[28] Ben Chapman, “Melissa Mark-Viverito Urges City To Probe Sex Ed at City Schools,” NY
Daily News, April 20, 2017, accessed April 29, 2017, http://www.nydailynews.com/new-york/education/
melissa-mark-viverito-urges-city-probe-sex-ed-city-schools-article-1.3077359.
[29] “City Not Enforcing Sex Ed Mandate,” TWC News, June 11, 2015, accessed April 29, 2017,
http://www.ny1.com/nyc/all-boroughs/news/2015/06/11/health-advocates-question-
whether-city-schools-following-mandate-to-teach-sex-ed.html.
[30] “Pornhub’s 2016 Year in Review,” Pornhub Insights, February 02, 2017, Accessed April 02,
2017, https://www.pornhub.com/insights/2016-year-in-review.
[31] EW Schrimshaw, Antebi-Gruszka, MJ Downing Jr, Viewing of Internet-Based Sexually
Explicit Media as a Risk Factor for Condomless Anal Sex among Men Who Have Sex
with Men in Four U.S. Cities, 2016, PLoS ONE 11(4): e0154439.
doi:10.1371/journal.pone.0154439
[32] “MEASURE B,” YES ON B, Accessed March 27, 2017, http://www.yesonb.info/measure-b.
[33] “Department of Health,” Partner Services is HIV/STD Prevention, Accessed March 29,
2017, https://www.health.ny.gov/diseases/communicable/std/partner_services/prevention
[34] James Keith Colgrove, Epidemic City: the Politics of Public Health in New York, (New
York: Russell Sage Foundation, 2011), 241. E-Book.
[35] John Aidan Byrne, “Why New York’s High Tobacco Taxes Cost the State Billions,” New York
Post, January 30, 2017, accessed March 14, 2017, http://nypost.com/2017/01/29/new-
yorks-high-tobacco-taxes-are-costing-the-state-billions/.
[36] Ben Miller, “NYC Parks Smoking Ban Barely Enforced,” Gothamist, April 21, 2014,
accessed February 26, 2017,
http://gothamist.com/2014/04/21/nyc_parks_smoking_ban_oddlybarely_e.php.
[37] Mireya Navarro, “U.S. Will Ban Smoking in Public Housing Nationwide,” The New York
Times, November 30, 2016, accessed February 26, 2017,
https://www.nytimes.com/2016/11/30/nyregion/us-will-ban-smoking-in-public-housing-nationwide.html.
[38] Susan M. Liss, “Campaign for Tobacco-Free Kids,” Campaign for Tobacco-Free Kids,
September 9, 2013, accessed April 03, 2017,
http://www.tobaccofreekids.org/press_releases/post/2013_09_09_cdc.
[39] Jeff Niederdeppe, Michael C. Fiore, Timothy B. Baker, and Stevens S. Smith, “Smoking-
Cessation Media Campaigns and Their Effectiveness Among Socioeconomically
Advantaged and Disadvantaged Populations,” American Journal of Public Health, May
2008, accessed April 03, 2017,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374829/.
[40] David B. Samadi, “Beijing Takes Extreme Measures to Ban Smoking, Should NYC Do the
Same?,” Observer, June 09, 2015, Accessed March 14, 2017, http://observer.com/2015/06/beijing-takes-extreme-measures-to-ban-smoking-should-nyc-do-the-same.
[41] “New NYC Smoking Data Should Be Wake Up Call for Policy Makers.” NYC Smoke Free
at Public Health Solutions, September 16, 2015, accessed March 14, 2017.
http://nycsmokefree.org/article/new-nyc-smoking-data-should-be-wake-call-policy-makers.
[42] William, Neuman, “Once a Leading Foe of Tobacco, New York Lags Under de Blasio,” The New
York Times, January 22, 2017, Accessed March 14, 2017,
https://www.nytimes.com/2017/01/22/nyregion/once-a-leading-foe-of-tobacco-new-york-
lags-under-de-blasio.html.
[43] James Keith Colgrove, Epidemic City: the Politics of Public Health in New York (New York:
Russell Sage Foundation, 2011), 246.
[44] James Keith Colgrove, Epidemic City: the Politics of Public Health in New York (New York: Russell Sage
Foundation, 2011), 180.
[45] William Neuman, “De Blasio Backs Plan to Lift Base Price of Pack of Cigarette to $13,” The
New York Times, April 19, 2017, accessed April 30, 2017,
https://www.nytimes.com/2017/04/19/nyregion/de-blasio-smoking-new-york-city-tobacco.html?_r=0.
References
American Heart Association, “Understanding the American Obesity Epidemic” (9 Mar 2016), http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Understanding-the-American-Obesity-Epidemic_UCM_461650_Article.jsp#.WKSIeLYrJ-V.
Berg, Bruce. Healing Gotham: New York City’s Public Health Policies for the Twenty-First Century. Baltimore: Johns Hopkins University Press, 2015.
Burr, Chandler. “The AIDS Exception: Privacy vs. Public Health.” The Atlantic. June 01, 1997. Accessed March 30, 2017. https://www.theatlantic.com/magazine/archive/1997/06/the-aids-exception-privacy-vs-public-health/308779/.
Byrne, John Aidan. “Why New York’s high tobacco taxes cost the state billions.” New York Post. January 30, 2017. Accessed March 14, 2017. http://nypost.com/2017/01/29/new-yorks-high-tobacco-taxes-are-costing-the-state-billions/.
Center for Disease Control. Recommended Community Strategies and Measurements to Prevent Obesity in the United States.
Citi Bike: Unlock a Bike, Unlock New York.” Citi Bike NYC. Accessed March 5, 2017. https://member.citibikenyc.com/map/.
Cohen, Deborah A. A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic and How We Can End It. Nation Books, 2013. E-Book.
Colgrove, James Keith. Epidemic City: The Politics of Public Health in New York. New York, NY: Russell Sage Foundation, 2011.
“Department of Health.” Partner Services is HIV/STD Prevention. Accessed March 29, 2017. https://www.health.ny.gov/diseases/communicable/std/partner_services/prevention.htm#privacy.
Durante, Juli. “Do Pop-up Ads Actually Work? Here’s the Data You Need.” Inbound Marketing Agency. June 10, 2016. Accessed March 10, 2017. https://www.smartbugmedia.com/blog/do-pop-up-ads-actually-work-heres-the-data-you-need.
Farley, Tom. Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives. New York City: W.W. Norton & Company, 2015.
“Frequently Asked Questions About the Tips Campaign.” Centers for Disease Control and Prevention. May 13, 2016. Accessed March 10, 2017. https://www.cdc.gov/tobacco/campaign/tips/about/faq.html.
Gonzalez-Campoy, Michael J. “Obesity in America: A Growing Concern”. (EndocrineWeb, 14 Apr. 2016), https://www.endocrineweb.com/conditions/obesity/obesity-america-growing-concern.
Harris, Jennifer L., John A. Bargh et al. “The Relationship between Television Viewing and Unhealthy Eating: Implications for Children and Media Interventions.” Health communication. October 2009. Accessed March 05, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829711/.
Laura Khan, PhD, Kathleen Sobush, MS, Dana Keener, PhD, Kenneth Goodman, MA, Amy Lowry, MPA, Jakub Kakietek, MPH, and Susan Zaro, Recommended Community Strategies and Measurements to Prevent Obesity in the United States.
Liss, Susan M. “Campaign for Tobacco-Free Kids.” Campaign for Tobacco-Free Kids. September 9, 2013. Accessed April 03, 2017. http://www.tobaccofreekids.org/press_releases/post/2013_09_09_cdc.
“MEASURE B.” MEASURE B. Accessed March 27, 2017. https://web.archive.org/web/20121102171328/http://www.yesonb.info/measure-b.
Miller, Ben. “NYC Parks Smoking Ban Barely Enforced.” Gothamist. April 21, 2014. Accessed February 26, 2017. http://gothamist.com/2014/04/21/nyc_parks_smoking_ban_oddlybarely_e.php.
Navarro, Mireya. “U.S. Will Ban Smoking in Public Housing Nationwide.” The New York Times. November 30, 2016. Accessed February 26, 2017. https://www.nytimes.com/2016/11/30/nyregion/us-will-ban-smoking-in-public-housing-nationwide.html.
Neuman, William. “De Blasio Backs Plan to Lift Base Price of Pack of Cigarette to $13.” The New York Times. April 19, 2017. Accessed April 30, 2017, https://www.nytimes.com/2017/04/19/nyregion/de-blasio-smoking-new-york-city-tobacco.html?_r=0.
Neuman, William. “Once a Leading Foe of Tobacco, New York Lags Under de Blasio.” The New York Times. January 22, 2017. Accessed March 14, 2017. https://www.nytimes.com/2017/01/22/nyregion/once-a-leading-foe-of-tobacco-new-york-lags-under-de-blasio.html.
“New York City Population.” NYC. Accessed April 03, 2017. http://www1.nyc.gov/site/planning/data-maps/nyc-population/population-facts.page.
Niederdeppe, Jeff, Michael C. Fiore, Timothy B. Baker, and Stevens S. Smith. “Smoking-Cessation Media Campaigns and Their Effectiveness Among Socioeconomically Advantaged and Disadvantaged Populations.” American Journal of Public Health. May 2008. Accessed April 03, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374829/.
“NIH study finds extreme obesity may shorten life expectancy up to 14 years.” National Institutes of Health. July 18, 2015. Accessed February 17, 2017. https://www.nih.gov/news-events/news-releases/nih-study-finds-extreme-obesity-may-shorten-life-expectancy-14-years.
“Obesity Prevention.” Department of Health. January 2017. Accessed February 15, 2017. https://www.health.ny.gov/prevention/obesity/.
“On the Fast-Track to end AIDS by 2030: Focus on location and population.” On the Fast-Track to end AIDS by 2030: Focus on location and population | UNAIDS. Accessed March 28, 2017. http://www.unaids.org/en/resources/documents/2015/FocusLocationPopulation.
“Pornhub’s 2016 Year in Review.” Pornhub’s 2016 Year in Review – Pornhub Insights. February 02, 2017. Accessed April 02, 2017. https://www.pornhub.com/insights/2016-year-in-review.
“Reversing the Epidemic: The New York City Task Force Plan to Prevent and Control Obesity.” NYC. May 31, 2012. Accessed February 16, 2017. http://www.nyc.gov/html/om/pdf/2012/otf_report.pdf.
Samadi, David B. “Beijing Takes Extreme Measures to Ban Smoking, Should NYC Do the Same?” Observer. June 09, 2015. Accessed March 14, 2017.
http://observer.com/2015/06/beijing-takes-extreme-measures-to-ban-smoking-should-nyc-do-the-same/.
Schrimshaw EW, Antebi-Gruszka N, Downing MJ, Jr. (2016) Viewing of Internet-Based Sexually Explicit Media as a Risk Factor for Condomless Anal Sex among Men Who Have Sex with Men in Four U.S. Cities. PLoS ONE 11(4): e0154439. doi:10.1371/journal.pone.0154439
Sonneville, Kendrin R. et al. “BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth.” Choices Project. July 2015. Accessed March 4, 2017.
“Supersize the label: The effect of prominent calorie labeling on sales.” Nutrition (Burbank, Los Angeles County, Calif.). December 7, 2016. Accessed March 5, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28241977.
“Worksite Obesity Prevention Recommendations: Complete List.” Obesity Prevention Source. April 13, 2016. Accessed March 9, 2017. https://www.hsph.harvard.edu/obesity-prevention-source/obesity-prevention/worksites/worksites-obesity-prevention-recommendations-complete-list/#ref8.
