Journal of Urban Health-Bulletin of the New York Academy of Medicine最新文献

In 2022, approximately 580,000 people experienced homelessness in the United States. In response, many cities have implemented "camping ban" policies enforced by involuntary displacement of homeless encampments. Displacement has been cited as a strategy to protect public health and safety. However, there is mixed evidence that displacement is effective in reducing crime, while it is associated with other adverse health outcomes. To evaluate the neighborhood-level association between displacement and crime, we performed a retrospective (November 2019 to July 2023) pre-post spatiotemporal analysis using administrative data from Denver, CO. We used the Knox test statistic to detect excess clustering and change in total crime, as well as crime stratified by the National Incident-Based Reporting System (NIBRS) category, within spatiotemporal proximity to displacement events. We found that, on average, clustering of crime is high both before and after displacement. Within a 0.25-mile radius, displacement is associated with a statistically significant but modest decrease in crime, between - 9.3% within 7 days (p < 0.001) and - 3.9% within 21 days (p = 0.002). We found no consistent change in composite crime at a 0.5- or 0.75-mile radius. Hyperlocal decreases were driven by significant decreases in public disorder and auto theft, while crimes against persons increased and displayed high clustering post-displacement. There were no changes in any other offense type. Involuntary displacement is not consistently associated with changes in clustering of crime and may exacerbate violence in nearby areas.

The WHO emphasizes the importance of taking area-level factors into account when formulating public health interventions. The aim of this systematic review was to identify which area-level factors are associated with children's dental caries in Europe and might therefore be a suitable starting point for public health interventions. We conducted a systematic review based on a search in PubMed, Web of Science, and Cochrane Library including all European studies on caries in children and their area-level factors published since the year 2000 in English or German. We included 39 studies and identified 13 area-level factors investigated in the literature: degree of urbanization, deprivation, mean housing price, gross-national product, mean level of education, unemployment proportion and income, density of supermarkets, snack bars and dental offices, health, diet, and crime. Rural residency and higher unemployment were weakly associated with poorer oral health regarding dental caries. Deprivation showed a stronger (inverse) association. For income, findings were ambiguous; studies showed associations in both directions. For the other determinants, the included studies found no association. Many studies reported associations between place of residence and children's dental caries, but the mediators on this causal path are still not clearly established. The area-level factors analyzed in this review seem to play a role, but more studies with designs that allow causal interpretation of findings are needed to establish solid robust evidence that can be used in the formulation of future health policies.

This study investigates blood lead level (BLL) rates and testing among children under 6 years of age across the 42 neighborhoods in New York City from 2005 to 2021. Despite a citywide general decline in BLL rates, disparities at the neighborhood level persist and are not addressed in the official reports, highlighting the need for this comprehensive analysis. In this paper, we analyze the current BLL testing distribution and cluster the neighborhoods using a k-medoids clustering algorithm. We propose an optimized approach that improves resource allocation efficiency by accounting for case incidences and neighborhood risk profiles using a grid search algorithm. Our findings demonstrate statistically significant improvements in case detection and enhanced fairness by focusing on under-served and high-risk groups. Additionally, we propose actionable recommendations to raise awareness among parents, including outreach at local daycare centers and kindergartens, among other venues.

Federal data indicate that assaults on transit workers resulting in fatalities or hospitalizations tripled between 2008 and 2022. The data indicated a peri-pandemic surge of assault-related fatalities and hospitalizations, but assaults with less dire outcomes were not recorded. In collaboration with the Transport Workers Union, Local 100, we conducted an online survey in late 2023 through early 2024 of New York City public-facing bus and subway workers that focused on their work experiences during the 2020-2023 period of the COVID-19 pandemic. Items for this analysis on victimization included measures of physical and sexual assault/harassment, verbal harassment/intimidation, theft, and demographic characteristics (e.g., sex, race, work division). We estimated separate modified Poisson models for each of the four outcomes, yielding prevalence ratios (PRs) and 95% confidence intervals (CIs). Potential interactions between variables with strong main effects in the adjusted model were further examined using product terms. Among 1297 respondents, 89.0% reported any victimization; respondents also reported physical assault (48.6%), sexual assault/harassment (6.3%), verbal harassment/intimidation (48.7%), and theft on the transit system (20.6%). Physical assault was significantly more common among women in the bus division compared to female subway workers, male bus workers, and male subway workers (adjusted PR (aPR) = 3.54; reference = male subway workers; Wald test p < .001). With the same reference group, sexual assault/harassment was more frequently reported among female subway workers (aPR = 5.15; Wald test, p < .001), but verbal assault/intimidation and experiencing theft were least common among women in the bus division (aPR = 0.22 and 0.13, respectively; Wald tests, p < .001). These data point to the need for greater attention to record and report on victimization against workers in both buses and subway.

According to the uncertain geographic context problem, a lack of temporal information can hinder measures of bias in mortgage lending. This study extends previous methods to: (1) measure the persistence of racial bias in mortgage lending for Black Americans by adding temporal trends and credit scores, and (2) evaluate the continuity of bias in discriminatory areas from 1990 to 2020. These additions create an indicator of persistent structural housing discrimination. We studied the Boston-Cambridge-Newton and Dallas-Fort Worth metropolitan statistical areas to examine distinct historical trajectories and urban development. We estimated the odds of mortgage denial for census tracts. Overall, all tracts in Boston-Cambridge-Newton (N = 1003) and Dallas-Fort Worth (N = 1312) displayed significant change, with greater odds of bias over time in Dallas-Fort Worth and lower odds in Boston-Cambridge-Newton. Historically redlined areas displayed the strongest persistence of bias. Results suggest that temporal data can identify persistence and improve sensitivity in measuring neighborhood bias. Understanding the temporality of residential exposure can increase research rigor and inform policy to reduce the health effects of racial bias.

Drug overdose death rates are the highest recorded in New York City (NYC). Substance use disorder (SUD) treatment termination can confer increased risk of drug overdose death. Our objective was to determine the probability of, and factors associated with, drug overdose death following SUD treatment termination. Using a retrospective longitudinal cohort design, we identified those who had NYC-based SUD treatment terminated (01/2016-06/2019) using Chief Medical Examiner and SUD treatment data. Using survival analyses, we examined drug overdose deaths ≤ 14 and ≤ 90 days following SUD treatment termination, respectively. Of 51,171 patients with SUD treatment termination, 140 and 342 had a drug overdose death < 14 and ≤ 90 days, respectively. The crude drug overdose death rate was 26.7 per 1000 person-years at-risk in the ≤ 90-day period and was 71.6 per 1000 person-years at-risk in the ≤ 14-day period. In adjusted Cox proportional hazard model examining death ≤ 14 days, those unemployed (compared to employed) and those terminated from residential treatment (compared to medically supervised withdrawal, opioid treatment programs, and outpatient treatment) were more likely to have had a drug overdose death (all p-values < 0.01). In adjusted Cox proportional hazard model examining death ≤ 90 days, non-Hispanic White people (compared to non-Hispanic Black people), those not stably housed (compared to stably housed), those unemployed and those terminated from residential treatment were more likely to have had a drug overdose death (all p-values < 0.01). Strategies to improve retention including the reassessment of program treatment termination criteria along with strategies to promote ongoing OUD treatment, engagement in harm reduction, and distribution of naloxone are needed.

During infectious disease epidemics, accurate diagnostic testing is key to rapidly identify and treat cases, and mitigate transmission. When a novel pathogen is involved, building testing capacity and scaling testing services at the local level can present major challenges to healthcare systems, public health agencies, and laboratories. This mixed methods study examined lessons learned from the scale-up of SARS-CoV-2 testing services in New York City (NYC), as a core part of NYC's Test & Trace program. Using quantitative and geospatial analyses, the authors assessed program success at maximizing reach, equity, and timeliness of SARS-CoV-2 diagnostic testing services across NYC neighborhoods. Qualitative analysis of key informant interviews elucidated key decisions, facilitators, and barriers involved in the scale-up of SARS-CoV-2 testing services. A major early facilitator was the ability to establish working relationships with private sector vendors and contractors to rapidly procure and manufacture necessary supplies locally. NYC residents were, on average, less than 25 min away from free SARS-CoV-2 diagnostic testing services by public transport, and services were successfully directed to most neighborhoods with the highest transmission rates, with only one notable exception. A key feature was to direct mobile testing vans and rapid antigen testing services to areas based on real-time neighborhood transmission data. Municipal leaders should prioritize fortifying supply chains, establish cross-sectoral partnerships to support and extend testing services, plan for continuous testing and validation of assays, ensure open communication feedback loops with CBO partners, and maintain infrastructure to support mobile services during infectious disease emergencies.

Racially restrictive covenants in housing deeds, commonplace in Minnesota for houses built from the 1910s to the 1950s, provided a foundation for the myriad of policies that made it difficult for people of color to obtain housing. Though covenants were ruled illegal in 1968, their legacy continues to shape neighborhoods. The Mapping Prejudice Project's efforts in Hennepin County, Minnesota, produced the first systematic documentation of racially restrictive covenants. We use this novel data set to explore the relationship between historic covenants and current health and wellbeing outcomes. Using regression analysis to control for neighborhood level covariates, we compare previously covenanted neighborhoods to neighborhoods without covenants. Today, previously covenanted neighborhoods have higher life expectancy and lower rates of obesity, diabetes, coronary heart disease, and asthma than neighborhoods without racially restrictive covenants. Additionally, previously covenanted neighborhoods have less upward mobility for children from poorer households, and there are larger gaps in upward mobility between white and Black children. These findings contribute to a growing literature that shows racist policies, even decades after they are legally enforceable, leave an imprint on neighborhoods. Using the novel data from the Mapping Prejudice Project, we provide statistical analysis that confirms qualitative and anecdotal evidence on the role of racial covenants in shaping neighborhoods.