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

Environmental exposures can have adverse associations with perinatal health and birth outcomes. This study aimed to identify the overlap and association between urban areas of environmental risk and adverse perinatal health indicator hotspots in New York City. We examined 2101 census tracts representing 575,257 births from 2016 to 2020 recorded by the New York City Bureau of Vital Statistics looking at preterm birth, adolescent pregnancy, and pre-pregnancy obesity rates. The Getis-Ord Gi* statistic was used to identify geospatial hotspots of adverse indicators. We used multivariable logistic regression to assess associations between areas of environmental risk and odds of indicator hotspot status and Poisson regression to assess associations of hotspot overlap. Overall, 54.6% of environmental risk areas were hotspots for at least one adverse perinatal indicator, accounting for 63.7% of preterm birth hotspots, 93.7% of adolescent pregnancy hotspots, and 67.3% of pre-pregnancy obesity hotspots. Compared with non-risk areas, risk areas had greater odds of being a hotspot of preterm birth (aOR = 2.11; 95% CI 1.60-2.78), adolescent pregnancy (aOR = 32.8; 21.8-49.4), and pre-pregnancy obesity (aOR = 3.15; 2.56-3.87). Environmental risk areas were expected to have 3.36 times the number of overlapping hotspots after adjusting for parental birthplace and parity. The overlap between environmental risk areas and hotspots of adverse perinatal health indicators and the associations with individual indicators and overlapping hotspots suggest that environmental risk area designation may be a useful measure of perinatal health vulnerability for targeted community interventions.

Neighborhood-scale environmental factors, including disinvestment in infrastructure, may impact cardiometabolic disease risk. To our knowledge, no prior studies have investigated the association between neighborhood disinvestment and incident diabetes. We used a virtual street audit of Google Street View Imagery to generate a neighborhood disinvestment score for participants' residential addresses in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). An item response theory model was fit to indicators (litter, graffiti, under-maintained buildings, bars on windows, and abandoned buildings) to form a scale measuring a latent level of disinvestment. Ordinary kriging was used to estimate levels for each residential address within the HCHS/SOL census tracts via spatial interpolation. HCHS/SOL is a longitudinal cohort study of self-identified Hispanic/Latino adults in the Bronx, Chicago, Miami, and San Diego. Using covariate-adjusted and survey-weighted Poisson regression models with data from 9120 participants free of diabetes at baseline (2008-2011), we investigated the association between neighborhood disinvestment and incident diabetes at visit 2 (2014-2017). A sensitivity analysis included only those who did not move during the follow-up period. A one-standard deviation increase in neighborhood disinvestment score was associated with a 13% (95% CI, 1-23%) lower risk of incident diabetes when adjusting for age, sex, education, income, study center/heritage, years in the US, family history, and a neighborhood socioeconomic index. Our sensitivity analysis yielded qualitatively similar results with lower precision. Overall, our analysis does not support the hypothesis that neighborhood physical disinvestment is associated with incident type 2 diabetes in this Hispanic/Latino population.

Despite US air quality improvements since the 1990 Clean Air Act Amendments, disparities in air pollution between communities persist. We studied whether persistent within-city geospatial disparities in pollution continued over time in historically minoritized and under-resourced areas codified as "redlined" in 1930's government mapping. We evaluated how longitudinal demographic patterns and disparities in community wealth and resources related to historical redlining score category in three US urban areas: Boston, MA, Nashville, TN, and Detroit, MI. We then examined longitudinal associations of redlining with changing levels of the air pollutants PM_2.5 and NO₂ between 2000 and 2016 in these cities. Our approach utilized daily estimates of air pollution levels from models with high spatiotemporal resolution, digitized redlining maps, and census data to evaluate temporal trends by redlining categories at the census tract level. Demographic and socioeconomic changes over time differed by city, but for each city, historically redlined areas continued to have a greater proportion of Black residents, higher poverty rates, lower income and home values, and a higher social vulnerability index (SVI). Over all areas, air pollution levels declined markedly over time, but for annual averaged NO₂, redlining-area-associated exposure disparities persisted in Boston and widened in Nashville. In contrast, by 2016, regardless of redlining history, areas in Detroit had similar NO₂ pollution levels. Our results highlight the lasting social, economic, and environmental effects of urban discriminatory practices, also showing that in some cities, areas may be equally exposed to specific criteria pollutants, regardless of area wealth.

The popularity of asbestos-containing products stemmed from their fire resistance, thermal insulation properties, and mechanical strength. However, their well-documented adverse health effects led to the prohibition of their use in many countries. This research aims to conduct a comprehensive examination of the often-overlooked social dimensions associated with asbestos, with a specific focus on the affected population's circumstances and the potential solutions accessible to them. Its analysis encompasses legal regulations concerning asbestos, societal awareness, and the economic implications of asbestos removal from the perspective of those impacted. The findings highlight that the remediation of asbestos-containing products is often contingent on the financial and social conditions of the affected population, posing significant challenges for the economic sector and environmental protection efforts. This research contributes to the development of integrated approaches that address social, economic, and environmental dimensions in tandem. Its originality lies in situating the concepts of social sustainability and socially oriented environmental development within the context of asbestos-related policies. The findings suggest that achieving asbestos-free environments is feasible only through the integration of social dimensions, taking into account the economic and social conditions of the affected communities.

Individuals with serious mental illness (SMI) are overrepresented in the criminal justice system. They frequently cycle between jail and emergency departments and experience poor health outcomes. Some jails offer mental health services, but the criminal justice environment is not conducive to optimal treatment and recovery. Individuals with SMI may require targeted interventions, but few studies have examined characteristics of individuals in jail with and without an SMI or compared their post-release trajectories. We conducted a retrospective cross-sectional study using health services and jail system data from the City and County of San Francisco from July 1, 2011 to June 30, 2021. We included 1568 adults with at least one jail incarceration from July 1, 2017 to June 30, 2018, stratified by the presence or absence of an SMI diagnosis, and compared health services use, jail system interactions, and associated factors. Compared to individuals without SMI, those with SMI had higher rates of substance use disorder (82.5% vs. 53.3%) and homelessness (82.2% vs. 61.0%). The longest single jail incarceration averaged 11.3 days longer for individuals with SMI (p < 0.05, 95% CI: 1.38, 21.26). Post-release, individuals with SMI had higher rates of health services use and reincarceration. We found that individuals with SMI in jail have higher rates of homelessness, health services use, and jail reincarceration. This underlines the responsibility placed on jails to address the complex needs of individuals with SMI. Investment should focus on reentry and diversion programs, as well as expanding jail and community-based mental health care for individuals with SMI.

Exposure to criminal-legal systems, including policing, arrest, and incarceration, has deleterious effects on access to health and social services among people who use drugs. Women who use drugs (WWUD) may be especially vulnerable to policing, due to the high prevalence of sex work among them, which is also a criminalized behavior. Recent epidemiologic events and policy reforms are thought to have reduced exposure to arrests for low-level, non-violent crimes; in Baltimore City, this decline was demonstrated following the COVID-19 pandemic and implementation of de facto decriminalization of misdemeanor offenses including drug possession and solicitation (prostitution). However, possible impacts of these changes on experiences of policing among WWUD remain unknown. This analysis explores self-reported police interactions and pandemic-related structural vulnerability among a cohort of WWUD in Baltimore City. We used multinomial and logistic regression to explore the association of ability to meet basic needs during the pandemic with the intensity and breadth of police interaction. We observed that overlapping unmet needs, such as access to medications, bathrooms, and harm reduction supplies, were associated with exposure to more intensive enforcement and greater breadth of police practices, as well as exposure to more egregious forms of policing. Despite broad changes to both policing and social service policies amid the pandemic, our results indicate that WWUD continued to experience both disproportionately high levels of material need insecurity and exposure to police. Findings have implications for tailoring policies and interventions to meet the needs of multiply marginalized women amid big events and policy volatility.

With changing trends in drug misuse in the United States, including the increased prominence of fentanyl misuse, transit operators have indicated concern that people who use drugs (PWUD) seek transit vehicles as shelter to escape from inclement weather. Research has yet to investigate the relationship between drug misuse on transit vehicles and weather conditions. We hypothesized that there would be a higher frequency of drug use incidents on transit vehicles during periods of reduced daylight hours, low temperatures, high precipitation, or high wind speeds. Using a dataset of drug use incidents reported by transit operators in King County, Washington, in 2022 (n = 1518), we descriptively characterized the frequency of daily drug use incidents. We used a Poisson regression model to further understand the association between daily incident count and daily weather patterns. Reported drug use incidents showed clear temporal trends, with a higher frequency of incidents in winter and spring than in summer; April had the highest mean daily incident count of 7.3 incidents/day. Higher temperature was significantly associated with lower incident count (IRR, 0.96; 95% CI, 0.95, 0.97). Daylight hours were also significantly positively associated with higher incident counts (IRR, 1.14; 95% CI, 1.11, 1.17). The findings of this study support the hypothesis that drug use incidents are more common on days with lower temperatures. These results can help guide the timely deployment of interventions, informed by drug use patterns, to reduce drug use incidents on transit and reduce operator and passenger exposure to secondhand drug use.

The goal of the School-Based Health Center (SBHC) Reproductive Health Project (RHP) was to increase access to effective methods of contraception for New York City (NYC) public school students. This paper evaluates the impact of the SBHC RHP by examining differences in contraceptive use between sexually active female high school students with and without project access. Data from the 2011-2019 NYC Youth Risk Behavior Surveys were pooled and flagged for SBHC RHP access. Complete case descriptive analyses compared contraceptive use at last sex, reported by weighted percentages. Multinomial logistic regression was conducted to identify the association between access to the SBHC RHP and use of more effective contraception. We found that the percentage of any contraceptive use at last sex did not differ between the intervention and comparison groups; however, there were significant differences in the category of method used. Compared to those without access, more students at schools with the SBHC RHP reported use of moderately effective hormonal contraception (28.6% vs 16.3%) or long-acting reversible contraception (LARC; 4.4% vs 1.8%). SBHC RHP access significantly increased the probability of primary use of moderately effective hormonal contraception (pill/patch/ring/Depo-Provera shot) and LARC at last sex by 12.9 and 1.9 percentage points, respectively. While these more effective methods are generally less accessible to teens, the provision of these methods within an SBHC setting can increase access and use.

Rising heat-wave frequency and strong urban-heat-island (UHI) effects threaten thermal comfort and health in Jordan's fast-growing cities. While engineering studies suggest that multi-storey apartments trap more heat than detached houses, resident-centred evidence is lacking. A cross-sectional questionnaire was administered to 766 adults (378 apartments, 388 detached-house residents) in Greater Irbid Municipality during the June-July 2025 heat season. Instruments captured (i) UHI perceptions, (ii) perceived effectiveness of passive-cooling design features, (iii) mental and physical heat-related health outcomes (PHQ-2, GAD-2, PSS-4, heat-specific sleep and symptom items), and (iv) coping strategies and psychosocial resources. Group differences were tested with independent-samples t-tests. Apartment dwellers reported a stronger neighbourhood UHI (mean 3.44 ± 0.95 vs 3.12 ± 0.95, p < 0.001, d = 0.33) and judged surrounding trees/shade and natural ventilation less effective (Δ ≈ 0.17-0.29 scale units, p ≤ 0.01). They also showed higher perceived stress (PSS-4 8.40 ± 1.35 vs 8.01 ± 1.63, p < 0.001, d = 0.30), shorter sleep duration, and poorer global sleep quality (p ≤ 0.003, d ≈ 0.22). Depression, anxiety, 13 heat-related physical symptoms, coping profiles, and service-stigma indicators were statistically indistinguishable between dwelling types. Living in an Irbid apartment confers a modest psychosocial heat burden-elevated stress and compromised sleep-linked more to perceived shading and ventilation deficits than to housing form alone. Targeted greening, façade reflectance, and cross-ventilation retrofits around apartment blocks could yield meaningful well-being gains without major energy penalties in Jordan's semi-arid urban fabric.

The 2-1-1 information and referral system connects vulnerable populations to essential services during public health emergencies. However, there is limited evidence examining the specific needs of unhoused populations during these events. This study examines associations between temperature variations, tropical cyclones, and service utilization patterns among unhoused populations using 2-1-1 call data from southern Louisiana (2014-2023). Analyzing over 20,000 calls, predominantly in urban areas (65%), we employed negative binomial regression, distributed lag non-linear modeling (DLNM), and natural language processing to uncover patterns in help-seeking behavior during temperature variations and tropical cyclones. Negative binomial models demonstrate declines in 2-1-1 utilization both during cyclone events (IRR: 0.77, CI: 0.60-0.99) and in the recovery period (IRR: 0.86, CI: 0.76-0.97). Significant associations were observed across the temperature distribution with both the coldest (D1, IRR: = 1.22, 95% CI = 1.08-1.38) and warmest (D10, IRR = 1.21, 95% CI = 1.06-1.38) temperature deciles, indicating increased call volume at the coldest and warmest temperatures compared to moderate temperatures. DLNM results corroborated a U-shaped association at temperature extremes, though effects were predominantly significant only at the coldest temperatures. Computational text analysis of call narratives revealed that mental health mentions increased significantly with temperature (from 19.4% in coldest conditions to 30.5% in warmest conditions), but decreased during cyclone periods (from 29.1% in non-cyclone conditions to 15.5-20.2% during various cyclone phases). While 2-1-1 data captures only those with phone access and service awareness, potentially underrepresenting the most marginalized, these findings provide actionable insights into help-seeking patterns among service-connected (e.g., 2-1-1) unhoused populations during and following extreme weather events.