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

In the face of escalating climate-related challenges, the resilience of healthcare systems is paramount. As was seen during COVID-19, the climate crisis exemplifies the critical need for a resilient workforce and robust healthcare infrastructure amidst increasing impacts including infrastructure disruptions, rising costs, and exacerbated health disparities. Structurally vulnerable communities, particularly those of color, face disproportionate exposure to climate risks, highlighting the urgent need for equitable resilience strategies. A focus on multifaceted approaches to fortifying healthcare systems against climate change includes emphasizing decarbonization, adaptability, data-driven planning, and support of sustainable infrastructure and health workers. The importance of integrating climate awareness into clinical and public health practices is underscored, promoting proactive measures and community engagement. Strategies to mitigate carbon footprint and enhance healthcare delivery can be enacted including with some federal and philanthropic funding support. This comprehensive approach ensures that healthcare systems remain robust, equitable, and responsive in the face of ongoing and future climate crisis challenges.

This study examined the extent to which the 1930s Home Owners' Loan Corporation (HOLC) redlining grades are associated with contemporary survival from screenable cancers among residents of three largest cities in Washington State. Redling assigned a mortgage security metric to neighborhoods. We used 2000-2018 data from the Washington State Cancer Registry to examine differences in survival from all-cause and cancer-specific mortality for breast (n = 14,725), cervical (n = 656), colorectal (n = 7,089), and lung (n = 8,365). Survival was examined in HOLC areas graded as A (best); B (still desirable); C (declining); and D (redlined) using Kaplan-Meier and Cox proportional hazards regression techniques. Among patients with breast cancer, the hazard ratio for all-cause mortality was highest for areas graded D followed by C and B. For colorectal and lung cancer, the hazard ratio for all-cause mortality was highest for areas graded C followed by D and B. The estimated marginal slopes for the log hazard of mortality decreased over time in HOLC areas graded A, B, and C for breast and lung cancers, and in areas graded D for colorectal and lung cancers. HOLC grade was not associated with survival among cervical cancer patients. These findings call for efforts to reduce screenable - but often unrecognized - health inequalities associated with residential location.

This study investigated the effectiveness of the Nurses Taking on Readiness Measures (N-TORM) intervention in improving disaster preparedness of Asian immigrant residents in New York City. N-TORM is an innovative, nurse-led, household disaster preparedness educational intervention provided to community members to help them create their disaster-related evacuation and communication plans, build disaster supply kits, and understand community resources available to assist residents before, during, and after disasters. The aims of this controlled before-after intervention study were to (a) pilot test the Korean translation of the Household Emergency Preparedness Instrument (K-HEPI), (b) evaluate the effectiveness of N-TORM to increase household disaster preparedness knowledge and behavior, and (c) describe the factors most necessary to maintain and expand N-TORM. Participants in the experimental group (N = 200) demonstrated significantly greater pre-to-post improvement in disaster preparedness compared to those in the control group (N = 199), as measured by the K-HEPI (effect on total General Preparedness scores, β = 1.66, SE = 0.105, p < .001). The Korean community organization that was involved in this study continues to offer N-TORM to its members, demonstrating the intervention's sustainability. Further testing of the K-HEPI and the intervention in longitudinal studies is recommended to explore potential associations between disaster preparedness and outcomes such as survival without rescue, prevention of injury, or acute exacerbations of chronic illnesses. Replicating the intervention across different immigrant populations is essential, and data from these studies can inform policy development to better address the needs of immigrant communities before, during, and after disasters. ClinicalTrials.gov Identifier: NCT0554478. Hunter College of City University of New York Protocol Record 2022-0542-Hunter, Korean Translation and Validation of the K-HEPI by a Phase 1 Feasibility Study in NYC, is registered and posted on the ClinicalTrials.gov website.

People experiencing homelessness (PEH) face a high risk of opioid-related deaths, yet there is limited qualitative data on the barriers encountered when accessing buprenorphine treatment for opioid use disorder (OUD). To address this gap, we interviewed 28 clinicians, outreach workers, and administrators from organizations serving PEH with OUD. Our goal was to understand the barriers and facilitators at the patient, clinic, and institutional levels and gather recommendations for improvement. Interviews, conducted via Zoom and analyzed through thematic analysis, revealed several barriers. At the patient level, themes related to barriers included knowledge and experience (e.g., limited knowledge about buprenorphine options; rejection of buprenorphine due to prior experience with precipitated withdrawal); concerns about the medication and its administration (e.g., distrust of injectable medications; concerns about treatment control, and a prolonged informed consent process for extended-release injectable buprenorphine); and challenges due to homelessness (e.g., identification requirement to access medication at pharmacies, difficulties managing buprenorphine while unsheltered). At the clinic level, themes centered around staffing (e.g., lack of training and experience in treating PEH and staffing shortages) and health care-related stigma (e.g., discriminatory attitudes toward PEH with OUD). Institutional-level themes included state-regulatory factors (e.g., practice regulations limiting clinical pharmacists' ability to prescribe buprenorphine) and access factors (e.g., stigmatization of buprenorphine prescribing, limited low-barrier buprenorphine access, and care system complexity). Recommendations included educational programs for patients and clinicians to increase understanding and reduce stigma, integrating buprenorphine treatment into non-traditional settings, and providing housing with treatment.

There is growing recognition of the need for collaboration between the healthcare and housing sectors to address the needs of people experiencing homelessness. This study explores how these cross-sector collaborations can be improved from the perspective of those with histories of homelessness and complex health needs. In-depth, semi-structured qualitative interviews (N = 23) were used to (1) understand the challenges faced by people with complex health needs when navigating services at the intersection of healthcare and housing and (2) identify strategies for improving these services. While some participants reported accessing cross-sector services, many found those efforts to be lacking and ineffective. Participants reported receiving support with healthcare needs from housing providers more frequently than assistance with housing needs from healthcare providers. They described challenges related to provider turnover, perceived stigma and discrimination, and insufficient resources. Proposed solutions included modernizing and centralizing care, providing an effective balance of in-person and virtual offerings with an emphasis on in-person services, and improving provider sensitivity to reduce stigma against service recipients. These findings align with existing research on cross-sector collaborations in other fields and highlight the need for comprehensive, compassionate care tailored to the unique needs of people experiencing homelessness. The study also underscores the urgent need for more effective implementation and evaluation of these cross-sector efforts to improve outcomes for this vulnerable population.

Globally, MSM experience severe health disparities, including an increased risk of HIV acquisition. In Ghana's urban centers, these disparities are influenced by intersectional stigma related to sexuality and gender nonconformity, yet limited research exists on the role of gender in driving stigma in the day-to-day interactions of MSM. This study is aimed at understanding (1) the experiences of gender identity and roles among MSM in Ghana and (2) how these experiences of gender shape daily urban life in Ghanaian social interactions, including interpersonal interactions in healthcare settings. We conducted a qualitative description using secondary data generated from focus groups and in-depth interviews with adult MSM and health care workers in Accra and Kumasi, Ghana. Data were analyzed using qualitative content analysis. We identified five factors that describe the experiences of gender roles, identities, and relations and identified one theme regarding the influence of gender on MSM daily life. First, understandings of gender roles were influenced by local binary gendered expectations regarding (1) appearance and presentation, (2) physical characteristics and personality traits, and (3) household and community responsibilities. The experience of gender identity was informed by perceptions of its (4) relationship to or (5) independence from physical anatomy. In Ghana, men's gender nonconformity and its linkages to discrimination are complex, context dependent, and evolving. The interplay between gender nonconformity and same-gender sex stigma undermines access to quality health care and threatens the well-being of Ghanaian MSM.

The COVID-19 pandemic, and the ensuing social policies enacted to control viral transmission of SARS-CoV-2, has had a significant impact on social support networks. For people living with HIV (PWH), including gay, bisexual, and other men who have sex with men (GBMSM), social support networks serve additional purposes in the self-management of HIV care and psychosocial health. Given the broad-reaching effects of the pandemic, characterizing its impact on specific dimensions of social support networks remains a prime area of investigation. We used egocentric social network data from an on-going longitudinal study of GBMSM with HIV, living in New York City (NYC), to examine changes in the structural, interactional, and functional characteristics of their social support networks from pre- to post-start of the pandemic. We analyzed data from 146 GBMSM who reported a total of 164 social support network members. We found that the average size of social support member networks increased over time, of which 57% and 25% provided companionship and confidant support, respectively. Follow-up questions about how often guidance, tangible, and emotional support was provided (if needed) suggest the quality of support decreased over time. At follow-up, nearly half (49%) of network members were friends, the vast majority (89%) were aware of GBMSM's HIV status, and most (74%) were also living within NYC. Characterizing the changes in social support networks over the course of the COVID-19 pandemic can help identify areas of need and resilience, especially for key populations such as GBMSM with HIV.

Higher outdoor temperatures are associated with greater incidence of firearm violence in urban areas in the United States. This study adds to the existing literature base by exploring the potential mitigating role of air conditioning (AC). The setting for this repeated-measures ecological cross-sectional study is New York City Housing Authority (NYCHA) developments, which are known to experience disproportionate rates of firearm violence. We extracted data for 2012-2017 for two types of shooting events: all New York City (NYC) shootings and those in NYCHA housing. Negative binomial mixed-effects regressions explored the relationship between electricity consumption, a proxy for AC use in warmer months, and shootings, controlling for housing development characteristics and the Area Deprivation Index. Separate analyses were conducted for months whose maximum average temperatures were in different deciles. During our study period, 18% of NYC shootings occurred in NYCHA housing. We observed a positive relationship between monthly maximum temperature decile and NYCHA shooting incidence (IRR = 1.11, 95% CI: 1.08, 1.14). For months with temperatures in the top decile (84-87°F), increased electricity consumption was associated with a decrease in the expected rate of shootings (IRR = 0.79, 95% CI: 0.63, 0.98). These findings suggest AC and other cooling-related interventions may be useful in reducing firearm violence in public housing during hotter months. However, improved data on AC access and use are needed to better understand this relationship.

Extreme heat poses a significant public health threat for people experiencing homelessness (PEH), who face heightened risks due to prolonged outdoor exposure and limited access to resources. This rapid review synthesizes research from the past five years on the health impacts of extreme heat for PEH in high-income countries. A total of 11 studies were identified through a systematic search of multiple databases, focusing on publications from 2019 to 2024. The review highlights key vulnerability factors, including demographic characteristics, pre-existing health conditions, and geographic disparities, that increase heat-related health risks for PEH. Physical health impacts, such as heat-related morbidity and mortality, are common, alongside mental health and substance use disorders exacerbated by heat exposure. The review also highlights a significant increase in emergency department visits among PEH during heat events, emphasizing the additional burden on healthcare systems. Barriers, including limited physical and social access to cooling centers, water insecurity, and stigma, further compound these challenges. Addressing the unique vulnerabilities of PEH is crucial to reducing their risks during extreme heat events. Improving housing access and stability is essential as a long-term strategy to decrease homelessness and reduce heat stress in this vulnerable population. The review also underscores the need for inclusive interventions such as accessible cooling centers with targeted programming, regular access to water, and tailored healthcare services to meet the needs of PEH. Future research should focus on long-term studies to assess potential cumulative heat exposure effects and evaluate the effectiveness of interventions aimed at mitigating extreme heat impacts on PEH, while applying an intersectionality lens to explore how factors like race, gender, and age shape vulnerabilities and potential intervention strategies.

Cardiovascular diseases (CVDs) are the leading cause of global mortality, and urban greenspace can reduce CVDs risk. However, the evidence relating various greenspace metrics to CVDs risk is inconclusive. To enhance the understanding of the correlation between greenspace and CVDs, we compared three greenspace indicators-street view-based greenspace (SVG), normalized difference vegetation index (NDVI), and green cover rate (GCR). We used a large sample of 36,504 CVDs hospitalization records with precise residential addresses from 2017 to 2022 in Jingzhou, China. Employing the geographically weighted regression (GWR) model, we investigated the association between greenspace and CVDs incidence at the population level. We found significant negative associations between NDVI/SVG and CVDs incidence (SVG: β = - 1.64; 95% CI, [- 2.12, - 1.15]; NDVI: β = - 8.57; 95% CI, [- 9.81, - 7.33]), with NDVI exhibiting a more substantial protective effect. However, no significant relationship was found in GCR (p = 0.161). The impacts varied by age, but not by gender, with younger individuals benefiting more than the elderly, and SVG showed no significant relationship with CVDs incidence in individuals over 65 years. Our findings suggested the importance of the presence of greenspace in CVDs prevention. Consequently, in urban greenspace planning, priority should be given to the vegetation quantity in residential areas over the size of greenspace facilities located distant from residences.