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

Our team developed content in English and Spanish for a technology-based intervention designed to increase vaccination against COVID-19 among people who inject drugs. From 2022 through 2024, we recruited 545 participants via peer referral, all of whom reported past 90-day injection drug use. Participants completed a tablet-based intervention, and software asked if they would like to vaccinate against COVID. Participants who did not vaccinate at the first visit received follow-up text messages. Participants who completed the intervention in Spanish were more than 2.5 times as likely to vaccinate at first visit (OR 2.525, 95% CI [1.059-6.076], p = 0.039), and 57% more likely to vaccinate at follow-up (OR 1.576, 95% CI [0.441-5.630], p = 0.484) compared to those who completed in English. These findings highlight the importance of developing intervention materials in languages beyond English. Research is warranted to understand how developing content in other languages may influence health outcomes.

We characterize within-city life expectancy gaps and their correlation with social and environmental characteristics in 948 US cities. Life expectancy estimates were drawn from the US Life Expectancy Estimation Program. City life expectancy gaps were calculated by subtracting the lowest tract-level life expectancy estimate from the highest for each city. Correlations were established using Spearman's correlation coefficient. The average city-level life expectancy gap in our sample was 11.8 years. Life expectancy gaps were larger in cities with lower average life expectancy and were evident across the USA. Life expectancy gaps of a decade were seen even in smaller cities and in high life expectancy cities. Life expectancy gaps were most strongly correlated with racialized residential segregation, children in poverty, and household income. Significant between-neighborhood gaps in life expectancy exist across US cities. Life expectancy gaps present a compelling target for establishing robust health equity goals.

Firearm injury survivors often face significant physical, mental, and logistical challenges following their injury, yet research on their healthcare needs remains limited. This mixed methods study examines health challenges, healthcare needs, and barriers to care among 107 firearm injury survivors in a small Northeastern city. The project emerged from a collaboration between university researchers and community-based violence prevention specialists. Participants completed a cross-sectional survey assessing physical health, functional disability, healthcare access, and demographic factors. A subsample of 15 survivors also participated in semi-structured interviews. Quantitative results show that a majority of survivors experience pain, require regular medical treatment, and report functional impairments that interfere with daily life. Respondents report high levels of unmet healthcare needs, including access to affordable care, specialists, and primary providers. Barriers to care include cost, lack of insurance, unreliable transportation, and difficulty navigating the healthcare system. Qualitative interviews illustrated the toll of post-injury pain, trauma, and anxiety, while also highlighting resilience, self-directed care, and changes in care-seeking behavior. Survivors voiced concerns about medication access, potential addiction, and logistical burdens. The findings underscore the complexity of survivor needs and point to opportunities for hospital-based violence intervention programs and trauma recovery centers to play a larger role in post-injury care coordination. This study highlights the value of participatory, community-engaged research in illuminating the lived experiences of firearm injury survivors and advancing care models that address both structural and personal barriers to recovery.

Recent increases in family homelessness place children at heightened risk for long-term health challenges. Research has shown that long-term rental subsidies reduce emotional-behavioral and sleep problems among children in homeless families, but the pathways driving these effects are not well understood. This study examined mediating pathways between assignment to housing assistance interventions and improvements in children's emotional-behavioral and sleep outcomes three years later. We used data from the Family Options Study (FOS), a randomized controlled trial by the US Department of Housing and Urban Development, which enrolled approximately 2,300 families that experienced an emergency shelter stay across 12 US sites. Findings from mediation models adjusting for baseline family and child characteristics to test five candidate mediators-homelessness, intimate partner violence, food insecurity, economic stress, psychological distress-as potential pathways linking housing interventions with children's emotional-behavioral and sleep problems indicated that approximately half (50.7%) of the impact of priority access to long-term rental subsidies (versus usual care) on decreased child emotional-behavior problems operated indirectly through lowered parent stressors, specifically economic and psychological distress. Conversely, the impact of priority access to long-term rental subsidies on decreased child sleep problems was predominantly direct, with minimal evidence of mediation. These findings suggest that stabilizing housing is foundational for children, and its benefits extend to family well-being. Additional research is needed to identify other modifiable pathways to improved child health.

This evaluation reports how the Catalyzing Communities Initiative, a whole-of-community, multi-site intervention, supported equity-focused policy, systems, and environmental (PSE) changes to prevent childhood obesity in three U.S. communities from 2023 to 2024. We conducted a mixed-methods evaluation using survey data from 35 committee members (multisector representatives selected by local health-promotion leaders) and interviews with 29 committee members across three communities. We used a three-framework analytic approach: the Getting to Equity Framework was used to classify PSE changes, the Consolidated Framework for Implementation Research guided analysis of contextual influences, and Ripple Effects Mapping, a systems science method, identified how PSE-related actions created chains of perceived impacts over time. Committee members reported a total of 339 PSE impacts, defined as perceived changes attributed to specific PSE-related actions, such as shifts in partnerships, practices, or community conditions. The majority of impacts fell within Getting to Equity Quadrants 4 (increasing community capacity and opportunity) and 1 (increasing healthy options). Systems thinking tools that were used by committee members as part of the Catalyzing Communities Initiative were noted to enhance cross-sector coordination. Ripple effect maps revealed reinforcing loops, such as systems-informed community action and community mobilization, that enhanced cross-sector collaboration and contributed to synergistic change. Implementation facilitators of change included strong leadership and supportive policy environments, while key barriers included affordability, stigma, and exposure to community violence. Findings illustrate how integrating equity frameworks, implementation science, and Ripple Effects Mapping can reveal mechanisms through which local actions promote equity-oriented change.

Recent growth in the share of household dollars spent on food consumed outside the home, in combination with growing obesity disparities, has heightened interest in food advertising by geography and population demographics. This study aimed to identify changes in advertising expenditure by US restaurant chains across counties, grouped by income, race, and ethnicity, specifically examining whether the lowest income and highest percentage of Black and Hispanic/Latino residents are disproportionately impacted by these trends. Using expenditure and location data for the top-100 grossing US restaurant chains and county-level demographic information, we measured patterns and trends in advertising expenditure at the county level. US counties were split by population density and socio-demographics. Quantile regression analysis was performed to identify baseline differences in total spending within county groups, as well as changes over time. Results show that fast food restaurant chains reported the highest expenditures among the types of restaurants and that the majority of advertising dollars were spent on television advertisements within the highest density counties. Our results show that-for all density types-the lowest levels and the greatest declines of advertising dollars occur among high-income counties and those with a low proportion of Black and Hispanic/Latino residents. Within the lowest density (rural) counties, the highest expenditure rates occurred in counties with a high proportion of Black and Hispanic/Latino residents, regardless of income. Among the highest density (urban) counties, the highest spending levels were observed in low-income counties. Together, these results suggest that restaurant advertising dollars in high- and low-density counties are consistently targeted toward populations who are also at greater risk for obesity in the United States.

Historical redlining, a housing policy applied across numerous cities in the United States in the 1930s, resulted in disinvestment in predominantly non-White, immigrant, or impoverished neighborhoods and has been associated with various adverse health outcomes. However, little is known about the effects of gentrification and residential mobility on health in historically redlined neighborhoods. Using linear regression, we evaluated the association between redlining, gentrification, and life expectancy at birth before and after adjustment for socio-spatial residential mobility in the Philadelphia metropolitan area. Tract-level data on life expectancy were obtained from the Centers for Disease Control and Prevention. Census data were used to define tract gentrification status in 2000-2010 (earlier-gentrification) and 2011-2018 (recent-gentrification). Tract socio-spatial mobility characteristics were defined using DataAxle's household-level data. Life expectancy at birth was generally higher in historically privileged than disadvantaged tracts. After stratification by gentrification status, however, life expectancy in historically disadvantaged (redlined) areas was higher in earlier-gentrified than non-gentrified tracts. This difference was largely explained by socio-spatial mobility, namely a greater influx of moderate- and higher-income households to gentrified and lower-income households to non-gentrified tracts. In redlined tracts, for example, life expectancy in the unadjusted model was 4.7 years lower in non-gentrified than earlier-gentrified tracts (confidence interval: - 6.4, - 2.9); this difference decreased to 1.7 years (- 3.2, - 0.1) after adjustment for socio-spatial mobility. These findings have substantial implications for future public health research, highlighting the importance of including gentrification and/or socio-spatial mobility data when evaluating the association between historical policies, like redlining, and health outcomes in a given geographic area.

The United States' public charge rule restricting who may enter or receive residency was expanded by the 2016 - 2020 federal administration and may be expanded again. This phenomenological study examines immigrant understandings of the use of public benefits and the consequences of penalizing immigrants in this way. As a feasibility study, it serves as an example of the merits and challenges of community-based organization (CBO) qualitative research. From September 2019 - April 2021, workers in a large urban CBO interviewed six immigrant participants about the public charge rule. We identify four themes: 1) mixed understandings, 2) avoidance of public benefits due to fear, 3) impact on children, and 4) interconnectedness. We describe immigrant insights on how anti-immigrant policies harm a nation as a whole.

Urban commuters increasingly face chronic stress, a known risk factor for cardiovascular and mental health issues. Active travel modes-such as walking or cycling-can potentially mitigate stress by integrating physical activity into daily routines; however, their effect on autonomic stress regulation remains unclear. This study aims to examine how different commuting modes influence autonomic nervous system recovery from stress in real-world urban environments. We analyzed minute-by-minute heart rate variability (HRV) data collected by wearable devices from 200 urban commuters in Beijing over 1 week, capturing HRV before, during, and after daily commutes. Active commuters demonstrated a 7.6% faster return to baseline HRV compared with passive commuters, indicating a more rapid recovery from commuting-induced stress. Notably, while overall active commuting supported faster recovery, higher levels of moderate-to-vigorous physical activity during the commute were associated with slower short-term recovery, suggesting that the intensity of exertion matters. These findings highlight that active commuting enhances both physical fitness and stress resilience, while emphasizing the importance of comfortable, moderate-intensity active travel conditions. The results support targeted investments in pedestrian and cycling infrastructure-particularly routes that are safe, connected, and designed to avoid excessive physical strain-to foster healthier, less stressed urban populations.

Racialized economic segregation is a known determinant of health disparities that has been associated with adverse pregnancy outcomes. However, no study has investigated its association with fecundability, the per-cycle probability of conception. We analyzed data from 10,438 U.S. participants enrolled in Pregnancy Study Online (2013-2022), an internet-based preconception cohort study. Eligible participants were aged 21-45 years, assigned female at birth, and trying to conceive without fertility treatment use. Using baseline residential addresses, we calculated segregation based on the Index of Concentration at the Extremes (ICE) from the American Community Survey 5-year estimates. ICE ranges from -1 ("disadvantaged") to 1 ("privileged"). We operationalized ICE metrics at the census tract level: economic segregation (ICE_income: ≥ $100 k vs. < $25 k), racial segregation (ICE_white/black: non-Hispanic White vs. non-Hispanic Black), and racialized economic segregation (ICE_{income + white/black}: non-Hispanic White ≥ $100 k vs. non-Hispanic Black < $25 k). We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for precision variables. We observed a monotonic inverse association for increasing quintiles of ICE_income and ICE_{income + white/black} with fecundability, but less evidence of associations with ICE_white/black. For instance, relative to ICE_{income + white/black} quintile 5 ("most privileged"), FRs for quintiles 4, 3, 2, and 1 ("most disadvantaged") were 0.92 (95% CI = 0.86-0.99), 0.84 (95% CI = 0.78-0.90), 0.84 (95% CI = 0.78-0.90), and 0.79 (95% CI = 0.73-0.86), respectively. Living in the most disadvantaged neighborhoods with respect to racialized economic segregation was associated with a moderate decrease in fecundability.