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

Safe Streets, a community violence intervention (CVI) program originally based on the Cure Violence model, aims to reduce gun violence through conflict mediation, behavior modification, and community-level normative change. Program effectiveness has varied across implementation sites in prior evaluations. To better understand community-level factors that may influence Safe Streets implementation and effectiveness, this study explores Safe Streets workers' descriptions of violence dynamics and violence prevention approaches at the community level. Semi-structured interviews with 27 staff across all ten active sites were conducted from July to November 2023. A thematic constant comparative approach was used, incorporating inductive and deductive coding. Findings were analyzed across sites, and previous estimates of program effects were integrated with current findings. Themes identified included differences in neighborhood stability, types of conflicts, approach to community norm change, depth of community relationships, and differences in policing. Variability in the level of transience between neighborhoods and the most prevalent conflicts suggests the need for model adaptations to fit neighborhood dynamics. Integration with recent estimates of Safe Streets' impact on homicides and non-fatal shootings suggests that Safe Streets is most effective in neighborhoods experiencing current generational conflicts, and strong relationships with community partners are associated with more effective violence reduction. Sites that reported recent large police takedowns were also more likely to be associated with significant violence reductions, suggesting that while siloed, the effectiveness of CVI and law enforcement may impact the other. Additional research exploring the mechanisms of community normative change is needed to inform program implementation at this level.

Protracted urban displacement poses unique challenges for older refugees, yet their mental health and psychosocial wellbeing remain underexplored. This study examines the experiences of older refugees in Nairobi, Kenya, focusing on systemic exclusion, social isolation, and loneliness. Using a community-based participatory research approach, we conducted 10 focus group discussions with 53 older refugees from the Democratic Republic of Congo, Ethiopia, Somalia, and South Sudan. We analyzed data using a framework analysis approach, generating the following themes: (a) systemic exclusion and forced dependency as determinants of distress, (b) displacement-disrupted networks and social isolation, and (c) loneliness as the emotional experience of social disconnection and systemic exclusion. Within these broader thematic areas, we found that exclusion and dependency stemmed from policy gaps, such as the delayed implementation of the 2021 Refugees Act in Kenya which restricted access to social protections. Many older refugees expressed a sense of intergenerational ambivalence and unmet expectations of aging resulting from forced displacement. Finally, participants described "being alone" as an idiom of distress related to loss of meaningful relationships, anger at societal exclusion, and hopelessness over present and future circumstances. Our findings underscore the need for age-inclusive and age-tailored strategies that address systemic exclusion and help older refugees build and restore social networks to mitigate isolation and loneliness. We provide recommendations to enhance social support in family and community contexts aligned with the Inter-agency Standing Committee's mental health and psychosocial support framework.

This study investigates healthcare access and health-seeking behavior in informal urban settlements of Bangladesh, focusing on the roles played by key stakeholders in the public, private, NGO, and informal sectors, toward positive health outcomes. Utilizing data gathered from service mapping (N = 5), validation sessions (N = 5) and case studies (N = 15) in five informal urban settlements. The study uncover many important barriers to healthcare access, with those linked to economic and infrastructural shortcomings emerging as particularly critical. Although healthcare is available, public hospitals are overcrowded and have long waiting lists. Poorer patients are often mistreated and fees at private health facilities are unaffordable for many residents. Culturally relevant alternatives, often referred to as informal healthcare providers play an important role in these communities. Local unlicensed pharmacies and Traditional Birth Attendants (TBAs) are particularly prominent. However, they often offer services that include risks such as over-prescribing and insufficient training. Factors including financial stress, low health literacy, and a fragmented healthcare system drive health inequities. This study underscores the importance of enhancing health literacy and education to enable marginalized groups to make effective health choices. The study provides fresh insights into the healthcare needs and associated inequities in these informal urban settlements. These findings reinforce the relevance of SDG 3 goals by emphasizing the need for inclusive, equitable, and community-oriented healthcare approaches to ensure healthy lives and promote well-being for all.

Cisgender women are underserved by current HIV prevention efforts, and substantial gender disparities persist in pre-exposure prophylaxis (PrEP) use. Recent diagnoses with a bacterial sexually transmitted infection (STI) are objective, readily available indicators of PrEP-eligibility that could be used to improve PrEP prescribing for cisgender women. To better understand missed opportunities for prescribing, we examined the prevalence and correlates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) diagnoses among cisgender women seeking care at a New York City obstetrics and gynecology (Ob/Gyn) clinic, along with the number of PrEP prescriptions provided post-STI diagnosis. A cross-sectional, retrospective review of electronic health record data was conducted for all HIV-negative cisgender women tested for CT and/or NG at the clinic between September 1, 2021 and September 19, 2022. Counts and prevalence for CT and NG infection were calculated, and multivariable log-binomial regression was used to examine associated factors. Among 7593 cisgender women receiving CT/NG testing during the study period, 186 had ≥ 1 CT infection (prevalence: 2.45%) and 18 had ≥ 1 NG infection (prevalence: 0.24%). In a multivariable model, CT/NG infection was significantly associated with age, having Spanish as a primary language, and a marital status of divorced, widowed, or separated. No cisgender women who received CT or NG diagnoses were prescribed PrEP during the study period. These findings highlight how opportunities to prescribe PrEP to cisgender women continue to be missed, even with readily available indicators for PrEP eligibility. More effective strategies are needed to promote PrEP prescribing among diverse populations of cisgender women, particularly in Ob/Gyn settings.

De facto segregation by racial identity and insurance persists in US hospitals, leading to health disparities. To understand factors driving healthcare segregation and NYC residents' experiences, we conducted the Health Equity and Access to Care project. The present study explores NYC residents' perspectives on and recommendations to mitigate healthcare segregation. To recruit English-speaking NYC residents (n = 184) stratified by race/ethnicity and insurance status for virtual and in-person focus groups (FG, n = 35), we utilized a multipronged outreach strategy with community groups and a research firm. We employed constructivist grounded theory and applied structural racism frameworks, Penchansky and Thomas' dimensions of healthcare access, and the socioecological model to guide the analysis of participants' perspectives on improving care. Participants described priorities across accessibility, availability, affordability, accommodation, and acceptability domains, while thematic differences emerged by race/ethnicity and insurance status (e.g., White participants highlighted how health system bureaucratic inefficiencies perpetuated harmful healthcare experiences whereas Black participants discussed how institutional and employment factors contributed to staff burnout, negative patient experiences). Structural factors (e.g., residential segregation, neighborhood resources, underinvestment in safety-net systems) were perceived as drivers of harmful healthcare experiences across all domains. Priorities for change include anti-bias training, authentic community engagement, patient navigation and digital connectivity investments, transparent and accessible healthcare operations, investment in neighborhood-based healthcare, and building a diverse workforce. Participants' recommendations call for coordinated, multidisciplinary efforts across interpersonal, community, institutional, and structural domains co-designed with communities. Elevating community voices can support stakeholders to act on the necessary levers to desegregate healthcare and advance health equity.

The rapid global increase in single-person households has created urgent public mental health challenges, with South Korea showing particularly high levels of depression and suicidal ideation in this group. To address this critical gap, this study applies the Social Determinants of Health framework to analyze how individual, community, and policy factors shape mental health among single-person households. Using data from 41,913 individuals in the 2023 Community Health Survey, combined with regional infrastructure and policy data, we conducted T-tests, regression models, and hierarchical linear modeling (HLM). Results show that single-person households experience depression 1.7 times more frequently than multi-person households and report significantly higher suicidal ideation. Trust and interpersonal networks consistently reduced these risks, while urban residency was associated with poorer outcomes. Local governments' policy commitments showed only limited associations with improved mental health. These findings underscore the need for evidence-based, multi-level policy approaches that enhance social capital and strengthen the capacity of local governments to address the mental health needs of single-person households.

Despite advances in HIV treatment, disparities in healthcare access remain across low-income (LIC), middle-income (MIC), and high-income (HIC) countries, limiting access to clinical care, antiretroviral therapy, and viral load testing. This study developed the HIV Care Access Index (HIV-CAI) to measure and compare HIV care service access across countries and within geographic regions and examined associations with economic and health indicators. A cross-sectional survey was conducted between August 2021 and June 2023 across nine countries: Botswana, China, Colombia, Kenya, Nigeria, Puerto Rico, South Africa, Thailand, and the United States. Participants were adults living with HIV recruited from urban, suburban, and rural settings through HIV service organizations, sexual and gender minority centers, and resource-limited communities. The HIV-CAI was scored from 0 to 1 (worst to best access) across three domains: Access to HIV Clinical Care and Providers, Access to HIV Medication, and Access to Viral Load Testing. Among 1,598 participants, Botswana demonstrated the highest HIV care access (0.93), followed by Thailand (0.91) and Kenya (0.90), while Nigeria showed the lowest access (0.64). Access to HIV medication was relatively consistent across regions, whereas access to clinical care and providers was limited, particularly in rural areas. Countries with higher HIV burden, incidence, and prevalence were associated with better care access. The HIV-CAI reveals disparities in HIV care access across geographic areas. Future interventions should prioritize improving equitable access, particularly in rural areas and countries with lower overall access scores.

This study examined the long-term mental health outcomes associated with childhood gun violence exposure by race/ethnicity and gender. Data were drawn from the National Longitudinal Survey of Youth 1997 (1997-2021). Gun violence exposure was measured as any exposure before age 18. Mental health outcomes assessed included depressive symptoms, heavy episodic drinking, and daily cigarette smoking. Hierarchical generalized linear models were used. Findings indicate that about 16.15% of the respondents reported childhood exposure to gun violence before the age of 18. Gun violence exposure was significantly associated with depressive symptoms among white men, white women, and Hispanic women. Additionally, it was associated with higher odds of heavy episodic drinking among Black men, white women, and Hispanic women. Gun violence exposure was associated with higher odds of daily smoking for all groups. The study findings suggest that there is a high prevalence of childhood exposure to gun violence in the U.S. The relationship between childhood gun violence exposure and adult mental health outcomes varies by race/ethnicity and gender. These results highlight the need for gun violence preventions and interventions tailored to specific demographic groups to address the long-term mental health consequences of childhood gun violence exposure.

This research studies the levels of environmental pollutants related to four different school of choice types in the cities of Detroit, Hamtramck, and Highland Park in 2021. It is hypothesized that public and for-profit charter schools will be located in older buildings and in areas of greater pollution. Indicators of pollution exposure included Superfund and Brownfield sites, location and pounds of Toxic Release Inventory, and mean blood lead levels of the children, which were geospatially joined to a 1-mile buffer surrounding the four school of choice types within the study area. The age of the school buildings was examined to estimate the potential for internal toxic exposures. The spatial relationship between neighborhood racial segregation, poverty, and schools of choice types was also assessed. Within the study area, public and for-profit charter schools and their surroundings exert the potential for greater internal and external pollution exposure to children. For-profit charter schools were significantly the oldest, potentially exposing students to a variety of toxicants. All schools were located in racially segregated and relatively high-poverty neighborhoods, with public and for-profit schools exhibiting the highest poverty percentages. Public policy, such as siting guidelines and school building maintenance, should be used to decrease these potential exposures to hazards and avoid worsening existing inequalities. Addressing them is important to prevent further disadvantage to already vulnerable children.

Neighborhood conditions significantly impact health and well-being, leading public health agencies to focus interventions on disadvantaged areas. Yet, a growing number of composite indices have been developed to measure neighborhood opportunity, deprivation, or vulnerability, and little is known about how they compare in relation to health. Our study compares 13 composite indices of neighborhood conditions commonly used in public health research. Using data for over 57,000 US census tracts, we evaluate correlations among indices and assess their associations with four health outcomes-poor mental health, diabetes, smoking, and life expectancy-relative to the poverty rate, a standard single-variable measure of neighborhood deprivation. We used spatial regression models to account for autocorrelation and ordinary least squares regression to compare explanatory power across measures. While indices correlate with one another and with poverty, their associations with health outcomes and explanatory power vary considerably. Some indices exhibit stronger associations with health compared to poverty, suggesting they may offer more nuanced insights into neighborhood health inequities. Conversely, other indices explained less variation in health outcomes, questioning their utility in guiding interventions. Our findings underscore that indices are not interchangeable and highlight the need for careful selection of indices based on specific public health contexts and outcomes. Our study suggests simpler measures like poverty may, in some cases, be equally or more effective while offering a more interpretable and practical benchmark for targeting resources.