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

Depression and post-traumatic stress disorder (PTSD) are serious consequences of physical injuries. Stress associated with living in urban neighborhoods with socioecological disadvantages and the cumulative burdens of adverse childhood experiences (ACEs) can lead to poorer psychological outcomes. Limited research has explored how ACEs and socioecological environmental exposures in childhood and adulthood, together, impact post-injury outcomes. This study assessed the relative contributions of ACEs and neighborhood exposures during childhood and adulthood on post-injury outcomes among Black men in Philadelphia. We used data from a prospective cohort of 414 Black men from the Philadelphia region, aged ≥ 18 years, who sustained acute physical injuries requiring hospitalization. Primary outcomes were post-injury PTSD and depression. Secondary outcomes were sleep quality, self-reported health status, changes in substance use, and return to work. The study used perceived and objective measures of neighborhood characteristics and self-reported ACEs to model their relative impact on outcomes 3 months after hospital discharge. Higher levels of ACEs and higher perceived neighborhood disorder during childhood and adulthood were significant predictors of PTSD and depression symptom severity. Perceived neighborhood disorder contributed to sleep disturbances and decline in post-injury health. Census/administrative objective measures of neighborhood disadvantage did not show consistent associations with post-injury outcomes. Findings suggest that both ACEs and subjective perception of neighborhood environments are critical factors influencing post-injury recovery in urban Black men. Interventions to improve post-injury outcomes should consider preventing ACEs and addressing the tangible conditions of neighborhoods and residents' perceptions of their surroundings to promote health equity and injury recovery.

Environmental context is an important predictor of health behavior. Understanding its effect on cannabis use among pregnant women is yet to be understood. The aim of the study is to assess the impact of perceived neighborhood environment on prenatal cannabis use and explore the mediating role of stress. Data are from the Life-Course Influences on Fetal Environments Study (LIFE), a retrospective cohort of postpartum African American women in Metropolitan Detroit, Michigan (2009-2011). Prenatal cannabis use was defined as self-reported ever use during pregnancy. Three perceived neighborhood scales were considered: social cohesion and trust, social disorder, and danger and safety. Out of 1,369 women, 151 (11.0%) self-reported using cannabis during pregnancy. After adjusting for age, marital status, income, years of education, and general social support scale, the odds of cannabis use significantly increased among the lowest quartiles of all the neighborhood scales suggesting higher cannabis use among women who perceived their neighborhoods to have the worst conditions. Compared to the highest quartile, the odds ratio (OR) for the lowest quartiles for social cohesion and trust, social disorder, and danger and safety were 1.77 (95% confidence interval (CI): 1.04-3.03), 1.83 (95% CI: 1.15-2.91), and 1.93 (95% CI: 1.12-3.31) respectively. Evidence of mediation by perceived stress was only present between the association of perceived levels of safety and danger with cannabis use during pregnancy. Future prospective studies are warranted to understand the causal associations between individual correlates and social and physical environmental factors of prenatal cannabis use.

Despite increasing interest in the role of parks on children's health, there has been little empirical research on the impact of park interventions. We used a quasi-experimental pre-post study design with matched controls to evaluate the effects of park redesign and renovation on children's health-related quality of life (QoL) in underserved neighborhoods in New York City, with predominantly Hispanic and Black populations. Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported health-related QoL of 201 children aged 3-11 years living within a 0.3-mile radius of 13 renovated parks compared to 197 children living near 11 control parks before and after the park intervention. Health-related QoL was measured using a modified version of the KINDL questionnaire that assessed children's physical and emotional well-being, self-esteem, and well-being in home, peer, and school functioning. Linear mixed regression model was used to examine the difference in difference (DID) between the intervention vs. control group for QoL. We found a significant differential improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID = 6.35, 95% confidence interval [CI] = 0.85-11.85, p = 0.024). The effect was particularly strong among girls (DID = 7.88, p = 0.023) and children of the lowest socio-economic background (p < 0.05). No significant DID was found in other KINDL domains. Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings lend support for investments in neighborhood parks to advance health equity.

From 2014 to 2017, the drug overdose death rate per 100,000 in New York City (NYC) increased by 81%, with 57% of overdoses in 2017 involving the opioid fentanyl. In response, overdose education and naloxone dispensing (OEND) efforts were expanded in NYC, informed by neighborhood-level and population-level opioid overdose fatality rates. We describe the demographic and geographical distribution of naloxone by NYC opioid overdose prevention programs (OOPPs; the primary distributor of naloxone to laypersons in NYC) as OEND was expanded in NYC. We developed and examined a measure of high-need naloxone distribution defined by OEND in a high-priority neighborhood, to a high-need population, or from a high-priority OOPP (i.e., syringe services programs, criminal legal-related programs, programs for unhoused people, substance use disorder treatment programs, etc.). We reported recipient-level naloxone dispensing data by OOPP type from April 2018 to March 2019 using descriptive statistics and age-adjusted population rates. We conducted univariable logistic regression analyses to identify predictors of naloxone receipt by race/ethnicity. Of the 69,333 naloxone recipients, 97.3% met our definition for high-need naloxone dispensing, with 55.8% residing in one of 13 high-priority neighborhoods. Naloxone receipt by race/ethnicity varied by OOPP type. Program goals to expand naloxone distribution to high-need populations were met. We observed racial/ethnic differences in receipt of naloxone by program type, which supports using a variety of OOPP program types to reach racially diverse populations.

Environmental noise is a significant public health concern, ranking among the top environmental risks to citizens' health and quality of life. Despite extensive research on atmospheric pollution's impact on mental health, spatial studies on noise pollution effects are lacking. This study fills this gap by exploring the association between noise pollution and depression in England, with a focus on localised patterns based on area deprivation. Depression prevalence, defined as the percentage of patients with a recorded depression diagnosis, was calculated for small areas within Cheshire and Merseyside ICS using the Quality and Outcomes Framework Indicators dataset for 2019. Strategic noise mapping for rail and road noise (Lden) was used to measure 24-h annual average noise levels, with adjustments for evening and night periods. The English Index of Multiple Deprivation (IMD) was employed to represent neighborhood deprivation. Geographically weighted regression and generalised structural equation spatial modeling (GSESM) assessed the relationships between transportation noise, depression prevalence, and IMD at the Lower Super Output Area level. The study found that while transportation noise had a low direct effect on depression levels, it significantly mediated other factors associated with depression. Notably, GSESM showed that health deprivation and disability were strongly linked (0.62) to depression through the indirect effect of noise, especially where transportation noise exceeds 55 dB on a 24-h basis. Understanding these variations is crucial for developing noise mitigation strategies. This research offers new insights into noise, deprivation, and mental health, supporting targeted interventions to improve quality of life and address health inequalities.

Chronological age is not an accurate predictor of morbidity and mortality risk, as individuals' aging processes are diverse. Phenotypic age acceleration (PhenoAgeAccel) is a validated biological age measure incorporating chronological age and biomarkers from blood samples commonly used in clinical practice that can better reflect aging-related morbidity and mortality risk. The heterogeneity of age-related decline is not random, as environmental exposures can promote or impede healthy aging. Social Vulnerability Index (SVI) is a composite index accounting for different facets of the social, economic, and demographic environment grouped into four themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. We aim to assess the concurrent and combined associations of the four SVI themes on PhenoAgeAccel and the differential effects on disadvantaged groups. We use electronic health records data from 31,913 patients from the Mount Sinai Health System (116,952 person-years) and calculate PhenoAge for years with available laboratory results (2011-2022). PhenoAge is calculated as a weighted linear combination of lab results, and PhenoAgeAccel is the differential between PhenoAge and chronological age. A decile increase in the mixture of SVI dimensions was associated with an increase of 0.23 years (95% CI 0.21, 0.25) in PhenoAgeAccel. The socioeconomic status dimension was the main driver of the association, accounting for 61% of the weight. Interaction models revealed a more substantial detrimental association for women and racial and ethnic minorities with differences in leading SVI themes. These findings suggest that neighborhood-level social vulnerability increases the biological age of its residents, increasing morbidity and mortality risks. Socioeconomic status has the larger detrimental role among the different facets of social environment.

Historical redlining, a racially discriminatory practice implemented by the US government in the 1930s, has been associated with present-day environmental outcomes. However, there is limited research examining the relationship between historical redlining and contemporary housing quality. The objective of the present study was to investigate the relationship between historical redlining and contemporary housing quality in Atlanta, Georgia. Spatial patterns of housing code violation complaints from 2015 to 2019 were examined using point-pattern and spatial cluster analyses. We used Bayesian hierarchical models, accounting for spatial autocorrelation, to estimate associations between historical redlining and housing complaints, after adjusting for contemporary neighborhood characteristics, such as poverty, median structure age, vacant and renter-occupied properties, and residential racial segregation. A total of 48,626 housing code violation complaints were reported during the study period, including 6531 complaints deemed "hazardous." Historical redlining was a statistically significant predictor of housing complaints. We observed a 167% increased risk (IRR = 2.67, 95% confidence interval = 1.49, 4.77) of housing complaints for historically redlined neighborhoods compared to neighborhoods historically graded as "best" or "still desirable," after adjusting for neighborhood characteristics. Redlined neighborhoods also had an increased risk of "hazardous" housing complaints (IRR = 1.94, 95% confidence interval = 1.11, 3.40), after adjusting for contemporary neighborhood characteristics. Historically redlined neighborhoods exhibited disproportionately higher rates of housing code violation complaints. Spatial analysis of housing code violation complaints can provide insights into housing quality and inform interventions targeted at addressing the environmental legacy of structural racism.

Neighborhoods or residential environments have physical and social attributes which may contribute to inequalities in the overweight and obesity pandemic. We examined the longitudinal associations of baseline neighborhood-level income and racial residential segregation (using the Gi* statistic: low, medium, high) with changes in body mass index (BMI in kg/m²), using geocoded data from 1821 civil servants in the municipality of Rio de Janeiro, Brazil, followed-up for approximately 13 years (baseline wave 1: 1999, wave 2: 2001-2002, wave 3: 2006-2007, wave 4: 2012-2013). Linear mixed effects models using BMI measured in all four study waves were performed, accounting for gender, race, length of residence, education and time-dependent age, and per capita family income. After adjustments, both income and racial segregation were positively associated with BMI differences (but not BMI changes) over time, in a dose-response pattern. For income segregation, mean differences in BMI for participants living in high and medium vs. low segregated neighborhoods were 1.04 kg/m² (β = 1.04; 95% CI 0.47, 1.62) and 0.86 kg/m² (0.86; 0.33, 1.39), respectively. For racial segregation, mean differences in BMI for participants living in high and medium vs low segregated neighborhoods were 0.71 kg/m² (0.71; 0.14, 1.29) and 0.30 kg/m² (0.30; - 0.24, 0.83), respectively. We also showed a moderate to strong correlation between racial and income segregation at baseline. Strategies to reduce BMI and obesity-related health inequalities should include special efforts aimed at segregated neighborhoods and its obesogenic environments.

Community violence is a major cause of injury and death in the USA. Empirical studies have identified that some place-based interventions of urban private places, such as remediations of vacant lots and buildings, are associated with reductions in community violence in surrounding areas. The aim of this study was to examine whether routine maintenance and repair of urban public places (e.g., street construction projects) are also associated with reductions in community violence, proxied by violent crime incidents. This staggered adoption difference-in-difference analysis investigated the association between street construction projects and community violence in New York City from 2010 to 2019, divided into 40 calendar quarters. The units of analysis were street-quarters (n = 155,280). Intervention street-quarters were those with completed projects in 2010-2019; control streets were those where projects were scheduled but not completed before 2019. The outcome of community violence was proxied by counts of crime and violence incidents reported to the New York Police Department, within street-quarters. There were 81,904 street-quarters with any community violence incidents (52.7%). We found that street construction projects were associated with a decrease in reckless endangerment (ATT = - 1.3%; 95% CI = - 2.1%, - 0.4%), robbery (ATT = - 3.4%; 95% CI = - 6.1%, - 0.7%), and weapons offenses (ATT = - 1.6%; 95% CI = - 3.0, - 0.08%) occurring on street-quarters. Street construction projects may be yet another type of place-based intervention to reduce community violence.