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

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.

Growing evidence suggests exposure to high temperatures may result in increased urban crime, a known driver of health and health inequity. Theoretical explanations have been developed to describe the heat-crime relationship without consensus yet achieved among experts. This scoping review aims to summarize evidence of heat-crime associations in U.S. cities. Further examination of empirical and translational inconsistencies in this literature will ensure future studies of urban heat-crime relationships in the U.S., and their policy impacts are informed by a thorough understanding of existing evidence. We performed a comprehensive literature search of empirical studies on heat-crime relationships in U.S. cities published between January 2000 and August 2023. The included studies were qualitatively synthesized based on operationalized exposures, outcomes, covariates, methodologies, theoretical framing, and policy implications. In total, 46 studies were included in this review. Most studies (93%) reported significant, positive associations between urban heat exposure and both violent and non-violent crime outcomes. The shape and strength of these associations varied based on operational definitions of urban heat exposures, crime outcomes, and relevant covariates in employed methods. We also found inconsistencies in the theoretical explanations and policy implications reported across studies. Climate-driven extreme heat events are projected to increase in frequency and severity. Our findings underscore the urgency of refining the understanding and translation of the complex relationship between urban heat and crime. In this review, we highlight opportunities to improve the methodological quality and responsible policy translation of future research in U.S. cities, which has implications for research globally.

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.

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.

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013-2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

Police use-of-force is a growing public health concern, with recent estimates suggesting that over 70,000 people are injured by police each year. To reduce the risk of injury to civilians, most police agencies authorize the use of various less-lethal weapons. However, to date, there is little consensus as to which types of less-lethal weapons are most effective at reducing injury risk. In this study, we test the differential effects of less-lethal weapons on civilian injury and injury severity using data on 2348 use-of-force incidents originating from 17 large urban and metropolitan law enforcement agencies from 2015 to 2019. Specifically, we assess the injury risks associated with conducted energy devices, chemical agents, impact weapons, and police canines, while controlling for a robust set of officer, civilian, and situational characteristics. Our results indicate that chemical agents reduce the risk of hospitalization or death significantly more than other weapon types, while police canines increase the risk of all injury outcomes significantly more than other weapon types. Adjusting for incident characteristics, chemical agents are predicted to cause hospitalization or death in 4% of cases, compared to 13% for conducted energy devices, 16% for impact weapons, and 37% for police canines. These findings suggest that civilian injury may be reduced through use-of-force policies that prioritize less severe modalities of force, though more research is needed on the contextual and long-term effects of these weapons.

Geostatistical data aggregated at state, county, municipality, or ZIP code levels often are utilized for assessing drug overdose epidemic impact and planning resource distribution. Data aggregated at these levels may obscure critical disparities among populations experiencing high rates of drug-related mortality (DRM), especially in densely populated urban areas. Our research was centered on Cuyahoga County (Cleveland), OH, which ranks 15th in the USA for drug-related mortality. This study built on recent efforts that adopted a finer geographical lens by examining DRM rates at the census tract level. Our investigation used Cuyahoga County census tracts with high and low DRM rates and compared them with Cuyahoga County census tracts with high and low levels of opportunity as developed by a publicly available, statewide opportunity index. Analyzing DRM data from 2014 to 2022, we found that the odds of an individual experiencing DRM in low-opportunity areas were quadruple the odds for someone in high-opportunity zones. Our findings highlight the critical need for more granular geographic analysis in urban areas, where heterogenous socioenvironmental conditions appear to correlate with significant heterogeneity in the ways in which residents experience the risk of dying from a drug overdose. By focusing on smaller areas, this approach provides a clearer understanding of the DRM landscape that could facilitate the prioritization of more targeted, culturally centered, public health interventions.

Spatial social polarization (SSP) refers to the uneven spatial distribution and subsequent concentration of polarized social and/or economic groups in a specified geographic area. However, there is heterogeneity in how SSP is measured and operationalized in research. To this end, we conducted a scoping review to characterize the use of SSP measures in public health research, providing a foundation for those seeking to navigate this complex literature, select measurement options, and identify opportunities for methodological development. Using a structured search strategy, we searched PubMed for any primary research, published since 2007, that examined the relationship between SSP and health outcomes. Across 117 included studies, we found a body of evidence that was primarily set in the United States (n = 104), published between 2020 and 2022 (n = 52), and focused on non-communicable diseases (n = 40). We found that defining SSP in the context of privilege, deprivation, and segregation returns a variety of measures. Among measures, we categorized 18 of them as SSP measures, with the Index of Concentration at the Extremes (n = 43) being the most common, and 5 of them as composite indices based on numerous underlying variables spanning several domains like education and race/ethnicity. While most employed a single SSP measure (n = 64), some included up to 5 measures to examine the robustness of findings or to identify how a multidimensional approach to SSP affected associations. Our findings fill a critical literature gap by summarizing options for operationalizing SSP measures and documenting their respective methodologies. Future research should consider using multiple SSP measures to capture the multidimensionality of SSP, widen the scope of health outcomes, and clearly explain the choice of measure(s) and methods used to derive them. Our findings can inform future research questions and help guide researchers in the selection and utilization of the various SSP measures.

Overdose prevention centers (OPCs) offer supervised environments for drug consumption and harm reduction services, yet their implementation in the United States (US) remains limited. The present study analyzed the perspectives of residents and employees within a 0.75-mile radius of the first state-authorized OPC in the US (N=125). Surveys revealed that 74% supported an OPC opening in their neighborhood, with a slightly higher proportion (81%) favoring an OPC elsewhere in the city. Support for an OPC was associated with greater perceived visibility of homelessness in the neighborhood (p=0.04) and younger age (p=0.01) but was not significantly associated with other socio demographics. While participants were generally supportive, some expressed concerns about increased drug activity. Findings may have been impacted by grassroots education and public awareness campaigns. Results emphasize the importance of engaging with community members to build support for evidence-based harm reduction interventions such as OPCs.

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.