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

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.

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.

Parks are one component of the built environment to promote regular physical activity (PA) among youth. This study investigated differences in park-based PA among youth based on demographics and park features in racially or ethnically diverse communities. In 2017-2018, parks were selected in majority Asian (n = 3), Latino (n = 5), and Black (n = 4) neighborhoods in North Carolina (n = 6) and New York (n = 6). Researchers recruited parents/caregivers of 5-10-year-olds to participate. Children wore an Actigraph GT3 + waist accelerometer and a QStarz GPS unit and were instructed to play normally for at least 15 min. Evenson cut-points were used to classify PA levels as sedentary, light, moderate, and vigorous. Chi-squared tests and non-parametric Kruskal-Wallis tests were used to examine differences in PA intensity minutes (sedentary, light, moderate-to-vigorous) across study location and demographic variables. Youth participated from NY (n = 200) and NC (n = 157). Overall, most park-based PA was spent in light intensity (59.9%), followed by moderate-to-vigorous intensity (32.4%). Females, compared to male participants, spent more time in sedentary behavior (9.0%, 6.1%) and less time in moderate-to-vigorous PA (26.6%, 38.1%). Participants who identified as Black (32.9% MVPA), Latino (35.8%), and Other (39.8%) spent higher percentages of time in moderate-to-vigorous PA than Asian (26.6%) and non-Hispanic White (21.3%) participants. The highest proportion of moderate-to-vigorous PA occurred on swing sets (46%) and basketball courts (45%). Racial and ethnic, sex, and activity area differences in park-based PA indicate that diverse youth use parks uniquely; these factors should be considered in designing parks for various ages and backgrounds.

The WHO emphasizes the importance of taking area-level factors into account when formulating public health interventions. The aim of this systematic review was to identify which area-level factors are associated with children's dental caries in Europe and might therefore be a suitable starting point for public health interventions. We conducted a systematic review based on a search in PubMed, Web of Science, and Cochrane Library including all European studies on caries in children and their area-level factors published since the year 2000 in English or German. We included 39 studies and identified 13 area-level factors investigated in the literature: degree of urbanization, deprivation, mean housing price, gross-national product, mean level of education, unemployment proportion and income, density of supermarkets, snack bars and dental offices, health, diet, and crime. Rural residency and higher unemployment were weakly associated with poorer oral health regarding dental caries. Deprivation showed a stronger (inverse) association. For income, findings were ambiguous; studies showed associations in both directions. For the other determinants, the included studies found no association. Many studies reported associations between place of residence and children's dental caries, but the mediators on this causal path are still not clearly established. The area-level factors analyzed in this review seem to play a role, but more studies with designs that allow causal interpretation of findings are needed to establish solid robust evidence that can be used in the formulation of future health policies.

Using 2022 data from 600 adults (≥ 60 years) in Porto, Portugal, we explored the association between housing insecurity and various health outcomes. We examined housing conditions, affordability, and stability in relation to loneliness, quality of life, cognitive function, perception of healthy ageing, and sleep using regression models. Older adults without house heating (β = 2.293; 95%CI = 0.753, 3.833), with leaks/dampness/rot (β = 3.741; 1.818, 5.664), insufficient daylight (β = 2.787; 0.095, 5.479), living in neighborhoods with noise (β = 1.793, 0.280 to 3.305), pollution/grime (β = 2.580; 0.746, 4.414), and violence/crime/vandalism (β = 3.940; 1.723, 6.157), who faced housing cost overburden (β = 2.001; 0.426, 3.577), eviction (β = 12.651; 0.852, 24.450), and moved frequently (β = 4.129; 1.542, 6.716) exhibited higher levels of loneliness. Similarly, lack of house heating (β = - 1.942; - 3.438, - 0.445), leaks/dampness/rot (β = - 4.157; - 5.999, - 2.316), insufficient daylight (β = - 3.124; - 5.714, - 0.534), noise (β = - 2.143; - 3.600, - 0.686), pollution/grime (β = - 2.093; - 3.860, - 0.325), violence/crime/vandalism (β = - 2.819; - 4.948, - 0.691), and those with housing cost overburden (β = - 2.435; - 3.930, - 0.940) reported lower quality of life. Those with no toilet (β =  - 1.891; - 3.760, - 0.021) or shower (β =  - 1.891; - 3.760, - 0.021) and who faced forced displacement (β =  - 2.179; - 3.516, - 0.842) presented lower cognitive function. Furthermore, those living in neighborhoods with pollution/grime (OR = 0.494; 0.322, 0.756) and violence/crime/vandalism (OR = 0.477; 0.284, 0.801), those in social housing (OR = 0.728; 0.575, 0.922), and those who moved frequently (OR = 0.475; 0.257, 0.879) reported lower levels of perceived healthy ageing. Insufficient sleep was more common among residents in social housing (OR = 2.155; 1.102, 4.213), while poor sleep quality was least likely both among those living in social housing (OR = 0.445; 0.220, 0.900) and affordable housing (OR = 0.381; 0.162, 0.896). Good quality, stable, and affordable housing seems crucial for healthy ageing.

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.

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.