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

The COVID-19 pandemic highlighted several challenges that cities face that can affect the health of urban populations. These challenges are an opportunity for sharpening of our urban health scholarship, to rethink the questions the field should be asking, and how the answers to those questions should guide practice. The central role of inequities in cities, the politics of urban health, communication for health, the deployment of health care, and the future of urban living are all areas that merit attention by scholars and practitioners in the field in coming decades.

The 2022-2023 mpox outbreak has disproportionately impacted gay, bisexual, and other men who have sex with men (GBMSM). The US CDC recommended individuals to explore safer sexual practices that minimize the potential risk of exposure and also strongly encouraged for eligible individuals to prioritize vaccination. This study aimed to analyze social media data related to mpox on Reddit since the mpox outbreak and identify themes associated with the impact on social behaviors and social processes among targeted population. Publicly available data were collected from the social media Reddit. We extracted the summarized mpox-related posts since the beginning of May 2022 from popular subreddits that were popular among GBMSM. We thematically analyzed the content to identify the overall themes related to the GBMSM's responses to the outbreak. There is an overall increase in the number of daily mpox-related posts, with three upticks in late May, late July, and early August 2022, which may correspond to the dates that the first mpox case was identified in the USA, the WHO declared a global public health emergency, and the US Department of Health and Human Services declared a public health emergency. Four themes were identified: (1) changes in sexual behaviors and social activities; (2) mpox vaccine attitude, uptake, and hesitancy; (3) perceived and experienced stigma and homophobia, and mental distress; and (4) online information-seeking and mutual aid and support. GBMSM changed their sexual behaviors and social activities to mitigate their exposure to the virus during this outbreak and actively sought and shared information about mpox vaccination in their respective settings, while some were hesitant due to concerns about side effects and potential effectiveness. Perceived and experienced stigma and discrimination on gay- and same sex-identify have impacted GBMSM's mental health. Interventions to promote the mpox vaccine must address the historical medical mistrust and vaccine hesitancy among GBMSM.

Gun-related violence exposure is a significant public health problem for urban youth. Few studies have implemented methods to estimate the spatial influence of activity spaces on gun violence exposure constrained by the physical configuration of walkable street networks. The present research uses computational network and local indicators of spatial autocorrelation methods to explore gun violence exposure along the walkable streets near schools in Compton, California. Findings demonstrated strong evidence that gun violence is clustered at all distances along the pedestrian network and in proximity to Compton Unified School District (K-12) schools, reaching a maximum between 1.2 and 1.8 mi; thereafter the "attractiveness" of schools to gun violence was inhibiting. Almost all schools had at least one shooting within a 5-min walk (i.e., about 400 m); 37.8% of schools had an average shooting distance of less than 400 m; about 250 incidents occurred within 5 min of schools; and about 30 schools had a shooting within a 5-min walking distance. Determining the spatial extent of violence exposure in proximity to key activity spaces for youth, such as schools, has substantial implications for the health and wellbeing of youth living in violence-prone areas. The public health and legal implications of this study are discussed in context.

Gun violence imparts a tremendous human and financial toll on local communities. Researchers have documented extensive mental and physical health consequences of generalized violence exposure but few studies have analyzed the particular impacts of gun violence on community well-being using nationally comprehensive data. We leverage a unique database of almost 16,000 neighborhoods in 100 US cities (2014-2019) to examine how year-over-year rates of gun violence correspond to overall neighborhood well-being and three aspects of community health: (1) health behaviors, (2) physical and mental health status, and (3) health prevention efforts. We simultaneously consider the reciprocal influence of neighborhood well-being on subsequent gun violence while accounting for concentrated disadvantage in communities. The results demonstrate that gun violence is associated with poorer community health in subsequent years, particularly health behaviors and mental/physical health status. Furthermore, we find substantial reciprocal effects for both gun violence and community health in their relationship to neighborhood concentrated disadvantage. These findings highlight the consequential role of gun violence in perpetuating cycles of harm in local communities.

US correctional facilities operate under a binary interpretation of gender, which can yield inherent risks and conflicts for incarcerated transgender people. We conducted a scoping literature review on challenges unique to transgender individuals within US correctional settings. Online databases were searched to identify papers that addressed the challenges of incarcerated transgender adults age 18 + within US correctional institutions. A concurrent analysis of legal literature was reviewed with key policy recommendations extracted. A total of 33 papers (21 scientific studies and 12 legal analyses) met criteria for inclusion. Of the 21 scientific studies, the majority of papers (n = 14) focused on transgender women and most (n = 13) utilized qualitative methods. Emerging themes revealed challenges in key domains of violence, health, healthcare access, housing, and a pervasive culture of transphobia. Legal analyses supported policy changes such as implementing case-by-case housing classification systems, providing all forms of gender-affirming care, and safeguarding gender expression. Transgender persons face distinct obstacles while incarcerated in US correctional facilities and are in need of expanded protections. Working in tandem with efforts to decarcerate and reduce criminal legal involvement, widespread institutional policy change, such as redefining housing assignment policies, ensuring gender-affirming healthcare, and expanding transgender-specific competency trainings for correctional staff, is necessary.

This study investigates the changes in physical church closings years 2013 to 2019 in New York City (NYC), Philadelphia, and Baltimore and the association with COVID-19 infection rates. We applied Bayesian spatial binomial models to analyze confirmed cases of COVID-19 as of February 28, 2022, in each city at the zip code-level. A one unit increase in the number of churches closed corresponded to a 5% higher COVID-19 infection rate, in NYC (rate ratio = 1.05, 95% credible interval = 1.02-1.08%), where the association was significant. Church closings appears to be an important indicator of neighborhood social vulnerability. Church closings should be routinely monitored as a structural determinant of community health and to advance health equity.

Little is known regarding the health outcomes of people who exit from housing assistance and if that experience varies by the circumstances under which a person exits. We asked two questions: (1) does the type of exit from housing assistance matter for healthcare utilization? And (2) how does each exit type compare to remaining in housing assistance in terms of healthcare utilization? This retrospective cohort study of 5550 exits between 2012 and 2018 used data from two large, urban public housing authorities in King County, Washington. Exposures were exiting from housing assistance and type of exit (positive, neutral, negative). Outcomes were emergency department visits, hospitalizations, and well-child checks (among those aged < 6) in the year following exit from housing assistance. After adjustment for demographics and baseline healthcare utilization, people with positive exits had 26% (95% confident interval: 6-39%) lower odds of having 1 + ED visits in the year following exit than people with negative exits and 20% (95% CI: 6-31%) lower odds than those who continued receiving housing assistance. Neutral and negative exits did not differ substantially from each other, and both exit types appear to be detrimental to health, with higher levels of ED visits and hospitalizations and lower levels of well-child checks. Why people exit from housing assistance matters. Those with negative exits experience poorer outcomes and efforts should be made to both prevent this kind of exit and mitigate its impact.

There have been no peer-reviewed, quantitative research studies on the effectiveness of gun-free school zones. The objective of this study was to use a cross-sectional, multi-group controlled ecological study design in St. Louis, MO city that compared the counts of crimes committed with a firearm occurring in gun-free school zones compared to a contiguous area immediately surrounding the gun-free school zone (i.e., gun-allowing zones) in 2019. Gun-free school zones were measured and analyzed in two ways. In the primary analysis, boundaries of the tax parcels were used for each school as the beginning of the gun-free school zone. Results from this analysis, after adjustment for pair-matching and confounding, were null. In the secondary analysis, gun-free school zones were measured as beginning at the geographic centroid of the school's address. After adjusting for the pair-matching and confounding, this analysis showed 13.7% significantly fewer crimes committed with a firearm in gun-free school zones compared to gun-allowing zones. These results suggest that gun-free school zones are not being targeted for firearm crime in St. Louis, MO.

Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. Interviews were audio recorded, transcribed, and translated, if needed. Initial data analyses were conducted rapidly in the field to inform public health actions. We then conducted additional analyses including line-by-line coding of the interview transcripts using a thematic analytic approach. We identified four main themes. First, inequity in language access was a predominant barrier. Second, multiple social and structural barriers existed. Third, HLMSM encountered intersectional stigma. Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population.

The Great Migration was a movement of roughly eight million Black Southerners relocating to the North and West from 1910 to 1980. Despite being one of the most significant mass internal migrations during the twentieth century, little is known about the health outcomes resulting from migration and whether migrators' destination choices were potential mechanisms. This study measured the association between destination county disadvantage and odds of low birth weight during the last decade of the Great Migration. We used the US Census from 1970 as well as the birth records of first-time Black mothers who migrated from the South collected through the National Center of Health Statistics from 1973 to 1980 (n = 154,145). We examined three measures of area-based opportunity: Black male high school graduation rate, Black poverty rate, and racialized economic residential segregation. We used multilevel logistic regression, where mothers were nested within US counties, to quantify the relationship between county disadvantage and low birth weight. After adjusting for individual risk and protective factors for infant health, there was no relationship between county opportunity measures and low birth weight among migrators. Although high socioeconomic opportunity is typically associated with protection of low birth weight, we did not see these outcomes in this study. These results may support that persistent racial discrimination encountered in the North inhibited infant health even as migrators experienced higher economic opportunity relative to the South.