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

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.

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.

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.

Place-based interventions may reduce violence, but approaches for capturing nearby incidents using kernel density estimation (KDE) vary. KDE smooths geospatial point data, like crime incidents, using a user-specified bandwidth often selected through data-driven approaches that rely on the underlying point pattern. Because point patterns vary by outcome, time, and context, data-driven methods can produce bandwidth sizes that are misaligned with the spatial extent of a place-based intervention, potentially limiting the ability to detect its effect. To illustrate the inferential challenges associated with data-driven bandwidth selection approaches, this study aimed to (1) quantify variability in bandwidths selected through data-driven methods and (2) examine the impact of bandwidth size on simulated intervention effects. We used violent crime data for Philadelphia (2013-2023). For Aim 1, we calculated bandwidth sizes for each crime-year combination using two default data-driven selection criteria and compared selected sizes across crime types and years. For Aim 2, we used a hypothetical place-based intervention with a known effect (30% reduction in nearby assaults) and ran simulations to examine how the intervention effect, estimated using Poisson regression, changed based on the bandwidth size used to estimate the crime density surface. Bandwidth sizes varied significantly by data-driven selection method, crime type, and year (range: 45.9-48,450 ft). For the simulated intervention, "true effects" (i.e., the reduction of nearby assaults attributed to the intervention) were only detectable at bandwidths between 200 and 2900 ft. Larger bandwidths resulted in estimates that incorrectly suggested the intervention was ineffective or increased crime. Data-driven bandwidth selection can obscure or distort intervention effects. Researchers should be critical and transparent when selecting KDE parameters in place-based violence prevention research.

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.

A growing body of research has revisited the social costs of U.S. interstate highways. In Kansas City, U.S. Highway 71 (Bruce R. Watkins Drive) was built through the city's East Side over nearly two decades, displacing residents, destroying community institutions, and raising safety and health concerns. Using Opportunity Atlas data, we compare long-term outcomes-income, economic mobility, incarceration, and teen birth-for the 1978-1983 cohorts by childhood residence: census tracts along the Highway 71 corridor versus other tracts in Kansas City. At age 35, those who grew up along the Highway 71 corridor had approximately 45% lower household incomes and 29% lower individual incomes than those from other parts of the city. They were more than twice as likely to be incarcerated and had substantially higher teenage birth rates. Disparities persisted in subgroup analyses of children from low-income families and remained statistically significant after adjusting for pre-existing neighborhood characteristics.

Ethnic enclaves are neighborhoods formed through discriminatory policies that concentrate disadvantage in marginalized communities. Living in these neighborhoods has important implications for maternal health; however, few studies have assessed this concerning severe maternal morbidity (SMM). We examined the relationship between residence in an ethnic enclave, comparing three methods of classification and SMM among 7 million births to Asian, Black, and Hispanic people in California from 1997 to 2018. SMM was constructed using the CDC's SMM index. We considered three methods of measuring ethnic enclaves (racial composition, location quotient, and the Gi* statistic) at the census tract level. Race-stratified mixed-effects logistic regression models accounting for area-level clustering were used to compare the odds of SMM in ethnic enclaves compared to average neighborhoods, adjusting for sociodemographic and pregnancy-related clinical factors and comorbidities. Among Hispanic birthing people, mixed results were found for ethnic enclave measures. Adjusted models showed lower odds of SMM for those in ethnic enclaves defined by Gi* (aOR 0.96, 95%CI 0.94, 0.98) and location quotient (aOR 0.90, 95%CI 0.88, 0.92) but higher odds using racial composition (aOR 1.03, 95%CI 1.01, 1.06). Black birthing people had higher odds of SMM in ethnic enclaves across all measures. Effect modification by nativity showed that US-born Black birthing people in enclaves had higher odds of SMM, while immigrant Black birthing people had lower odds. Overall, residence in ethnic enclaves is associated with SMM among Asian, Hispanic, and Black birthing people, with variations by ethnic enclave measure and nativity.

Prior research links violence inside the home to reduced dental care utilization, yet little is known about how community firearm violence affects dental care behaviors. The current study used data from wave V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), linked to census tract-level fatal and nonfatal shooting data from the American Violence Project for the 100 largest cities in the United States. The analytic sample included 1925 respondents aged 33-42. The primary outcome was self-reported dental care use in the past year. Firearm violence exposure was categorized as 0, 1, or 2 + shootings in a respondent's census tract over a 2-year period. Logistic regression models were used to estimate the relationship between shootings and dental care use, adjusting for individual sociodemographic factors, prior dental use, violence exposure, and contextual variables including poverty and dentists per capita. Respondents exposed to multiple shootings had significantly lower odds of past-year dental care use (OR = 0.625, 95% CI: 0.418-0.934) compared to those with no exposure, after adjustment. These findings provide new evidence that suggests exposure to neighborhood violence may reduce dental care use, net of key confounding variables. Public health and dental initiatives may consider violence exposure when designing interventions to increase care utilization.

Telehealth offers an avenue for older adults to access providers, discuss care needs, and have serious illness conversations. However, telehealth is embraced by some and not by others. Urban-dwelling, low-income older adults have unique challenges in accessing continuous care, engaging with the healthcare system and receiving support to address serious illness care needs. To investigate telehealth acceptance in low-income older adults, we conducted individual semi-structured qualitative interviews with 46 residents of three Medicaid-funded assisted living facilities (MALFs) which provide social, functional, and clinical support to underserved populations. Interview transcripts were analyzed using conventional content analysis. Four qualitative themes describing telehealth acceptance in low-income assistant living communities were identified. Benefit: Telehealth offers convenience-participants highlighted how telehealth facilitates access to healthcare appointments, making it easier to receive care. Barrier: Technology fluency and access is not universal-many described physical and technological barriers that limit their ability to use telehealth effectively. Preference: general distaste for telehealth-this theme captures participants' overall attitudes and gut reactions to telehealth, ranging from enthusiasm to skepticism. Concern: mistrust in clinical connection-patients expressed concerns about trust, security, and the ability to build meaningful connections with providers through telehealth. While telehealth can make care more convenient, telehealth encounters may hinder trust in the therapeutic relationship between urban-dwelling low-income older adults and providers. For telehealth conversations discussing serious illness, additional efforts are needed to support engagement, foster trust, and provide patient-centered care in populations that have been historically marginalized.