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

Urban commuters increasingly face chronic stress, a known risk factor for cardiovascular and mental health issues. Active travel modes-such as walking or cycling-can potentially mitigate stress by integrating physical activity into daily routines; however, their effect on autonomic stress regulation remains unclear. This study aims to examine how different commuting modes influence autonomic nervous system recovery from stress in real-world urban environments. We analyzed minute-by-minute heart rate variability (HRV) data collected by wearable devices from 200 urban commuters in Beijing over 1 week, capturing HRV before, during, and after daily commutes. Active commuters demonstrated a 7.6% faster return to baseline HRV compared with passive commuters, indicating a more rapid recovery from commuting-induced stress. Notably, while overall active commuting supported faster recovery, higher levels of moderate-to-vigorous physical activity during the commute were associated with slower short-term recovery, suggesting that the intensity of exertion matters. These findings highlight that active commuting enhances both physical fitness and stress resilience, while emphasizing the importance of comfortable, moderate-intensity active travel conditions. The results support targeted investments in pedestrian and cycling infrastructure-particularly routes that are safe, connected, and designed to avoid excessive physical strain-to foster healthier, less stressed urban populations.

Racialized economic segregation is a known determinant of health disparities that has been associated with adverse pregnancy outcomes. However, no study has investigated its association with fecundability, the per-cycle probability of conception. We analyzed data from 10,438 U.S. participants enrolled in Pregnancy Study Online (2013-2022), an internet-based preconception cohort study. Eligible participants were aged 21-45 years, assigned female at birth, and trying to conceive without fertility treatment use. Using baseline residential addresses, we calculated segregation based on the Index of Concentration at the Extremes (ICE) from the American Community Survey 5-year estimates. ICE ranges from -1 ("disadvantaged") to 1 ("privileged"). We operationalized ICE metrics at the census tract level: economic segregation (ICE_income: ≥ $100 k vs. < $25 k), racial segregation (ICE_white/black: non-Hispanic White vs. non-Hispanic Black), and racialized economic segregation (ICE_{income + white/black}: non-Hispanic White ≥ $100 k vs. non-Hispanic Black < $25 k). We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for precision variables. We observed a monotonic inverse association for increasing quintiles of ICE_income and ICE_{income + white/black} with fecundability, but less evidence of associations with ICE_white/black. For instance, relative to ICE_{income + white/black} quintile 5 ("most privileged"), FRs for quintiles 4, 3, 2, and 1 ("most disadvantaged") were 0.92 (95% CI = 0.86-0.99), 0.84 (95% CI = 0.78-0.90), 0.84 (95% CI = 0.78-0.90), and 0.79 (95% CI = 0.73-0.86), respectively. Living in the most disadvantaged neighborhoods with respect to racialized economic segregation was associated with a moderate decrease in fecundability.

Climate change has led to an increase in extreme weather events. Adverse weather conditions limit outdoor activities, reduce step counts, and negatively affect health. Malls offer a possible alternative for walking in such weather; however, their step-loss mitigating role remains unexplored. We analyzed data from 18,666 individuals aged ≥ 18 years (mean ± standard deviation: 48.0 ± 12.6; women: 71.5%), tracking daily step counts over a year using a smartphone application. Step count data were collected via devices owned by the participants and then transferred to the program database through the application. Multilevel mixed-effects linear regression was used to estimate the associations between daily step counts and various interaction terms, focusing on two-way interactions between mall visits and weather, and three-way interactions involving sociodemographic factors. On days with maximum temperatures of < 15 °C or ≥ 35 °C, as well as during rain, deep snow depth, or strong winds, step counts were lower. However, on days when malls were visited, step counts were 1,269 higher compared with those on non-visit days. This difference was more pronounced during adverse weather: < 15 °C, ≥ 35 °C temperature, 0.1-4.9 and > 5 mm precipitation, snow depth > 3 cm, and wind speeds > 2.50 m/s. Mall visits mitigated weather-related step count reductions, particularly among older adults, women, and low-density area residents who generally take fewer steps. These findings underscore the role of weather-independent spaces, such as malls, in mitigating step count reductions during adverse weather. Improving access to and promoting their use are essential for maintaining physical activity in such conditions.

Safe Streets, a community violence intervention (CVI) program originally based on the Cure Violence model, aims to reduce gun violence through conflict mediation, behavior modification, and community-level normative change. Program effectiveness has varied across implementation sites in prior evaluations. To better understand community-level factors that may influence Safe Streets implementation and effectiveness, this study explores Safe Streets workers' descriptions of violence dynamics and violence prevention approaches at the community level. Semi-structured interviews with 27 staff across all ten active sites were conducted from July to November 2023. A thematic constant comparative approach was used, incorporating inductive and deductive coding. Findings were analyzed across sites, and previous estimates of program effects were integrated with current findings. Themes identified included differences in neighborhood stability, types of conflicts, approach to community norm change, depth of community relationships, and differences in policing. Variability in the level of transience between neighborhoods and the most prevalent conflicts suggests the need for model adaptations to fit neighborhood dynamics. Integration with recent estimates of Safe Streets' impact on homicides and non-fatal shootings suggests that Safe Streets is most effective in neighborhoods experiencing current generational conflicts, and strong relationships with community partners are associated with more effective violence reduction. Sites that reported recent large police takedowns were also more likely to be associated with significant violence reductions, suggesting that while siloed, the effectiveness of CVI and law enforcement may impact the other. Additional research exploring the mechanisms of community normative change is needed to inform program implementation at this level.

Despite advances in HIV treatment, disparities in healthcare access remain across low-income (LIC), middle-income (MIC), and high-income (HIC) countries, limiting access to clinical care, antiretroviral therapy, and viral load testing. This study developed the HIV Care Access Index (HIV-CAI) to measure and compare HIV care service access across countries and within geographic regions and examined associations with economic and health indicators. A cross-sectional survey was conducted between August 2021 and June 2023 across nine countries: Botswana, China, Colombia, Kenya, Nigeria, Puerto Rico, South Africa, Thailand, and the United States. Participants were adults living with HIV recruited from urban, suburban, and rural settings through HIV service organizations, sexual and gender minority centers, and resource-limited communities. The HIV-CAI was scored from 0 to 1 (worst to best access) across three domains: Access to HIV Clinical Care and Providers, Access to HIV Medication, and Access to Viral Load Testing. Among 1,598 participants, Botswana demonstrated the highest HIV care access (0.93), followed by Thailand (0.91) and Kenya (0.90), while Nigeria showed the lowest access (0.64). Access to HIV medication was relatively consistent across regions, whereas access to clinical care and providers was limited, particularly in rural areas. Countries with higher HIV burden, incidence, and prevalence were associated with better care access. The HIV-CAI reveals disparities in HIV care access across geographic areas. Future interventions should prioritize improving equitable access, particularly in rural areas and countries with lower overall access scores.

De facto segregation by racial identity and insurance persists in US hospitals, leading to health disparities. To understand factors driving healthcare segregation and NYC residents' experiences, we conducted the Health Equity and Access to Care project. The present study explores NYC residents' perspectives on and recommendations to mitigate healthcare segregation. To recruit English-speaking NYC residents (n = 184) stratified by race/ethnicity and insurance status for virtual and in-person focus groups (FG, n = 35), we utilized a multipronged outreach strategy with community groups and a research firm. We employed constructivist grounded theory and applied structural racism frameworks, Penchansky and Thomas' dimensions of healthcare access, and the socioecological model to guide the analysis of participants' perspectives on improving care. Participants described priorities across accessibility, availability, affordability, accommodation, and acceptability domains, while thematic differences emerged by race/ethnicity and insurance status (e.g., White participants highlighted how health system bureaucratic inefficiencies perpetuated harmful healthcare experiences whereas Black participants discussed how institutional and employment factors contributed to staff burnout, negative patient experiences). Structural factors (e.g., residential segregation, neighborhood resources, underinvestment in safety-net systems) were perceived as drivers of harmful healthcare experiences across all domains. Priorities for change include anti-bias training, authentic community engagement, patient navigation and digital connectivity investments, transparent and accessible healthcare operations, investment in neighborhood-based healthcare, and building a diverse workforce. Participants' recommendations call for coordinated, multidisciplinary efforts across interpersonal, community, institutional, and structural domains co-designed with communities. Elevating community voices can support stakeholders to act on the necessary levers to desegregate healthcare and advance health equity.

This study examined the long-term mental health outcomes associated with childhood gun violence exposure by race/ethnicity and gender. Data were drawn from the National Longitudinal Survey of Youth 1997 (1997-2021). Gun violence exposure was measured as any exposure before age 18. Mental health outcomes assessed included depressive symptoms, heavy episodic drinking, and daily cigarette smoking. Hierarchical generalized linear models were used. Findings indicate that about 16.15% of the respondents reported childhood exposure to gun violence before the age of 18. Gun violence exposure was significantly associated with depressive symptoms among white men, white women, and Hispanic women. Additionally, it was associated with higher odds of heavy episodic drinking among Black men, white women, and Hispanic women. Gun violence exposure was associated with higher odds of daily smoking for all groups. The study findings suggest that there is a high prevalence of childhood exposure to gun violence in the U.S. The relationship between childhood gun violence exposure and adult mental health outcomes varies by race/ethnicity and gender. These results highlight the need for gun violence preventions and interventions tailored to specific demographic groups to address the long-term mental health consequences of childhood gun violence exposure.

Protracted urban displacement poses unique challenges for older refugees, yet their mental health and psychosocial wellbeing remain underexplored. This study examines the experiences of older refugees in Nairobi, Kenya, focusing on systemic exclusion, social isolation, and loneliness. Using a community-based participatory research approach, we conducted 10 focus group discussions with 53 older refugees from the Democratic Republic of Congo, Ethiopia, Somalia, and South Sudan. We analyzed data using a framework analysis approach, generating the following themes: (a) systemic exclusion and forced dependency as determinants of distress, (b) displacement-disrupted networks and social isolation, and (c) loneliness as the emotional experience of social disconnection and systemic exclusion. Within these broader thematic areas, we found that exclusion and dependency stemmed from policy gaps, such as the delayed implementation of the 2021 Refugees Act in Kenya which restricted access to social protections. Many older refugees expressed a sense of intergenerational ambivalence and unmet expectations of aging resulting from forced displacement. Finally, participants described "being alone" as an idiom of distress related to loss of meaningful relationships, anger at societal exclusion, and hopelessness over present and future circumstances. Our findings underscore the need for age-inclusive and age-tailored strategies that address systemic exclusion and help older refugees build and restore social networks to mitigate isolation and loneliness. We provide recommendations to enhance social support in family and community contexts aligned with the Inter-agency Standing Committee's mental health and psychosocial support framework.

Noise pollution is a persistent stressor in urban settings, which affects all segments of the population. Its neurological impacts are less studied than those of hypertension, heart disease, or mental health, but there is evidence suggesting that neurological health is affected by noise pollution. We searched six databases (PubMed, EBSCO, Semantic Scholar, Web of Science, Embase, and Scopus) for studies published post-2000 that report residential noise exposure and its neurological effects. We mapped studies based on geographical location, exposure measurement, and study results. Two researchers independently screened and extracted data, and 117 distinct studies from 100 publications were included. European countries and high-income countries dominate the evidence base, and noise is most commonly modeled as 24-h exposure through L-metrics (e.g., Lden). Included studies showed mostly positive associations between noise exposure and adverse neurological outcomes, such as stroke events and mortality, neurodegenerative diseases, cognitive decline, and poorer cognitive performance in schoolchildren. There was no overall relationship between noise exposure and brain structure. While noting the heterogeneity in our included studies, it is clear that long-term noise exposure has neurological impacts. Further research is needed to understand the impact of all-source noise and how noise exposure affects the brain. Further, infrastructure for monitoring noise and population health in developing countries is needed to remedy the global imbalance in data.