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

This study examined the cross-sectional and longitudinal associations between neighborhood socioeconomic disadvantage and frailty in middle-to-older-aged adults. Data were obtained from a cohort study conducted in Brisbane, Australia, with 3966 participants (mean age 58.2 years; female 57.6%) included in cross-sectional analysis and 2846 in longitudinal analysis (3-year follow-up). A frailty index (FI), a composite score consisting of 32 items, was used continuously (range 0-1) and categorized into frail (FI > 0.35) and non-frail. Neighborhood disadvantage was measured using the Index of Relative Socioeconomic Disadvantage, an area-level composite index, and was categorized into tertiles. Two-level mixed-effects linear and logistic regression models were fitted, accounting for area-level clustering through random intercepts for areas and adjusting for demographic variables and individual-level socioeconomic status. In the cross-sectional analysis, 11% of participants were frail. Compared to residents of low disadvantage neighborhoods, those in middle and high disadvantage neighborhoods had higher levels of frailty and greater odds of being frail (OR = 1.54 [95% CI 1.13, 2.09] and OR = 2.86 [2.11, 3.88], respectively). In the longitudinal analysis, residing in middle and high disadvantage neighborhoods was significantly associated with increases in FI scores, relative to low disadvantage neighborhoods. Incident frailty was observed in 5% of participants at the follow-up. Residing in high disadvantage neighborhoods showed significantly higher odds of incident frailty (OR = 1.75 [1.08, 2.86]). Mid-to-older-aged residents of disadvantaged neighborhoods are more likely to be frail and to become frail over 3 years, compared to those in advantaged neighborhoods. Community-level interventions to reduce frailty should target disadvantage neighborhoods.

The economic disruption of the COVID-19 pandemic combined with a pre-existing housing affordability crisis to threaten a wave of evictions from rental housing in the United States. Eviction and housing loss were associated with a range of adverse outcomes even prior to the pandemic; during the public health emergency, housing instability could have additionally increased opportunities for viral spread. Mitigating eviction risk was therefore an important form of prevention. We evaluate one federal policy response to the potential eviction crisis, the Emergency Rental Assistance program (ERA). Under ERA, approximately $47 billion was transferred to state and local governments to establish programs to financially assist at-risk renter households. We examine the relationship between receipt of rental assistance and rental housing stability, both overall and for higher-risk groups defined by presence of children and respondent racial and ethnic identity. Our analysis used U.S. Census Bureau Household Pulse Survey data (July, 2021-April, 2023) and two analytical techniques. First, we created matched treatment and comparison groups using applicants awaiting a decision and coarsened exact matching (n = 18,329) to examine the relationship between rental assistance and 1) whether the household was in rental arrears and 2) perceived risk of housing loss from eviction. Second, we estimated recursive bivariate probit models simultaneously modeling rental assistance receipt and rental arrears in a larger sample (n = 160,443). We found rental assistance receipt substantially reduced the risk of being in arrears and perceived risk of eviction. Effects on arrears were somewhat larger for households with children and for Black households compared to others in the matching analysis.

While the number of state legislative changes to relaxed concealed firearm carrying laws continues to increase, research examining the impact of these laws on changes in criminal behavior, particularly in urban contexts, has not kept pace. To enhance our understanding of the potential impact of permitless carry legislative changes, we examined the temporal association between legislative changes and changes in illegal and dangerous behavior most likely to be associated with firearms violence and arrests in Lexington (KY), Oklahoma City (OK), and Tulsa (OK). We use statistical controls to account for a major temporal confounder: the disruption of social order that occurred during and after the global COVID-19 pandemic in 2020. Our findings show violent criminal offenses did not shift in the post-permitless carry period. However, there were consistent and robust statistically significant increases in illegal possession of a firearm, as well as an upward shift in threatening firearm behavior (i.e., brandishing a gun/pointing a firearm), net of controls and confounders. We also find significant and sizeable increases in stolen and recovered firearms in Lexington (KY), the lone setting that collected this outcome measure during our study period. We conclude by discussing how the findings can inform policy, forthcoming legislative initiatives, and future research.

Previous studies have established that neighborhood environments influence mental health (MH), but the mediating role of physical activity in this relationship remains underexplored. Additionally, there is a lack of longitudinal research that investigates how neighborhood environments affect MH through physical activity pathways. We aimed to (1) analyze the cross-sectional relationships and longitudinal changes between neighborhood environments and MH, considering the mediating role of physical activity, and (2) investigate the urban-rural disparities in these associations. Data came from 15,470 adults in the 2010 and 2014 waves of the China Family Panel Studies. We applied multilevel structural equation modeling to examine cross-sectional and longitudinal relationships between neighborhood environments and MH via the pathway of physical activity. Cross-sectional results indicated that environmental aesthetics were positively associated with MH. The count of leisure facilities and environmental aesthetics were indirectly and positively associated with MH through participating in more physical activities. Meanwhile, there was no strong evidence on the association between longitudinal changes in neighborhood environments and longitudinal changes in MH. We also observed notable urban-rural variations in how neighborhood environments relate to MH. Environmental aesthetics were positively associated with MH in rural China, and physical activity did not mediate these associations. These findings suggested that improving access to sports and exercise facilities and enhancing environmental aesthetics and encouraging more physical activities could improve MH, especially in rural Northern China.

As populations age globally, ensuring equitable healthcare access and social support for older adults in underserved urban areas has become increasingly critical. Elderly residents in low-income districts face challenges, including poor living conditions, social isolation, and healthcare access barriers. Community health workers (CHWs) are vital in bridging these gaps, yet their effectiveness is often Limited by resources and training. This qualitative study explores the healthcare and social needs of elderly residents receiving community services, identifies gaps in support systems, and examines the challenges faced by CHWs in delivering care in an underserved urban district. The study took place in Sham Shui Po, a district in Hong Kong with a high concentration of economically disadvantaged elderly residents. Data were collected through 17 semi-structured interviews with older residents and non-governmental organization (NGO) staff, alongside three focus group discussions with CHWs, and were analyzed using thematic analysis. The results showed that senior residents faced poor living conditions, chronic illnesses, and mobility issues, exacerbated by financial constraints and limited healthcare access. Long wait times, transportation challenges, and language barriers hindered medical service use. Many struggled with digital healthcare tools, limiting their ability to manage health independently. CHWs provided vital support but encountered physical strain, inadequate training, and logistical difficulties, highlighting the need for structured training and better resources. Addressing elderly care challenges requires integrated healthcare models, expanded financial and digital literacy programs, and enhanced CHW training and support. Strengthening these areas can improve health outcomes and well-being for aging populations in low-income urban settings.

Summer heat and air pollution may pose a great threat to public health in the context of climate warming, however, their interactive effects on deaths from chronic ischemic heart disease (CIHD) have not been evaluated in existing investigations. This study aims to assess the associations of concurrent heatwave and ozone pollution with CIHD mortality in Chinese population. We carried out a province-wide, individual-level case-crossover study by analyzing 33,770 CIHD deaths occurring in warm season (May-September) across Jiangsu, eastern China, between 2016 and 2019. Spatially resolved estimates of maximum 8-h average ozone concentrations and air temperatures were estimated on case days and control days at the residential address. Heatwave events were defined using multiple temperature thresholds (percentiles 90-97.5) and durations (2-4 days). Conditional logistic regression model was employed to assess the odds ratio (OR) and its 95% confidence interval (CI) of CIHD death associated with heatwave and ozone exposure. Stratified analyses were performed to compare ozone-related risks on heatwave days versus non-heatwave days, and heatwave-related risks on low-ozone days versus high-ozone days. Additive interactive effects were testified using multiple metrics including relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (SI). In the overall population, the odds of CIHD mortality were 1.010 (95% CI, 1.007-1.014) for a 10-µg/m³ rise in warm-season ozone at lag-01 day and ranged from 1.20 (95% CI, 1.15-1.25) to 1.64 (95% CI, 1.54-1.73) for heatwaves under various definitions. Stratified analyses showed intensified ozone-related CIHD risks on heatwave days compared to non-heatwave days and higher heatwave-related risks on high-ozone days than low-ozone days. We observed significant synergistic interactive effects of heatwave and high-level ozone on CIHD mortality (SI > 1), where the excess risk was elevated by 10-19% (REOI > 0) under co-exposure scenarios, and 8-11% (AP > 0) of the odds could be attributed to the additive interaction. Excess fractions of CIHD deaths attributable to heatwave and high-level ozone among overall populations ranged from 4.73% (95% CI, 3.21-6.25%) to 6.43% (95% CI, 4.33-8.45%) under different heatwave definitions. In stratified analyses, we observed similar synergistic effects across age groups and among female subgroups only in multiple heatwave definitions. This study provided novel evidence for the synergistical effects of short-term exposure to heatwave and ozone in elevating CIHD death risk and burden. Our findings highlighted the public health urgency of collective response to climate warming crisis and ambient ozone pollution.

Air pollutants have been known as the most persistent environmental risk factors of elevated blood pressure (BP). However, most of the existing studies measured resting BP only, which is not accurate as ambulatory BP. This study investigated the effects of short-term exposure to air pollutants on ambulatory BP. Wearable devices were used to measure personal ambulatory systolic BP (ASBP) and diastolic BP (ADBP) and movement trajectories of 172 participants for one week, with a 1-min interval. Daily concentrations of the six major air pollutants were estimated at a spatial resolution of 1 km. Linear mixed-effect models and distributed lag non-linear models estimated the associations between air pollutant exposure and ambulatory BP. ASBP was positively associated with PM_2.5 (β = 0.010 [95% CI: 0.005, 0.015]), PM₁₀ (β = 0.006 [0.005, 0.008]), and SO₂ (β = 0.046 [0.021, 0.071]), and negatively with NO₂ (β = -0.009 [-0.017, -0.001]); ADBP was positively associated with PM_2.5 (β = 0.008 [0.005, 0.010]) and PM₁₀ (β = 0.003 [0.002, 0.004]), and negatively with NO₂ (β = -0.008 [-0.012, -0.004]), O₃ (β = -0.002 [-0.004, -0.001]), and CO (β = -0.366 [-0.652, -0.081]). At 14-h lag, ASBP and ADBP were positively associated with PM₁₀ and O₃, and negatively with NO₂. The cumulated exposure to PM₁₀ and CO was associated with ambulatory BP at all levels of concentration, while SO₂ was associated with ambulatory BP only when the concentration was over 15 μg/m³. The findings have important implications for BP management and hypertension prevention, by providing solid evidence for developing cost-effective strategies of minimizing adverse environmental exposure and improving health equity.

Project VITAL (Vacant Lot Improvement to Transform Adolescent Lives) is a study designed to evaluate the impact of revitalized vacant lots on adolescent health in Baltimore, Maryland. We implemented a mixed-methods research approach, which included surveys of 14- to 19-year-olds, observations of nearby vacant lots, and street block assessments during 2023-2024. The aim was to understand how greening vacant lots affected adolescent mental health, experiences of violence, and food insecurity. Linear regression models were used to examine the association between living near a maintained vacant lot and various outcomes. Effect size was measured for each significant association using Cohen's f². Out of the 313 survey participants with geo-coded addresses, 50.2% resided within 0.20 mi of a maintained lot. Proximity to these maintained green spaces was associated with greater happiness (p = 0.01, f² = 0.04) and reduced food insecurity among adolescents, although the latter did not achieve statistical significance (p = 0.08, f² = 0.06). No significant link was found between the proximity to green spaces and either depressive symptoms or experiences of weapon-related violence. These findings highlight the complexity of the effects of urban greening, indicating that while it may not address all negative outcomes, it can modestly improve certain positive aspects of adolescent well-being. Public health initiatives focusing on these efforts could help address urban decay and promote long-term health equity.

While research has highlighted discrimination and its health impacts, whether and how housing-related discrimination is related to the health of public housing residents remains understudied. This paper places discrimination in the public housing context to disentangle the relationship between discrimination and health outcomes, and the moderating role of gender in such a link to fill knowledge gaps. Using an individual-level longitudinal dataset in Seoul, Korea, this paper employed individual fixed effects models and also included interaction terms to estimate how such associations differ by gender. First, about 7% of public housing residents experience housing discrimination. Second, individuals who experience housing-related discrimination report significantly higher levels of stress. Discrimination is linked to an increase in unhealthy behaviors, including smoking initiation and alcohol drinking. Also, the effect of discrimination on stress is significantly greater for women. In contrast, there are no significant gender differences in the effect of discrimination on smoking initiation or the frequency of alcohol consumption. This paper not only confirmed the negative effect of housing discrimination on stress and unhealthy behaviors but also gender differences in the negative association between housing discrimination and stress. The findings highlight the need for gender-sensitive interventions to address the health impacts of discriminatory housing experiences.

While neighborhood socioeconomic status (NSES) significantly impacts health outcomes, its measurement often assumes that the social and economic mechanisms that drive NSES operate similarly across the urban-rural continuum. This study aimed to develop a census-tract-level NSES measure that accounts for differences across community type and assesses its measurement invariance. Using data from 71,908 census tracts in the contiguous United States, we employed exploratory and confirmatory factor analyses to derive a one-factor NSES construct consisting of five variables: percent below the poverty line, households receiving public assistance, population unemployed, households without cars, and population with less than a high school education. Measurement invariance analysis revealed that while the overall NSES structure is consistent across urban and rural community types, factor loadings varied significantly. The percentage of the population living below poverty was the most reflective indicator across all community types, while other indicators, such as car access and unemployment, exhibited context-specific variability. These findings highlight the importance of incorporating urbanicity into NSES measures in health disparity research and to improve the effectiveness of public health interventions.