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Housing Australian Children: A Snapshot of Health Inequities in the First 2000 Days. 澳大利亚儿童住房:前 2000 天的健康不平等现象掠影》(Snapshot of Health Inequities in the First 2000 Days)。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-01 DOI: 10.1007/s11524-024-00925-0
Yuxi Li, Ankur Singh, Rebecca Bentley

Housing is a critical social determinant of children's health. While individual pathways between housing and health are well evidenced, there has been less attention on the co-occurrence of housing disadvantages. We aim to identify typologies of children's housing disadvantage and describe the health inequities they generate. A cross-sectional latent class analysis (LCA) was conducted on 4355 Australian children aged 4 to 5 years who participated in the Longitudinal Study of Australian Children. Nine binary indicators-dwelling tenure, external condition, affordability, stability, crowding, cleanliness, fuel poverty, and noise exposure-were used to generate latent housing typologies. Generalized linear models with robust standard errors described disparities in quality of life, injury, disability, and health service use across these housing typologies. Four distinct housing typologies were identified in this cohort: "good condition, affordable, and secure" (60%); "insecure" (11%); "crowded" (24%); and "unsuitable" (5%). Unsuitable housing, characterized by crowding, poor external conditions, and noise exposure, was more likely to be occupied by single-parent families, low-income households, and be headed by parents with low levels of education. Children in unsuitable housing lagged on quality of life indicators at preschool age (e.g., by 8.0 points on emotional functioning, 95% CI - 10.6, - 5.5), and underutilized primary healthcare services (e.g., prevalence ratio 0.76 for GP services, 95% CI 0.67, 0.87), compared to children in good quality housing. This finding supports the case for early intervention strategies that account for children's housing circumstances.

住房是影响儿童健康的重要社会决定因素。虽然住房与健康之间的个别途径已得到充分证明,但人们对住房不利条件的共同发生却关注较少。我们的目标是确定儿童住房不利条件的类型,并描述其造成的健康不平等。我们对参加澳大利亚儿童纵向研究(Longitudinal Study of Australian Children)的 4355 名 4-5 岁澳大利亚儿童进行了横截面潜类分析(LCA)。九个二元指标--居住权、外部条件、可负担性、稳定性、拥挤程度、清洁度、燃料匮乏和噪音暴露--被用来生成潜在的住房类型。带有稳健标准误差的广义线性模型描述了这些住房类型在生活质量、伤害、残疾和医疗服务使用方面的差异。在这批人群中发现了四种不同的住房类型:"条件好、负担得起、安全"(60%);"不安全"(11%);"拥挤"(24%);以及 "不合适"(5%)。不合适住房的特点是拥挤、外部条件差和噪音大,更有可能由单亲家庭、低收入家庭和教育水平低的家长居住。与居住在优质住房中的儿童相比,居住在不适宜住房中的儿童在学龄前生活质量指标上落后(例如,在情绪功能上落后 8.0 分,95% CI - 10.6,- 5.5),而且初级医疗保健服务利用率不足(例如,全科医生服务的流行率为 0.76,95% CI 0.67,0.87)。这一发现支持了考虑儿童住房情况的早期干预战略。
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引用次数: 0
Participatory Systems Thinking to Elucidate Drivers of Food Access and Diet Disparities among Minoritized Urban Populations. 通过参与式系统思考来阐明城市少数民族人口中食物获取和饮食差异的驱动因素。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-07-24 DOI: 10.1007/s11524-024-00895-3
Brent A Langellier, Sofia Argibay, Rosie Mae Henson, Caroline Kravitz, Alexandra Eastus, Ivana Stankov, Irene Headen

The purpose of this study was to use participatory systems thinking to develop a dynamic conceptual framework of racial/ethnic and other intersecting disparities (e.g., income) in food access and diet in Philadelphia and to identify policy levers to address these disparities. We conducted three group model building workshops, each consisting of a series of scripted activities. Key artifacts or outputs included qualitative system maps, or causal loop diagrams, identifying the variables, relationships, and feedback loops that drive diet disparities in Philadelphia, Pennsylvania. We used semi-structured methods informed by inductive thematic analysis and network measures to synthesize findings into a single causal loop diagram. There were twenty-nine participants with differing vantages and expertise in Philadelphia's food system, broadly representing the policy, community, and research domains. In the synthesis model, participants identified 14 reinforcing feedback loops and one balancing feedback loop that drive diet and food access disparities in Philadelphia. The most highly connected variables were upstream factors, including those related to racism (e.g., residential segregation) and community power (e.g., community land control). Consistent with existing frameworks, addressing disparities will require a focus on upstream social determinants. However, existing frameworks should be adapted to emphasize and disrupt the interdependent, reinforcing feedback loops that maintain and exacerbate disparities in fundamental social causes. Our findings suggest that promising policies include those that empower minoritized communities, address socioeconomic inequities, improve community land control, and increase access to affordable, healthy, and culturally meaningful foods.

本研究的目的是利用参与式系统思维,为费城在食物获取和饮食方面存在的种族/民族及其他交叉差异(如收入)制定一个动态概念框架,并确定解决这些差异的政策杠杆。我们举办了三次小组模型构建研讨会,每次研讨会都包括一系列脚本活动。主要成果或产出包括定性系统图或因果循环图,确定了驱动宾夕法尼亚州费城饮食差异的变量、关系和反馈回路。我们采用半结构化方法,并辅以归纳式主题分析和网络测量,将研究结果综合成一个因果循环图。共有 29 位参与者,他们在费城的食品系统中具有不同的优势和专业知识,广泛代表了政策、社区和研究领域。在综合模型中,与会者确定了 14 个强化反馈回路和一个平衡反馈回路,它们是费城饮食和食物获取差异的驱动因素。关联度最高的变量是上游因素,包括与种族主义(如住宅隔离)和社区权力(如社区土地控制)相关的变量。与现有框架一致,解决差异问题需要关注上游社会决定因素。然而,现有框架应加以调整,以强调并打破维持和加剧基本社会原因差异的相互依存、相互强化的反馈循环。我们的研究结果表明,有发展前景的政策包括那些增强少数民族社区能力、解决社会经济不平等、改善社区土地控制以及增加获得负担得起的、健康的和有文化意义的食品的机会的政策。
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引用次数: 0
The Promises and Potential Pitfalls of Highway Reclamation for Population Health: A Research Framework. 公路填海对人口健康的承诺和潜在隐患:研究框架。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 DOI: 10.1007/s11524-024-00933-0
Mary D Willis, Fintan Mooney, Jennifer Weuve, Perry Hystad, Heyden Walker, Addie Walker, Amy Stelly, Stacy Fox, Loretta Lees

Highway reclamation (i.e., the removal of highways or placing existing highways underground to create mixed-use urban areas) is being implemented around the United States, often touting co-benefits for population health. As part of the Bipartisan Infrastructure Law and the Inflation Reduction Act, the Reconnecting Communities and Neighborhoods grant program is a first-of-its-kind investment in launching even more highway reclamation projects. Depending on how the projects are implemented, these projects may create gentrification (i.e., the displacement of poor long-time residents by wealthier new people), thereby displacing the populations these projects are designed to protect. However, little work has systematically examined the extent to which highway reclamation projects provide the promised benefits for neighborhood environments (e.g., reduced air pollution), minimize gentrification, and improve health outcomes. This commentary proposes a framework by which the multidimensional impacts of highway reclamation can be evaluated, unlocking potential new structural pathways toward urban health equity.

美国各地正在实施高速公路开垦(即拆除高速公路或将现有高速公路置于地下,以创建多功能城市区域),并经常标榜其对人口健康的共同益处。作为《两党基础设施法》(Bipartisan Infrastructure Law)和《通货膨胀削减法》(Inflation Reduction Act)的一部分,"重新连接社区和邻里"(Reconnecting Communities and Neighborhoods)赠款计划是启动更多高速公路开垦项目的一项首创性投资。根据项目的实施方式,这些项目可能会造成贵族化(即较富裕的新居民取代贫困的长期居民),从而使这些项目旨在保护的人群流离失所。然而,很少有工作系统地研究高速公路填海项目在多大程度上为社区环境带来了所承诺的好处(如减少空气污染),最大限度地减少了城市化,并改善了健康状况。本评论提出了一个框架,通过该框架可以评估高速公路填海的多维影响,从而为实现城市健康公平开辟潜在的新结构途径。
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引用次数: 0
Smartphone GPS-Based Exposure to Greenspace and Walkability and Accelerometer-Assessed Physical Activity During Pregnancy and Early Postpartum-Evidence from the MADRES Cohort. 基于智能手机 GPS 的孕期和产后早期绿地接触、步行能力和加速计评估的体力活动--来自 MADRES 队列的证据。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-08-15 DOI: 10.1007/s11524-024-00903-6
Li Yi, Rima Habre, Tyler B Mason, Yan Xu, Jane Cabison, Marisela Rosales, Daniel Chu, Thomas A Chavez, Mark Johnson, Sandrah P Eckel, Theresa M Bastain, Carrie V Breton, John P Wilson, Genevieve F Dunton

A growing number of studies have associated walkability and greenspace exposure with greater physical activity (PA) in women during pregnancy. However, most studies have focused on examining women's residential environments and neglected exposure in locations outside the home neighborhood. Using 350 person-days (N = 55 participants) of smartphone global positioning system (GPS) location and accelerometer data collected during the first and third trimesters and 4-6 months postpartum from 55 Hispanic pregnant women from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study, we examined the day-level effect of women's exposure to walkability and greenspace on their PA outcomes during pregnancy and in the early postpartum period. Moderate-to-vigorous physical activity [MVPA] minutes per day was assessed using accelerometers. Walkability and greenspace were measured using geographic information systems (GIS) within women's daily activity spaces (i.e., places visited and routes taken) recorded using a smartphone GPS and weighted by time spent. We used a generalized linear mixed-effects model to estimate the effects of daily GPS-derived environmental exposures on day-level MVPA minutes. Results showed that women engaged in 23% more MVPA minutes on days when they had some versus no exposure to parks and open spaces in activity spaces (b = 1.23; 95%CI: 1.02-1.48). In addition, protective effects of daily greenspace and walkability exposure on MVPA were stronger in the first and third trimesters, among first-time mothers, and among women who had high pre-pregnancy body mass index (BMI) and lived in least-safe neighborhoods. Our results suggest that daily greenspace and walkability exposure are important for women's PA and associated health outcomes during pregnancy and early postpartum.

越来越多的研究表明,适宜步行的环境和绿地接触与孕期妇女更多的身体活动(PA)有关。然而,大多数研究都集中于研究女性的居住环境,而忽略了女性在家庭邻里之外的地点的接触情况。我们利用 "环境和社会压力因素对孕产妇和发育造成的风险"(MADRES)研究中收集的 55 名西班牙裔孕妇在怀孕第一和第三季度以及产后 4-6 个月期间 350 人天(N = 55 名参与者)的智能手机全球定位系统(GPS)定位和加速度计数据,研究了妇女在怀孕期间和产后早期暴露于步行环境和绿地对其 PA 结果的日级影响。每天中等强度到高强度的身体活动[MVPA]分钟数使用加速度计进行评估。使用地理信息系统(GIS)对妇女的日常活动空间(即访问过的地方和走过的路线)进行测量,这些空间是使用智能手机 GPS 记录的,并根据花费的时间进行加权。我们使用广义线性混合效应模型来估算每天从全球定位系统获取的环境暴露对全天 MVPA 分钟数的影响。结果表明,女性在接触公园和开放空间的活动时间比不接触公园和开放空间的活动时间多 23% (b = 1.23;95%CI:1.02-1.48)。此外,每天接触绿地和步行对 MVPA 的保护作用在第一胎和第三胎、初为人母以及孕前体重指数(BMI)高和居住在最不安全社区的妇女中更强。我们的研究结果表明,在怀孕期间和产后早期,每天接触绿地和步行对妇女的体育锻炼和相关健康结果非常重要。
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引用次数: 0
Neighborhood Social and Physical Environments and Sedentary Behaviors: Importance of Early Childhood in Shaping Health Behaviors. 邻里社会和物理环境与久坐行为:幼儿期对塑造健康行为的重要性。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-01 DOI: 10.1007/s11524-024-00929-w
Yeonwoo Kim, Ahyoung Lee, Darashagam Nahal, Natalie Colabianchi

This study aims to investigate the persistence of sedentary behaviors from early childhood to adolescence and the longitudinal association between neighborhood social and physical environments and childhood sedentary behaviors. Using the Future of Families & Child Wellbeing Study (N = 2716), we conducted a cross-lagged path analysis to examine the longitudinal association between neighborhood social and physical environments (neighborhood socioeconomic status, observed physical disorder, and crime rates) and sedentary behaviors at subsequent measurement points, after controlling for demographic factors and family socioeconomic status. We observed the continuity of sedentary behaviors in early childhood, extending throughout adolescence. Neighborhood socioeconomic status was significantly associated with sedentary behaviors at subsequent measurement points from early childhood to adolescence. Observation-based physical disorder and crime rates were associated with engagement in greater sedentary behaviors in adolescence but not in early and middle childhood. We also observed a partial mediation effect of neighborhood physical disorder and crime rates in the association between neighborhood socioeconomic status and sedentary behaviors in adolescence. Our results demonstrated the importance of early childhood in shaping healthy behaviors and highlighted the contribution of unfavorable environments to sedentary behaviors. These findings call for the need to support disadvantaged neighborhoods, particularly by addressing safety concerns and physical disorder, for promoting physical activity and reducing sedentary behaviors among adolescents.

本研究旨在调查从幼儿期到青少年期久坐行为的持续性,以及邻里社会和物理环境与儿童久坐行为之间的纵向联系。利用 "未来家庭与儿童福祉研究"(N = 2716),我们进行了交叉滞后路径分析,在控制了人口统计因素和家庭社会经济状况后,考察了邻里社会和物理环境(邻里社会经济状况、观察到的物理紊乱和犯罪率)与后续测量点的久坐行为之间的纵向联系。我们观察到久坐行为在儿童早期就已存在,并一直延续到青少年时期。从幼儿期到青春期,邻里社会经济地位与后续测量点的久坐行为有显著关联。基于观察的身体失调率和犯罪率与青少年时期更多的久坐行为有关,但与儿童早期和中期的久坐行为无关。我们还观察到,在邻里社会经济地位与青少年时期久坐行为之间的关系中,邻里身体失调和犯罪率具有部分中介效应。我们的研究结果表明了幼儿期对塑造健康行为的重要性,并强调了不利环境对久坐行为的影响。这些研究结果表明,有必要为贫困社区提供支持,特别是通过解决安全问题和物质混乱问题来促进青少年的体育锻炼和减少久坐行为。
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引用次数: 0
From Neighborhood to Household: Connections Between Neighborhood Vacant and Abandoned Property and Family Violence. 从邻里到家庭:邻里空置和废弃财产与家庭暴力之间的联系。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-14 DOI: 10.1007/s11524-024-00938-9
Julia M Fleckman, Julie Ford, Sophia Eisenberg, Catherine A Taylor, Michelle Kondo, Christopher N Morrison, Charles C Branas, Stacy S Drury, Katherine P Theall

Rates of family violence, including intimate partner violence (IPV) and child maltreatment, remain high in the USA and contribute to substantial health and economic costs. How neighborhood environment may influence family violence remains poorly understood. We examine the association between neighborhood vacant and abandoned properties and family violence, and the role collective efficacy may play in that relationship. Data were used from a longitudinal cohort of 218 maternal-child dyads in a southern US city known for elevated rates of violence. Women were matched on their propensity score, for living in a neighborhood with elevated vacant and cited properties. Analyses accounting for clustering in neighborhood and matched groups were conducted to examine the association between neighborhood vacant and abandoned property and family violence and the potential mediating relationship of collective efficacy. The likelihood of experiencing child maltreatment at 12 months of age was more than twice as high for children living in neighborhoods with high vacant and cited property rates compared with women living in neighborhoods with fewer vacant and cited properties (OR = 2.11, 95% CI = 1.03, 4.31). Women living in neighborhoods characterized by high levels of vacant and cited properties were also more than twice as likely to report IPV (OR = 2.52, 95% CI = 1.21, 5.25). Associations remained mostly stable after controlling for key covariates. Collective efficacy did not act as a mediator in the relationship between vacant and cited properties and family violence. Reducing neighborhood vacant and cited properties may be an important target for interventions focused on reducing family violence.

在美国,包括亲密伴侣暴力(IPV)和虐待儿童在内的家庭暴力发生率居高不下,造成了巨大的健康和经济损失。人们对社区环境如何影响家庭暴力仍然知之甚少。我们研究了邻里空置和废弃房产与家庭暴力之间的关系,以及集体效能在这种关系中可能发挥的作用。我们使用的数据来自美国南部一个以暴力事件高发而闻名的城市中 218 个母子二人组的纵向队列。研究人员根据妇女的倾向得分对其进行了配对,以确定她们是否居住在空置和引证物业较多的社区。对邻里和匹配组的聚类进行了分析,以研究邻里空置和废弃财产与家庭暴力之间的关系,以及集体效能的潜在中介关系。与居住在空置和引用物业较少的社区的妇女相比,居住在空置和引用物业率高的社区的儿童在 12 个月大时遭受虐待的可能性要高出两倍多(OR = 2.11,95% CI = 1.03,4.31)。居住在空置和引用房产较多的社区的女性报告 IPV 的可能性也是其他社区的两倍多(OR = 2.52,95% CI = 1.21,5.25)。在控制了主要的协变量后,这些关联基本保持稳定。在空置和引用物业与家庭暴力之间的关系中,集体效能并没有起到中介作用。减少社区空置和引用房产可能是减少家庭暴力干预措施的一个重要目标。
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引用次数: 0
Temporal Trends of Early COVID-19 Infections in New York City Transit Workers and Residents: March 01, 2020-May 02, 2020. 纽约市公交工人和居民早期 COVID-19 感染的时间趋势:2020年3月1日至2020年5月2日。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-11 DOI: 10.1007/s11524-024-00934-z
Michael Cziner, Devan Hawkins, Jonathan Rosen, Daniel Hagen, Alexis Merdjanoff, David Vlahov, Robyn Gershon

The continuity of public transportation was necessary during the COVID-19 pandemic so that essential workers could report for duty. Therefore, it is important to consider COVID-19's impact on transit workers themselves. We described COVID-19 incidence rates over time in New York City (NYC) transit workers and the NYC general population during March-May, 2020. NYC transit COVID-19 cases were abstracted from occupational injury and illness logs, and health department data was used to ascertain NYC resident cases. COVID-19 rates among transit workers peaked during the week of March 22-28 (429.8 cases/100,000 workers). The peak in transit workers occurred 1-2 weeks before the general public's peak (March 29-April 4: 368.8 cases/100,000 people; April 5-11: 357.8 cases/100,000 people). These data suggest that NYC transit workers may have been impacted by COVID-19 earlier than the general public. Thus, improving early detection and response of respiratory disease outbreaks may be vital to protecting transit workers.

在 COVID-19 大流行期间,公共交通的连续性是必要的,这样重要的工作人员才能报到上班。因此,考虑 COVID-19 对公交工人本身的影响非常重要。我们描述了 2020 年 3 月至 5 月期间纽约市(NYC)公交工作人员和纽约市普通人群的 COVID-19 发病率。纽约市公交公司的 COVID-19 病例摘自职业伤病日志,卫生部门的数据用于确定纽约市居民病例。公交工人的 COVID-19 感染率在 3 月 22-28 日的一周内达到峰值(429.8 例/100,000 名工人)。公交工作者的发病高峰比普通民众的发病高峰早 1-2 周(3 月 29 日至 4 月 4 日:368.8 例/100,000 人;4 月 5 日至 11 日:357.8 例/100,000 人)。这些数据表明,纽约市公交工作人员受到 COVID-19 影响的时间可能早于普通公众。因此,加强对呼吸道疾病爆发的早期检测和应对可能对保护公交工人至关重要。
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引用次数: 0
Less-Lethal Weapons and Civilian Injury in Police Use of Force Encounters: A Multi-agency Analysis. 警察使用武力事件中的低致命武器和平民伤害:多机构分析。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-11 DOI: 10.1007/s11524-024-00940-1
Kevin Petersen, Christopher S Koper, Bruce G Taylor, Weiwei Liu, Jackie Sheridan-Johnson

Police use-of-force is a growing public health concern, with recent estimates suggesting that over 70,000 people are injured by police each year. To reduce the risk of injury to civilians, most police agencies authorize the use of various less-lethal weapons. However, to date, there is little consensus as to which types of less-lethal weapons are most effective at reducing injury risk. In this study, we test the differential effects of less-lethal weapons on civilian injury and injury severity using data on 2348 use-of-force incidents originating from 17 large urban and metropolitan law enforcement agencies from 2015 to 2019. Specifically, we assess the injury risks associated with conducted energy devices, chemical agents, impact weapons, and police canines, while controlling for a robust set of officer, civilian, and situational characteristics. Our results indicate that chemical agents reduce the risk of hospitalization or death significantly more than other weapon types, while police canines increase the risk of all injury outcomes significantly more than other weapon types. Adjusting for incident characteristics, chemical agents are predicted to cause hospitalization or death in 4% of cases, compared to 13% for conducted energy devices, 16% for impact weapons, and 37% for police canines. These findings suggest that civilian injury may be reduced through use-of-force policies that prioritize less severe modalities of force, though more research is needed on the contextual and long-term effects of these weapons.

警察使用武力是一个日益严重的公共健康问题,最近的估计表明,每年有超过 70,000 人被警察打伤。为了降低平民受伤的风险,大多数警察机构授权使用各种低致命性武器。然而,迄今为止,对于哪类低致命性武器能最有效地降低伤害风险还没有达成共识。在本研究中,我们利用 2015 年至 2019 年间 17 个大型城市和大都市执法机构发生的 2348 起使用武力事件的数据,检验了低致命性武器对平民伤害和伤害严重程度的不同影响。具体而言,我们评估了与传导能量装置、化学制剂、冲击武器和警犬相关的伤害风险,同时控制了一组可靠的警官、平民和情境特征。我们的结果表明,化学制剂降低住院或死亡风险的程度明显高于其他武器类型,而警犬增加所有伤害结果风险的程度明显高于其他武器类型。对事件特征进行调整后,预计化学制剂导致住院或死亡的比例为 4%,而传导能量装置为 13%,冲击武器为 16%,警犬为 37%。这些研究结果表明,尽管还需要对这些武器的背景和长期影响进行更多的研究,但可以通过优先使用不那么严重的武力方式的武力使用政策来减少对平民的伤害。
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引用次数: 0
Gun Free Zones in Alcohol-Serving Establishments and Risk for Firearm Violence: A Cross-Sectional, Geospatial Study in Texas. 酒类供应场所的无枪区与枪支暴力风险:德克萨斯州的一项横断面地理空间研究。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-06 DOI: 10.1007/s11524-024-00928-x
Paul M Reeping, Hannah S Laqueur, Rose M C Kagawa

To date, there have been no peer-reviewed studies in the United States estimating the impact of gun-free zone policies in alcohol-serving establishments on rates of firearm violence in and around such establishments. In this study, we utilized a cross-sectional design to estimate the impact of Texas's 51% alcohol law, which prohibits the carrying of firearms in establishments that generate over half of their revenue from alcohol sales. The analysis focused on the difference in shooting incidents in and around establishments with and without firearm carrying prohibitions in 2021 and 2022. After adjusting for establishment type (bar/restaurant), alcohol sales volume, census tract level demographic factors, and the number of nearby restaurants and bars, results indicated that gun-prohibiting bars experienced significantly fewer shootings compared to those that allowed guns. Specifically, establishments that were gun-prohibited had 37% fewer shootings within 50 m than those that were gun-allowing, with a 95% confidence interval ranging from 60% fewer to 0.2% fewer. This association was more prominent in bars than in restaurants. The protective association with gun-prohibited status diminished with increased distance from the establishments; results were not significant at 100 m. Our study findings align with research suggesting that gun-free zones can reduce firearm violence. However, future studies using quasi-experimental designs that can better support causal inference are needed to support such a conclusion, as are studies exploring the efficacy of such policies in various settings and over longer periods.

迄今为止,美国还没有同行评议研究估计过酒类供应场所的无枪区政策对此类场所内及周边枪支暴力事件发生率的影响。在本研究中,我们采用横截面设计来估算得克萨斯州 51% 酒精法的影响,该法禁止在酒类销售收入超过一半的场所携带枪支。分析的重点是 2021 年和 2022 年禁止携带枪支和不禁止携带枪支的场所及其周围发生的枪击事件的差异。在对场所类型(酒吧/餐馆)、酒类销售量、人口普查区人口因素以及附近餐馆和酒吧的数量进行调整后,结果表明,与允许持枪的场所相比,禁止持枪的酒吧发生的枪击事件要少得多。具体而言,与允许持枪的场所相比,禁止持枪的场所在 50 米范围内发生的枪击事件要少 37%,95% 的置信区间从少 60% 到少 0.2% 不等。这种关联在酒吧比在餐馆更为突出。与禁枪区的保护性关联随着与禁枪区距离的增加而减弱;在距离禁枪区 100 米时,结果并不显著。然而,未来的研究还需要使用准实验设计来更好地支持因果推论,以支持这一结论,同时还需要研究探索此类政策在不同环境和较长时间内的有效性。
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引用次数: 0
Mental Health and Substance Use Among Black Women Attending STD Clinics in Baltimore: The Role of Overt and Subtle Discrimination. 巴尔的摩性传播疾病诊所就诊黑人妇女的心理健康和药物使用情况:公开和隐蔽歧视的作用》。
IF 4.3 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1007/s11524-024-00930-3
Stephanie A Meyers-Pantele, Marguerite B Lucea, Jacquelyn C Campbell, Andrea N Cimino, Keith J Horvath, Kiyomi Tsuyuki, Mona Mittal, Jamila K Stockman

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013-2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

黑人女性受到抑郁症、创伤后应激障碍(PTSD)和药物使用伤害等心理健康问题的影响尤为严重。歧视经历可能会导致或加剧这些状况,但人们对不同类型的歧视(公开歧视与隐蔽歧视)与这些结果之间的关系知之甚少。本研究试图评估黑人女性中公开和隐晦的歧视、心理健康和药物滥用结果之间的关联。数据来自ESSENCE,这是一项关于马里兰州巴尔的摩市性传播疾病(STD)诊所就诊的黑人女性(n = 199)的性侵犯和艾滋病风险的回顾性队列研究(2013-2018 年)。多变量泊松回归模型检验了公开和隐蔽歧视、抑郁症和创伤后应激障碍症状以及药物滥用之间的关联,同时控制了协变量。近一半的参与者(42.2%)报告了抑郁症状,超过三分之一的参与者报告了严重的创伤后应激障碍症状(35.2%)。较高程度的微妙歧视与抑郁症状风险的增加有关(调整后相对风险 [aRR] = 1.32,95% 置信区间 [CI]:1.16, 1.50, 1.16, 1.50, 1.50):1.16, 1.50, p
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Journal of Urban Health-Bulletin of the New York Academy of Medicine
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