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

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.

Incarceration is a recognized risk factor for homelessness. However, most research focuses on the relationship between homelessness and prison incarceration. Jail incarceration is more common compared to prison incarceration, but little data exists on its impact on housing. The objective of this study is to examine the occurrence of housing loss after jail incarceration among individuals without prior evidence of homelessness and the associated risk of reincarceration. In this retrospective cross-sectional study, we identified adults without evidence of homelessness who became unhoused within 6 months of jail incarceration. We compare pre-incarceration emergent and urgent health and social services utilization among housed and unhoused individuals, as well as the risk of reincarceration. Data are from the San Francisco (SF) Department of Public Health Coordinated Care Management System linked with SF City and County criminal justice data during fiscal years 2015-2018. We find that a quarter (25.1%) of individuals lost housing after jail incarceration, with a median incarceration length of 4 days in both the housed and unhoused groups. Compared to those without evidence of housing loss, more unhoused individuals had pre-incarceration substance use and mental health diagnoses and related service utilization. Unhoused individuals had 1.9 greater odds of reincarceration. In conclusion, we find that a significant number of individuals had evidence of housing loss after even a short jail incarceration; behavioral health diagnoses were more common among this group. Housing loss was associated with subsequent reincarceration. Given our findings, jail re-entry programs would benefit from incorporating housing assistance and housing loss mitigation strategies.

Despite growing interest in the social determinants of hypertension, nationally representative studies examining intra-urban effects of individual and contextual socioeconomic conditions within unequal urban areas, such as those in Latin America, remain scarce. This study describes gender disparities in the association of individual and contextual socioeconomic conditions with hypertension among older adults residing in urban areas of Brazil. We analyzed data from 6,767 participants from the baseline (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative cohort of community-dwelling adults aged ≥ 50years. Analyses were conducted as part of the ELSI-Urbe project, which integrates individual-level ELSI-Brazil data with contextual urban information. Hypertension was self-reported. The measure of socioeconomic condition was education, and the contextual measure was the Brazilian Deprivation Index (IBP; acronym in Portuguese) of the census tract of the participant's residence. Multilevel logistic regression models (individuals and census tracts), adjusted for age and stratified by gender, were used. The prevalence of hypertension by education and the IBP differed between men and women. In women, higher education (≥9 years versus ≤4 years of schooling) was associated with a lower chance of hypertension (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.52-0.74), and residing in census tracts with higher deprivation was associated with a higher chance of hypertension (OR per standard deviation [SD] = 1.04; 95%CI = 1.01-1.09). In men, there was no significant association between education or IBP and hypertension. Our findings suggest that public policies in middle- and low-income countries, such as Brazil, should be gender-sensitive context-specific to effectively address the burden of this disease.

Housing insecurity is a key social determinant of a wide range of health outcomes, subject to large racial inequities, and with a likely sensitive period in childhood. Housing insecurity can manifest in multiple ways and change over time, but previous studies have primarily focused on single dimensions or a single time point. This study examines cumulative exposure to multiple forms of housing insecurity from birth to adolescence, overall, and by race in large US cities. Using data from the Future of Families and Child Wellbeing Study (FFCWS), we estimated cumulative incidence and mean cumulative count of several forms of housing insecurity, accounting for missing data (due primarily to gaps between waves) using lower bounds and a mixed modeling approach. Between 45% (lower bound) and 71% (modeled) of children experienced at least one housing insecurity event by age 15. The average number of events among children who had any event was between 2.63 (lower bound) and 6.11 (modeled). Children of non-Hispanic Black and Hispanic mothers, compared to non-Hispanic White mothers, were more likely to experience an initial event, but once experienced, had similar numbers of events. We find a massive and cyclical burden of housing insecurity during childhood. Large racial differences in incidence of first events, but not repeated events, suggest that preventive interventions would most effectively mitigate racial inequities in housing insecurity.

Sub-Saharan Africa's (SSA) rapid urbanization and climate change have resulted in habitat loss, deforestation, and reduction in urban green spaces. Urban greenness is vital for biodiversity, public health, and climate resilience. Urban green spaces have several health advantages, including lowering urban heat stress and enhancing mental and physical well-being of the population. However, little is known about the accessibility, use, and effects of urban greenness on population health in the region. This scoping review maps the evidence on urban green space availability, utilization, and population health impacts in SSA. The review also identifies the barriers and facilitators that strengthen and contribute to sustainability and urban health. In accordance with the JBI scoping review framework and PRISMA-ScR criteria, this study screened 10,683 records from major databases, grey literature, and reference checks. Initial title and abstract screening produced 118 records for full-text screening, from which 72 records were incorporated into the final analysis, which mapped the evidence using thematic analysis and narrative synthesis. It was found that urban green spaces in SSA are characterized by significant disparities in availability and accessibility, with such areas frequently falling short of international standards. Poor maintenance, corruption, safety issues, and socioeconomic disparities are factors that limit urban green space utilization, while proximity facilitates usage. Stress reduction, increased physical activity, and lower risk of non-communicable diseases, including obesity and hypertension, are identified benefits of the usage of urban green spaces. However, lack of green spaces and neglect of these spaces increase the risk of respiratory problems and vector-borne diseases. Strategic investments in urban green spaces, policy reforms, and community-led greening initiatives are required to improve access and utilization, especially in green-depleted areas. Future research needs to concentrate on experimental and longitudinal methods to demonstrate causal links between urban green space and health outcomes, enhancing sustainable urban planning and health equity in SSA to achieve Sustainable Development Goals 3 and 13.

Using generalised linear models (GLMs) with a Poisson link, this study analysed the short-term effect of NO₂, ozone, PM₁₀ and PM_2.5 on the daily number of emergency hospital admissions due to cardiovascular disease (CVD), acute cerebrovascular disease, acute myocardial infarction (AMI) and ischaemic heart disease (IHD). The impact of the minimum daily temperature in cold waves and maximum daily temperature in heat waves was likewise analysed. Specific dose-response functions were calculated for each province and cause of admission considered. We used random effects mixed models to analyse the relationship between the percentage of admissions in each province and the following provincial variables: income level; number of inhabitants; population percentage aged 65 years and over and percentage of women. Our results indicated that in Spain there were 10,167 (95%CI: 3.679, 16.554) emergency CVD-related annual admissions attributable to the variables considered, which accounted for 7.7% of total annual CVD-related admissions in Spain and broke down as follows: 6.9% attributable to air pollution in general, and NO₂ and O₃ in particular, and 0.8% attributable to extreme temperatures, especially during cold waves. A similar pattern could be observed for the specific causes. With respect to the percentage of CVD-related admissions attributable to air pollution, higher income level was a protective element and age over 65 years was a risk factor for the percentage of the population concerned. Air pollution is a risk factor for short-term emergency hospital admissions due to CVD in Spain, with the effect NO₂ and O₃ being especially noteworthy, in terms of all CVD-related causes and the specific causes considered. The impact of extreme temperatures is of a lower order of magnitude than that of air pollution, and the effect of the maximum daily temperature in heat waves on CVD is extremely small.