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

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.

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.

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.

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.

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.

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.

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.

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.

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.

Coverage levels of maternal and neonatal health services in Mali's major cities vary due to the combined effect of several factors, including poverty and migration to urban centers. This worsened from 2012 due to the security crisis. We conducted an analysis of the trends and differences in several indicators of maternal and neonatal care coverage in Bamako using secondary data from Mali's Demographic and Health Surveys from 2001 to 2018. Our results highlighted differential access to antenatal and childbirth care for non-poor and non-migrant women compared to their counterparts categorized as poor and migrant. The gaps were much larger depending on migration status (i.e., number of years since resettling in Bamako) and even tended to increase over time. This was particularly the case regarding the number of antenatal visits (ANC 4+), with differences according to poverty level at 7 percentage points in 2001 and 8.3 percentage points in 2018. Migration status showed even larger gaps to the disadvantage of migrant women of 13.4 percentage points (2006) and 24.4 percentage points (2018). There is a higher proportion of cesarean section among non-poor women. The results suggested an opposite pattern for postnatal care of newborns, with a difference of 6.8 percentage points of coverage in favor of the poor in 2018. The high coverage of maternal and newborn health interventions in Bamako city conceals intra-urban disparities to the detriment of poor migrant women and those who recently migrated to the city, partly due to the conflicts and security issues. A redefinition of health programs to include such targets would be desirable from an equity perspective.