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

Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from the National Archives (historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015-2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources.

Existing literature has widely explored the individual roles of housing and neighborhood quality, and there is limited research examining their interactive effects on mental health. This 3-year cohort study utilized a longitudinal design to investigate the individual and interactive effects of housing and neighborhood quality on mental health among 962 community-dwelling adults in Hong Kong. Participants were asked to rate their residential qualities over the 3-year period. Mental health outcomes, including levels of psychological distress and common mental disorders (CMD), were assessed using the Revised Clinical Interview Schedule (CIS-R). Logistic regression and generalized linear models were used to examine the association between housing and neighborhood quality and CMD/psychological distress, adjusting for sociodemographic and residential characteristics and baseline mental disorders. Housing quality was associated with the 3-year CMD (adjusted OR 0.95; 95% CI 0.91 to 0.98). Likewise, neighborhood quality was associated with CMD over 3 years (adjusted OR 0.92; 95% CI 0.87 to 0.96). In a separate model including both quality measures, the effect of housing quality on CMD was attenuated, whereas the neighborhood impact remained significant (adjusted OR 0.92; 95% CI 0.87 to 0.98). Generalized linear models indicated that for participants residing in substandard housing, those with high neighborhood quality had lower CIS-R scores at follow-up compared to those with low neighborhood quality (p = 0.041). Better neighborhood quality alleviated the detrimental effects of poor housing quality on mental health. Planning for an enhanced neighborhood would improve population mental health in an urban environment.

Few studies have investigated plants' healing effects, particularly through touch-based therapy, on older adults. As hypertension rates continue to climb worldwide, touch-based therapy for hypertension prevention has become a significant priority in public health initiatives. This study investigated the impact of tactile interaction with real grass (a landscape activity) versus artificial grass on older adults' physical and cognitive abilities. Employing a within-subject design, we assessed the physiological and emotional effects of touching real grass versus artificial glass for 10 min. Study participants included 50 Chinese individuals, with an average age of 85.64 ± 3.72 years. Measurements included blood pressure, electroencephalogram, State-Trait Anxiety Inventory, and standard deviation (SD). Analyzing the SD data revealed that participants experienced a heightened sense of relaxation and calmness after touching real grass, compared to artificial grass. Furthermore, the participants' brainwave patterns-measured in mean power units-exhibited an upward trend while interacting with real grass, whereas they exhibited a downward trend during the interaction with artificial grass. Moreover, the mean systolic blood pressure significantly decreased following interaction with real grass. These findings suggest that engaging with real grass through touch potentially alleviates mental stress, in contrast to the effects of artificial grass.

Knowledge about neighborhood characteristics that predict disease burden can be used to guide equity-based public health interventions or targeted social services. We used a case-control design to examine the association between area-level social vulnerability and severe COVID-19 using electronic health records (EHR) from a regional health information hub in the greater Philadelphia region. Severe COVID-19 cases (n = 15,464 unique patients) were defined as those with an inpatient admission and a diagnosis of COVID-19 in 2020. Controls (n = 78,600; 5:1 control-case ratio) were a random sample of individuals who did not have a COVID-19 diagnosis from the same geographic area. Retrospective data on comorbidities and demographic variables were extracted from EHR and linked to area-level social vulnerability index (SVI) data using ZIP codes. Models adjusted for different sets of covariates showed incidence rate ratios (IRR) ranging from 1.15 (95% CI, 1.13-1.17) in the model adjusted for individual-level age, sex, and marital status to 1.09 (95% CI, 1.08-1.11) in the fully adjusted model, which included individual-level comorbidities and race/ethnicity. The fully adjusted model indicates that a 10% higher area-level SVI was associated with a 9% higher risk of severe COVID-19. Individuals in neighborhoods with high social vulnerability were more likely to have severe COVID-19 after accounting for comorbidities and demographic characteristics. Our findings support initiatives incorporating neighborhood-level social determinants of health when planning interventions and allocating resources to mitigate epidemic respiratory diseases, including other coronavirus or influenza viruses.

Frailty is a dynamic condition encompassing physical, psychological, and social domains. While certain factors are associated with overall or specific frailty domains, research on the correlations between physical, psychological, and social frailty is lacking. This study aims to investigate the associations between physical, psychological, and social frailty in European older adults. The study involved 1781 older adults from the Urban Health Centres Europe project. Baseline and 1-year follow-up data were collected on physical, psychological, and social frailty, along with covariates. Linear regression analyzed unidirectional associations, while cross-lagged panel modeling assessed bi-directional associations. Participants' mean age was 79.57 years (SD = 5.54) and over half were female (61.0%). Physical and psychological frailty showed bi-directional association (effect of physical frailty at baseline on psychological frailty at follow-up: β = 0.14, 95%CI 0.09, 0.19; reversed direction: β = 0.05, 95%CI 0.01, 0.09). Higher physical frailty correlated with increased social frailty (β = 0.05, 95%CI 0.01, 0.68), but no association was found between social and psychological frailty. This longitudinal study found a reciprocal relationship between physical and psychological frailty in older adults. A relatively higher level of physical frailty was associated with a higher level of social frailty. There was no association between social and psychological frailty. These findings underscore the multifaceted interplay between various domains of frailty. Public health professionals should recognize the implications of these interconnections while crafting personalized prevention and care strategies. Further research is needed to confirm these findings and investigate underlying mechanisms.

Exposure to violence is a critical aspect of contemporary racial inequality in the United States. While extensive research has examined variations in violent crime rates across neighborhoods, less attention has been given to understanding individuals' everyday exposure to violent crimes. This study investigates patterns of exposure to violent crimes among neighborhood residents using cell phone mobility data and violent crime reports from Chicago. The analysis reveals a positive association between the proportion of Black residents in a neighborhood and the level of exposure to violent crimes experienced by residents. Controlling for a neighborhood's level of residential disadvantage and other neighborhood characteristics did not substantially diminish the relationship between racial composition and exposure to violent crimes in everyday life. Even after controlling for violence within residents' neighborhoods, individuals residing in Black neighborhoods continue to experience significantly higher levels of violence in their day-to-day contexts compared to those living in White neighborhoods. This suggests that racial segregation in everyday exposures, rather than residential segregation, plays a central role in racial inequality in exposure to violence. Additionally, the analysis suggests that neighborhoods with more Hispanic and Asian residents are exposed to less and more violent crime, respectively, compared to neighborhoods with more White residents. However, this is only observed when not adjusting for the volume of visits points of interest receive; otherwise, the finding is reversed. This study offers valuable insights into potentially novel sources of racial disparities in exposure to violent crimes in everyday contexts, highlighting the need for further investigation.

Historical structural racism in the built environment contributes to health inequities, yet to date, research has almost exclusively focused on racist policy of redlining. We expand upon this conceptualization of historical structural racism by examining the potential associations of probable blockbusting, urban renewal, and proximity to displacement from freeway construction, along with redlining, to multiple contemporary health measures. Analyses linked historical structural racism, measured continuously at the census-tract level using archival data sources, to present-day residents' physical health measures drawn from publicly accessible records for Allegheny County, Pennsylvania. Outcome measures included average life expectancy and the percentage of residents reporting hypertension, stroke, coronary heart disease, smoking, insufficient sleep, sedentary behavior, and no health insurance coverage. Multiple regression analyses were conducted to examine separate and additive associations between structural racism and physical health measures. Redlining, probable blockbusting, and urban renewal were associated with shorter life expectancy and a higher prevalence of cardiovascular conditions, risky health behaviors, and residents lacking health insurance coverage. Probable blockbusting and urban renewal had the most consistent correlations with all 8 health measures, while freeway displacement was not reliably associated with health. Additive models explained a greater proportion of variance in health than any individual structural racism measure alone. Moreover, probable blockbusting and urban renewal accounted for relatively more variance in health compared to redlining, suggesting that research should consider these other measures in addition to redlining. These preliminary correlational findings underscore the importance of considering multiple aspects of historical structural racism in relation to current health inequities and serve as a starting point for additional research.

The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous women. We conducted a secondary analysis of data of the nuMoM2b Study (2010-2013) to examine the associations between individual- and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n = 9148) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration at the Extremes (ICE) to measure structural racism. After adjustment, we observed a significant individual and structural racism interaction on gestational length (p = 0.012). In subgroup analyses, we found that among those with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (β = 1.27, 95% CI: 0.48, 2.06). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.

Urban communities in the United States were transformed at the end of the twentieth century by a rapid decline in neighborhood crime and violence. We leverage that sharp decline in violence to estimate the relationship between violent crime rates and racial disparities in birth outcomes. Combining birth certificate data from US counties with the FBI's Uniform Crime Reporting statistics from 1992 to 2002, we show that lower crime rates are associated with substantially smaller Black-White disparities in birth weight, low birth weight, and small for gestational age. These associations are stronger in more segregated counties, suggesting that the impacts of the crime decline may have been concentrated in places with larger disparities in exposure to crime. We also estimate birth outcome disparities under the counterfactual that the crime decline did not occur and show that reductions in crime statistically explain between one-fifth and one-half of the overall reduction in Black-White birth weight, LBW, and SGA disparities that occurred during the 1990s. Drawing on recent literature showing that exposure to violent crime has negative causal effects on birth outcomes, which in turn influence life-course outcomes, we argue that these results suggest that changes in national crime rates have implications for urban health inequality.