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

A likely determinant of cognitive function is incarceration. Structural racism directs adverse policing to differentially patrol groups racialized as Black increasing the chances of incarceration, leading to disproportionate representation in prisons. Direct and indirect exposure to incarceration produces chronic stress and trauma for adults racialized as Black. Due to the unique expansion of U.S. prisons after the Violent Crime Control and Law Enforcement Act of 1994, we examined the association between the 10-year average racialized disparity in prison population for the decade succeeding the Crime Bill, 1995-2005, with the overall 14-year cognitive test performance for older adults racialized as Black living in the same county between 2006 and 2020. This observational study linked the average county-level racialized disparity in U.S. prisons to biannual cognitive performance interviews for mid-to-late life adults racialized as Black (> 50 years; N = 1784) from the Health and Retirement Study using baseline county of residence. Cognitive performance was assessed using a 27-item global cognitive score from the modified Telephone Interview for Cognitive Status administered in-person or online. Mixed-effects regressions estimated that greater incarceration of people racialized as Black in prisons was associated with lower overall cognitive test performance among participants racialized as Black (mean difference per 1000 more incarcerated people per 1000 population racialized as Black vs White = - 0.172, 95% CI = - 0.331, - 0.014). As artist Marvin Gaye sang in his song Flyin' High (in the Friendly Sky), "I go to the place where danger waits me," which describes how structural racism via incarceration disparities occurring in one's surroundings increases cognitive health for people racialized as Black irrespective of population size.

Exposure to greenspace has been linked to reductions in depression symptoms; however, limited research has examined how this association impacts individual components of depression, such as depressed affect, somatic complaints, social interactions, and positive affect. This study aimed to explore the relationship between greenspace exposure and the subscales of the CESD-20 depression scale among women in Sabzevar, Iran. In 2019, a cross-sectional study was conducted with 741 women aged 15 to 45. Greenspace exposure for each participant was measured by assessing the distance to the nearest green space (of any size and those ≥ 5,000 m²) as well as the Normalized Difference Vegetation Index (NDVI) and the Modified Soil Adjusted Vegetation Index 2 (MSAVI2) within 100, 300, and 500 m buffers around their residences. Quasi-Poisson models were used to analyze the associations between greenspace exposure and CESD-20 scores and subscales. Results showed that NDVI at a 300 m buffer and MSAVI2 at 300 and 500 m buffers were inversely associated with total depression scores. In contrast, greater distances to green spaces of ≥ 5,000 m² were positively associated with higher total depression scores. Somatic complaints were significantly negatively associated with higher NDVI and MSAVI2 across several buffer sizes, while social interaction scores (Dis-Inter-Relation) were inversely related to MSAVI2 at 300 and 500 m buffers. Notably, positive affect scores were positively associated with NDVI at 100 and 300 m buffers. The likelihood of depression symptoms was lower with higher NDVI and MSAVI2 at 300 and 500 m buffers, while greater distances to larger green spaces were associated with higher symptoms. These findings suggest that higher greenspace exposure may reduce symptoms of depression, especially its negative components, among women.

This study explores the use of virtual reality (VR) as an innovative tool to enhance awareness, understanding of accessibility for persons with vision loss (VL), and acceptance. Through a VR-based workshop developed in collaboration with New York City's Department Of Transportation, participants experienced immersive simulations of VL and related immersive mobility challenges. The methodology included the development of a VR environment, simulations of vision loss, testing with the DOT team during the workshop, and an assessment of changes in participants' knowledge, confidence in addressing accessibility challenges, and overall perception through pre- and post-intervention questionnaires. Participants included urban planners, designers, and architects. Results showed a significant increase in awareness of VL-related challenges that affect design guidelines, as well as improved confidence in addressing such challenges. Participants also expressed strong support for VR as a pedagogical tool, noting its potential for reshaping professional practices, improving capacity building, and enhancing inclusive design. The study demonstrates the effectiveness of VR as an experiential learning platform, fostering empathy and a long-term commitment to integrating VL considerations into urban design. These findings highlight the transformative potential of VR in advancing equity and accessibility in urban environments.

While there is growing awareness of discriminatory housing policies and their adverse impacts on health, little is known about how housing policy may promote health equity. We focused on the Low-Income Housing Tax Credit (LIHTC), the largest affordable housing program in the United States, and examined how living in neighborhoods with LIHTC housing may moderate associations between elevated blood pressure and race/ethnicity in Chicago, IL. A retrospective cohort included 15,339 adult patients at an academic medical center from 2018 to 2019. We used mixed-effects hierarchal logistic regression models to examine elevated blood pressure (diastolic blood pressure ≥ 90 mmHg or systolic blood pressure ≥ 140 mmHg) as a function of race/ethnicity, LIHTC, and race/ethnicity-LIHTC interaction effects, adjusting for patient- and neighborhood-level covariates. A majority were female (63.2%) and non-Hispanic Black (57.6%), with an average age of 50.2 years (SD 19.1). One in ten (9.9%) patients lived in a census tract with LIHTC. Overall, Black patients had 2.52 times the adjusted odds of elevated blood pressure compared to White patients (95% CI = 2.25-2.82). In models examining the moderating effects of LIHTC, the odds ratio of hypertension in Black patients vs. White patients was reduced from 2.62 to 1.52, representing a 67.9% reduction in the difference between Black and White patients. Notably, Black patients, who have been disproportionately impacted by discriminatory housing policies, were the only group found to have moderating effects associated with LIHTC. Housing policies may mitigate neighborhood effects associated with racial disparity, possibly supporting efforts to achieve health equity.

Google Street View's historical imagery is a promising data source for measuring neighborhood conditions over time. However, images are not available for all years. To assess bias that may arise due to a mismatch between the year imagery is available and the year of researcher interest, we assessed prevalence of change in 20 commonly assessed built environment features between the oldest and newest available high-quality images (median difference 10.5 years, range from 2007 to 2023) on Street View at 2118 total locations in four US cities representing the Hispanic Community Health Study/Study of Latinos (New York City, Chicago, Miami, and San Diego). Seventeen (85%) of the features were the same in more than 90% of images; only litter differed in more than 20%. Patterns of change were consistent across all four cities and not notably different in tracts with higher or lower median household incomes. For built environment features reflecting sidewalk conditions and disinvestment in neighborhoods not selected for their known rapid change, auditing an image that does not temporally match the time of etiological interest is unlikely to be a major source of bias.

Depression is a common mental disorder formed by a combination of various factors. Existing researches have already demonstrated that noise indeed impacts the level of depression, but their results were inconsistent. To reconcile seemingly contradictory findings, this study aims to investigate how noise affects individual depression using big data mining and analysis techniques. The individual data was obtained from the China Health and Retirement Longitudinal Study (CHARLS) over 3 years (2013, 2015, and 2018) totaling 9693 participants coming from 125 different cities. The Chinese version of the 10-item Center for Epidemiologic Studies Depression Scale (CES-D) was employed to assess depression scores, while the search index for noise-related keywords was obtained from Baidu Index to measure noise levels across different cities. A curvilinear model with fixed effects was applied to analyze the relationship between noise and depression. Additionally, moderating effect analyses were conducted to examine the influence of city size and green space. The results indicate a U-shaped relationship between depression and noise, wherein depression initially decreases with increased noise, then subsequently rises. The moderating effect analysis suggests that both city size and green space influence this U-shaped curve; notably, in cities with larger populations or higher green coverage rates, the curve flattens. This study reveals that the impact of noise on depression is complex, which is the result of a multifactorial synergy. It underscores the necessity for urban planning and management to prioritize the creation of friendly sound environments, which could enhance the physical and mental health of urban residents.

Few existing data sources quantify the magnitude of court-ordered and illegal residential evictions, among historically marginalized groups. We describe the Social Epidemiology to Combat Unjust Residential Evictions (SECURE) Study (2021-2024; n = 1,428; 91.1% response rate) methodology and participant characteristics. Univariable and multivariable statistics including Spearman correlations were used to describe data. Unadjusted and adjusted modified Poisson regression with robust error variance estimated relative risk (RR) and associated 95% confidence intervals (95% CI) for associations between five eviction measures and self-rated health (SRH), and self-rated health relative to most similarly aged peers (RSRH). A quarter of the participants reported experiencing an eviction as a child (n = 354). Over half of the study sample reported ever experiencing a court-ordered (n = 432) and/or an illegal eviction (n = 360). In the past 2 years, 15.2% of the sample reported experiencing a court-ordered (n = 122) and/or illegal eviction (n = 95). Eviction during childhood, and ever experiencing both court-ordered and/or illegal eviction was associated with between 12 and 17% higher risk of poor SRH, and childhood eviction and ever experiencing illegal eviction was associated with between 34 and 37% higher risk of worse RSRH among reproductive age Black women. More community-partnered research using participatory action research methods are needed to understand and intervene upon the health impacts of residential evictions among disproportionately impacted groups.

There is growing recognition of the need for collaboration between the healthcare and housing sectors to address the needs of people experiencing homelessness. This study explores how these cross-sector collaborations can be improved from the perspective of those with histories of homelessness and complex health needs. In-depth, semi-structured qualitative interviews (N = 23) were used to (1) understand the challenges faced by people with complex health needs when navigating services at the intersection of healthcare and housing and (2) identify strategies for improving these services. While some participants reported accessing cross-sector services, many found those efforts to be lacking and ineffective. Participants reported receiving support with healthcare needs from housing providers more frequently than assistance with housing needs from healthcare providers. They described challenges related to provider turnover, perceived stigma and discrimination, and insufficient resources. Proposed solutions included modernizing and centralizing care, providing an effective balance of in-person and virtual offerings with an emphasis on in-person services, and improving provider sensitivity to reduce stigma against service recipients. These findings align with existing research on cross-sector collaborations in other fields and highlight the need for comprehensive, compassionate care tailored to the unique needs of people experiencing homelessness. The study also underscores the urgent need for more effective implementation and evaluation of these cross-sector efforts to improve outcomes for this vulnerable population.

People experiencing homelessness have high rates of violent victimization, overdose, suicidality, and non-suicidal self-injury. These health-related critical incidents contribute to high mortality rates among homeless populations, making their prevention a critical public health goal. The objective of this study was to identify trends and correlates of physical violence, overdose, and self-injury in homeless shelters in Toronto, Canada. A retrospective study was conducted using administrative data on health-related critical incidents in Toronto's shelter system from 2012 to 2021. Log-linked negative binomial regression models were fitted to (a) predict physical violence, overdose, and self-injury incident counts during the study period by year, season, and pandemic onset, and (b) examine programmatic, environmental, and temporal correlates of these outcomes, with separate analyses performed for the pre-pandemic and pandemic periods. Shelter-based physical violence (incidence rate ratio [IRR] 1.08; 95% confidence interval [CI] 1.06-1.11), overdose (IRR 1.20; CI 1.13-1.26), and self-injury (IRR 1.16; CI 1.11-1.21) incidents increased over the study period, with the rates of the increases for violence (IRR 1.10; CI 1.00-1.20) and overdoses (IRR 1.66; CI 1.48-1.86) intensifying during the COVID-19 pandemic. Larger congregate shelters had higher rates of violence, overdose, and self-injury, whereas shelter-based hotels had lower incident rates. Critical incidents were also higher during the winter, and there was an increased rate of overdoses during cheque week. The development of smaller shelters that offer greater privacy to service users warrants further examination to advance safety in shelter settings. Increasing access to naloxone and other substance use supports, especially during check week, is also recommended for reducing drug-related harms.

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.