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

People experiencing homelessness (PEH) face a high risk of opioid-related deaths, yet there is limited qualitative data on the barriers encountered when accessing buprenorphine treatment for opioid use disorder (OUD). To address this gap, we interviewed 28 clinicians, outreach workers, and administrators from organizations serving PEH with OUD. Our goal was to understand the barriers and facilitators at the patient, clinic, and institutional levels and gather recommendations for improvement. Interviews, conducted via Zoom and analyzed through thematic analysis, revealed several barriers. At the patient level, themes related to barriers included knowledge and experience (e.g., limited knowledge about buprenorphine options; rejection of buprenorphine due to prior experience with precipitated withdrawal); concerns about the medication and its administration (e.g., distrust of injectable medications; concerns about treatment control, and a prolonged informed consent process for extended-release injectable buprenorphine); and challenges due to homelessness (e.g., identification requirement to access medication at pharmacies, difficulties managing buprenorphine while unsheltered). At the clinic level, themes centered around staffing (e.g., lack of training and experience in treating PEH and staffing shortages) and health care-related stigma (e.g., discriminatory attitudes toward PEH with OUD). Institutional-level themes included state-regulatory factors (e.g., practice regulations limiting clinical pharmacists' ability to prescribe buprenorphine) and access factors (e.g., stigmatization of buprenorphine prescribing, limited low-barrier buprenorphine access, and care system complexity). Recommendations included educational programs for patients and clinicians to increase understanding and reduce stigma, integrating buprenorphine treatment into non-traditional settings, and providing housing with treatment.

Diabetes is a significant public health concern with significant implications for health equity. Functional disability undermines disease control and may be associated with the relationship between criminal legal involvement and poor chronic disease outcomes, but this relationship has not been studied. This study examined the association between recent criminal legal involvement and functional disability among a nationally representative sample of US adults with diabetes. Adult respondents to the National Survey of Drug Use and Health (2015-2019) who reported a diagnosis of diabetes were included in this analysis examining the association between three forms of recent criminal legal involvement (past year arrest, or supervision on probation or parole) and functional disability, as measured by the World Health Organization Disability Assessment Score 2.0. In multivariate linear regression analyses adjusted for relevant socio-demographic and clinical confounders, the functional disability score increased by 2.7 (95% CI, 1.6-3.9) for those with past year arrest compared to no past year arrest; 1.2 (95% CI, -0.1, 2.6) for those with past year probation compared to no past year probation; and 0.4 (95% CI, -1.1, 1.8) for those with past year parole compared to no past year parole. Recent criminal legal involvement, specifically past year arrest, is associated with greater functional disability, which may serve as an important mediator for poor health outcomes in patients with diabetes. Future research should examine this pathway and prioritize interventions to improve both functional disability and glycemic control among individuals with diabetes and recent criminal legal involvement.

Sexually minoritized men (SMM), transgender women (TW), and particularly Black SMM and Black TW may be disproportionately impacted by alcohol-related problems. Few studies have empirically examined neighborhood factors that may contribute to alcohol use, specifically among these populations. Using data from the N2 longitudinal cohort study in Chicago, IL, survey data from the second wave of longitudinal assessment (n = 126) and GPS mobility data from enrollment were used to evaluate neighborhood alcohol outlet availability, neighborhood disorder, and neighborhood poverty as correlates of individual alcohol use. Neighborhood exposures were measured using 200-m-derived activity space areas, created from GPS data, using publicly accessible geospatial contextual data. Separate multivariable quasi-poison regression models tested for association between neighborhood alcohol outlet density (AOD), measured separately for on-premise (e.g., bars) and off-premise consumption outlets (e.g., liquor stores), neighborhood poverty (defined as the percentage of neighborhood areas at 150% or greater of the US poverty line), exposure to vacant buildings, and neighborhood violent crime density. Separate analytical models found no significant effect between alcohol use and exposure to on-premise consumption venue AOD (risk ratio (RR) = 0.99, p = 0.57), off-premise consumption AOD (RR = 0.94, p = 0.56), neighborhood poverty (RR = 1.04, p = 0.07), or neighborhood violent crime (RR = 1.00, p = 0.94). Exposure to higher levels of vacant buildings (RR = 1.03, p = 0.04) was found to be significantly associated with increased alcohol use. Among this population, opposed to geospatial access, neighborhood measurements indicative of disorder may have a greater influence on shaping alcohol use.

Cardiovascular diseases (CVDs) are the leading cause of global mortality, and urban greenspace can reduce CVDs risk. However, the evidence relating various greenspace metrics to CVDs risk is inconclusive. To enhance the understanding of the correlation between greenspace and CVDs, we compared three greenspace indicators-street view-based greenspace (SVG), normalized difference vegetation index (NDVI), and green cover rate (GCR). We used a large sample of 36,504 CVDs hospitalization records with precise residential addresses from 2017 to 2022 in Jingzhou, China. Employing the geographically weighted regression (GWR) model, we investigated the association between greenspace and CVDs incidence at the population level. We found significant negative associations between NDVI/SVG and CVDs incidence (SVG: β = - 1.64; 95% CI, [- 2.12, - 1.15]; NDVI: β = - 8.57; 95% CI, [- 9.81, - 7.33]), with NDVI exhibiting a more substantial protective effect. However, no significant relationship was found in GCR (p = 0.161). The impacts varied by age, but not by gender, with younger individuals benefiting more than the elderly, and SVG showed no significant relationship with CVDs incidence in individuals over 65 years. Our findings suggested the importance of the presence of greenspace in CVDs prevention. Consequently, in urban greenspace planning, priority should be given to the vegetation quantity in residential areas over the size of greenspace facilities located distant from residences.

Changing built environment conditions to impact health mindsets and health equity may be a promising target for public health interventions. The present study was a cluster randomized controlled trial to test the impact of remediating vacant and abandoned properties on factors related to health mindset-including well-being, health interconnectedness, social capital markers, neighborhood disorder, and worry-as well as direct and indirect violence experiences and the moderating role of racial and income segregation on outcomes. A residential cohort of 405 participants from 194 randomly assigned geographic clusters was surveyed over five waves from 2019 to 2023. Compared to clusters with no treatment, participants in clusters where both vacant lots and abandoned homes were treated experienced significant increases in sense of community (83%, 95% CI = 71 to 96%, p = 0.01). Among participants in randomization clusters where only vacant lots were treated, there were declines in perceived neighborhood disorder (- 55%, 95% CI = - 79 to - 5, p = 0.06) and worry about community violence (- 56%, 95% CI = - 58 to - 12, p = 0.06). There was also a moderating effect of racial and income spatial polarization, with the greatest changes in sense of community observed among more deprived areas with both homes and lots treated, and the largest changes in neighborhood worry and disorder were seen in more deprived areas with only lots treated. Remediation of vacant and abandoned properties may be one approach to change some but not all mindsets around health, and the effects may depend on the type of remediation as well as larger neighborhood conditions such as segregation.

This study investigated the effectiveness of the Nurses Taking on Readiness Measures (N-TORM) intervention in improving disaster preparedness of Asian immigrant residents in New York City. N-TORM is an innovative, nurse-led, household disaster preparedness educational intervention provided to community members to help them create their disaster-related evacuation and communication plans, build disaster supply kits, and understand community resources available to assist residents before, during, and after disasters. The aims of this controlled before-after intervention study were to (a) pilot test the Korean translation of the Household Emergency Preparedness Instrument (K-HEPI), (b) evaluate the effectiveness of N-TORM to increase household disaster preparedness knowledge and behavior, and (c) describe the factors most necessary to maintain and expand N-TORM. Participants in the experimental group (N = 200) demonstrated significantly greater pre-to-post improvement in disaster preparedness compared to those in the control group (N = 199), as measured by the K-HEPI (effect on total General Preparedness scores, β = 1.66, SE = 0.105, p < .001). The Korean community organization that was involved in this study continues to offer N-TORM to its members, demonstrating the intervention's sustainability. Further testing of the K-HEPI and the intervention in longitudinal studies is recommended to explore potential associations between disaster preparedness and outcomes such as survival without rescue, prevention of injury, or acute exacerbations of chronic illnesses. Replicating the intervention across different immigrant populations is essential, and data from these studies can inform policy development to better address the needs of immigrant communities before, during, and after disasters. ClinicalTrials.gov Identifier: NCT0554478. Hunter College of City University of New York Protocol Record 2022-0542-Hunter, Korean Translation and Validation of the K-HEPI by a Phase 1 Feasibility Study in NYC, is registered and posted on the ClinicalTrials.gov website.

Neighborhoods or residential environments have physical and social attributes which may contribute to inequalities in the overweight and obesity pandemic. We examined the longitudinal associations of baseline neighborhood-level income and racial residential segregation (using the Gi* statistic: low, medium, high) with changes in body mass index (BMI in kg/m²), using geocoded data from 1821 civil servants in the municipality of Rio de Janeiro, Brazil, followed-up for approximately 13 years (baseline wave 1: 1999, wave 2: 2001-2002, wave 3: 2006-2007, wave 4: 2012-2013). Linear mixed effects models using BMI measured in all four study waves were performed, accounting for gender, race, length of residence, education and time-dependent age, and per capita family income. After adjustments, both income and racial segregation were positively associated with BMI differences (but not BMI changes) over time, in a dose-response pattern. For income segregation, mean differences in BMI for participants living in high and medium vs. low segregated neighborhoods were 1.04 kg/m² (β = 1.04; 95% CI 0.47, 1.62) and 0.86 kg/m² (0.86; 0.33, 1.39), respectively. For racial segregation, mean differences in BMI for participants living in high and medium vs low segregated neighborhoods were 0.71 kg/m² (0.71; 0.14, 1.29) and 0.30 kg/m² (0.30; - 0.24, 0.83), respectively. We also showed a moderate to strong correlation between racial and income segregation at baseline. Strategies to reduce BMI and obesity-related health inequalities should include special efforts aimed at segregated neighborhoods and its obesogenic environments.

Globally, MSM experience severe health disparities, including an increased risk of HIV acquisition. In Ghana's urban centers, these disparities are influenced by intersectional stigma related to sexuality and gender nonconformity, yet limited research exists on the role of gender in driving stigma in the day-to-day interactions of MSM. This study is aimed at understanding (1) the experiences of gender identity and roles among MSM in Ghana and (2) how these experiences of gender shape daily urban life in Ghanaian social interactions, including interpersonal interactions in healthcare settings. We conducted a qualitative description using secondary data generated from focus groups and in-depth interviews with adult MSM and health care workers in Accra and Kumasi, Ghana. Data were analyzed using qualitative content analysis. We identified five factors that describe the experiences of gender roles, identities, and relations and identified one theme regarding the influence of gender on MSM daily life. First, understandings of gender roles were influenced by local binary gendered expectations regarding (1) appearance and presentation, (2) physical characteristics and personality traits, and (3) household and community responsibilities. The experience of gender identity was informed by perceptions of its (4) relationship to or (5) independence from physical anatomy. In Ghana, men's gender nonconformity and its linkages to discrimination are complex, context dependent, and evolving. The interplay between gender nonconformity and same-gender sex stigma undermines access to quality health care and threatens the well-being of Ghanaian MSM.

This study examined the extent to which the 1930s Home Owners' Loan Corporation (HOLC) redlining grades are associated with contemporary survival from screenable cancers among residents of three largest cities in Washington State. Redling assigned a mortgage security metric to neighborhoods. We used 2000-2018 data from the Washington State Cancer Registry to examine differences in survival from all-cause and cancer-specific mortality for breast (n = 14,725), cervical (n = 656), colorectal (n = 7,089), and lung (n = 8,365). Survival was examined in HOLC areas graded as A (best); B (still desirable); C (declining); and D (redlined) using Kaplan-Meier and Cox proportional hazards regression techniques. Among patients with breast cancer, the hazard ratio for all-cause mortality was highest for areas graded D followed by C and B. For colorectal and lung cancer, the hazard ratio for all-cause mortality was highest for areas graded C followed by D and B. The estimated marginal slopes for the log hazard of mortality decreased over time in HOLC areas graded A, B, and C for breast and lung cancers, and in areas graded D for colorectal and lung cancers. HOLC grade was not associated with survival among cervical cancer patients. These findings call for efforts to reduce screenable - but often unrecognized - health inequalities associated with residential location.

Chronological age is not an accurate predictor of morbidity and mortality risk, as individuals' aging processes are diverse. Phenotypic age acceleration (PhenoAgeAccel) is a validated biological age measure incorporating chronological age and biomarkers from blood samples commonly used in clinical practice that can better reflect aging-related morbidity and mortality risk. The heterogeneity of age-related decline is not random, as environmental exposures can promote or impede healthy aging. Social Vulnerability Index (SVI) is a composite index accounting for different facets of the social, economic, and demographic environment grouped into four themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. We aim to assess the concurrent and combined associations of the four SVI themes on PhenoAgeAccel and the differential effects on disadvantaged groups. We use electronic health records data from 31,913 patients from the Mount Sinai Health System (116,952 person-years) and calculate PhenoAge for years with available laboratory results (2011-2022). PhenoAge is calculated as a weighted linear combination of lab results, and PhenoAgeAccel is the differential between PhenoAge and chronological age. A decile increase in the mixture of SVI dimensions was associated with an increase of 0.23 years (95% CI 0.21, 0.25) in PhenoAgeAccel. The socioeconomic status dimension was the main driver of the association, accounting for 61% of the weight. Interaction models revealed a more substantial detrimental association for women and racial and ethnic minorities with differences in leading SVI themes. These findings suggest that neighborhood-level social vulnerability increases the biological age of its residents, increasing morbidity and mortality risks. Socioeconomic status has the larger detrimental role among the different facets of social environment.