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Abstract: Abstract Low-income populations are at higher risk of missing appointments, resulting in fragmented care and worsening disparities. Compared to face-to-face encounters, telehealth visits are more convenient and could improve access for low-income populations. All outpatient encounters at the Parkland Health between March 2020 and June 2022 were included. No-show rates were compared across encounter types (face-to-face vs telehealth). Generalized estimating equations were used to evaluate the association of encounter type and no-show encounters, clustering by individual patient and adjusting for demographics, comorbidities, and social vulnerability. Interaction analyses were performed. There were 355,976 unique patients with 2,639,284 scheduled outpatient encounters included in this dataset. 59.9% of patients were of Hispanic ethnicity, while 27.0% were of Black race. In a fully adjusted model, telehealth visits were associated with a 29% reduction in odds of no-show (aOR 0.71, 95% CI: 0.70–0.72). Telehealth visits were associated with significantly greater reductions in probability of no-show among patients of Black race and among those who resided in the most socially vulnerable areas. Telehealth encounters were more effective in reducing no-shows in primary care and internal medicine subspecialties than surgical specialties or other non-surgical specialties. These data suggest that telehealth may serve as a tool to improve access to care in socially complex patient populations. PubDate: 2023-03-08
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Abstract: Abstract This study focuses on the space-time patterns of the COVID-19 Omicron wave at a regional scale, using municipal data. We analyze the Basque Country and Cantabria, two adjacent regions in the north of Spain, which between them numbered 491,816 confirmed cases in their 358 municipalities from 15th November 2021 to 31st March 2022. The study seeks to determine the role of functional urban areas (FUAs) in the spread of the Omicron variant of the virus, using ESRI Technology (ArcGIS Pro) and applying intelligence location methods such as 3D-bins and emerging hot spots. Those methods help identify trends and types of problem area, such as hot spots, at municipal level. The results demonstrate that FUAs do not contain an over-concentration of COVID-19 cases, as their location coefficient is under 1.0 in relation to population. Nevertheless, FUAs do have an important role as drivers of spread in the upward curve of the Omicron wave. Significant hot spot patterns are found in 85.0% of FUA area, where 98.9% of FUA cases occur. The distribution of cases shows a spatially stationary linear correlation linked to demographically progressive areas (densely populated, young profile, and with more children per woman) which are well connected by highways and railroads. Based on this research, the proposed GIS methodology can be adapted to other case studies. Considering geo-prevention and WHO Health in All Policies approaches, the research findings reveal spatial patterns that can help policymakers in tackling the pandemic in future waves as society learns to live with the virus. PubDate: 2023-02-24
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Abstract: Abstract Adverse childhood experiences (ACEs) have been associated with poor mental health outcomes in adulthood. Childhood maltreatment is related to both depressive and anxiety symptoms. Our objective was to investigate these associations among low-income, mostly Black and Latino men who have sex with men (MSM), as these may be a particularly vulnerable population group. Data come from a longitudinal study of MSM with varied substance use behaviors (n = 321) collected between August 2014 and April 2022. Cumulative, childhood maltreatment ACEs, and the single ACE of childhood sexual abuse were investigated as potential predictors of self-reported depressive and anxiety symptoms in mixed-effects logistic and ordinal regression models. There was no evidence of a dose-response relationship between the number of ACEs and the predicted probability of depressive and anxiety symptoms. Compared to MSM reporting fewer than five ACEs, those with five or more ACEs had approximately double the odds ratio of reporting depressive (OR = 1.93; 95% CI: 1.04–3.60) and anxiety symptoms (OR = 2.21; 95% CI: 1.05–4.68). The dimension of childhood maltreatment had a more robust prediction of depressive symptoms than the dimension of household dysfunction across all models. The association between childhood sexual abuse history and depressive symptoms remained after adjustment for the other nine ACEs (OR = 2.27; 95% CI: 1.11–4.68). The ordinal logistic model suggested that cumulative ACEs more than triple the odds of being in a higher anxiety category (OR = 3.12; 95% CI: 1.58–6.14), with associations reported for childhood maltreatment ACEs (OR = 1.31; 95% CI: 1.06–1.66) and childhood sexual abuse (OR = 1.93; 95% CI: 0.89–4.21). Childhood maltreatment ACEs, particularly childhood sexual abuse, are salient predictors of depressive and anxiety symptoms among adult urban MSM. Mitigating the impact of childhood maltreatment requires understanding the additional burden of social distress often faced by MSM throughout the life course. PubDate: 2023-02-24
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Abstract: Abstract Violence is a public health issue that disproportionately affects communities of color in urban centers. There is limited understanding of how violent crime is associated with adult physical inactivity and obesity prevalence given the racial/ethnic composition of community residents. This research aimed to address this gap by examining census tract-level data in Chicago, IL. Ecological data gathered from a variety of sources were analyzed in 2020. Violent crime rate represented the number of police-reported incidents of homicide, aggravated assault, and armed robbery per 1,000 residents. Spatial error and ordinary least square regression models were evaluated to determine if violent crime rate was significant associated with prevalence (%) of adult physical inactivity and obesity among all Chicago census tracts (N = 798), majority non-Hispanic (NH) White tracts (n = 240), majority NH Black tracts (n = 280), majority Hispanic tracts (n = 169), and racially diverse tracts (n = 109). Majority was defined as ≥ 50% representation. After adjusting for socioeconomic and environmental measures (e.g., median income, grocery store availability, walkability index), violent crime rate was associated with % physical inactivity and % obesity at the census tract level in Chicago, IL (both p < 0.001). Associations were statistically significant among majority NH Black and Hispanic tracts, but not majority NH White and racially diverse tracts. Future studies should evaluate the structural drivers of violence and the influence these drivers have on adult physical inactivity and obesity risk, particularly in communities of color. PubDate: 2023-02-16
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Abstract: Abstract Research shows youth police contact—a stressor experienced by more than one-quarter of urban-born youth by age 15—has deleterious mental health consequences for both youth and their mothers. Less is known about how youth’s fathers respond to this police contact, despite differences in how men and women respond to stress and relate to their children. I use data from the Fragile Families and Child Wellbeing Study to investigate the association between youth police stops and depression among youth’s fathers. Results show that fathers of youth stopped by the police, compared to fathers of youth not stopped by the police, are more likely to report depression, net of father and youth characteristics associated with selection into experiencing youth police stops. This association is concentrated among non-Black fathers and fathers of girls. The findings highlight how the repercussions of youth criminal legal contact extend to youth’s fathers and, more broadly, suggest that future research incorporate the responses of men connected to those enduring criminal legal contact. PubDate: 2023-02-15
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Abstract: Breast cancer is the most commonly diagnosed cancer among women worldwide. Studies have reported minimal birth cohort effects on the incidence rates of breast cancer in Western countries but have reported notable birth cohort effects in some Asian countries. The risks of breast cancer may also vary within a country. In the present study, we abstracted female invasive breast cancer data from the Taiwan Cancer Registry for the period 1997–2016. We used the age–period–cohort model to compare birth cohort effects on breast cancer incidence rates between urban and rural regions in Taiwan. We identified a notable urban–rural disparity in birth cohort effects on breast cancer incidence rates in women in Taiwan. The incidence rates in the urban regions were higher than those in the rural regions across all cohorts. However, the incidence rates rose faster in the rural regions than in the urban regions across the cohorts. The risks of breast cancer observed for women born in 1992 were approximately 22 and 11 times than those observed for women born in 1917 in rural and urban regions, respectively. The observed gap in breast cancer incidence rates between the urban and rural regions gradually disappeared across the cohorts. Accordingly, we speculate that urbanization and westernization in Taiwan may be the drivers of female breast cancer incidence rates across birth cohorts. PubDate: 2023-02-13
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Abstract: Abstract Under the Stop, Question, and Frisk (SQF) policy, New York City (NYC) police stopped Black Americans at more than twice the rate of non-Hispanic whites, after controlling for arrests and precinct differences. We examined whether police stops of Black Americans during SQF correspond positively with psychiatric emergency department (ED) visits among Black residents in NYC. We utilized as the exposure all police stops, stops including frisking, and stops including use of force among Black Americans in NYC between 2006 and 2015 from the New York City Police Department’s New York City—Stop, Question, and Frisk database. We examined 938,356 outpatient psychiatric ED visits among Black Americans in NYC between 2006 and 2015 from the Statewide Emergency Department Database (SEDD). We applied Box-Jenkins time-series methods to control for monthly temporal patterns. Results indicate that all stops, frisking, and use of force of Black residents correspond with increased psychiatric ED visits among Black Americans in NYC (all stops—coef = 0.024, 95%CI = 0.006, 0.043; frisking—coef = 0.048, 95%CI = 0.015, 0.080; use of force—coef = 0.109, 95%CI = 0.028, 0.190). Our findings indicate that a one standard deviation increase in police stops equates to a 2.72% increase in psychiatric ED visits among Black residents in NYC. Use of force may have the greatest mental health consequences due to perceived threats of physical violence or bodily harm to other members of the targeted group. Racially biased and unconstitutional police encounters may have acute mental health implications for the broader Black community not directly involved in the encounter itself. PubDate: 2023-02-10
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Abstract: Abstract In summer 2020, New York City (NYC) implemented a free air conditioner (AC) distribution program in response to the threats of extreme heat and COVID-19. The program distributed and installed ACs in the homes of nearly 73,000 older, low-income residents of public and private housing. To evaluate the program’s impact, survey data were collected from October 2020 to February 2021 via mail and online from 1447 program participants and 902 non-participating low-income NYC adults without AC as a comparison group. Data were examined by calculating frequencies, proportions, and logistic regression models. Participants were 3 times more likely to report staying home during hot weather in summer 2020 compared to non-participants (adjusted odds ratio [AOR] = 3.0, 95% confidence interval [CI] = 2.2, 4.1), with no difference between groups in summer 2019 (AOR = 1.0, CI = 0.8, 1.3). Participants were less likely to report that 2020 hot weather made them feel sick in their homes compared to non-participants (AOR = 0.2, CI = 0.2, 0.3). The program helped participants—low-income residents and primarily people of color—stay home safely during hot weather. These results are relevant for climate change health-adaptation efforts and heat-health interventions. PubDate: 2023-02-09
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Abstract: Abstract In the first two years of the COVID-19 pandemic, members of Boston Emergency Medical Services, the City of Boston’s municipal ambulance service, had 7,689 encounters with confirmed-positive Boston residents. As COVID-19 virus strains continue to infect residents in Boston and across the country, understanding the correlation between population positivity, EMS encounters, and hospitalizations can inform healthcare response. This study examines urban virus-surveillance indicators that can serve as an early warning of the volume of Emergency Medical Services (EMS) encounters with COVID-19 positive patients and subsequently how EMS encounters with confirmed COVID-19 patients can serve as an early indicator of future hospital-demand surges. With daily data from Boston EMS and three other public agencies, we evaluate the relationship between five indicators and confirmed Boston EMS COVID-19 encounters by estimating separate Auto Regressive Integrated Moving Average models and cross-correlating their residuals. This study finds a significant and positive correlation between new COVID-19 cases citywide and EMS encounters 6 days later (p < 0.01), as well as between confirmed EMS encounters with COVID-19 patients and the number of intensive care unit beds occupied 7- and 18 -days later (p < 0.01). This study provides city health leadership needed clarity on the specific ordering and associated time lag in which infections in the population increase, EMS members encounter positive patients, and hospitals deliver care. PubDate: 2023-02-01
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Abstract: Abstract An outbreak of mpox virus (MPV) among humans in the United States (U.S.) was described in May 2022. This outbreak disproportionately affects Black and Hispanic sexual minority men (SMM) and these groups have lower rates of vaccination compared to Whites. Between July and August 2022, a partnership between a nonprofit and two local health departments successfully designed and implemented a community intervention to administer MPV vaccines to Black SMM in the Washington D.C. metropolitan area. We administered a quantitative survey to 178 respondents across four vaccinations clinics. We found that study participants had high socioeconomic status, high levels of anticipated MPV stigma, and were relatively skeptic about MPV. We demonstrated how a partnership between an urban nonprofit and government agency can facilitate quick and effective dissemination of a community intervention in a relatively low cost manner. PubDate: 2023-01-20
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Abstract: Abstract COVID-19-related health outcomes displayed distinct geographical patterns within countries. The transmission of SARS-CoV-2 requires close spatial proximity of people, which can be influenced by the built environment. Only few studies have analysed SARS-CoV-2 infections related to the built environment within urban areas at a high spatial resolution. This study examined the association between built environment factors and SARS-CoV-2 infections in a metropolitan area in Germany. Polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infections of 7866 citizens of Essen between March 2020 and May 2021 were analysed, aggregated at the neighbourhood level. We performed spatial regression analyses to investigate associations between the cumulative number of SARS-CoV-2 infections per 1000 inhabitants (cum. SARS-CoV-2 infections) up to 31.05.2021 and built environment factors. The cum. SARS-CoV-2 infections in neighbourhoods (median: 11.5, IQR: 8.1–16.9) followed a marked socially determined north–south gradient. The effect estimates of the adjusted spatial regression models showed negative associations with urban greenness, i.e. normalized difference vegetation index (NDVI) (adjusted β = − 35.36, 95% CI: − 57.68; − 13.04), rooms per person (− 10.40, − 13.79; − 7.01), living space per person (− 0.51, − 0.66; − 0.36), and residential (− 0.07, 0.16; 0.01) and commercial areas (− 0.15, − 0.25; − 0.05). Residential areas with multi-storey buildings (− 0.03, − 0.12; 0.06) and green space (0.03, − 0.05; 0.11) did not show a substantial association. Our results suggest that the built environment matters for the spread of SARS-CoV-2 infections, such as more spacious apartments or higher levels of urban greenness are associated with lower infection rates at the neighbourhood level. The unequal intra-urban distribution of these factors emphasizes prevailing environmental health inequalities regarding the COVID-19 pandemic. PubDate: 2023-01-12
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Abstract: Abstract Childhood obesity is a precursor to future health complications. In adults, neighborhood walkability is inversely associated with obesity prevalence. Recently, it has been shown that current urban walkability has been influenced by historical discriminatory neighborhood disinvestment. However, the relationship between this systemic racism and obesity has not been extensively studied. The objective of this study was to evaluate the association of neighborhood walkability and redlining, a historical practice of denying home loans to communities of color, with childhood obesity. We evaluated neighborhood walkability and walkable destinations for 250 participants of the Healthy Start cohort, based in the Denver metropolitan region. Eligible participants attended an examination between ages 4 and 8. Walkable destinations and redlining geolocations were determined based on residential addresses, and a weighting system for destination types was developed. Sidewalks and trails in Denver were included in the network analyst tool in ArcMap to calculate the precise walkable environment for each child. We implemented linear regression models to estimate associations between neighborhood characteristics and child body mass index (BMI) z-scores and fat mass percent. There was a significant association between child BMI and redlining (β: 1.36, 95% CI: 0.106, 2.620). We did not find an association between walkability measures and childhood obesity outcomes. We propose that cities such as Denver pursue built environment policies, such as inclusionary zoning and direct investments in neighborhoods that have been historically neglected, to reduce the childhood health impacts of segregated poverty, and suggest further studies on the influences that redlining and urban built environment factors have on childhood obesity. PubDate: 2023-01-09 DOI: 10.1007/s11524-022-00703-w
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Abstract: Abstract Transgender and nonbinary (trans) young adults report high rates of substance use and adverse mental health outcomes; however, few studies have examined how social, economic, and legal factors may contribute to health inequities in this population. Guided by the structural vulnerability framework, this study sought to explore structural needs and whether these needs were associated with substance use and mental health outcomes among trans young adults. Between 2019 and 2021, 215 trans young adults aged 18–29 from San Francisco Bay Area were recruited into a longitudinal study. Baseline data were used to examine bivariate and multivariable associations between structural needs and substance use and mental health outcomes. There were bivariate differences in the number of structural needs by education, income source, incarceration history, and ethnicity, and the number of unmet structural needs was associated with education and income source. After adjusting for sociodemographics, the number of structural needs was associated with daily marijuana use (AOR 1.29, 95% CI: 1.10–1.49) and suicidal ideation (AOR 1.24, 95% CI: 1.06–1.45), and the number of unmet structural needs was associated with daily marijuana use (AOR 1.30, 95% CI: 1. 10–1.55) and depressive symptoms (β 2.00, 95% CI: 1.00–3.00). Additionally, both numbers of structural needs and unmet structural needs mediated the relationship between income source (traditional employment vs. other income only) and depressive symptoms (TIE β 2.51, 95% CI: 0.99–4.04; β 1.37, 95% CI: 0.23–2.52, respectively). Findings highlight a need for multisector efforts to address structural vulnerabilities among trans young adults. PubDate: 2023-01-03 DOI: 10.1007/s11524-022-00700-z
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Abstract: Abstract Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences. PubDate: 2022-12-22 DOI: 10.1007/s11524-022-00699-3
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Abstract: Abstract Urban environments shape early childhood exposures, experiences, and health behaviors, including outdoor free play, influencing the physical, cognitive, social, and emotional development of young children. We examined evidence for urban or suburban built environment influences on outdoor free play in 0–6-year-olds, considering potential differences across gender, culture, and geography. We systematically searched seven literature databases for relevant qualitative, quantitative, and mixed methods studies: of 5740 unique studies, 53 met inclusion criteria. We assessed methodological quality and thematically synthesized findings from included studies. Three broad themes, features of spaces for play, routes, and social factors intersected to influence the availability, accessibility, and acceptability of neighborhoods for young children’s outdoor free play across diverse cultural and geographic contexts. Proximity to formal or informal space for play, protection from traffic, pedestrian environment, green and natural environments, and opportunity for social connection supported outdoor free play. Family and community social context influenced perceptions of and use of space; however, we did not find consistent, gendered differences in built environment correlates of outdoor free play. Across diverse contexts, playable neighborhoods for young children provided nearby space for play, engaging routes protected from traffic and facilitated frequent interaction between people, nature, and structures. PubDate: 2022-12-19 DOI: 10.1007/s11524-022-00696-6
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