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Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Abstract: 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. PubDate: 2025-06-18
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Abstract: Anti-Black mortgage lending discrimination (MLD) has resulted in homeownership disparities among White and Black households. This study examines the association between MLD and health opportunities, based on various neighborhood determinants of health (e.g., employment, education, and housing status), in Michigan’s three largest metropolitan areas. Multilevel models using data from the Home Mortgage Disclosure Act and Census from 2015 to 2019 were used to examine the Black-White odds ratio of mortgage denial. An association analysis was performed to examine the relationship between the Black-White odds ratio of mortgage denial and neighborhood health opportunities. Loan denial for Black mortgage applicants was 1.99 (95% CI1.87, 2.12) times more likely than for White applicants. Neighborhoods with greater anti-Black MLD had fewer harmful environmental exposures, greater health insurance coverage, and better housing and socio-economic conditions. Anti-Black MLD remains a common practice and supports the assertion that Black home-seekers experience greater MLD in neighborhoods with better opportunities for health compared to White home-seekers, who access these benefits more freely. Greater protections against MLD—including increasing oversight of the data reporting requirements and improving mortgage access for Black households—are needed to promote health equity. PubDate: 2025-06-11
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Abstract: 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. PubDate: 2025-06-09
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Abstract: Randomized controlled trials (RCTs) aiming to address the multiple health and social challenges of people experiencing homelessness (PEH) are lacking. Here we report the findings from a multicenter, open, pilot RCT. The intervention involved independent prescriber pharmacist from the National Health Service working on outreach in partnership with dedicated workers from Homeless Voluntary Charity or Social Enterprises (HVCSEs) (Pharmacist and third sector charity worker integrated Homeless Outreach Engagement Non-medical Independent prescriber Rx’-PHOENIx) in low threshold HVCSE venues or temporary accommodation addressing PEH participants’ health and wider needs through repeated outreach. The trial aimed to investigate whether sufficient numbers of participants could be recruited, retained, the intervention delivered as planned, and sufficient data collected to inform a subsequent definitive RCT. Clinical outcomes were also collected at follow-up (6 months). Participants were recruited from five community pharmacies and nearby venues in urban centers of Glasgow-Scotland and Birmingham-England, then randomized one-to-one into PHOENIx intervention in addition to usual care (UC) or UC only. A priori progression criteria were achieved: 55% of those assessed as eligible were recruited; at 6 months, 72% remained in the study, 91% had emergency department and mortality data available, and 72% completed questionnaire booklets. Fifty-three percent of participants received at least 50% of the planned PHOENIx intervention consultations (in-person or phone) at 6 months. Signs of improvement in clinical outcomes in the PHOENIx group included fewer ambulance call-outs, ED visits, and hospitalizations; higher outpatient attendances; and higher scores on self-reported health-related quality of life. A definitive RCT is merited. PubDate: 2025-06-09
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Abstract: Overdose deaths involving fentanyl represent a major public health crisis in the USA. This study investigates the spatiotemporal dynamics of fentanyl-involved deaths before, during, and after the COVID-19 pand... PubDate: 2025-06-05
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Abstract: 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, s... PubDate: 2025-06-05
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Abstract: 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. PubDate: 2025-06-04
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Abstract: Crowded living conditions are associated with negative health outcomes, particularly for children. Federal rental assistance may reduce household crowding by improving access to affordable housing for low-income families. We leveraged NHANES data linked with HUD administrative rental assistance records to examine relationships between different forms of HUD rental assistance and multiple measures of crowding for households with children. We found a statistically significant reduction in the odds of crowding for those currently receiving HUD assistance compared to a control group who entered rental assistance within 2 years of their NHANES interview (95% CI, 0.39 to 0.93). The specific relationships between rental assistance and crowding and the magnitude of these associations varied by rental assistance type (public housing, multi-family, and vouchers). Fewer than 1 in 4 eligible households receive rental assistance. Our findings suggest that expanding access to this resource can reduce household crowding and its adverse impacts on health and well-being. PubDate: 2025-05-15
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Abstract: 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. PubDate: 2025-05-14
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Abstract: Epidemiologic research has found worsening behavioral health in the USA since 2020. Local policies may have contributed to these patterns and associated disparities. However, scant research has systematically documented county-level COVID-19-era policymaking or empirically investigated its health impacts. To investigate this question, we linked the US COVID-19 County Policy Database—a novel database with weekly data from 2020 to 2021 on 26 policies for 309 primarily urban counties—to data on adult behavioral health from the cross-sectional 2021 National Survey on Drug Use and Health (N = 25,600). We created measures of policy comprehensiveness by aggregating individual policies into an overall score, and into three domains: containment/closure, economic response, and public health. Outcomes included any past-30-day use and frequency of use of multiple substances (alcohol, binge alcohol, cigarettes, marijuana, non-marijuana illicit drug use, and vaping) and past-30-day psychological distress. Models adjusted for individual covariates, county fixed effects, and time-varying county-level COVID-19 covariates. We found that increases in overall policy comprehensiveness—and comprehensiveness in each of three domains—over time were not associated with the behavioral health outcomes assessed. Meanwhile, stratified models found some variability in associations across sex, racial/ethnic, education, and urban subgroups. This study established the feasibility, utility, and potential challenges of linking newly available COVID-19-related county policy data with health data to examine county-level policy influences on behavioral health. Further research is needed to inform responses to current behavioral health needs and future public health emergencies. PubDate: 2025-05-07
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Abstract: 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. PubDate: 2025-05-01
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Abstract: Gun violence is a leading cause of death and injuries in the USA, adversely affecting physical and mental health among its survivors. Declared as a public health crisis in 2024, It disproportionately affects African Americans. It is linked to discriminatory policies like “redlining,” which fostered racial segregation and systemic inequities, perpetuating cycles of violence and mental health disparities. This study explores the relationships between racial segregation, systemic inequities, gun violence, and mental health through a data-driven, longitudinal study (2005–2021) of Milwaukee, WI, a hyper segregated metropolitan region. Our investigation aims to inform evidence-based, place-sensitive policies to promote social justice, reduce disparities, and foster healthy communities. Utilizing location-based demographic and socio-economic data from the U.S. Census, gun violence data from the Wisconsin Incident-Based Reporting System, and mental health data from the CDC’s PLACES dataset, we conduct spatial and temporal analyses and geovisualization in GIS. To understand trends and correlations, we conduct time series decomposition, Mann–Kendall trend tests, and entropy statistics. Our findings indicate that racially segregated neighborhoods experience higher rates of gun violence and poorer mental health outcomes. Predominantly African American neighborhoods exhibit patterns of “consecutive,” “sporadic,” and “new” hotspots of gun violence, while predominantly white neighborhoods are characterized as “cold spots.” Physical and mental health disparities in Milwaukee indicate similar patterns. The results of this study highlight the profound impact of historical and systemic socioeconomic discrimination on contemporary public health issues. PubDate: 2025-04-22
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Abstract: Overdose prevention centers (OPCs) offer supervised environments for drug consumption and harm reduction services, yet their implementation in the United States (US) remains limited. The present study analyzed the perspectives of residents and employees within a 0.75-mile radius of the first state-authorized OPC in the US (N=125). Surveys revealed that 74% supported an OPC opening in their neighborhood, with a slightly higher proportion (81%) favoring an OPC elsewhere in the city. Support for an OPC was associated with greater perceived visibility of homelessness in the neighborhood (p=0.04) and younger age (p=0.01) but was not significantly associated with other socio demographics. While participants were generally supportive, some expressed concerns about increased drug activity. Findings may have been impacted by grassroots education and public awareness campaigns. Results emphasize the importance of engaging with community members to build support for evidence-based harm reduction interventions such as OPCs. PubDate: 2025-04-10
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Abstract: In the face of escalating climate-related challenges, the resilience of healthcare systems is paramount. As was seen during COVID-19, the climate crisis exemplifies the critical need for a resilient workforce and robust healthcare infrastructure amidst increasing impacts including infrastructure disruptions, rising costs, and exacerbated health disparities. Structurally vulnerable communities, particularly those of color, face disproportionate exposure to climate risks, highlighting the urgent need for equitable resilience strategies. A focus on multifaceted approaches to fortifying healthcare systems against climate change includes emphasizing decarbonization, adaptability, data-driven planning, and support of sustainable infrastructure and health workers. The importance of integrating climate awareness into clinical and public health practices is underscored, promoting proactive measures and community engagement. Strategies to mitigate carbon footprint and enhance healthcare delivery can be enacted including with some federal and philanthropic funding support. This comprehensive approach ensures that healthcare systems remain robust, equitable, and responsive in the face of ongoing and future climate crisis challenges. PubDate: 2025-04-04
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Abstract: 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. PubDate: 2025-04-03
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Abstract: 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 PubDate: 2025-03-31
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Abstract: 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. PubDate: 2025-03-27
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Abstract: 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. PubDate: 2025-03-24
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Abstract: 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. PubDate: 2025-03-20
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