Resilience, a key protective factor for mental health, may vary across intersecting identities, but this remains underexplored. This study applied Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy to examine resilience inequities at the intersection of race/ethnicity, sex, and sexual orientation among U.S. adults in a predominantly urban and suburban sample. Data came from 6543 adults in the National Wellbeing Survey 2024. Resilience was measured using 6-item Brief Resilience Scale (range 1–5), where higher scores indicate greater resilience. Participants were classified into 24 intersectional social strata based on race/ethnicity, sex, and sexual orientation. Multilevel models estimated the total variance in resilience due to between-strata differences and the share explained by additive main effects of these social dimensions. Mean resilience was 3.2 (SD = 0.8), with 35.1
Adolescents are both key beneficiaries and underrepresented partners in urban exposure research. We co-designed the CIRCULATE study with students from two secondary schools in the Metropolitan Area of Barcelona to collaboratively develop research questions and a feasible school-based protocol for investigating non-exhaust traffic emissions, specifically tire-related pollutants. Applying an Urban Health Laboratory methodology, the process unfolded in three stages: (i) participatory diagnosis to identify students' environmental concerns and build a shared understanding of tire-related pollution, (ii) citizen science co-definition and prioritization of research questions within the predefined thematic framework of tire-related chemicals (TRCs), and (iii) collaborative design of a school-compatible study protocol (variables, tools, where and when to sample). Across the two schools, traffic-related pollution consistently emerged as the dominant concern; tires were widely recognized as a pollution source, yet knowledge about tire-wear particles and associated additives was limited. Students produced idea summaries that were iteratively refined into draft research questions and categorized for analysis, prioritizing exposure pathways close to where they live and study. The co-design process proved feasible and context-appropriate for schools, integrating low-cost personal monitoring (passive/low-burden/voluntary silicone wristbands, portable sensors) and biological monitoring (urine samples) with school-level observation and structured discussions to guide near-term interventions. The co-creation process increased literacy, ownership, and motivation to act, and yielded a protocol that may be adapted and tested in future deployments across neighborhoods with varying traffic loads and urban morphologies. Overall, including adolescent perspectives strengthens the relevance and practicality of urban exposure research, surfaces blind spots on tire wear, and mobilizes school-level actions while laying groundwork for larger, comparative deployments.
Extreme heat poses growing health risks in U.S. cities, particularly for people experiencing unsheltered homelessness (PEUH) who lack consistent access to indoor cooling. This study assessed personal heat exposure among PEUH in Salt Lake City, Utah, one of the fastest-warming U.S. cities. Eight PEUH carried GPS-enabled smartphones and wearable temperature sensors for six days during a period of extreme summer heat. Nearly 10,000 geolocated heat index observations were intersected with a tree canopy polygon layer to quantify the role of urban tree cover in mitigating heat risk among PEUH. PEUH routinely experienced risky heat conditions, with prolonged exposure to heat above moderate (≥ 32.8 °C) and high-risk (≥ 39.4 °C) heat index thresholds. Nights offered little thermal relief; participants spent an average of 69
Children living in urban slums face persistent nutritional and health inequities, many of which are rooted in the food environment. This study examined the drivers of children’s food behaviors in Dhaka, Bangladesh, comparing slum and non-slum settings through a cross-sectional survey of 300 mothers of school-aged children (8–12 years) and focus group discussions. Quantitative analysis revealed disparities in diet quality: children in non-slum areas had a 13
Analyzing data by geopolitical districts, like congressional districts, is increasing in popularity in public health monitoring and evaluation but remains relatively rare compared to geographies such as census tracts and counties. In this study, we use city council districts in the City of Philadelphia to illustrate the utility and importance of investigating public health metrics by local political districts. We report on two metrics-tree canopy coverage and health insurance coverage-by city council district and census tract. We discuss the variation within and between districts to show heterogeneity across the city. Lastly, we discuss ways that data can be made accessible to the public through an online dashboard to support advocacy with local politicians.
Gun violence is a persistent public health concern in the United States, particularly in disadvantaged neighborhoods facing social and economic hardships. Washington, D.C., ranks among cities with the highest gun violence rates, incurring an estimated annual economic burden of over 2 billion. This issue is shaped not only by place-based factors but also by dynamic processes, such as local recurrence and spillover from nearby events that elevate short-term risk. This study utilized an endemic–epidemic model to disentangle contributions to background risk versus dynamic processes, analyzing approximately 24,000 firearm-related incidents in D.C. census tracts over 596 weeks from January 2014 to July 2025. Time-varying structural factors, including social vulnerability metrics and alcohol outlet access, were considered. Key findings revealed that 79
Structural racism and lethal police violence shape community environments, particularly in urban and urban-adjacent contexts, and may influence reproductive health. While disparities in birth outcomes among Black populations are well documented, fewer studies have examined how these structural and state-linked exposures jointly pattern risk for adverse birth outcomes. Using 2020 National Center for Health Statistics natality data and Mapping Police Violence data (2015–2019), we analyzed associations between county-level lethal police violence, a multidomain. Structural Racism Exposure Index (SREI), and low birth weight (LBW) and preterm birth (PTB) among non-Hispanic Black birthing people in the United States (N = 407,840). Incidence rate ratios (IRRs) were estimated using. Poisson and multilevel Poisson models, adjusting for maternal sociodemographic characteristics, with multiple sensitivity analyses assessing robustness. Higher levels of structural disadvantage were consistently associated with greater rates of LBW and PTB. Associations between lethal police violence and adverse outcomes were smaller and varied across model specifications. One interaction suggested a possible elevation in PTB in counties with both high police violence and medium structural disadvantage, though interaction findings were limited and should be interpreted cautiously. Findings provide suggestive evidence that structural disadvantage and policing are contextual factors linked with birth outcomes among Black birthing people. Results highlight the importance of examining structural and place-based conditions when assessing reproductive inequities and underscore the need for further research on how these contextual exposures shape Black reproductive well-being.
Gun violence is a pervasive and multifaceted public health problem. This study describes a novel application of group model building—a process that centers stakeholder voices to describe a complex problem—to investigate drivers of gun violence and design community-led interventions for prevention in New Haven, Connecticut. We recruited community leaders to participate in 2 group model building sessions in New Haven. Discussions and diagrams created during the sessions were used to produce a causal loop diagram illustrating proposed relationships between gun violence and other variables. Our resulting “iceberg model” illustrates how short-term and visible responses to gun violence “above the surface,” such as incarceration and policing, may only transiently decrease gun violence. Long-term, downstream effects of “above the surface” responses may ultimately increase gun violence and are summarized in 3 layers “under the surface,” which examine the effects of incarceration and lack of re-entry support, vulnerability to stress and social stigmatization, and community-police relations and community safety, respectively. This study demonstrates the value of using group model building to design community-driven interventions for gun violence prevention, as well as reiterates the importance of targeting structural causes of gun violence. This work has informed TRUE HAVEN, a multi-level intervention that addresses community gun violence in New Haven.
Structural inequities, including historical redlining, have created compounding climate-related vulnerabilities in marginalized communities, with potential implications for pediatric cardiometabolic diseases (CMD). However, the joint effects of redlining, climate risk, and urban heat on pediatric CMD remain poorly understood. Using New York State hospital administrative data (2018–2022), we examined associations between neighborhood redlining, climate risk, urban heat, and CMD-related emergency department (ED) and outpatient visits among children aged < 18 years. Exposures included historical redlining (Home Owners’ Loan Corporation grades C/D vs. A/B), climate risk (high vs. low, based on the Climate Vulnerability Index), and urban heat (high vs. low, based on satellite-derived land surface temperature). Associations were estimated using Poisson regression with interaction terms and subtype-specific analyses. Among 342,220 CMD-related visits in the climate-risk cohort and 9,195 in the urban-heat cohort (mean age, 7.4 years; 49
Resilience is increasingly recognized as a protective factor in maternal health, yet limited research has explored how pregnant women living in low-income, immigrant-dense urban neighborhoods define and express resilience in their everyday environments. This study used photovoice to capture community-rooted strengths among pregnant participants living in Elmhurst, Queens, a multicultural area with a significant immigrant population. Ten English-speaking pregnant participants were recruited from the CHIMES (Community and Household Infant-Maternal Exposures Study), a longitudinal cohort examining environmental and psychosocial influences on maternal and child health. Participants were asked to take 10–12 photographs representing “resilience” in their neighborhoods. At a follow-up study visit, they selected up to five images to discuss in semi-structured interviews. Interview transcripts were analyzed using Braun and Clarke’s six-phase thematic analysis approach, with inductive coding to identify shared themes. Four key themes emerged: (1) Nature and Outdoor Spaces as a Form of Relief, highlighting parks and green areas as calming, restorative spaces; (2) Emotional Strength through Family Connections, emphasizing support from children and relatives; (3) Community Resources as Everyday Supports, including proximity to schools, clinics, and stores; and (4) Emotional Well-being and Inner Strength, reflecting participants’ mental reframing and personal growth. Participants described resilience as rooted in everyday life, grounded in social connections, local environments, and individual outlooks. These findings challenge deficit-based narratives and underscore the importance of community-informed understandings of health and coping. Photovoice revealed layered dimensions of resilience among pregnant participants, offering insight for designing maternal health interventions that build on existing community strengths.
Disruptions to the US criminal legal system during the SARS-CoV-2 pandemic temporarily reduced the numbers of people in prisons while exacerbating racial disparities in their populations, increasing the percentage of incarcerated people who are Black. Less is known about jail populations, including disparate impacts by race. We used web-scraped data from the publicly available rosters of North Carolina (NC) jails to examine their population sizes, admission and release rates, and racial composition during 2020–2022. Data were available from 45 jails (of 93 total in NC) representing 194,230 incarcerations. Relative to pre-pandemic (January–February 2020) sizes, populations decreased to a median of 66
The COVID‑19 pandemic disrupted human relationships through public health distancing mandates and migration shifts. These changes had the potential to be especially disruptive in public housing, which are government‑funded developments for housing low‑income, frequently mobile, populations. In light of these social upheavals, our goal is to leverage this natural experiment to understand the persistence of relationships, measured as ties in social networks, within disadvantaged public housing communities. We develop a predictive model of relationship maintenance, what we call ego-alter tie-retention, using data from an egocentric longitudinal survey of 187 adults residing in two Boston public‑housing developments. Baseline data were collected between March 2019 and 2020. Our outcome variable is tie-retention (yes vs. no) of each reported tie at approximately 1 year post baseline. Predictors include the degree to which different types of tie overlap (multiplexity), tie‑strength measures (frequency of contact, shared meals, closeness, years known, relationship type, residence), individual ego and alter attributes (age, education, employment, caregiver status), and homophily of relationships (based on gender, Hispanic ethnicity, housing category, caregiver status, sugar‑sweetened beverage/food consumption, self‑rated health, education, smoking). Multilevel hierarchical logistic regression with penalized quasi‑likelihood estimation was used, and model fit was compared via Akaike information criterion. The best fitting model includes multiplexity, longer relationship duration, shared (i.e., homophilous) educational background, and ego-level smoking (AIC = 519.2). These findings have implications for the design of social network-based interventions in public housing contexts. Leveraging durable, homophilous social ties may achieve greater intervention longevity and reach in similar low‑income urban settings.
Extreme heat events increasingly threaten public health, particularly in rapidly urbanizing areas like Maricopa County, Arizona. This study addresses gaps in identifying communities most vulnerable to extreme heat and heat waves by creating a Heat Vulnerability Index (HVI) that integrates often-overlooked populations. Utilizing US census data, satellite imagery, chronic illness prevalence rates, and unhoused population data, this HVI assesses vulnerability across census tracts in Maricopa County's diverse urban-rural landscape. Principal components analysis identified nine factors influencing heat vulnerability: (1) socioeconomic disadvantage; (2) isolation; (3) elderly populations; (4) chronic illness; (5) environmental risks; (6) African American race and language barriers, (7) Native American and unemployment status; (8) lack of housing and male; and (9) mobile home residents. Model validation found that heat-related mortality rate increased with heat vulnerability. Despite statistical limitations from data resolution and timeframe, this study integrates unhoused data into vulnerability assessments, emphasizing the need for equitable approaches that include underserved communities to address extreme heat vulnerability.
Gun violence exposure (GVE) is associated with adverse mental health outcomes and firearm carrying. The extent to which community-led programs aimed at reducing violence counteract these effects is unknown. This study sought to examine (1) the relationships between GVE, anticipated risk of assault, psychological distress, and the perceived need to carry a firearm for protection and (2) whether awareness of community violence intervention (CVI) efforts in one’s neighborhood moderates these associations. We used weighted survey data from a representative sample of 2,285 Detroit residents collected in 2024. Structural equation modeling approaches were used to estimate relationships. We found that past 6-month GVE was positively associated with psychological distress, anticipated assault risk, and a greater perceived need to carry a firearm for protection. GVE was also indirectly associated with a greater perceived need to carry a firearm through increased anticipation of assault. Path coefficients from GVE to psychological distress, anticipated assault risk, and the perceived need to carry a firearm were smaller among the CVI awareness group, and, apart from the association between GVE and anticipated assault risk, not significant. The positive association between GVE and psychological distress was significantly weaker among those who reported being aware of CVI in their neighborhood. Overall, these findings suggest that CVI awareness may be associated with a weaker relationship between GVE and mental well-being and safety-related perceptions. Additional research that examines broader health and safety-related outcomes is needed to more fully characterize the potential benefits of CVI, including among the broader community.
Older people with HIV (PWH) experience higher rates of physical function decline and frailty than those without HIV. This study aimed to examine the association between physical function measures and geolocated social determinants of health (SDOH) in two geographically distinct groups of older sedentary PWH. We conducted a cross-sectional analysis using baseline data from a randomized exercise trial (the High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults with HIV; HEALTH) of 120 sedentary PWH aged ≥ 50 years from two sites (Aurora/Denver, Colorado [CO], and Seattle, Washington [WA]). Geolocated SDOH (neighborhood socioeconomic status, mobility infrastructure, environmental amenities and hazards, and access to healthcare) were derived from residential addresses and linked with physical function indicators (400-m walk time, chair rise time, PROMIS function, steps per day, and frailty). Spearman’s correlations were used to quantify the associations between the study variables. For CO, a higher Area Deprivation Index (ADI) was significantly associated with slower chair rise times. In WA, a higher Social Vulnerability Index (SVI) correlated with slower 400-m walk times, and a greater distance to parks was observed among pre-frail/frail participants. Pooled analyses revealed that participants classified as pre-frail/frail resided in neighborhoods with significantly higher SVI scores. Higher neighborhood deprivation, greater social vulnerability, and increased distance to parks were significantly associated with poorer physical function, with site-specific patterns. These findings suggest that the neighborhood context may influence functional health and highlight the need for larger studies to inform place-based interventions.
During public health emergencies, infection control policies play a critical role in curbing disease transmission. However, little is known about the ways in which these policies shape family dynamics. Challenges may be more pronounced among families living in low-income, high-risk urban communities. This study investigated conflicts related to COVID-19 within households, using data from a randomized control trial (n = 392) conducted between 08/2021 and 07/2022. The participants—primarily Latino or Black (95
We assessed correlates (sociodemographic, substance use, and injection-related factors) of obtaining syringes from syringe services programs (SSPs) and/or pharmacies among persons who inject drugs (PWID) in the United States (US) in 2022 to identify gaps in use among subpopulations of PWID. The 2022 National HIV Behavioral Surveillance conducted biobehavioral surveys among PWID using respondent-driven sampling. Using log-linked Poisson regression models, we examined past-year characteristics associated with obtaining syringes from (1) SSPs; (2) pharmacies; or (3) SSPs and pharmacies in the last 12 months. Of 7095 participants, 47
The Healthy Cities initiative, initially a grassroots movement and later adopted by the World Health Organization (WHO), is a health promotion approach that was developed primarily to increase municipal governments’ capacities to address citizen health. The Healthy Cities initiative aims to incorporate health within urban policymaking through local intersectoral, community-driven collaboration. Given that the Healthy Cities movement has been underway for several decades, understanding how the Healthy Cities initiative itself has been evaluated is important. This is particularly timely given recent major shifts in global health governance, including funding cuts at the WHO that may have repercussions for efficiency and results. In this study, we investigate how Healthy Cities projects have been evaluated over the years. We conducted a scoping review reported in accordance with the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). We searched for both peer-reviewed and grey literature in Ovid MEDLINE, Ovid Embase, Web of Science Core Collection, SCOPUS, and the WHO Institutional Repository for Information Sharing (IRIS) from database inception to the date the search was conducted. Our scoping review identified 2206 non-duplicate results for screening, which yielded a total of 95 texts evaluating the Healthy Cities initiative conducted across 57 unique settings that met the inclusion criteria. We present our findings according to regional distribution, evaluation methods, and focus of evaluations. The distribution of evaluations across regions varied significantly, with certain locations serving as focal points for research activity, such as the WHO European Healthy Cities Network. The widespread use of surveys and interviews underscores the emphasis on capturing both quantitative and qualitative dimensions in assessing the Healthy Cities initiative. Although the strong representation of themes such as implementation approach, community participation, and policy development reflects a clear focus on implementation, engagement, and policy outcomes, the underrepresentation of themes such as intersectoral collaboration and capacity building points to areas requiring greater attention.
Living in a neighborhood with greater tobacco retailer availability (TRA) is associated with tobacco use, and there are persistent neighborhood racialized and socioeconomic inequities in TRA. Zoning could be leveraged as an innovative policy tool to equitably reduce TRA. In this study, we simulated the effect of zoning policies on reducing inequities in TRA in Oklahoma City (OKC) and Tulsa (Oklahoma). We spatially joined locations of tobacco retailers, zoning areas, and census tract sociodemographic characteristics (year 2023). We conducted 500 simulations to randomly remove 5–90
