Inadequate physical activity (PA) elevates chronic disease risk in low-income urban populations. Neighborhood parks may offer venues for PA, but effects likely depend on park quality and use patterns. This study examined whether citywide park renovations were associated with changes in adult PA and sedentary behavior (SB) in low-income New York City neighborhoods and whether associations between park use and PA/SB changes differed for residents near renovated vs. control parks. We conducted a quasi‑experimental prospective cohort study (2016–2022) in neighborhoods surrounding 31 renovated and 21 matched control parks. Participants included 344 adults living ≤ 0.3 miles of a study park (186 intervention, 158 control). Outcomes were accelerometry‑based PA/SB measures collected pre‑ and post‑renovation: vector magnitude per minute (VMPM) and minutes/day of sedentary time, light PA, and moderate‑to‑vigorous PA. Surveys assessed self‑reported typical frequency and duration of park visits. Linear mixed‑effects difference-in-differences models estimated associations between renovations and PA/SB changes; interaction models examined associations of park use with PA/SB changes in intervention vs. control groups. Changes in PA/SB were not significantly different between intervention and control groups. However, intervention participants who reported visiting their study park ≥ 30 min on a weekend day experienced a 140.0-unit/day greater increase in VMPM (95

As programs and policies designed to improve urban health and sustainability have matured, many urban scholars question the fairness of their implementation. Our study addresses this issue by evaluating the association of census tract-level gentrification in New York City with both the creation or renovation of major green spaces and investment in a municipal brownfield Voluntary Cleanup Program (VCP). For each tract, we computed an index of gentrification based on the relative change of key input variables for the years 2000 through 2019. Using a 400-meter edge buffer for each tract, we then computed the percent overlap with major parks that were recently created or renovated and the number of properties remediated through the city's VCP program. The proportion of remediated VCP sites, relative to the number of properties designated with possible environmental hazards, was significantly higher among tracts in the top 20th percentile of gentrification, relative to tracts in the lowest 20th percentile (9.8 % vs 4.3 %, p-value <0.0001). Simultaneous autoregressive spatial error models, with or without adjusting for geographic strata (pre-determined from k-means clustering), revealed positive effects from the number of VCP sites, which were consistently strong (p < 0.001), and from park proximity (1 if any percent overlap, 0 otherwise), which were marginally significant (0.02 < p < 0.09) but which modified (p < 0.001) the effect of VCP sites. These quantitative results, together with geovisualization, document how the phenomenon of green gentrification may be associated with multiple interacting forces; plus certain sustainability initiatives may distribute environmental improvements unevenly, favoring neighborhoods undergoing redevelopment and subsequent gentrification.

Urban parks may promote health through physical activity, stress management, and social connectedness. However, poor-quality parks in disrepair are underutilized, limiting these benefits. This study evaluated the impact of a citywide park renovation program known as the Community Parks Initiative (CPI) on changes in park use patterns and park satisfaction among residents living in low-income New York City neighborhoods. Repeated cross-sectional surveys were administered to residents living near 31 parks undergoing CPI renovations (545 pre-renovation and 201 post-renovation respondents) and near 21 parks in socio-demographically matched control neighborhoods (345 pre-renovation and 129 post-renovation respondents). Surveys measured self-reported past-month park visits, typical park visit duration, and satisfaction with park quality and facilities. Using a difference-in-differences (DID) approach, generalized estimating equations were fit to compare changes over time in park use and satisfaction among residents living near parks receiving renovations compared to those living near control parks. Models were adjusted for age, body mass index, income, public housing, marital status, and children in household. Residents in neighborhoods receiving park renovations reported a larger increase in minutes spent at the park on weekdays [DID = 30.0 min (95% CI 10.3, 49.7)] and total minutes spent at the park in the last 30 days [DID = 466.3 min (95% CI 63.0, 869.6)] compared to controls. Residents of renovated park neighborhoods also reported larger increases in park satisfaction relative to residents of control neighborhoods, with the largest improvements in the percent of residents satisfied with overall park quality [DID = 38.4% (95% CI 25.2, 51.6)] and maintenance of grounds and facilities [DID = 40.9% (95% CI 27.7, 54.1)]. This study provides evidence that park renovations are an important urban planning strategy to support community health through increased park use and improved park perceptions.

Area-level livability indices are commonly used tools for policymakers to evaluate and improve built and social environments, but their relationship to mental health is not well-understood. In this study, we used geographically weighted Poisson regression (GWPR) to measure spatially varying associations between neighborhood livability and poor mental health across New York City (NYC) census tracts. A small-area livability index was previously constructed with publicly available data for 2,101 census tracts in NYC using principal components analysis applied to 38 variables across six domains: socioeconomic, housing, resources, environment, safety, and accessibility & transportation. The outcome was cases of self-reported mental health not good for ≥14 days in past month among adults (CDC 500 Cities - 2016). GWPR models measured spatially varying associations of poor mental health cases, offset by adult population size, with the overall livability score and, separately, with each of the domain sub-scores. Estimated risk ratios were mapped to identify areas in NYC where livability domains acted as protective/risk factors for poor mental health, depending on the location. Socioeconomic livability was a geographically consistent protective factor (negative associations across all census tracts), while the overall livability score and other domain sub-scores showed geographically varying associations with poor mental health (associations ranging from negative to positive). Geographic areas showing protective associations between livability and poor mental health highlight opportunities to improve mental health outcomes through targeted domain-specific interventions. In areas where elements of livability were positively associated with poor mental health, tackling mental health disparities may require more multifaceted approaches.

Nearly three years after onset of the COVID-19 pandemic in New York City (NYC), cumulative hospitalization and mortality rates were not uniformly distributed across the city. To help understand potential drivers of this geospatial disparity, we applied geographically weighted Poisson regression (GWPR), which allows associations between these outcomes and community-level predictors to be location-dependent.Cumulative COVID-19 hospitalization and mortality rates in n = 177 NYC modified ZIP code tabulation areas as of December 31, 2022 were obtained from the NYC Department of Health and Mental Hygiene, while socioeconomic and demographic predictors were queried from the 2018 American Community Survey. The GWPR model, and its multiscale generalization, yielded better diagnostics than the more conventional global models that assume spatially stationary associations, with the non-multiscale GWPR model performing the best.Several predictors acted as both risk and protective factors for both outcomes, depending on location, which means one common model for the whole city would be misleading. These include the percentage of non-Hispanic whites, foreign born citizens, male, mean commute time and having had at least one vaccination.Other predictors showed more geographically consistent effects. For mortality, the percentage of residents without health insurance acted solely as a risk factor. Similarly, for hospitalizations, the percentage of residents with a disability acted solely as a risk factor. The percentage of residents > 24y with a bachelor’s degree or higher acted solely as a protective factor against both outcomes. These community factors could therefore help guide local place-based interventions to reduce disparities and the overall burden of future epidemics.

Quality parks have the potential to promote well-being and health equity in urban communities through reduced stress, yet high-quality epidemiological evidence is limited. This quasi-experimental study measured associations between park renovation and changes in perceived stress among low-income adults in New York City. Pre- and post-renovation data on the Perceived Stress Scale and park use from 162 adults living near (< 0.3 miles) 31 renovated parks and 151 adults living near 21 sociodemographically matched control parks were analyzed. Linear mixed-effects difference-in-difference (DID) regression measured the association between park renovation and change in perceived stress (post-pre) in the overall sample and stratified by baseline sociodemographics. Additional models explored the interaction of post-renovation park use frequency [high (≥ once/week), low (< once/week)] and intervention status on changes in perceived stress. Overall, changes in perceived stress were similar between intervention and control groups [DID = 0.28 (95

To control the COVID-19 epidemic, the Japanese government and the local governments have repeatedly implemented non-pharmaceutical interventions (NPIs) throughout 2020-2022. Using Bayesian state-space mediation models, we examined the effect of repeated NPIs on infection spread mitigation, mediated by human mobility changes in each prefecture during three epidemic phases: from April 1, 2020 to February 28, 2021; from March 1, 2021 to December 16, 2021; and from December 17, 2021 to December 31, 2022. In the first phase, controlling downtown populations at nighttime was effective in mitigating the infection spread in almost all prefectures. In the second and third phases, the effect was not clear, especially in metropolitan prefectures. Controlling visitors from the central prefectures of metropolitan areas was effective in mitigating infection spread in the surrounding prefectures during all phases. These results suggest that the local spread of infection can be mitigated by focusing on nighttime human mobility control in downtown areas before the epidemic spreads widely and transmission routes become more diverse, and that the geospatial spread of infection can be prevented by controlling the flows of people from large cities to other areas.

The sources of fine particulate matter (PM2.5, particles with diameter < 2.5 µm) in four monitoring sites in the New York/New Jersey metropolitan statistical area from 2007 to 2017 were apportioned by positive matrix factorization (PMF) of chemical speciation data. Biomass burning, secondary inorganic (i.e., ammonium sulfate and nitrate) and primary traffic exhausts were the predominant PM2.5 sources. The declining trends of PM2.5 mass in all four sites were very well correlated with decreasing secondary sulfate levels due to SO2 emission reductions by coal-fired power plants. The contributions of secondary nitrate, primary traffic exhausts and diesel particles did not change (or slightly increased) over time except for the Queens site, where statistically significant declines were computed. Biomass burning contributions increased in the Queens and Chester sites but declined in the Division Str and Elizabeth Lab sites, although significant interannual variability was observed. Wintertime biomass burning aerosols were most likely due to combustion of contemporary biomass for industrial and domestic heating, and it was linked to the intensity (average minimum temperature) and duration (number of freezing days) of cold weather. The annual summertime biomass burning contributions were correlated with the number of and area burnt by lightning-ignited wildfires. These results indicate that PM2.5 sources in urban environments is changing from anthropogenic secondary sulfate and nitrate to carbonaceous aerosol from local anthropogenic and regional climate-driven biomass burning. This trend may counterbalance emissions controls on anthropogenic activities and modify the biological and toxicological responses and resultant health effects.

Hispanics in the USA, particularly those of Caribbean descent, experience high levels of diet-related diseases and dietary risk factors. Restaurants are an increasingly important yet understudied source of food and may present opportunities to positively influence urban food environments. We sought to explore food environments further, by examining the association between neighborhood characteristics and restaurant consumer nutrition environments within New York City’s Hispanic Caribbean (HC) restaurant environments. We applied an adapted version of the Nutrition Environment Measurements Survey for Restaurants (NEMS-R) to evaluate a random sample of HC restaurants (n=89). NEMS-HCR scores (continuous and categorized as low, medium, and high based on data distribution) were examined against area sociodemographic characteristics using bivariate and logistic regression analysis. HC restaurants located in Hispanic geographic enclaves had a higher proportion of fried menu items (p<0.01) but presented fewer environmental barriers to healthy eating, compared with those in areas with lower Hispanic concentrations. No significant differences in NEMS-R scores were found by other neighborhood characteristics. Size was the only significant factor predicting high NEMS-HCR scores, where small restaurants were less likely to have scores in the high category (NEMS-HCR score>6), compared with their medium (aOR: 6.6, 95% CI: 1.8–24.6) and large counterparts (aOR: 5.6, 95% CI: 1.5–21.4). This research is the first to examine the association between restaurant location and consumer nutrition environments, providing information to contribute to future interventions and policies seeking to improve urban food environments in communities disproportionately affected by diet-related conditions, as in the case of HC communities in New York City.

Objectives: To investigate factors associated with delays to obtaining contraception during the COVID-19 pandemic among pregnancy-capable adults in New York State.& nbsp;Study Design: We administered a cross-sectional survey in June-July 2020 to female/transgender male New York State residents aged 18-44 years (n = 1,525). This analysis focused on respondents who were not pregnant and sought contraception (n = 953). We conducted bivariate and multinomial logistic regression analyses to assess sociodemographic, social, and health characteristics, by the outcome of delays to obtaining birth control (delayed due to COVID-19, delayed due to other reasons, no delay). We also analyzed a sub-sample who reported COVID-19 as a reason for delays (n = 317) and report the frequencies of type of contraceptive methods/procedures delayed and availability of telemedicine visits.& nbsp;Results: Half of respondents had no contraceptive delays, 39% reported delays due to COVID-19, and 11% reported delays due to reasons other than COVID-19. In adjusted analyses, those who missed a rent/mortgage payment during the pandemic (aOR: 2.23; CI: 1.55, 3.22), participated in a supplemental government program in 2019 (aOR: 1.88; CI: 1.36, 2.60), and themselves/household member had COVID-19 (aOR: 1.48; CI: 1.04, 2.12) were more likely to report delays to contraception due to COVID-19 (versus no delays). In the sub-sample, 63% reported available virtual contraceptive visits, 28% unavailable, and 9% not sure. The most frequently (42%) reported delays were new prescriptions for the pill, patch, or ring.& nbsp;Conclusions: Reducing financial barriers that help individuals maintain their housing and living necessities, and promoting telemedicine visits, may help increase access to contraception.

Declining ambient PM2.5 concentrations have been attributed to fuel consumption standards and emission controls of secondary sulfate and nitrate aerosol precursors from transportation and industrial sectors. As a result, the relative contribution of PM2.5 sources is modified, shifting PM2.5 trends, physicochemical characteristics, and health effects. Carbonaceous fine aerosol account for most of PM2.5 mass in the US. This study aims to examine the spatiotemporal trends of ambient PM2.5 levels and their association with primary PM2.5 emissions from anthropogenic activities and fires in the New York/New Jersey metropolitan statistical area (NYNJ MSA) airshed. PM2.5 mass concentrations were obtained from the U.S. Environmental Protection Agency (USEPA) Air Data. Ambient PM2.5 mass levels declined on average by 47%, at a rate of −0.61 ± 0.01 μg/m3/year in urban locations and −0.25 ± 0.01 μg/m3/year in upwind and peri-urban locations over the 2007 to 2017 period. The strong spatial gradient in 2007, with high PM2.5 levels in urban locations and low PM2.5 levels in peri-urban locations gradually weakened by 2013 but re-appeared in 2017. Over the same period, primary PM2.5 emissions declined by 52% from transportation, 15% from industrial, and 8% from other anthropogenic sources corresponding to a decrease of 0.8, 0.9, and 0.6 μg/m3 on ambient PM2.5 mass, respectively. Wildland and prescribed fires emissions increased more than 3 times adding 0.8 μg/m3 to ambient PM2.5 mass. These results indicate that (i) fire emissions may impede the effectiveness of existing policies to improve air quality and (ii) the chemical content of PM2.5 may be changing to an evolving mixture of aromatic and oxygenated organic species with differential toxicological responses as compared to inert ammonium sulfate and nitrate salts.

This paper presents a small-area index of the multifactorial phenomenon loosely referred to as gentrification, with application to New York City (NYC). The relative change of key input variables (median family income, median rent and proportions of non-Hispanic white, 20-34-year-olds and adults with a 4-year college degree) was computed from the years 2000 to 2016 for NYC census tracts that are spatially normalized to the year 2010. Raw scores derived from principal components analysis were then spatially smoothed through a fully Bayesian conditional autoregressive model, presenting an innovation over previous methods since it essentially blurs the otherwise artificial tract boundaries and results in a simulated posterior distribution of scores for each tract. The median and upper/lower percentiles provide a point estimate and assessment of uncertainty, respectively, of gentrification for each tract. The mapped index is visually consistent with the general understanding of gentrification in NYC, and the index is positively associated with census tract-level change in home values, as measured separately from a real property database. Although we developed this index as the quantitative part of a mixed methods approach to understanding gentrification in New York City, the methodology is intended to be applicable in other cities.

Although the prevalence of elevated childhood blood lead levels (BLLs) has been declining, there are still an estimated 500,000 children (1 to 5 years) with BLLs above the CDC’s reference value (≥ 5 μg/dL). The objective of this study was to evaluate the ecological association between soil lead (Pb) concentrations in greenspaces in Brooklyn, NY and elevated BLLs of children aged 1 to 5 years old. Soil samples (n = 1504) were collected from a wide variety of parks within 43 neighborhood tabulation areas (NTAs) located in Brooklyn, NY, analyzed with a portable XRF with a subset (n = 350), and also analyzed by ICP-MS. Lead concentrations were right skewed with a mean of 160.4 ppm and a median of 113.1 ppm. The Pb concentration range spanned three orders of magnitude with most samples (66.7%) ≥ 80 ppm and 6.7% of samples ≥ 400 ppm. Elevated BLL (≥ 5ug/dL) data on children 1 to 5 years were obtained from the New York City Department of Health and Mental Hygiene (2011–2015). Weighted median soil Pb concentrations were calculated for each NTA and stratified into quartiles. The overall median rate of children from 1 to 5 years old with BLLs ≥ 5 µg/dL was 28.6 per 1000; the median rate was highest (p = 0.070) in the fourth quartile (Pb concentrations ≥ 150 ppm) compared to the first quartile (Pb concentrations < 88 ppm), 37.2 vs. 28.3 per 1000, respectively. We then used multivariable linear regression to determine the ecological association between BLL rates and soil Pb concentrations. In the final stepwise multivariable regression model, controlling for known risk factors, there was a significant positive association between soil Pb concentrations and increased childhood BLL rates (beta = 0.0008; p = 0.004). Our findings suggest that there is an ecological association between high soil Pb levels and increased rates of elevated childhood BLLs.

Given that New York State's (NYS) was the first epicenter of the COVID-19 pandemic in the United States (US), we were interested in potential racial/ethnic differences in pregnancy-related experiences among women pregnant during versus prior to the pandemic. We surveyed 1,525 women (18-44 years) proportionate to geographic and sociodemographic distribution between June 9, 20 and July 21, 20. We carried out bivariate analysis of various social and pregnancy-related factors by racial/ethnic identity (White, Black, Hispanic) and binary logistic and linear regression assessing the association between race/ethnicity, pregnancy prior to/during the pandemic, demographic characteristics, health and social wellbeing, and employment as an essential worker with pregnancy-related healthcare delays and changes. Overall, Black and Hispanic women were significantly more likely to experience a host of negative prenatal and postpartum experiences. In general, multivariate analyses revealed that individuals who were pregnant during the pandemic, lived in NYC, participated in social welfare programs, lacked health insurance, and/or were essential workers were more likely to report delays in prenatal and postpartum care and/or more changes/negative experiences. In light of previous evidence of racial disparities in birth experiences, the higher rates of negative pregnancy/birth-care and postpartum/newborn-care experiences among Black and Hispanic women in bivariate analysis warrant further inspection given that their aggregation for multivariate analysis may have obscured differences at the level of individual events. Findings support continued efforts for universal health insurance and improved social welfare programs. Guidelines are needed to protect essential workers' access to health services, particularly related to pregnancy given the time-sensitive nature of this care. Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1997893 .

We investigate the association between nativity status (U.S.- vs foreignborn) and viral suppression among women of color (WOC) with HIV (HIV +) and whether this association was modified by education and housing. Methods: Data were from 549 HIV + WOC, who participated in the Health Resources and Services Administration-funded WOC Initiative 2009–2013. We used generalized estimating equation models to quantify the association between the respondents’ nativity status and viral suppression. Results: After adjusting for covariates, foreign-born WOC were 2.2 times (95% confidence interval: 1.25, 3.85) more likely to achieve viral suppression than U.S.-born WOC. This association was not modified by education or housing status. Conclusions: Despite facing barriers to care, foreign-born WOC were more likely to achieve viral suppression than U.S.-born WOC. Programs aiming to end the HIV epidemic and reduce HIV disparities in the U.S. should consider these findings as they provide a more nuanced understanding of HIV + WOC.

Question What is the county-level prevalence of extreme obesity in the United States? Findings In this cross-sectional study of adults in the United States, county-level prevalence of self-reported extreme obesity ranged from 1.3% to 15.7%. Several prominent clusters of high prevalence were identified, including in the Mississippi Delta and the Southeast. Meaning Prevalence of extreme obesity appears to vary considerably by county; heterogeneity is obscured by available state-level prevalence estimates. This cross-sectional study estimates county-level rates of extreme obesity identifies clusters of high and low prevalence within the US. Importance The prevalence of extreme obesity continues to increase among adults in the US, yet there is an absence of subnational estimates and geographic description of extreme obesity. This shortcoming prevents a thorough understanding of the geographic distribution of extreme obesity, which in turn limits the ability of public health agencies and policy makers to target areas with a known higher prevalence. Objectives To use small-area estimation to create county-level estimates of extreme obesity in the US and apply spatial methods to identify clusters of high and low prevalence. Design, Setting, and Participants A cross-sectional analysis was conducted using multilevel regression and poststratification with data from the 2012 Behavioral Risk Factor Surveillance System and the US Census Bureau to create prevalence estimates of county-level extreme obesity (body mass index >= 40 [calculated as weight in kilograms divided by height in meters squared]). Data were included on adults (aged >= 18 years) living in the contiguous US. Analysis was performed from June 4 to December 28, 2018. Main Outcomes and Measures Multilevel logistic regression models estimated the probability of extreme obesity based on individual-level and area-level characteristics. Census counts were multiplied by these probabilities and summed by county to create county-level prevalence estimates. Moran index values were calculated to assess spatial autocorrelation and identify spatial clusters of hot and cold spots. Estimates of moderate obesity were obtained for comparison. Results Overall, the weighted prevalence of extreme obesity was 4.0% (95% CI, 3.9%-4.1%) and the prevalence of moderate obesity was 23.7% (95% CI, 23.4%-23.9%). County-level prevalence of extreme obesity ranged from 1.3% (95% CI, 1.3%-1.3%) to 15.7% (95% CI, 15.3%-16.0%). The Pearson correlation coefficient comparing model-predicted estimates with direct estimates was 0.81 (P < .001). The Moran index I score was 0.35 (P < .001), indicating spatial clustering. Significant clusters of high and low prevalence were identified. Hot spots indicating clustering of high prevalence of extreme obesity in several regions, including the Mississippi Delta region and the Southeast, were identified, as well as clusters of low prevalence in the Rocky Mountain region and the Northeast. Conclusions and Relevance Substantial geographic variation was identified in the prevalence of extreme obesity; there was considerable county-level variation even in states generally known as having high or low prevalence of obesity. The results suggest that extreme obesity prevalence demonstrates spatial dependence and clustering and may support the need for substate analysis and benefit of disaggregation of obesity by group. Findings from this study can inform local and national policies seeking to identify populations most at risk from very high body mass index.

Diarrhea is a major contributor to child morbidity and mortality in West Africa. Non-spatial regression and geographically weighted Poisson regression applied to data from 10 Demographic and Health Surveys conducted in West Africa from 2008 to 2013 show that water source, toilet type, mother's education, latitude, temperature, rainfall, altitude, and population density influence the risk of diarrhea. The risk associated with these factors is dependent on location and may be higher or lower than the rest of the study area. Areas with increased relative risk for diarrhea include several urban centers, low-elevation areas (coastal and along rivers), remote areas such as western Mali, and conflict zones (northeast Nigeria).

Lead is pervasive, although lead exposure has fallen in response to public health efforts. Observationally, lead is positively associated with cardiovascular disease and hypertension. We used separate-sample instrumental variable analysis with genetic instruments (Mendelian randomization) based on 13 single nucleotide polymorphisms (SNP), from a genome wide association study, strongly (p-value < 5 × 10 −6 ) and independently associated with blood lead. These SNPs were applied to a large extensively genotyped coronary artery disease (CAD) study (cases = <76014, controls = <264785) largely based on CARDIoGRAPMplusC4D 1000 Genomes and the UK Biobank SOFT CAD, to the UK Biobank (n = 361,194) for blood pressure and to the DIAGRAM 1000 genomes diabetes case (n = 26,676)-control (n = 132,532) study. SNP-specific Wald estimates were combined using inverse variance weighting, MR-Egger and MR-PRESSO. Genetically instrumented blood lead was not associated with CAD (odds ratio (OR) 1.01 per effect size of log transformed blood lead, 95% confidence interval (CI) 0.97, 1.05), blood pressure (systolic −0.18 mmHg, 95% CI −0.44 to 0.08 and diastolic −0.03 mmHg, 95% CI −0.09 to 0.15) or diabetes (OR 0.98, 95% CI 0.92 to 1.03) using MR-PRESSO estimates corrected for an outlier SNP (rs550057) from the highly pleiotropic gene ABO . Exogenous lead may have different effects from endogenous lead; nevertheless, this study raises questions about the role of blood lead in CAD.