Journal of urban health : bulletin of the New York Academy of Medicine
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Although numerous studies have documented excess mortality and health inequality among individuals with serious mental illness (SMI), none has been done among individuals in a large, diverse urban setting, such as New York City (NYC). We used referral data for adults aged 18 and older referred to the NYC Department of Health and Mental Hygiene public mental health services between January 2004 and December 2018 and matched it to the NYC death registry. Age at death, leading causes of death, years of potential life lost (YPLL), and standardized mortality ratios (SMRs) were calculated for this population. ⋯ Cause-specific SMRs show an increased risk of death among SMI from diabetes (SMR 2.8 [95% CI 2.4-3.10]), heart disease (SMR 2.7 [95% CI 2.6-2.9]), psychoactive substance use and accidental overdose (SMR 4.5 [95% CI 4.1-4.9]), and suicide (SMR 6.7 [95% CI 6.0-7.4]). Our results highlight the need to implement effective, preventive, and rehabilitative measures that integrate physical and behavioral healthcare services and address upstream drivers of health to achieve health equity and eliminate health disparities. In order to achieve gains in life expectancy, specific considerations for reducing excess mortality in the SMI population must be accounted for.
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Understanding when and where heat adversely influences health outcomes is critical for targeting interventions and adaptations. However, few studies have analyzed the role of indoor heat exposures on acute health outcomes. To address this research gap, the study partnered with the New York City Fire Department Emergency Medical Services. ⋯ There was some evidence that indoor temperatures further increased the odds of cardiovascular distress (OR, 1.44; 95% CI, 0.97-2.13). Sensitivity testing suggested indoor temperatures at a lower threshold (≥ 26 °C) were unrelated to either health outcome. Along with converging lines of evidence linking extreme heat to adverse cardiovascular outcomes, we present one of the first indoor heat observational studies.
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Depression and post-traumatic stress disorder (PTSD) are serious consequences of physical injuries. Stress associated with living in urban neighborhoods with socioecological disadvantages and the cumulative burdens of adverse childhood experiences (ACEs) can lead to poorer psychological outcomes. Limited research has explored how ACEs and socioecological environmental exposures in childhood and adulthood, together, impact post-injury outcomes. ⋯ Census/administrative objective measures of neighborhood disadvantage did not show consistent associations with post-injury outcomes. Findings suggest that both ACEs and subjective perception of neighborhood environments are critical factors influencing post-injury recovery in urban Black men. Interventions to improve post-injury outcomes should consider preventing ACEs and addressing the tangible conditions of neighborhoods and residents' perceptions of their surroundings to promote health equity and injury recovery.
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Environmental context is an important predictor of health behavior. Understanding its effect on cannabis use among pregnant women is yet to be understood. The aim of the study is to assess the impact of perceived neighborhood environment on prenatal cannabis use and explore the mediating role of stress. ⋯ Compared to the highest quartile, the odds ratio (OR) for the lowest quartiles for social cohesion and trust, social disorder, and danger and safety were 1.77 (95% confidence interval (CI): 1.04-3.03), 1.83 (95% CI: 1.15-2.91), and 1.93 (95% CI: 1.12-3.31) respectively. Evidence of mediation by perceived stress was only present between the association of perceived levels of safety and danger with cannabis use during pregnancy. Future prospective studies are warranted to understand the causal associations between individual correlates and social and physical environmental factors of prenatal cannabis use.