Journal of urban health : bulletin of the New York Academy of Medicine
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In 2019, there were nearly 50,000 opioid-related deaths in the US, with substantial variation across sociodemographic groups and geography. To systematically investigate patterns of racial/ethnic inequities in opioid-related mortality, we used joinpoint regression models to estimate the trajectory of the opioid epidemic among non-Hispanic Black versus non-Hispanic white residents in Washington DC, 45 states, and 81 sub-state areas. We highlight the unique inequities observed in Washington DC. In 2019, the observed opioid-related mortality rate among Black DC residents was 11.3 times higher than white DC residents, resulting in 56.0 more deaths per 100,000 (61.5 vs. 5.5 per 100,000). This inequity was substantially higher than any other jurisdiction on both the relative and absolute scales. Most opioid-related deaths in DC involved synthetic opioids, which was present in 92% (N=198) of deaths among Black DC residents and 69% (N=11) of deaths among white DC residents. Localized, equitable, culturally-appropriate, targeted interventions are necessary to reduce the uniquely disproportionate burden of opioid-related mortality among Black DC residents. ⋯ The online version contains supplementary material available at 10.1007/s11524-021-00573-8.
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Randomized Controlled Trial
Recruitment, Retention, and Intervention Outcomes from the Dedicated African American Dad (DAAD) Study.
A significant proportion of African American (AA) fathers live in households apart from their young children. This living arrangement can have detrimental effects for children, families, and fathers. One hundred seventy-eight (n = 178) AA fathers, not residing with their 2-6-year-old children, were enrolled in a randomized trial to test the Building Bridges to Fatherhood (BBTF) program against a financial literacy comparison condition. ⋯ Program satisfaction was high in both conditions. Even so recruitment and retention challenges influenced the ability to detect father and child outcomes. This study informs the participation of vulnerable urban AA fathers in community-based fatherhood intervention research and provides insight into bolstering engagement in studies focused on this population.
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The USA leads the world in healthcare spending but trails dozens of countries in life expectancy. Government spending may reduce overall mortality by redistributing resources from the rich to the poor. We linked mortality data from 2006 to 2015 to municipal and state government spending in 149 of the largest American cities. ⋯ However, among Whites, increases in city government spending were associated with a reduction in mortality of 4.8% (2.1-7.5%), but among Blacks and Asians, increased city government spending was associated with respective mortality increases of 1.7% (0.6-2.9%) and 5.1% (2.1-6.2%). State government spending is associated with reduced mortality in American cities. City government spending appears to benefit White longevity and hurt non-White longevity.
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The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. ⋯ We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.
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"Hey, We Can Do This Together": Findings from an Evaluation of a Multi-sectoral Community Coalition.
Multi-sectoral coalitions focused on systemic health inequities are commonly promoted as important mechanisms to facilitate changes with lasting impacts on population health. However, the development and implementation of such initiatives present significant challenges, and evaluation results are commonly inconclusive. ⋯ Direct impacts on community members were more difficult to assess: perceived access to health and other services improved, while community violence and poor sanitation, which were also priorities for community members, remained important challenges. Findings suggest significant progress, as well as continued need.