Journal of urban health : bulletin of the New York Academy of Medicine
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Gun-related crime continues to be an urgent public health and safety problem in cities across the US. A key question is: how are firearms diverted from the legal retail market into the hands of gun offenders? With close to 8 million legal firearm transaction records in California (2010-2020) linked to over 380,000 records of recovered crime guns (2010-2021), we employ supervised machine learning to predict which firearms are used in crimes shortly after purchase. Specifically, using random forest (RF) with stratified under-sampling, we predict any crime gun recovery within a year (0.2% of transactions) and violent crime gun recovery within a year (0.03% of transactions). ⋯ Among transactions identified as extremely risky, e.g., transactions with a score of 0.98 and above, 74% (35/47 in the test data) are recovered within a year. The most important predictive features include purchaser age and caliber size. This study suggests the potential utility of transaction records combined with machine learning to identify firearms at the highest risk for diversion and criminal use soon after purchase.
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Direct and indirect gun violence exposure (GVE) is associated with a broad range of detrimental health effects. However, much of this research has examined the effects of a single type of GVE (e.g., being shot) on discrete outcomes (e.g., daily pain, PTSD). Since people may experience numerous types of GVE (e.g., being threatened with a gun and hearing gunshots in their neighborhood) with broad effects on their well-being, we study the association between four types of direct and indirect GVE and five aspects of quality of life (overall, physical, psychological, social, and environmental). ⋯ Cumulative GVE was also associated with significant decreases in overall physical, psychological, social, and environmental quality of life. For example, individuals with four GVEs had an adjusted average physical quality of life that was 11.14 points lower and environmental quality of life that was 7.18 points lower than individuals with no GVE. Decreasing gun violence is a critical component of improving community health and well-being.
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This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. ⋯ A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower.
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According to the uncertain geographic context problem, a lack of temporal information can hinder measures of bias in mortgage lending. This study extends previous methods to: (1) measure the persistence of racial bias in mortgage lending for Black Americans by adding temporal trends and credit scores, and (2) evaluate the continuity of bias in discriminatory areas from 1990 to 2020. These additions create an indicator of persistent structural housing discrimination. ⋯ Historically redlined areas displayed the strongest persistence of bias. Results suggest that temporal data can identify persistence and improve sensitivity in measuring neighborhood bias. Understanding the temporality of residential exposure can increase research rigor and inform policy to reduce the health effects of racial bias.
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The USA has some of the highest utilization rates of the Emergency Department (ED) worldwide, leading to increased healthcare costs, constrained resources, and fragmented care. Many of the highest ED utilizers are persons experiencing homelessness (PEH) and those with mental health conditions, with even higher use by those with comorbid social challenges. This study reviewed the literature assessing interventional approaches in the ED to minimize the burden of ED utilization by PEH with associated mental health conditions. ⋯ Comparison of these studies reveals that the success of related strategies like housing support often have different outcomes which can be attributed to the differences between the populations studied, previously available community resources, and other psychosocial factors affecting study participants. Overall, the most successful studies found that a tailored approach that addresses the unique needs of participants had the greatest impact on reducing ED visits and hospitalizations. Further research is needed to determine the best strategies for specific populations and how to promote health equity among PEH with associated mental health conditions.