Journal of urban health : bulletin of the New York Academy of Medicine
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The purpose of this study was to use participatory systems thinking to develop a dynamic conceptual framework of racial/ethnic and other intersecting disparities (e.g., income) in food access and diet in Philadelphia and to identify policy levers to address these disparities. We conducted three group model building workshops, each consisting of a series of scripted activities. Key artifacts or outputs included qualitative system maps, or causal loop diagrams, identifying the variables, relationships, and feedback loops that drive diet disparities in Philadelphia, Pennsylvania. ⋯ Consistent with existing frameworks, addressing disparities will require a focus on upstream social determinants. However, existing frameworks should be adapted to emphasize and disrupt the interdependent, reinforcing feedback loops that maintain and exacerbate disparities in fundamental social causes. Our findings suggest that promising policies include those that empower minoritized communities, address socioeconomic inequities, improve community land control, and increase access to affordable, healthy, and culturally meaningful foods.
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This study aims to investigate the persistence of sedentary behaviors from early childhood to adolescence and the longitudinal association between neighborhood social and physical environments and childhood sedentary behaviors. Using the Future of Families & Child Wellbeing Study (N = 2716), we conducted a cross-lagged path analysis to examine the longitudinal association between neighborhood social and physical environments (neighborhood socioeconomic status, observed physical disorder, and crime rates) and sedentary behaviors at subsequent measurement points, after controlling for demographic factors and family socioeconomic status. We observed the continuity of sedentary behaviors in early childhood, extending throughout adolescence. ⋯ We also observed a partial mediation effect of neighborhood physical disorder and crime rates in the association between neighborhood socioeconomic status and sedentary behaviors in adolescence. Our results demonstrated the importance of early childhood in shaping healthy behaviors and highlighted the contribution of unfavorable environments to sedentary behaviors. These findings call for the need to support disadvantaged neighborhoods, particularly by addressing safety concerns and physical disorder, for promoting physical activity and reducing sedentary behaviors among adolescents.
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Housing is a critical social determinant of children's health. While individual pathways between housing and health are well evidenced, there has been less attention on the co-occurrence of housing disadvantages. We aim to identify typologies of children's housing disadvantage and describe the health inequities they generate. ⋯ Unsuitable housing, characterized by crowding, poor external conditions, and noise exposure, was more likely to be occupied by single-parent families, low-income households, and be headed by parents with low levels of education. Children in unsuitable housing lagged on quality of life indicators at preschool age (e.g., by 8.0 points on emotional functioning, 95% CI - 10.6, - 5.5), and underutilized primary healthcare services (e.g., prevalence ratio 0.76 for GP services, 95% CI 0.67, 0.87), compared to children in good quality housing. This finding supports the case for early intervention strategies that account for children's housing circumstances.
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While mobility in older age is of crucial importance for health and well-being, it is worth noting that currently, there is no German language framework for measuring walkability for older adults that also considers the functional status of a person. Therefore, we combined the results of an expert workshop, a literature review, and a Delphi consensus survey. Through this, we identified and rated indicators relevant for walkability for older adults, additionally focusing on their functional status. ⋯ The Delphi process resulted in a list of 72 indicators deemed relevant for walkability in older age groups, grouped into three main categories: "Built environment and transport infrastructure," "Accessibility and meeting places," and "Attractiveness and sense of security." For 35 of those indicators, it was suggested that functional status should be additionally considered. This framework represents a significant step forward in comprehensively covering indicators for subjective and objective walkability in older age, while also incorporating aspects of functioning relevant to older adults. It would be beneficial to test and apply the indicator set in a community setting.
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Exposure to high environmental temperature is detrimental to health through multiple pathways. This paper describes disparities in school-based high-temperature exposure at metropolitan schools in the United States. ⋯ When the Black or Hispanic student population is greater than the neighborhood population, LST is an additional 0.20 °C and 0.40 °C for each 10% increase in students over neighborhood population, respectively. Black and Hispanic students are overrepresented in the hottest schools, making up 58.7% of students in the hottest 20% of schools, compared to only 30.0% of students in the coolest 20% of schools.