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Abstract Background Routine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. Methods We reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership. Results We included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was

Abstract Background Lung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person’s location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients’ and informal carers’ participation in and experience of the lung cancer care pathway. Methods A qualitative cross-sectional interview study with people diagnosed with lung cancer

Abstract Background Increasing dietary diversity is a sustainable solution to combat micronutrient deficiencies. Given the large slum population in urban India, double burden of malnutrition, nutritional transition among slum-dwellers, and limited studies focusing on dietary intake and diversity among pregnant slum-dwellers, this study aimed to 1) describe macro- and micronutrient intakes and compare them with guidelines, 2) describe dietary diversity and intake of unhealthy foods and, 3) investigate the sociodemographic and lifestyle determinants of adequate dietary diversity among pregnant slum-dwellers in Pune, Maharashtra, India. Methods This study presents cross-sectional data of 454 pregnant slum-dwelling women completing mid-pregnancy visit collected from a larger cohort study. Sociodemographic and lifestyle data were collected at baseline (

Infectious diseases depend on intensified social intercourse within large cities, resulting in a super-linear allometric scaling law with city size. But how this scaling relationship changes throughout an evolving pandemic is seldom studied and remains unclear. Here, we investigate allometric scaling laws between cases/deaths and city size and their temporal evolution using daily COVID-19 cases/deaths of cities in the United Kingdom from March 2020 to May 2022. Results indicate that cases exhibit a super-linear scaling pattern with city size, revealing higher morbidity in large cities. Temporally, scaling exponents stabilized at around 1.25 after a rapid increase from less than one and then decreased to one. Scaling exponents of COVID-19 deaths exhibited a comparable trend to cases but with a lag in time and a weaker super-linear relationship. Scaling exponents increased first, then stabilized, and then decreased during each wave. Temporal variations of scaling exponents reveal the spatial diffusion of infectious diseases from large to small cities, whose mechanism needs further exploration.

Abstract Background Accommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual’s perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question ‘how do individuals with non-communicable chronic conditions perceive their health as healthy or ill’?. Methods This study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling. Results The participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care. Conclusions Due to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual’s health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach.

Background: Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. Objective: The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. Methods: This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. Results: Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. Conclusions: Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

Background: Age, gender and household infrastructure are important social determinants affecting health inequalities. This study aims to assess the ways that age and gender of the household head and household infrastructure intersect to create relative advantage and disadvantage in COVID-19 vulnerability. Methods: Using household primary care survey data from Mamelodi, Gauteng, headed households were sorted into three risk categories for each of the relevant infrastructural determinants of COVID-19. Bivariate ordinal logistic regression was used to determine the odds of households falling into each risk category. The proportion of high-risk (HR) categories and dwelling types was also calculated. Results: Households headed by someone ≥ 65 years were less likely to be in all HR categories and more frequently had formal houses. Male-head households were more likely to be HR for water, sanitation and hygiene infrastructure and indoor pollution; however, female-headed households (FHHs) were at higher risk for crowding. In Mamelodi, households headed by ≥ 65 years olds were relatively infrastructurally protected, likely because of pro-equity housing policy, as were FHHs, except for crowding. The care load on FHHs results in their infrastructural protection benefiting more community members, while simultaneously incurring risk. Conclusion: Infrastructural support based on the household head’s age and gender could improve targeting and the effectiveness of health interventions. These results demonstrate the importance of a contextual understanding of gender and age inequalities and tailoring public health support based on this understanding. Contribution: This research describes patterns of health-related infrastructural inequality, identifies ways to improve health interventions, and demonstrates the importance of equity-focused policy in an African context.

Abstract Malaria ranks high among prevalent and ravaging infectious diseases in sub-Saharan Africa (SSA). The negative impacts, disease burden, and risk are higher among children and pregnant women as part of the most vulnerable groups to malaria in Nigeria. However, the burden of malaria is not even in space and time. This study explores the spatial variability of malaria prevalence among children under five years (U5) in medium-sized rapidly growing city of Akure, Nigeria using model-based geostatistical modeling (MBG) technique to predict U5 malaria burden at a 100 × 100 m grid, while the parameter estimation was done using Monte Carlo maximum likelihood method. The non-spatial logistic regression model shows that U5 malaria prevalence is significantly influenced by the usage of insecticide-treated nets—ITNs, window protection, and water source. Furthermore, the MBG model shows predicted U5 malaria prevalence in Akure is greater than 35% at certain locations while we were able to ascertain places with U5 prevalence > 10% (i.e. hotspots) using exceedance probability modelling which is a vital tool for policy development. The map provides place-based evidence on the spatial variation of U5 malaria in Akure, and direction on where intensified interventions are crucial for the reduction of U5 malaria burden and improvement of urban health in Akure, Nigeria.

Background: Inadequate water, sanitation and hygiene (WASH) may lead to an increase in water-borne diseases like diarrhoea. The objective of the study was to assess water, sanitation and hygiene in the urban slums of Patpur, Bankura and to determine the implications of WASH on the occurrence of diarrhoea among under-five (U-5) children. Materials and Methods: A cross-sectional observational study was conducted during January–March 2020 by interviewing persons involved in water collection from each of the 182 slum households of Patpur, by two-stage sampling using a pre-designed structured schedule and the core questions on drinking WASH for household surveys: 2018 update by UNICEF and WHO. For testing the association between categorical variables, a Chi-square test was done. Binary logistic regression and the Hosmer Lemeshow test were done to know the predictors of diarrhoea in U-5 children. A P value of < 0.05 was considered statistically significant. Results: The proportion of diarrhoea among U-5 children was 0.34. Limited drinking WASH services were found in 3.30, 45.05 and 24.18% of households, respectively. Mobile objects users for handwashing were 14.05 times more prone to diarrhoea in U-5 children than those who had fixed handwashing facilities at their dwellings, yards or plots. Feeding children without handwashing had 5.70 times increased chances of diarrhoea among U-5 children than those who washed their hands before feeding. Conclusion: Handwashing facilities (fixed, mobile object or no facility) and handwashing with soap and water before feeding the child significantly affected the occurrence of diarrhoea among U-5 children.

Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world’s fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989–2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet. Paper Context Main findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental. Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings. Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.

ABSTRACTGlobal challenges around biodiversity loss, climate change, and public health are heightening the importance of urban green spaces for supporting ecosystem services and human wellbeing. Trees, parks and forests integrated across cityscapes are proposed strategies to combat climate change and promote human health for current and future cities. This is true for small urban green spaces, perhaps just < 1 ha in size. Depending on their structure and size, these spaces can provide structural vegetation complexity, promote species diversity, regulate temperatures and offer human thermal comfort. These spaces also provide recreation opportunity, nature experience, sense of belonging, and restoration to people. As cities densify, it is crucial to understand where these dimensions intersect in theory and practice to design and manage small green spaces in particular, as these systems may be easier than large green spaces to implement in urban planning. In this paper, we narratively review known biophysical and ecological properties of green spaces that support biodiversity, promote temperature regulation and climate resilience, and may ultimately benefit residents’ health through different use activities and multisensory experiences that promote restoration and wellbeing. Furthermore, we review how stakeholder engagement and participatory processes can guide equitable green space provision and design, and we use case studies and our own research as examples. In doing so, this paper aims to further the understanding of the social-ecological importance of small urban green spaces and calls for inter- and transdisciplinary research that generates insight to design, manage and protect these places in a changing climate.

Black sexually minoritized men (BSMM) are the most likely to acquire HIV in Chicago- a racially segregated city where their daily travel may confer different HIV-related risks. From survey and GPS data among participants of the Neighbourhoods and Networks Cohort Study, we examined spatial (proportion of total activity space away from home), temporal (proportion of total GPS points away from home), and motivation-specific (discordance between residential and frequented sex or socializing neighbourhoods) dimensions of mobility. To identify potential drivers of BSMM’s risk, we then examined associations between mobility and sexual behaviours known to cause HIV transmission: condomless anal sex, condomless anal sex with a casual partner, transactional sex, group sex, and sex-drug use. Multivariable logistic regression models assessed associations. Of 269 cisgender BSMM, most were 20-29 years old, identified as gay, and lowincome. On average, 96.9% (Standard Deviation: 3.7%) of participants’ activity space and 53.9% (Standard Deviation: 38.1%) of participants’ GPS points occurred outside their 800m home network buffer. After covariate adjustment, those who reported sex away from home were twice as likely to report condomless sex (Odds Ratio: 2.02, [95% Confidence Interval (CI): 1.08, 3.78]). Those who reported socializing away from home were four times more likely to have condomless sex with a casual partner (Odds Ratio: 4.16 [CI: 0.99, 29.0]). BSMM are on the move in Chicago, but only motivation-specific mobility may increase HIV transmission risk. Multidimensional investigations of mobility can inform place-based strategies for HIV service delivery.

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident’s perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents’ experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p

Abstract Food security strategies are essential for cities to respond to stresses and shocks while promoting urban health and quality of life. In Brazil, twenty-seven million city dwellers face severe food insecurity. Urban planning, local climate action and food security promotion are within Brazilian cities’ legal scope of action, providing opportunities to strengthen urban resilience. In this context, the proposed investigation aimed to verify if and how Brazilian cities coordinate these public policies to promote urban resilience and what accomplishments stem from this coordination. The investigation developed as a multiple case study covering ten Brazilian cities. It comprised the qualitative analysis of public policy documents using NVivo for data treatment, quantification, and categorisation. The results showed a wide variety in the breadth and depth of policy measures, indicating diverse maturity levels and implementation and pointing out opportunities for future investigation and policy improvements.

Middle-aged and older adults living in rural settings have been consistently less likely to report regular physical activity (PA) than those living in urban settings. While past literature has identified sociodemographic and environmental correlates of PA that may contribute to these differences, consideration of psychological correlates has been limited. A total of 95 rural and urban adults ≥50 years old provided self-reported sociodemographic information, PA level, and psychological correlates of PA including measures assessing motivation, self-efficacy, social support, and attitudes related to PA. The average participant age was 68.6 years, and most were female (62.1%) and married (70.5%). While PA level did not differ significantly between the rural and urban groups, different psychological correlates contributed significantly to separate rural and urban linear regression models considering PA status. Among rural adults, more positive attitudes toward PA, and greater PA self-efficacy and social support were associated with greater amounts of PA while for urban adults, no psychological correlates were significantly associated with PA. Psychosocial factors may be key considerations in developing more effective PA interventions in middle-aged and older adults living in rural areas.

Objective: Using different perspectives and methods to investigate the links between the urban phenomenon and health is critical in an urbanizing world. This review discusses qualitative methods in the context of urban health research.Methods: We conducted a narrative review following these steps: We identified the qualitative data collection, analysis and sampling methods that could be more relevant for the problems researched in the urban health field. We conducted searches for methodological articles and other documents about those methods. We included some influential materials and examples of empirical urban health studies using those methods.Results: We included 88 studies and identified several qualitative data gathering, analysis and sampling methods relevant for urban health researchers. We present those methods, focusing their strengths and limitations, and providing examples of their use in the field of urban health. These methods are flexible and allow in-depth analysis of small samples by collecting and analyzing rich and nuanced data.Conclusion: This article should contribute to a better understanding of how, and when, qualitative methods may improve our knowledge on urban health.

Assessing healthy cities is a crucial strategy for realizing the concept of “health in all policies”. However, most current quantitative assessment methods for healthy cities are predominantly city-level and often overlook intra-urban evaluations. Building on the concept of geographic spatial case-based reasoning (CBR), we present an innovative healthy city spatial case-based reasoning (HCSCBR) model. This model comprehensively integrates spatial relationships and attribute characteristics that impact urban health. We conducted experiments using a detailed multi-source dataset of health environment determinants for middle-layer super output areas (MSOAs) in Birmingham, England. The results demonstrate that our method surpasses traditional data mining techniques in classification performance, offering greater accuracy and efficiency than conventional CBR models. The flexibility of this method permits its application not only in intra-city health evaluations but also in extending to inter-city assessments. Our research concludes that the HCSCBR model significantly improves the precision and reliability of healthy city assessments by incorporating spatial relationships. Additionally, the model’s adaptability and efficiency render it a valuable tool for urban planners and public health researchers. Future research will focus on integrating the temporal dimension to further enhance and refine the healthy city evaluation model, thereby increasing its dynamism and predictive accuracy.

Low-grade inflammation (LGI) mainly acted as the mediator of the association of obesity and inflammatory diet with numerous chronic diseases, including neuropsychiatric diseases. However, the evidence about the effect of LGI on brain structure is limited but important, especially in the context of accelerating aging. This study was then designed to close the gap, and we leveraged a total of 37,699 participants from the UK Biobank and utilized inflammation score (INFLA-score) to measure LGI. We built the longitudinal relationships of INFLA-score with brain imaging phenotypes using multiple linear regression models. We further analyzed the interactive effects of specific covariates. The results showed high level inflammation reduced the volumes of the subcortex and cortex, especially the globus pallidus (β [95% confidence interval] = −0.062 [−0.083, −0.041]), thalamus (−0.053 [−0.073, −0.033]), insula (−0.052 [−0.072, −0.032]), superior temporal gyrus (−0.049 [−0.069, −0.028]), lateral orbitofrontal cortex (−0.047 [−0.068, −0.027]), and others. Most significant effects were observed among urban residents. Furthermore, males and individuals with physical frailty were susceptive to the associations. The study provided potential insights into pathological changes during disease progression and might aid in the development of preventive and control targets in an age-friendly city to promote great health and well-being for sustainable development goals.

Global environmental and health issues such as climate change and the COVID-19 pandemic have highlighted the weaknesses of current urban systems, including the poor availability and accessibility of green and public spaces in cities. Nature-based Solutions are configured as promising solutions to increase the resilience and health of the built environment by addressing climate and pandemic issues, promoting the psycho-physical well-being of users and proposing solutions for the protection of the environment and ecosystems. Following a systematic review of the scientific literature using the PRISMA methodology, this study aims to provide a taxonomic framework for Nature-based Solutions for the built environment that is applicable to the urban and building scales, highlighting key benefits in addressing pandemic and climate challenges and achieving urban resilience. This framework proposes a holistic and multifunctional approach that will prove to be a useful tool for researchers and policy makers to incorporate greening strategies into urban regeneration and redevelopment processes. The application of Nature-based Solutions still seems to be limited. It is therefore necessary to raise awareness of this issue among citizens and policy makers and to promote close co-operation between the different actors in territorial decision-making processes.

BackgroundDespite numerous government initiatives, concerns and disparities among older adults have continually been growing. Empirical studies focused on older adults in the Philippines and Vietnam appear minimal and mostly regarding perceptions of aging. An effective geriatric care strongly relies on functional service providers requiring their perspectives to be explored toward inclusive service delivery.ObjectiveTo investigate the perceived gaps and opportunities in geriatric care service delivery among health and social care workers in selected urban areas in the Philippines and Vietnam.MethodsA qualitative case study approach drawn on social constructivism theory, examined working experiences, observed characteristics of older adults, geriatric services and needs, difficulties on service delivery, and recommended solutions. A total of 12 semi-structured interviews and 29 focus group discussions were conducted in the Philippines, with 174 health and social care workers, while in Vietnam, there were 23 semi-structured interviews and 29 focus group discussions with 124 participants. An inductive thematic analysis was employed.ResultsInterview participants highlighted the increasing unmet needs such as accessibility, availability, and acceptability of geriatric care services. The implementation of interventions on the older population faced multiple challenges, including issues related to older adult conundrums and dilemmas in geriatric care providers and facilities. The participants from the two countries felt that strengthening implementation of collaboration toward an integrated geriatric care structure and expansion of training and capability in handling older adults can be potential in addressing the gaps at both individual and institutional levels. Additionally, a committed leadership was viewed to be the important step to effectively operationalize the strategy.ConclusionHealth and social workers emphasized that the needs of older adults are exacerbated by various challenges within a fragmented geriatric care system. To address this issue, an establishment of an integrated service delivery mechanism with dedicated leadership is needed. The findings from this study may help develop appropriate solutions for addressing the health and social care needs of older adults in similar settings across Southeast Asia. Further examination of the impact of these challenges and solutions on service delivery and the wellbeing of older adults is essential.

Introduction: Rural adults are less likely to receive cancer screening than urban adults, likely due to systematic differences in community- and individual-level factors. The purpose of this study was to analyze the relative contributions of rurality, travel time, medical mistrust, and cancer fatalism in explaining uptake of clinical cancer prevention services. Methods: We conducted a secondary data analysis of 2019–2020 survey data from women, ages 45–65, in rural and urban counties in central Pennsylvania, examining rurality, travel time to a primary care provider, medical mistrust, and cancer fatalism, as well as uptake of guideline-recommended colorectal cancer screening, cervical cancer screening, and preventive check-up. Final models used multivariable logistic regression to assess the relationships among study variables, controlling for participant demographics. Results: Among 474 participants, 48.9 % resided in rural counties. Most participants had received clinical cancer prevention services (colorectal cancer screening: 55.4 %; cervical cancer screening: 82.8 %; preventive check-up in the last year: 75.4 %). Uptake of services was less common among participants with higher medical mistrust (colorectal cancer screening: adjusted odds ratio [aOR] = 0.87, 95 % confidence interval [CI] = 0.76–1.00; cervical cancer screening: aOR = 0.79, 95 % CI = 0.63–1.00; last-year check-up: aOR = 0.74, 95 % CI = 0.63–0.88). Conclusions: Patient attitudes, particularly medical mistrust, may contribute to rural/urban disparities in clinical cancer prevention among women. Community- and individual-level interventions are needed to improve cancer outcomes in rural areas.

IntroductionThis paper was based on data from the core course in environmental health (EH) for master’s in public health students at Rutgers School of Public Health (SPH), Rutgers Biomedical and Health Sciences at Rutgers, and The State University of New Jersey (NJ).MethodsThe multi-part poll or survey of students was in the first module (2 weeks) of the course’s eight module organization on Rutgers Canvas Learning Management System. We collected data every time the first author led this course section during the three academic semesters of each calendar year 2015-2023 (excluding winter 2022-summer 2023 due to grants buyout during COVID-19 pandemic).ResultsData suggested interesting trends and changes in geographic levels of interest over time for EH. When examining interests separately for urban EH and rural EH, the trend was toward approximately equal interests in local, county and state levels (lower than national level—U.S. or student’s home country/nation—but higher than global level). This is where many EH job opportunities are located. Overall, 95% of students reported they believed climate change is real, and 95% of students agreed (“yes”) human activities including combustion sources of pollution contribute to climate change. No one stated “no;” the rest were not sure at the time.DiscussionThese insights from new public health students across majors/concentrations in NJ could inform other accredited SPH across the U.S. and in other nations to help plan future versions of core courses in EH or SPH-wide integrated core courses in compliance with required competencies for accreditation.

We live in an urban planet. As the world continues to urbanize, urban development that support the health and wellbeing of city dwellers is far more important than ever before to achieve sustainable development targets. This study explores the complex relationship among urban planning, city growth, and health as critical drivers of sustainable development in the rapidly growing nodal city of Akure, Nigeria. The study provides a four-decade spatio-temporal model of urban Land Use Land Cover (LULC) changes in Akure between the years 1984 and 2023 from acquired Landsat satellite imageries. The result shows more than 20% net change increase in developed LULC classes between the study years. A strong positive correlation exists between the years covered in the analyses and urban development (r = 0.93, p = 0.002), and a strong negative relationship with the forest land use (r = −0.94, p = 0.002) with potential debilitating impacts on residents’ health, green infrastructures and the city’s sustainability in the future. Furthermore, results of key informant interviews (KIIs) of officials of the Ministry of Physical Planning and Urban Development (MPPUD) in Akure, Ondo State, unveil various views on the “place of health” in urban planning practices in Akure. A lack of synergy between urban planners and public health practitioners in the city and limiting scope of functions of urban planning on the impact of health in Akure were observed. Thus, we recommend the integration of a sustainable urban planning approach as a guide to manage the city.

Abstract Background The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions. Aim To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods. Methods We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators. Results Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96). Conclusion We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Abstract Background Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries. Methods In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18–97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. Results Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61–0.74) but higher odds among men (OR = 1.65; 95%CI 1.47–1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76–0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02–1.12; OR = 1.11 per SD, 95%CI = 1.05–1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased. Conclusion The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.

Introduction: Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India. Methods: Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial. Results: Prevalence of hypertension was found to be 34.8% (95% CI 33.5–34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16). Conclusion: One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.

Abstract Background Teenage pregnancies continue to disrupt teenage girls’ academic development. As a result, teenage mothers are at risk of unemployment, maternal death, and poverty. Previous research, however, has shown that both individual and environmental factors can have a significant impact on the prevalence of adolescent pregnancy. However, there has been little rigorous research on the impact of these factors on pregnant students’ academic performance. Objectives The purpose of this study was to determine the relationship between environmental (neighbourhood) and individuals (sexual attitudes, peer attachment) factors. It also examined the influence of individual factors on the academic performance of pregnant teens. Methods The study included a cross-sectional study of 400 pregnant adolescent students aged 15–19 years. The target groups were drawn from three major cities in Nigeria. Respondents were identified through targeted snowballing. Pregnant participants were a combination of married and unmarried girls attending school from home. Data were collected using a structured and self-completed questionnaire. Thus, frequency, mean and standard deviation were used for descriptive analysis. Pearson correlation analysis was applied to show the relationship between variables. Results The study found that neighbourhood (r=-.125, p = .12) had a negative and significant relationship with peer attachment. However, there was no significant evidence of a relationship between sexual attitudes and neighbourhood (r=-.040, p = .422). There was, however, a significant relationship between sexual attitudes and academic performance (r = .236, p = .000). There was also a relationship between peer attachment and academic performance (r=-.401, p =

Abstract Background The health of a population is determined by urban factors such as the physical, social and safety environment, which can be modified by urban regeneration policies. The aim of this study was to analyze the associations of elements of the social, physical and safety environment of the neighborhood in the urban context with self-perceived health (SPH), according to axes of inequality, such as gender and educational level in Chile in 2016. Methods Cross-sectional study using a nationally representative population-based survey of Chile. We used data from the 2016 National Survey of Quality of Life and Health. Poor SPH in the urban population older than 25 years was analyzed in relation to social, physical and safety environment variables. Poisson multilevel regression models were estimated to obtain prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). All analyses were stratified by sex and educational level. Results SPH was worse in women than in men, especially in those with a lower education level. Poor SPH was associated with lack of support networks (PR = 1.4; 95%CI = 1.1–1.7), non-participation in social organizations (PR = 1.3; 95%CI = 1.1–1.6) and perceived problems with the quality of public space (PR = 1.3; 95%CI = 1.2–1.5) in women with a medium-high educational level and with a feeling of not belonging to the neighborhood (PR = 1.5; 95%CI = 1.2–1.8) and the perception of pollution problems (PR = 1.2; 95%CI = 1.0-1.4) in women with a low educational level. A feeling of unsafety was associated with both educational levels (PR = 1.3; 95%CI = 1.0-1.5). Poor SPH was associated with the feeling of not belonging (PR = 1.7; 95%CI = 1.2–2.5), and unsafety (PR = 2.1; 95%CI = 1.8–2.4) in men with a medium-high educational level, while there were fewer associations in men with a lower education level. Conclusions Urban interventions are recommended to improve the health of the resident population and should take into account axes of inequality.

Improving street jogging environments can promote urban health and sustainability, especially within urban built-up areas. Public attention to the environment during jogging has not been sufficiently studied, and the recommended route data from the fitness app offers an opportunity for multiscale spatial exploration. Initially, by analyzing the recommendation reason text, the study identified 22 environmental factors and proposed the Environmental Factor Public Attention Intensity (EFPAI) for quantification, with subsequent comparisons to expert opinions. Further, by analyzing five types of data from the recommended routes, the relationships between EFPAI and jogging frequency, route shape, spatial distribution, and seasonal variations were uncovered. The study revealed: (1) discrepancies between expert opinions and public attention, with experts more likely to overlook factors such as slope, visual quality, width, and acoustic quality; (2) the public tends to notice factors like pedestrians, green spaces, waterfront spaces, landscapes, culture, sports facilities, and accessibility on routes with high jogging frequency; (3) EFPAI for traffic infrastructure, waterfront spaces, landscapes, residential areas, and campuses is associated with route shape; (4) EFPAI of certain environmental factors is influenced by urban geographical spatial factors, and substantial differences exist between different cities. Specific recommendations were provided from three different scales—site scale, street block scale, and urban scale—to guide the resolution of issues in planning and decision-making processes for urban renewal.

Accessible and high-quality urban green space (UGS) can provide significant benefits to refugee children for their development, health, and well-being. However, few studies have examined the actual accessibility of UGS from refugee children’s perspectives (i.e., with restricted walking radius, particular vulnerability towards barriers such as traffic infrastructures and disconnected road forms) and related them with other environmental or social burdens under the context of environmental justice. It is necessary to explore related evidence and investigate the underlying causes since refugee facilities are primarily located in areas with restricted social and environmental resources strongly related to attributes of environmental justice. This paper investigated (1) availability, accessibility, and attractiveness of UGS in 30 refugee accommodation locations in Berlin using GIS and Space Syntax, (2) environmental burdens using the Berlin Atlas of Environmental Justice, and (3) neighbourhood characteristics. Findings indicate that 63% of refugee accommodations have availability of green space that is above average official standards, but from refugee children’s perspectives, 60% of the locations have limited access to UGS, lower attractive green spaces, and most locations face multi-environmental burdens. Currently, little guidance focuses on ensuring equal access to and the usability of UGS for specific socioeconomic and demographic groups, such as refugee children. Therefore, this paper has contributed empirical materials to begin such research and develop inclusive decision-making strategies in environmental and health policy to ensure the provision and high quality of UGS for refugee children who need it.

Objectives Young mothers are vulnerable to postpartum depression due to role transition-related stress. Understanding the causes underlying these stressors is essential for developing effective interventions. Methods This study analyzed the 2018 Indonesian Basic Health Research data. The Mini International Neuropsychiatric Interview was used to assess postpartum depression symptoms in mothers aged 15-24 years with infants aged 0-6 months. In 1285 subjects, the risk factors for postpartum depression were evaluated using multivariate logistic regression. Results The overall prevalence of depression in the 6 months postpartum was 4.0%, with a higher prevalence in urban areas (5.7%) than in rural areas (2.9%). Urban and rural young mothers showed distinct postpartum depression risk factors. In urban areas, living without a husband (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.24 to 11.76), experiencing preterm birth (OR, 4.67; 95% CI, 1.50 to 14.50), having pregnancy complications (OR, 3.03; 95% CI, 1.20 to 7.66), and having postpartum complications (OR, 5.23; 95% CI, 1.98 to 13.80) were associated with a higher risk of postpartum depression. In rural areas, postpartum depression was significantly associated with a smaller household size (OR, 3.22; 95% CI, 1.00 to 10.38), unwanted pregnancy (OR, 4.40; 95% CI, 1.15 to 16.86), and pregnancy complications (OR, 3.41; 95% CI, 1.31 to 8.88). Conclusions In both urban and rural contexts, postpartum depression relates to the availability of others to accompany young mothers throughout the postpartum period and offer support with reproductive issues. Support from the family and the healthcare system is essential to young mothers’ mental health. The healthcare system needs to involve families to support young mothers’ mental health from pregnancy until the postpartum period.

Spatial justice has different dimensions and is to a large extent determined by its specific political-administrative context, which guides its development on the local level. In view of the varying living conditions in urban environments I would like to draw attention to the relevance of urban health as a crucial component of spatial justice. The resilience of the population, the spaces they inhabit and the urban infrastructure are closely interlinked as regards sustainability in the face of the current multiple crises. This paper aims to reflect upon the links between urban health and resilience and their contribution to spatial justice, particularly with regard to challenges in the built urban environment as visualised in the Health Map of Barton and Grant (2006). Referring to the City Resilience Profiling Tool developed by UN-Habitat (2021), my argument addresses the interfaces between urban health and resilience. Particularly essential to me is the collection and evaluation of data for monitoring spatial development which also forms the basis for public participation in planning procedures to achieve better urban health and spatial resilience. In this endeavour, special attention should be paid to neglected urban neighbourhoods and their populations. This is even more important as the current crisis requires flexible and adaptive goals and processes linked to a learning culture approach. By striving for urban health and spatial resilience in urban structures and processes spatial justice can be achieved via innovative and transformative development paths towards sustainability.

The focus is on the demographic drivers and demographic implications of urban health and wellbeing in towns and cities across the globe. The aim is to identify key linkages between demographic change and urban health – subjects of two largely disparate fields of research and practice – with a view to informing arguments and advocacy for urban health while identifying research gaps and priorities. The core arguments are threefold. First, urban health advocates should express a globalized perspective on demographic processes, encompassing age-structural shifts in addition to population growth and decrease, and acknowledging their uneven spatial distributions within and between urban settings in different contexts. Second, advocates should recognize the dynamic and transformational effects that demographic forces will exert on economic and political systems in all urban settings. While demographic forces underpin the production of (intra)urban inequities in health, they also present opportunities to address those inequities. Third, a demographic perspective may help to extend urban health thinking and intervention beyond a biomedical model of disease, highlighting the need for a multi-generational view of the changing societal bases for urban health, and enjoining significant advances in how interested parties collect, manage, analyse, and use demographic data. Accordingly, opportunities are identified to increase the availability of granular and accurate data to enable evidence-informed action on the demographic/health nexus.

Equitable access to urban vegetation (also known as greenness), an environmental determinant of health, is an important environmental justice issue. Researchers often consider parks a source of greenness but there is a lack of research explicitly investigating the sociodemographic correlates of greenness within city parks. Using a high-resolution landcover dataset, publicly available park boundaries, and American Community Survey data, we investigated the relationship between greenness within urban public parks and the sociodemographic characteristics of surrounding neighborhoods. We found that parks were substantially greener than surrounding neighborhoods and that Black race, Hispanic/Latino ethnicity, and socioeconomic deprivation was associated with less tree canopy and more grass and impervious surface or soil within parks. Public parks are indeed an important source of greenness for urban populations, but the type of vegetation in those spaces depends on the city and sociodemographic characteristics of neighborhoods. Future research and interventions should consider both the type and amount of vegetation within parks.

Worsening vision is a life-altering process that affects individuals in many aspects of daily life. While worsening vision can be caused by normal physiological processes that occur with age, there can be underlying systemic or ocular diseases that may be the root cause. Routine eye exams can screen for disease as well determine the degree of vision correction required to attain acceptable vision. Access to an eye exam ordinarily requires vision insurance and one must consider the added expense of glasses if they are recommended. While this can be a life-improving visit for many, there are several socioeconomic barriers that discourage homeless and low-income individuals from being able to access this service. The lack of resources to access regular eye exams and the resulting inadequate eye care may lead to underdiagnosis of serious ocular pathology. The Kansas City Free Eye Clinic is located inside a homeless shelter and, therefore, provides a convenient location for homeless and low-income individuals to receive comprehensive eye exams as well as prescription glasses at no cost. In this paper, we discuss the unique setup and demographics of this student-run eye clinic and the ways in which it has served the Kansas City population and how its integration into a homeless shelter could serve as a role model for free community eye clinics.

Abstract Background Urban environments impact negatively on the risks of non-communicable diseases and perpetuate health inequalities. Against this, law could play a critical role, notably through implementing and securing visions of health and well-being, and evidence-based interventions. Methods Seven teams conducted 123 interviews with 132 actors in urban planning in England. Teams had expertise in urban planning, transport, real estate, public health, public policy, administration, and management. An additional team with expertise in law analysed data from all interviews to explore how the law is perceived and used to promote health in urban planning. Results Six issues were identified as preventing actors from using the law to improve health in urban planning: (i) density and complexity of the law; (ii) weak and outdated regulatory standards; (iii) absence of health from legal requirements in the decision-making process; (iv) inconsistent interpretations by actors with competing interests; (v) lack of strong health evidence-based local planning policies; and (vi) inertia of the law. Conclusions The legal determinants of health listed in the Lancet-O’Neill Commission’s report need to be strengthened at the local level to effectively deploy law in English urban development. The findings call for strong, evidence-based local planning policies and decision-making frameworks, placing health as (one of the) core value(s) of urban planning and showing what types of development benefit health, i.e., prevent NCDs risks and reduce health inequalities on the long term. The legal capacity of local government should be strengthened to empower decision-makers in shaping urban development that promotes health for everyone.

Background: Most school communities lack awareness and health education toward dengue and its transmission. Aim: To assess the impact of implemented school-based health education intervention program on cognitive and affective domain as well as behavior of high school children as a change agent in the prevention and control of dengue fever in an urban area. Methods: All the children were self-administered a pretested semi-structured questionnaire to assess the baseline knowledge and attitude on dengue fever and its prevention in an epidemic. Multimodal health education intervention was provided and after 1 week, the same questionnaire was used to assess the postintervention level of knowledge and attitude. The Chi-square test and ordinal logistic regression were performed in R. v. 3.5.2. Sample of students was administered observation checklist to document the practices. Results: Majority belonged to the Class X 379 (60.64%) and their level of knowledge during pretest was higher compared to Class VIII and IX. Posttest, level of education of father's (P = 0.006), student's (P = 0.000), and occupation of mother's (P = 0.048) significantly associated with knowledge of students. While mother's education significantly associated with both knowledge (P = 0.000) and (P < 0.036) attitude of the students toward dengue fever. Knowledge and attitude of the students toward dengue significantly improved posttest. There was significant change in behavior practices as evident by reduction of breeding sites after intervention. Conclusion: The cognitive and affective domain of the high school students toward dengue fever improved after the health education program along with behavioral change which highlights the role of students as change agents.

Aim: To compare health-promoting behaviours among rural and urban residents following primary treatment for cancer. Methods: A cross-sectional survey collecting demographic variables and data pertaining to health-promoting behaviours, documented using the 52-item Health Promotion Lifestyle Profile II (HPLP-II) measure, which is categorised into six subscales: (1) health responsibility, (2) spiritual growth, (3) physical activity, (4) interpersonal relations, (5) nutrition, and (6) stress management. Residence was defined using the U.K. Office for National Statistics RUC 2011 Rural Urban Classifications. The Index of Multiple Deprivation (IMD) Decile was used to measure deprivation. Quantitative data were analysed using independent samples t-test and multiple linear regression. Qualitative data from open-ended questions were analysed thematically. Results: In total, 227 participants with a range of cancer types completed the questionnaire. Fifty-three percent were residents in urban areas and forty-five percent in rural areas. Rural participants scored significantly higher on health responsibility (p = 0.001), nutrition (p = 0.001), spiritual growth (p = 0.004), and interpersonal relationships (p = 0.001), as well as on the overall HPLP-II (p = 0.001). When controlling for deprivation, age, marital status, and education, rural–urban residence was a significant predictor of exhibiting health-promoting behaviours. A central theme from the qualitative data was the concept of “moving on” from cancer following treatment, by making adjustments to physical, social, psychological, spiritual, and emotional wellbeing. Conclusions: This research revealed, for the first time, differences in health-promoting behaviours among rural and urban U.K. populations who have completed primary cancer treatment. Rural residence can provide a positive environment for engaging with health-promoting behaviours following a cancer diagnosis and treatment.

Abstract Background This study examined the association between cognitive function and three neighborhood ‘disamenities’ that may pose local barriers to utilizing community resources and increase risk for cognitive decline. Method Using national data from 21,165 urban- and suburban-dwelling Black and white adults (mean age: 67 years) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we assessed global cognitive function through a factor score of five cognitive screening tests. General Additive Mixed Models (GAMM) tested whether residing in areas with more polluting sites, highways, and limited walkability was associated with worse cognitive function. Results Limited walkability and the presence of polluting sites had a significant negative association with cognitive function after controlling for individual and neighborhood factors. Conclusion Neighborhood disamenities may be linked to cognitive function among aging residents. Identifying neighborhood factors that pose barriers to accessing community resources may inform upstream policy applications to reduce risk for cognitive decline.

Abstract Background Despite the importance of domesticated animals in the generation and transmission of antibiotic‐resistant Staphylococcus aureus, the role of wild animals, specifically rodents, in the ecology of S. aureus remains unclear. We recovered and genotyped S. aureus isolates from wild Norway rats (Rattus norvegicus) in Boston, Massachusetts to examine genetic relationships between common human and animal S. aureus isolates in a large US metropolitan area. Methods We collected and necropsied 63 rats from June 2016 to June 2017. Nasal, foot pad, fur, and fecal swabs were collected. Staphylococcus aureus was isolated using culture‐based methods and polymerase chain reaction confirmation. S. aureus isolates were spa typed, tested for antibiotic susceptibility, and whole genome sequenced. Assembled sequences were uploaded to the Comprehensive Antibiotic Resistance Database to identify antibiotic resistance elements. A phylogenetic tree was constructed using the neighbor‐joining method with the maximum composite likelihood distance in MEGA7. Results We recovered 164 Gram‐positive bacterial isolates from Norway rats. Nineteen isolates from eight individual rats were confirmed as S. aureus (prevalence: 12.9% (8/63)). All S. aureus isolates were methicillin‐susceptible S. aureus (MSSA), pvl‐negative, and resistant to penicillin. Two isolates displayed resistance to erythromycin. Four different S. aureus spa types were detected (t933, t10751, t18202, and t189). Thirteen unique antibiotic resistance elements were identified, and all isolates shared genes mepR, mgrA, arlR, and S. aureus norA. Phylogenetic analysis if the 19 S. aureus isolates revealed they were genetically similar to four clades of S. aureus with similar resistance gene profiles isolated from both human‐ and animal‐derived S. aureus, as well as formed a distinct phylogenetic cluster composed only of rat isolates. Conclusions Wild rodents may serve as a reservoir or vector of antibiotic resistance genes in the urban environment with relevance for human and animal health.

Land use types other than specialized athletic fields provide a variety of jogging environments, addressing the shortage of urban fitness facilities and promoting urban health as well as sustainability. Currently, there is limited research comparing the differences in jogging support among various land use types, which can assist decision-makers in setting priorities and targeted strategies for urban renewal, especially in urban built-up areas with limited land resources. Initially, spatial information, statistical data, and recommendation reason text were extracted from recommended routes in mobile fitness apps and categorized into six land use types. Subsequently, spatial potential was measured through descriptive statistics, buffer area analysis, spatial autocorrelation analysis, and line density analysis. Environmental preferences were gauged by text analysis using jieba word segmentation and grouped word frequency calculation. Finally, the measurement results of different land uses were compared, including scale differences, spatial differentiation, environmental perception, and environmental elements. The research found that streets, residential areas, campuses, parks, and greenways possess significant potential to support jogging, particularly streets. These types of land use exhibit varying spatial potentials and attractions in environmental preferences. Targeted recommendations have been proposed to support the renewal of urban built-up areas and research in related fields.

Background: The biggest health problem in most developed countries of the world, including Kazakhstan, is high morbidity and death rates due to cardiovascular diseases (CVD), both in urban and rural areas. As is known during the outbreak of COVID-19, the inaccessibility of many medical services played a big role in the incidence of CVD, in particular in the northern regions of the Republic of Kazakhstan (KZ). The objective of our research was to analyze the prevalence of CVD in city and village regions of the northern regions of the Republic of Kazakhstan, considering the outbreak period with forecasting. Methods: A descriptive study with forecasting was conducted based on the “Health of the population of the Republic of Kazakhstan and the activities of healthcare organizations”, secondary statistical reporting data (collected volume) of the KZ. Information from this database was collected for five districts, two cities and one city of regional significance in the northern region of the KZ. Results: According to our descriptive study, the incidence of CVD indicates a comparatively large prevalence of CVD among the municipal population of the northern regions of the KZ. The prevalence of CVD in urban areas of the North Kazakhstan region (NKR) was 1682.02 (2015) and 4784.08 (2020) per 100,000 population. Among rural NKR residents, it was (per 100,000 population) 170.84 (2015) and 341.98 (2020). According to the forecast, by 2025, the incidence of CVD will grow, both in urban (7382.91/100,000) and in rural areas (417.29/100,000). Conclusions: Given the situation during the pandemic, the incidence of CVD has had a sharp increase, both in the rural and in urban areas of the northern regions of the KZ. This may be due to the poor availability of medical facilities, and medical services, which may have prevented timely diagnosis, as well as the psychology of the situation and the load on cardiac activity in relation to the pandemic.

Introduction: There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities. Methods: Semistructured interviews were conducted with key stakeholders (N=11) from across the public health landscape in New York City (health departments, healthcare delivery systems, and community-based organizations) to assess perspectives on how social determinants of health data can be used to address cardiovascular disease and health equity, what data-driven tools would be useful, and challenges to using these data sources and developing tools. A matrix analysis approach was used to analyze the interview data. Results: Stakeholders were optimistic about using social determinants of health data to address health equity by delivering holistic care, connecting people with additional resources, and increasing investments in under-resourced communities. However, interviewees noted challenges related to the quality and timeliness of social determinants of health data, interoperability between data systems, and lack of consistent metrics related to cardiovascular disease and health equity. Conclusions: Future research on this topic should focus on mitigating the barriers to using social determinants of health data, which includes incorporating social determinants of health data from other sectors. There is also a need to assess how data-driven solutions can be implemented within and across communities and organizations.

Background: Health information-seeking behavior (HISB) of college students is of importance due to health information inconsistencies at a time when personal independence and concurrent personal health decision making may be increased. Currently, there is a dearth of research about the HISB of college students, especially from diverse backgrounds. Therefore, the purpose of this study was to identify and describe the sources college students use when engaging in HISB; and to explore associations between HISB and demographic factors. Methods: This cross-sectional study was conducted with undergraduate students at a diverse, public institution in New York City. The sample was drawn from an institutional social science research pool and asked to complete a survey on HISB. A total of 226 respondents completed the survey. Results: The believed accuracy of the information found online was positively correlated with related behaviors and beliefs. The number of followers on Instagram proved to be an important mediator of HISB of college students. The number of followers a health information provider has was fittingly positively correlated with the belief that social media is a helpful resource for health information r(233)=0.18, P=0.01. Students from families with two or more generations living in the United States accessed health professionals more frequently than students from one or less generation (χ2=8.107(2), P=0.017). Conclusion: Targeted educational programs designed to increase health information seeking skills, including discernment of information quality should be a priority for college students.

Abstract Background Cardiovascular disease presents an increasing health burden to low- and middle-income countries. Although ample therapeutic options and care improvement frameworks exist to address its prime risk factor, hypertension, blood pressure control rates remain poor. We describe the results of an effectiveness study of a multisector urban population health initiative that targets hypertension in a real-world implementation setting in cities across three continents. The initiative followed the “CARDIO4Cities” approach (quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership). Method The approach was applied in Ulaanbaatar in Mongolia, Dakar in Senegal, and São Paulo in Brazil. In each city, a portfolio of evidence-based practices was implemented, tailored to local priorities and available data. Outcomes were measured by extracting hypertension diagnosis, treatment and control rates from primary health records. Data from 18,997 patients with hypertension in primary health facilities were analyzed. Results Over one to two years of implementation, blood pressure control rates among enrolled patients receiving medication tripled in São Paulo (from 12·3% to 31·2%) and Dakar (from 6·7% to 19·4%) and increased six-fold in Ulaanbaatar (from 3·1% to 19·7%). Conclusions This study provides first evidence that a multisectoral population health approach to implement known best-practices, supported by data and digital technologies, and relying on local buy-in and ownership, can improve hypertension control in high-burden urban primary care settings in low-and middle-income countries.

Urbanization has brought in expeditious changing world trends from dispersed rural settlements to denser urban centers. Higher frequent economic activities have attracted a large in-flow of job seekers, migrant laborers, and foreign investors to urban centers, furthering the complexity. Contrary to beliefs, urban demography has not brought people together; instead, it has created a new concern, Urban Isolation. The paper tries to explain issues related to urban isolation from examples of cities experiencing it. Results from a survey to determine factors leading to urban isolation for three major cities in India, namely, Mumbai, Kolkata, and Kochi, are also presented. The study includes sensitivity analysis using ANOVA for gender, age group, and household sizes. Factor analysis resulted in two prominent factors, “Sociability” and “Acceptability.” The paper provides probable solutions to counter the adverse effects of Urban Isolation. The findings from this study may be highly demographic-centric, catering to the Indian scenario.

Abstract Background Understanding how urban environments influence people’s health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations. Objectives To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association. Methods Cross-sectional analyses of 71,541 adults aged 25–97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators. Results Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73–0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction

Abstract Purpose A qualitative study was carried out to explore obese adolescents' understanding of physical activity, perceptions of the ideal body type and to identify facilitators of and barriers to physical activity. Methods Twenty‐two adolescents 12–18 years of age and 14 of their parents were recruited from an obesity intervention programme in Brooklyn, New York, from June to November 2017. Data were collected using focus groups and individual semi‐structured interviews, followed by interpretative phenomenological analysis of the transcripts. Results The adolescents wanted to ‘lose some weight’, but not to be ‘thin’ or ‘look hungry’. Most females desired a ‘slim‐thick’ figure, which was ‘a flat stomach with big thighs, and curvy’. Fun and support from parents, peers and programme staff facilitated achieving their physical activity goals. Barriers included low self‐efficacy, inactive families, fear of neighbourhood gangs and crime and perceptions that the parks were small and overcrowded, with limited physical activity options for adolescents. Conclusion These findings highlight the need to consider local norms concerning body image when designing obesity interventions. To effectively reduce childhood obesity in New York City, policy should prioritize the promotion of public safety, improvement of neighbourhood parks and increase options for physical activity. Patient or Public Contribution The voices and narratives of patients and their families informed this study.

Objective: To explore the effect of rural–urban residence on the self-reported health status of UK cancer survivors following primary treatment. Design: A post-positivist approach utilizing a cross-sectional survey that collected data on demographics, postcode and self-reported health status. Methods: An independent samples t test was used to detect differences in health status between rural and urban respondents. Pearson’s χ2 was used to control for confounding variables and a multivariate analysis was conducted using Stepwise linear regression. Setting: East Midlands of England. Participants: Adult cancer survivors who had undergone primary treatment in the last five years. Participants were excluded if they had recurrence or metastatic spread, started active oncology treatment in the last twelve months, and/or were in receipt of palliative or end-of-life care. Main outcome: Residence was measured using the UK Office for National Statistics (ONS) RUC2011 Rural–Urban Classifications and Health Status via the UK ONS self-reported health status measure. Ethics: The study was reviewed and approved (Ref: 17/WS/0054) by an NHS Research Ethics Committee and the Health Research Authority (HRA) prior to recruitment and data collection taking place. Results: 227 respondents returned a questionnaire (response rate 27%). Forty-five percent (n = 103) were resident in a rural area and fifty-three percent (n = 120) in an urban area. Rural (4.11 ± 0.85) respondents had significantly (p < 0.001) higher self-reported health statuses compared to urban (3.65 ± 0.93) respondents (MD 0.47; 95% CI 0.23, 0.70). Conclusion: It is hoped that the results will stimulate further work in this area and that researchers will be encouraged to collect data on rural–urban residency where appropriate.