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Introduction Latin America is burdened by high levels of violence. Although boys and men often experience more violence and fatalities, girls and women face a greater risk of being killed by family members or intimate partners due to their gender, a phenomenon known as femicide. Our study estimates femicide rates in Latin America across age groups, examining city-level variations and temporal trends.Methods Utilising data from the Salud Urbana en America Latina project, we analysed mortality data from 343 cities in nine countries between 2000 and 2019. We calculate the variability between and within countries using data from 2015 to 2019. We then describe time trends using femicide counts by year and city and fitting a three-level negative binomial model with a random intercept for country, fixed effects for age categories, and city-level and country-level random slopes for time (scaled to decades). Finally, we assess longitudinal time trends by age by including an interaction term for age and time (scaled to decades).Results Our results highlight substantial heterogeneity in femicide rates within and between countries. Additionally, we find that women 15–29 and 30–44 years of age experience the highest femicide rates across all countries. While our findings suggest a slight decline in femicide rates per additional decade (RR 0.95, 95% CI: 0.74 to 1.24) between 2000 and 2019, the trends diverge in different countries, suggesting increasing rates in some countries like Mexico. Age-specific trends suggest the persistence of higher rates among women 15–29 and 30–44 years of age over time.Conclusion We underscore the need to consider gender dynamics in understanding and preventing femicides, focusing on city-level interventions to address the multifaceted causes of violence against girls and women in the region.

Introduction The burden of Alzheimer’s disease (AD) and AD-related dementias (ADRD) is increasing nationally and globally, with disproportionate impacts on lower-income, lower education and systematically marginalised older adults. Presence of inequalities in neighbourhood factors (eg, social context, physical and built environments) may affect risk of cognitive decline and be key for intervening on AD/ADRD disparities at the population level. However, existing studies are limited by a dearth of longitudinal, detailed neighbourhood measures linked to rich, prospective cohort data. Our main objective is to identify patterns of neighbourhood change related to prevalence of—and disparities in—cognitive decline and dementia.Methods and analyses We describe the process of collecting, processing and linking extensive neighbourhood data to the Multi-Ethnic Study of Atherosclerosis (MESA), creating a 25+ years dataset. Within the MESA parent study, the MESA Neighborhoods and Aging cohort study will characterise dynamic, longitudinal neighbourhood social and built environment variables relevant to cognition for residential addresses of MESA participants. This includes administering new surveys, expanding residential address histories, calculating new measures derived from spatial data and implementing novel deep learning algorithms on street-level imagery. Applying novel statistical techniques, we will examine associations of neighbourhood environmental characteristics with cognition and clinically relevant AD/ADRD outcomes. We will investigate determinants of disparities in outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighbourhood environments to these disparities. This project will provide new evidence about pathways between neighbourhood environments and cognitive outcomes, with implications for policies to support healthy ageing.Ethics and dissemination This project was approved by the University of Washington and Drexel University Institutional Review Boards (protocols #00009029 and #00014523, and #180900605). Data will be distributed through the MESA Coordinating Center. Findings will be disseminated in peer-reviewed scientific journals, briefs, presentations and on the participant website.

Polycyclic aromatic hydrocarbons (PAHs) are air pollutants that are costly to measure using traditional air-quality monitoring methods. We used an epiphytic bio-indicator (moss genus: Orthotrichum) to cost-effectively evaluate atmospheric deposition of PAHs in Portland, Oregon in May 2013. However, it is unclear if measurements derived from these bioindicators are good proxies for human exposure. To address this question, we simultaneously, measured PAH-DNA adducts in blood samples of non-smokers residing close to the sites of moss measurements. We accounted for individual determinants of PAH uptake that are not related to environmental air quality through questionnaires, e.g., wood fires, consumption of barbecued and fried meats. Spearman rank correlation and linear regression (to control for confounders from the lifestyle factors) evaluated the associations. We did not observe evidence of an association between PAH levels in moss and PAH-DNA adducts in blood of nearby residents (e.g., all correlations p≥0.5), but higher level of adducts were evident in those who used wood fire in their houses in the last 48 hours. It remains to be determined whether bio-indicators in moss can be used for human health risk assessment.

Summary: Background: Several small experimental studies and cross-sectional observational studies have shown that exposure to the natural environment might protect against attention-deficit hyperactivity disorder (ADHD) or moderate the symptoms of ADHD in children. We aimed to assess whether exposure to the natural environment protects against ADHD and whether this hypothesised protective effect varies across a child's life course. Methods: We did a longitudinal study with data collected from all children born in New Zealand in 1998, excluding those without an address history, those who were not singleton births, and those who died or emigrated before 18 years of age. We used Statistics New Zealand's Integrated Data Infrastructure to identify children with ADHD and to define covariates. ADHD was defined according to hospital diagnosis or pharmacy records (two or more prescriptions for ADHD drugs). Exposure to green space for each year of a child's life (from gestation to 18 years of age) was estimated at the meshblock level (the smallest geographical unit for which the New Zealand Census reports data) using normalised difference vegetation index (NDVI), and land-use data from Landcare Research New Zealand. We used logit models to assess the associations between ADHD prevalence and minimum, maximum, and mean lifetime NDVI, as well as rural living, controlling for sex, ethnicity, mother's educational level, mother's smoking status, mother's age at parturition, birth order, antibiotic use, and low birthweight. Findings: Of the 57 450 children born in New Zealand in 1998, 49 923 were eligible and had available data, and were included in the analysis. Children who had always lived in a rural area after 2 years of age were less likely to develop ADHD (odds ratio [OR] 0·670 [95% CI 0·461–0·974), as were those with increased minimum NDVI exposure after age 2 years (standardised OR for exposure vs first quartile: second quartile 0·841 [0·707–0·999]; third quartile 0·809 [0·680–0·963]; fourth quartile 0·664 [0·548–0·805]). In early life (prenatal to age 2 years), neither rural living nor NDVI were protective against ADHD. Neither mean nor maximum greenness was significantly protective against ADHD. Interpretation: Rurality and increased minimum greenness were strongly and independently associated with a reduced risk of ADHD. Increasing a child's minimum lifetime greenness exposure, as opposed to maximum or mean exposure, might provide the greatest increment of protection against the disorder. Funding: None.

Despite a myriad of potential pathways linking neighborhood change and gentrification to health, existing quantitative measures failed to capture individual-level, self-reported perceptions of these processes. We developed the Perceptions About Change in Environment and Residents (PACER) survey to measure the gentrification-related neighborhood change experienced by individuals relevant to health. We employed a multi-stage process to develop PACER including a scoping review, question refinement, content validity, and cognitive interviews. Content validity and cognitive interviews were assessed within the National Neighborhood Indicators Partnership (NNIP) and for residents of different tenure in both gentrifying and non-gentrifying neighborhoods to ensure PACER considers the complex nature of neighborhood change for different people within different urban contexts. We piloted the instrument to a sample from the resident panel BeHeardPhilly to assess acceptability and data quality. Finally, we assessed internal consistency, dimensionality, and criterion-related validity using Principal Components Analysis (PCA), descriptive statistics, and correlation coefficients. Testing showed good internal consistency for PACER questions, as well as for each of four resulting factors (Feelings, Built Environment, Social Environment, and Affordability). Correlations between factors and other context measures demonstrated strong criterion-related validity. PACER offers an unprecedented tool for measuring and understanding resident perceptions about gentrification-related neighborhood change relevant to health. Rigorously tested and tailored for health, PACER holds utility for application across different settings to examine changes from events that may impact and shift neighborhoods.

Background The association between psychosocial stress and coronary heart disease (CHD) may be stronger in women than men and may differ across types of stressors. In this study, we assessed associations of psychosocial stressors, including job strain, stressful life events, and social strain with the incidence of CHD in women. Methods and Results We used longitudinal data from 80 825 WHI‐OS (Women's Health Initiative Observational Study) participants with a mean age of 63.4 years (7.3 years) at baseline. Job strain was assessed through linkage of Standard Occupational Classification codes to the Occupational Information Network. Stressful life events and social strain were assessed via validated self‐reported questionnaires. Cox proportional hazard models were used to evaluate associations of each stressor with CHD separately and jointly. A total of 3841 (4.8%) women developed CHD during an average of 14.7 years of follow‐up. After adjustment for age, other stressors, job tenure, and socioeconomic factors, high stressful life events score was associated with a 12% increased CHD risk, and high social strain was associated with a 9% increased CHD risk. Job strain was not independently associated with CHD risk, but we observed a statistically significant interaction between job strain and social strain (P=0.04), such that among women with high social strain, passive job strain was associated with a 21% increased CHD risk. Conclusions High stressful life events and social strain were each associated with higher CHD risk. Job strain and social strain work synergistically to increase CHD risk.

A walkable neighborhood becomes particularly important for older adults for whom physical activity and active transportation are critical for healthy aging-in-place. For many older adults, regular walking takes place in the neighborhood and is the primary mode of mobility. This study took place in eight neighborhoods in Metro Portland (USA) and Metro Vancouver (Canada), examining older adults' walking behavior and neighborhood built environmental features. Older adults reported walking for recreation and transport in a cross-sectional telephone survey. Information on physical activity was combined with audits of 355 street segments using the Senior Walking Environmental Audit Tool-Revised (SWEAT-R). Multi-level regression models examined the relationship between built environmental characteristics and walking for transport or recreation. Older adults [N = 434, mean age: 71.6 (SD = 8.1)] walked more for transport in high-density neighborhoods and in Metro Vancouver compared to Metro Portland (M = 12.8 vs. M = 2.2 min/day; p < 0.001). No relationship was found between population density and walking for recreation. Older adults spent more time walking for transport if pedestrian crossing were present (p = 0.037) and if parks or outdoor fitness amenities were available (p = 0.022). The immediate neighborhood built environment supports walking for transport in older adults. Comparing two similar metropolitan areas highlighted that high population density is necessary, yet not a sufficient condition for walking in the neighborhood.

Few studies have evaluated physical activity changes in response to active transportation investments in low-income disadvantaged communities. This quasi-experimental pre-post paired location design assessed physical activity responses to a 1.5-mile urban greenway constructed in 2013 along arterial streets in a poor, high-crime, predominantly African-American neighborhood in Philadelphia, Pennsylvania. Pre-construction (2011) and post-construction (fall 2014), systematic observations (N = 8783) and environmental audit data were collected at the greenway and a comparison area. Post-construction intercept surveys were collected at the greenway (N = 175). Secondary data sources included census 2010–2014 and crime rates. Post-construction, there were notable improvements in street and sidewalk design, however, conditions remained sub-optimal and crime remained high. Most greenway users resided in the neighborhood and were daily users. Systematic observations at the greenway found slight increases in non-walking MVPA after construction (running or bicycling rose from 4% to 9%) and MVPA that included walking-fast (rose from 16% to 18%). However, the magnitude of the increase was similar to the increase in MVPA observed at the comparison site, which suggested that intensity of physical activity did not change as a result of the greenway (p-value > 0.15 for adjusted interaction between pre-post and location). Greenways, absent comprehensive improvements to the built and social environment, may be insufficient to promote MVPA in very disadvantaged high-crime urban communities. Keywords: Physical activity, Built environment, Neighborhood, Poverty, Active transportation, Walking, Walkability, Trail

Many studies have identified an association between exposure to the natural environment and improved public-health outcomes. However, much of this observational work lacks a theoretical foundation, so we look to the humanities for a stronger basis for green-health research, examining how trees have been used as religious metaphors and symbols for health and wellbeing. In particular, the tree of life, sacred trees, and other religious symbols provide a promising theoretical basis for green-health research. Based on this review, we propose the value of incorporating attributes such as vegetation species and size in exposure metrics, and considering the interactions between exposure attributes (e.g., species) and individual attributes (e.g., culture).

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps.Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities.Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer’s disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed.Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

Abstract INTRODUCTION We examined whether a combined measure of neighborhood greenspace and neighborhood median income was associated with white matter hyperintensity (WMH) and ventricle size changes. METHODS The sample included 1260 cognitively normal ≥ 65‐year‐olds with two magnetic resonance images (MRI; ≈ 5 years apart). WMH and ventricular size were graded from 0 (least) to 9 (most) abnormal (worsening = increase of ≥1 grade from initial to follow‐up MRI scans). The four‐category neighborhood greenspace–income measure was based on median neighborhood greenspace and income values at initial MRI. Multivariable logistic regression tested associations between neighborhood greenspace–income and MRI measures (worsening vs. not). RESULTS White matter grade worsening was more likely for those in lower greenspace–lower income neighborhoods than higher greenspace–higher income neighborhoods (odds ratio = 1.73; 95% confidence interval = 1.19–2.51). DISCUSSION The combination of lower neighborhood income and lower greenspace may be a risk factor for worsening white matter grade on MRI. However, findings need to be replicated in more diverse cohorts. HIGHLIGHTS Population‐based cohort of older adults (≥ 65 years) with greenspace and MRI data Combined measure of neighborhood greenspace and neighborhood income at initial MRI MRI outcomes included white matter hyperintensities (WMH) and ventricular size Longitudinal change in MRI outcomes measured approximately 5 years apart Worsening WMH over time more likely for lower greenspace‐lower income neighborhoods

Abstract Background There are hundreds of bikeshare programs worldwide, yet few health-related evaluations have been conducted. We enrolled a cohort of new bikeshare members in Philadelphia (Pennsylvania, USA) to assess whether within-person moderate and vigorous physical activity (MVPA) increased with higher use of the program and whether effects differed for vulnerable sub-groups. Methods During 2015–2018, 1031 new members completed baseline and one-year follow-up online surveys regarding their personal characteristics and past 7-day MVPA minutes per week (minutes per week with- and without walking). Participants were linked to their bikeshare trips to objectively assess program use. Negative binomial (for continuous outcomes) and multinomial (for categorical outcomes) regression adjusted for person characteristics (socio-demographics, health), weather, biking-infrastructure, and baseline biking. Results Participant median age was 30, 25% were of Black or Latino race/ethnicity, and 30% were socioeconomically disadvantaged. By follow-up, personal bike ownership increased and 75% used bikeshare, although most used it infrequently. Per 10 day change in past year (PY) bikeshare use, non-walking MVPA min/wk increased 3% (roughly 6 min/wk, P

While census-defined measures of gentrification are often used in research on gentrification and health, surveys can be used to better understand how residents perceive neighborhood change, and the implications for mental health. Whether or not gentrification affects mental health may depend on the extent to which an individual perceives changes in their neighborhood. Using health and map-based survey data, collected from 2020 to 2021, from the Interventions, Research, and Action in Cities Team, we examined links between perceptions of neighborhood change, census-defined neighborhood gentrification at participant residential addresses, and mental health among 505 adults living in Montréal. After adjusting for age, gender, race, education, and duration at current residence, greater perceived affordability and more positive feelings about neighborhood changes were associated with better mental health, as measured by the mental health component of the short-form health survey. Residents who perceived more change to the social environment had lower mental health scores, after adjusting individual covariates. Census-defined gentrification was not significantly associated with mental health, and perceptions of neighborhood change did not significantly modify the effect of gentrification on mental health. Utilizing survey tools can help researchers understand the role that perceptions of neighborhood change play in the understanding how neighborhood change impacts mental health.

Several recent longitudinal studies have found that exposure to the natural environment is associated with lower non-accidental mortality. However, most of these studies used the normalized difference vegetation index (NDVI) as an exposure metric; and because NDVI might not be sensitive enough to adequately capture changes in urban vegetation, these studies might lack true longitudinal variation in exposure. Therefore, we used a natural experiment to assess the impact of 30 years of tree planting by the nonprofit Friends of Trees on non-accidental, cardiovascular, lower-respiratory, and accidental mortality in Portland, Oregon (mortality data were provided by the Oregon Health Authority). We estimated autoregressive mixed models of Census-tract level mortality rate (deaths per 100,000 population) associated with trees planted, including a tract-level random effect. All models used data from the American Community Survey to control for year, race, education, income, and age. Each tree planted in the preceding 15 years was associated with significant reductions in non-accidental (-0.21, 95 % CI: −0.30, −0.12) and cardiovascular mortality (-0.066, 95 % CI: −0.11, −0.027). Furthermore, the dose–response association between tree planting and non-accidental mortality increased in magnitude as trees aged and grew. Each tree planted in the preceding 1–5 years was associated with a reduction in mortality rate of −0.154 (95 % CI: −0.323, 0.0146), whereas each tree planted in the last 6–10 and 11–15 years was associated with a reduction in mortality rate of −0.262 (95 % CI: −0.413, −0.110) and −0.306 (95 % CI: −0.527, −0.0841) respectively. Using US EPA estimates of a value of a statistical life, we estimated that planting a tree in each of Portland’s 140 Census tracts would generate $14.2 million in annual benefits (95 % CI: $8.0 million to $20.4 million). In contrast, the annual cost of maintaining 140 trees would be $2,716–$13,720.

Polycyclic aromatic hydrocarbons (PAHs) are air pollutants that are costly to measure using traditional air-quality monitoring methods. We used an epiphytic bio-indicator (moss genus: Orthotrichum) to cost-effectively evaluate atmospheric deposition of PAHs in Portland, Oregon in May 2013. However, it is unclear if measurements derived from these bioindicators are good proxies for human exposure. To address this question, we simultaneously, measured PAH-DNA adducts in blood samples of non-smokers residing close to the sites of moss measurements. We accounted for individual determinants of PAH uptake that are not related to environmental air quality through questionnaires, e.g., wood fires, consumption of barbecued and fried meats. Spearman rank correlation and linear regression (to control for confounders from the lifestyle factors) evaluated the associations. We did not observe evidence of an association between PAH levels in moss and PAH-DNA adducts in blood of nearby residents (e.g., all correlations p≥0.5), but higher level of adducts were evident in those who used wood fire in their houses in the last 48 hours. It remains to be determined whether bio-indicators in moss can be used for human health risk assessment.

Abstract Background Pediatric primary care visits are a foundational element in the health maintenance of children. Differential access may be a driver of racial inequities in health. We hypothesized that pediatric primary care accessibility would be lowest in neighborhoods with higher proportion of non-Hispanic Black residents. Methods Annual ratios (2008–2016) of providers to pediatric population were calculated by census tract in Philadelphia, Pennsylvania. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders. Results In general, low access to care was associated with greater neighborhood disadvantage (e.g., SES, % poverty, % public insurance). After controlling for neighborhood indicators of disadvantage, risk of being in the lowest quintile of access significantly increased as the percent of non-Hispanic Black residents increased. Conclusion A new measure of pediatric primary care accessibility demonstrates a persistent disparity in primary care access for predominantly non-Hispanic Black neighborhoods.

Little is known about the effect of the rural environment on children’s physical activity and food choices. In this study, six rural adolescents participated in a photovoice assessment to document conditions that influenced children’s activity and diets. Physical activity was hindered by inadequate recreational resources, unsafe streets, and distance, but was promoted by the natural environment and support for youth sports. Healthy eating was hindered by busy lifestyles, limited access to healthy foods, access to and promotion of unhealthy foods, and social values, but was promoted by the agricultural setting and gardening. While many of these factors occur in non-rural settings, the findings suggest that rural communities have unique strengths and barriers that must be considered when developing interventions.

Sedentary behavior is associated with deleterious health outcomes. This study evaluated the association between sedentary time and physical function among postmenopausal women in the Women's Health Initiative Observational Study. Data for this prospective cohort study were collected between 1993–1998 (enrollment) and 2009, with an average of 12.3 follow-up years. Analyses included 61,609 women (aged 50–79 years at baseline). Sedentary time was estimated by questionnaire; physical function was measured using the RAND SF-36 physical function scale. Mixed-model analysis of repeated measures was used to estimate the relationship of sedentary time exposures and changes in physical function adjusting for relevant covariates. Compared to women reporting sedentary time of ≤6 hours/day, those with greater amounts of sedentary time (>6–8 hours/day, >8–11 hours/day, >11 hours/day) reported lower physical function between baseline and follow up (coefficient = −0.78, CI = −0.98, −0.57, −1.48, CI = −1.71, −1.25, −3.13, and CI = −3.36, −2.89, respectively P

Mobility restrictions in older adults are common and increase the likelihood of negative health outcomes and premature mortality. The effect of built environment on mobility in older populations, among whom environmental effects may be strongest, is the focus of a growing body of the literature. We reviewed recent research (1990–2010) that examined associations of objective measures of the built environment with mobility and disability in adults aged 60 years or older. Seventeen empirical articles were identified. The existing literature suggests that mobility is associated with higher street connectivity leading to shorter pedestrian distances, street and traffic conditions such as safety measures, and proximity to destinations such as retail establishments, parks, and green spaces. Existing research is limited by differences in exposure and outcome assessments and use of cross-sectional study designs. This research could lead to policy interventions that allow older adults to live more healthy and active lives in their communities.