Low-income Neighborhoods Research Articles

Neighbourhood income inequalities in mental health in Barcelona 2001-2016: a Bayesian smoothed estimate

ObjectiveObtaining reliable health estimates at the small area level (such as neighbourhoods) using survey data usually poses the problem of small sample sizes. To overcome this limitation, we explored smoothing techniques in order to estimate poor mental health prevalence at the neighbourhood level and analyse its profile by income in Barcelona city (Spain). MethodA Bayesian smoothing model with a logit-normal transformation was applied to four repeated cross-sectional waves of the Barcelona health survey for 2001, 2006, 2011 and 2016. Mental health status was identified from the 12-item General Health Questionnaire. Income inequalities were analysed with neighbourhood income in quantiles for each year and trends in the pooled analysis. ResultsThe prevalence of poor mental health ranged from 14.6% in 2001 to 18.9% in 2016. The yearly difference between neighbourhoods was 12.4% in 2001, 16.7% in 2006, 14.2% in 2011, and 20.0% in 2016. The odds ratio and 95% credible interval (95%CI) of experiencing poor mental health was 1.40 times higher (95%CI: 1.02-1.91) in less advantaged neighbourhoods than in more advantaged neighbourhoods in 2001, 1.61 times higher (95%CI: 1.01-2.59) in 2006 and 2.31 times higher (95%CI: 1.57-3.40) in 2016. ConclusionsThis study shows that the Bayesian smoothed techniques allows detection of inequalities in health in neighbourhoods and monitoring of interventions against them. In Barcelona, mental health problems are more prevalent in low-income neighbourhoods and raised in 2016.

Clinic navigation and home visits to improve asthma care in low income adults with poorly controlled asthma: Before and during the pandemic

Asthma-related deaths, hospitalizations, and emergency visits are more numerous among low-income patients, yet management guidelines do not address this high-risk group's special needs. We recently demonstrated feasibility, acceptability, and preliminary evidence of effectiveness of two interventions to improve access to care, patient-provider communication, and asthma outcomes: 1) Clinic Intervention (CI): study staff facilitated patient preparations for office visits, attended visits, and afterwards confirmed patient understanding of physician recommendations, and 2) Home Visit (HV) by community health workers for care coordination and informing clinicians of home barriers to managing asthma. The current project, denominated “HAP3,” combines these interventions for greater effectiveness, delivery of guideline-based asthma care, and asthma control for low-income patients recruited from 6 primary care and 3 asthma specialty practices. We assess whether patients of clinicians receiving guideline-relevant, real-time feedback on patient health and home status have better asthma outcomes.In a pragmatic factorial longitudinal trial, HAP3 enrolls 400 adults with uncontrolled asthma living in low-income urban neighborhoods. 100 participants will be randomized to each of four interventions: (1) CI, (2) CI with HVs, (3) CI and real-time feedback to asthma clinician of guideline-relevant elements of patients' current care, or (4) both (2) and (3). The outcomes are asthma control, quality of life, ED visits, hospitalizations, prednisone bursts, and intervention costs. The COVID-19 pandemic struck 6.5 months into recruitment. We describe study development, design, methodology, planned analysis, baseline findings and adaptions to achieve the original aims of improving patient-clinician communication and asthma outcomes despite the markedly changed pandemic environment.

0514 Risk Factors for Symptoms and Signs of Sleep Apnea Impacting Quality of Life in an Urban Pediatric Community-Based Sample

Abstract Introduction Pediatric obstructive sleep apnea (OSA) disproportionately affects children from minority groups and children living in disadvantaged neighborhoods, but the risk factors that drive this risk are not well understood. We investigated the relationship between minority race/ethnicity, household risk factors (smoking, socio-economic status [SES]), and neighborhood disadvantage with OSA-related quality of life (QOL) scores in participants in the Environmental Assessment of Sleep Youth (EASY) observational study. Methods Families of children 5-12 years old recruited from largely low-income Boston-area neighborhoods participated in an extensive in-home evaluation of OSA risk factors. OSA-related QOL was assessed with parent-reported OSA-18 questionnaire (values >37 indicative of negative impact of symptoms and signs of OSA on QOL). Secondhand smoking (SHS) was defined by parent-report of smoking in the home. Neighborhood disadvantage was characterized using geocoded addresses, calculating the Neighborhood Socioeconomic (NSES) index. We performed logistic regression with OSA-18 >37 as the dependent variable and age, gender, race/ethnicity, BMI, household smoking, household measures of SES and NSES index as independent variables. Results The sample included 256 children (40%-Hispanic ethnicity, 31%-Black, 20%-White, 9%-Other; 56% were female), with a mean age 9.1±1.9 and BMI percentile 69.9±29.8. 33% and 40% of children were from households with income <$25,000 and $25,000-$75,000, respectively, and 10% had SHS exposure. Mean NSES index was 47.9±15.4 (national average of 50). An elevated OSA-18 was reported for 35% of participants and significantly associated with Hispanic ethnicity and smoking exposure (OR=2.16, CI 1.01-4.62 and OR=2.71, CI 1.2-6.3) after adjusting for age, gender, and BMI percentile. Further adjustment for family income attenuated the association of OSA-18 with Hispanic ethnicity, but a significant association with household smoking persisted. NSES index and BMI percentile were not associated with OSA-18. Conclusion High symptoms and signs of OSA impacting QOL were associated with Hispanic ethnicity, household smoking and SES in this diverse cohort of children living in urban and predominantly low-income communities. The study points to the need for strategies to reduce household smoking as one strategy for decreasing sleep health disparities, and the further need to understand other factors associated with low SES that increase risk for poor sleep health. Support (If Any) NIH-NHLBI/T32HL007901, R35HL1358181, P30ES000002, K24AI106822, R01Hl137192, K23ES031663

Touristification, commercial gentrification, and experiences of displacement in a disadvantaged neighborhood in Busan, South Korea

ABSTRACT One of the most prominent topics in scholarship on touristification and gentrification is displacement, including not only direct physical displacement, but also the emotional and social impacts associated with indirect displacement. Although research on touristification and gentrification has begun to examine the experiences and perceptions of residents undergoing displacement in low-income urban neighborhoods, it has paid less attention to the spatial characteristics of indirect displacement and the distinctive characteristics of displacement associated specifically with tourism. In Gamcheon Culture Village (GCV) in Busan, South Korea, touristification and commercial gentrification have generated limited direct physical displacement of residents and business owners spatially concentrated in areas adjacent to the main tourist thoroughfare. However, indirect displacement in the sense of displacement pressure and un-homing has a more widespread and complex presence within the community, depending in part on residents’ proximity to tourist activity. In addition, tourism-induced displacement can create dimensions of un-homing less common in typical gentrifying neighborhoods. Our findings suggest a need both for more comparative empirical research on indirect displacement and for urban policies attentive to un-homing associated with touristification and gentrification.

Reclaiming Placemaking for an Alternative Politics of Legitimacy and Community in Homelessness.

This study is about the struggle for legitimacy in place among a group of people often assumed to have neither. It examines the roll of informal placemaking and community building in struggles for settlement among people experiencing homelessness. It does so through ethnographic observation, photo-documentation, and participatory action research at three sites in Oakland, California, on which unhoused people (and some housed members of the surrounding community) have demonstrated bold forms of grassroots placemaking on public land. The first site, which came to be known as Housing and Dignity Village, was a small intentionally organized community of unhoused women and families that existed for 41 politically charged days in a low-income residential neighborhood before being cleared by authorities in 2018. The second, a highly visible piece of desirable city-owned land, has been occupied by unhoused people to varying degrees since 2016 while being considered for various housing development proposals. The third is the Wood Street Encampment, Oakland’s largest encampment and one of its longest standing, which has survived numerous partial evictions and a web of jurisdictional authority to become home to an extensive and innovative informal community-building effort. Despite their differences, each offers a powerful case of place-based bottom-up community organizing among unhoused people, in which placemaking becomes part of a subtle politics of visibility, being, and legitimacy. The study argues that these instances and others not only demonstrate a different sort of placemaking, but demand that we reconsider and reclaim the concept itself.

Why don’t people plant trees? Uncovering barriers to participation in urban tree planting initiatives

Urban tree cover is inequitable in many American cities, with low-income and non-white neighborhoods typically having the least coverage. Some municipal and non-profit tree planting programs aim to address this inequity by targeting low-income neighborhoods; however, many programs face lack of participation or resistance from local residents. In this study, we aimed to uncover the economic, social, cultural, and physical barriers that community leaders face in planting trees and fostering engagement in a neighborhood with low tree canopy. In collaboration with an urban greening nonprofit in Philadelphia, Pennsylvania (US), twenty in-depth interviews were conducted with community leaders in a low canopy neighborhood, North Philadelphia. Half of these leaders were already involved with local tree planting programs, while the other half were not. Findings reveal that despite broad appreciation for trees and greenspaces, there are concerns about the risks and costs residents assume over the course of a tree’s life cycle, the threat of neighborhood development and gentrification associated with trees, limited plantable space, and limited time and capacity for community organizations. Additionally, these barriers to participation may be amplified among low-income and communities of color who face the legacies of historical tree disservices and municipal structural disinvestment. Addressing community concerns regarding the long-term care of trees beyond the initial tree planting would likely require further programmatic support. Overall, this research highlights the complexity of addressing inequities in tree canopy and the importance of integrating resident and community leader perspectives about disservices and management costs into tree planting initiatives.

Resilience building among small businesses in low-income neighborhoods

ABSTRACT The purpose of this article is to investigate the drivers of static and dynamic resilience as a response to the COVID-19-induced crisis among small business entrepreneurs in Brazil. This study explores the role of human, social, and financial capital in the building of resilience responses based on 38 longitudinal case studies. Our interviews indicate that small businesses with lower levels of human capital and social capital were associated with static resilience responses. However, those with higher levels of human capital and higher levels of family social capital had a higher likelihood of developing a richer resource repertoire associated with stronger social media and financial management capabilities, which were associated with dynamic resilience responses. Our study helps in the theoretical understanding of reasons entrepreneurs at times fail to develop novel responses to the crises.

Ride-Hailing Data Suppression and Exclusion Strategies Can Lead to Biased Outcomes

The Chicago ride-hailing data set is one of the few data sets in the United States containing details of individual ride-hail trips. To protect privacy, locations and times are aggregated, and locations are further suppressed when the frequency of trips is low. Most researchers using this data remove the trips with suppressed locations or external destinations from their analysis. This research finds that when suppressed and external trips are excluded, the trip length, cost, and distance are all underestimated, as are trips in low-income neighborhoods. Future research should consider including these trips at a more aggregate spatial resolution.

Disputed meanings about child labour, its consequences, and interventions: discussions based on ethnographic research in Argentina

ABSTRACT Based on ethnographies with working children and their families in low-income neighbourhoods in Argentina, this article explores the experiences constructed around child labour, its meanings, and consequences, taking into account the locations and social relations in which it takes place. In doing so, it offers a nuanced reading of child labour that distances it from the dualistic thinking, deeply rooted in social sciences, in which, on the one hand, researchers conclude that child labour should be eradicated (the work-free childhood discourse) and, on the other hand, it is recognised as a right (the regulationist perspective). Based on field studies, the article challenges this dualistic thinking and presents a nuanced, alternative narrative.

Disparities in air quality downscaler model uncertainty across socioeconomic and demographic indicators in North Carolina

Studies increasingly use output from the Environmental Protection Agency's Fused Air Quality Surface Downscaler (“downscaler”) model, which provides spatial predictions of daily concentrations of fine particulate matter (PM2.5) and ozone (O3) at the census tract level, to study the health and societal impacts of exposure to air pollution. Downscaler outputs have been used to show that lower income and higher minority neighborhoods are exposed to higher levels of PM2.5 and lower levels of O3. However, the uncertainty of the downscaler estimates remains poorly characterized, and it is not known if all subpopulations are benefiting equally from reliable predictions. We examined how the percent errors (PEs) of daily concentrations of PM2.5 and O3 between 2002 and 2016 at the 2010 census tract centroids across North Carolina were associated with measures of racial and educational isolation, neighborhood disadvantage, and urbanicity. Results suggest that there were socioeconomic and demographic disparities in surface concentrations of PM2.5 and O3, as well as their prediction uncertainties. Neighborhoods characterized by less reliable downscaler predictions (i.e., higher PEPM2.5 and PEO3) exhibited greater levels of aerial deprivation as well as educational isolation, and were often non-urban areas (i.e., suburban, or rural). Between 2002 and 2016, predicted PM2.5 and O3 levels decreased and O3 predictions became more reliable. However, the predictive uncertainty for PM2.5 has increased since 2010. Substantial spatial variability was observed in the temporal changes in the predictive uncertainties; educational isolation and neighborhood deprivation levels were associated with smaller increases in predictive uncertainty of PM2.5. In contrast, racial isolation was associated with a greater decline in the reliability of PM2.5 predictions between 2002 and 2016; it was associated with a greater improvement in the predictive reliability of O3 within the same time frame.

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic.

The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care. We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared. ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years. Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

MP17-12 PROXIMITY TO FOOD DESERTS INCREASES RISK OF PEDIATRIC NEPHROLITHIASIS

You have accessJournal of UrologyCME1 May 2022MP17-12 PROXIMITY TO FOOD DESERTS INCREASES RISK OF PEDIATRIC NEPHROLITHIASIS Arthi Hannallah, Aurash Naser-Tavakolian, Zoë Baker, Shirley Saker, Thalia Bajakian, Nadine Khouzam, Andrew Freedman, and S. Scott Sparks Arthi HannallahArthi Hannallah More articles by this author , Aurash Naser-TavakolianAurash Naser-Tavakolian More articles by this author , Zoë BakerZoë Baker More articles by this author , Shirley SakerShirley Saker More articles by this author , Thalia BajakianThalia Bajakian More articles by this author , Nadine KhouzamNadine Khouzam More articles by this author , Andrew FreedmanAndrew Freedman More articles by this author , and S. Scott SparksS. Scott Sparks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002550.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study sought to identify a relationship between proximity to food deserts and the prevalence of pediatric nephrolithiasis in Southern California. METHODS: This was a multi-site review of patients with nephrolithiasis from two pediatric hospitals in a dense urban region from 2006 to 2021. Demographics and stone histories were reviewed. Patients’ home addresses were correlated with census tract data and compared to locations of food deserts per the United States Department of Agriculture. Food deserts are regions with no supermarket access within a half-mile radius in urban areas or a 10-mile radius in rural areas. Median household income (MHI) was assessed with the 2019 American Community Survey 5-Year Estimates. Poverty was defined by the California Poverty Measure (CPM), with near poverty as 1-1.5x CPM. Logistic and linear regression models were utilized to analyze the associations between sociodemographic factors and stone-related outcomes. RESULTS: We identified 429 pediatric patients in Southern California seen for nephrolithiasis. Table 1 includes demographic data, poverty rate, and access to supermarkets. Compared to those who did not live in food deserts, patients living in food deserts experienced their first stone episode 1.13 years earlier (95% CI: 0.08-2.19 years earlier; p=0.04) and were 1.53 times more likely to require surgery for stones with a trend toward statistical significance (95% CI: 0.96-2.43; p=0.07, Figure 1). Patients living in low-income neighborhoods were 1.86 times more likely to be overweight or obese than patients with stones living in higher-income neighborhoods (95% CI: 1.10-3.15; p=0.02). CONCLUSIONS: Proximity to food deserts is associated with an increased risk of pediatric nephrolithiasis at a younger age and potentially requiring more surgical stone interventions. Obesity is more prevalent among patients residing in low-income neighborhoods. Dietary efforts that assess the access and ability to provide adequate nutrition should be evaluated in pediatric patients with nephrolithiasis. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e289 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arthi Hannallah More articles by this author Aurash Naser-Tavakolian More articles by this author Zoë Baker More articles by this author Shirley Saker More articles by this author Thalia Bajakian More articles by this author Nadine Khouzam More articles by this author Andrew Freedman More articles by this author S. Scott Sparks More articles by this author Expand All Advertisement PDF DownloadLoading ...

Abstract 22: Racial And Ethnic Differences In Bystander Cardiopulmonary Resuscitation For Witnessed Out-of-Hospital Cardiac Arrest

Background: Racial disparities in bystander cardiopulmonary resuscitation (CPR) treatment contributes to inequities in survival for out-of-hospital cardiac arrest (OHCA). Whether bystander CPR rates differ by race/ethnicity for witnessed OHCAs in public settings is unclear but critical to understand for informing public health interventions. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified 110,054 witnessed OHCAs during 2013-2019. Using hierarchical logistic regression, we compared rates of bystander CPR in Blacks/Hispanics vs. Whites for OHCAs at home vs. in public locations, overall and by neighborhood race and income groups. Results: Overall, 35,469 (32.2%) witnessed OHCAs occurred in Black/Hispanic individuals and 25,758 (23.4%) OHCAs occurred in public locations. Blacks/Hispanics were less likely to receive bystander CPR at home (38.5% vs. 47.4% for Whites; adjusted OR [aOR]=0.74 [95% CI: 0.71-0.76]) and in public (45.6% vs. 60.0%; aOR=0.59 [0.56-0.63]), and the magnitude of this disparity was greater for OHCAs occurring in public ( P for interaction <0.001). Lower bystander CPR rates for Blacks/Hispanics at home and in public were found in majority Black/Hispanic, Integrated, and predominantly White neighborhoods ( Table ), and the magnitude of this difference was greater for public OHCAs in each neighborhood race/ethnicity stratum (all P- values for interaction < 0.02). A similar pattern was found in high, middle, and low-income neighborhoods, with lower bystander CPR rates for Blacks/Hispanics at home and in public and a larger treatment disparity for OHCAs in public vs. at home in each income strata (all P- values for interaction < 0.001). Conclusions: Black and Hispanic victims of witnessed OHCA are less likely to receive potentially life-saving bystander CPR, as compared with White patients, and the magnitude of this disparity was greater for OHCAs witnessed in public than at home.

Behind Gentrification’s Gloss

Policy and scholarly debates on gentrification have mainly focused on displacement or improvements to neighborhood amenities. Less attention has been paid to actively worsening conditions for residents who don’t leave and for whom poor housing conditions are a perverse consequence of gentrification. Mapping city data on apartment code violations, we find that substandard housing conditions are surprisingly concentrated in gentrifying areas and not just low-income neighborhoods. Drawing on ethnographic observations our research finds that in gentrification while bringing new amenities to neighborhoods, can also give strong incentives to landlords to mistreat tenants in an attempt to drive them out intentionally.

MP26-14 ASSOCIATIONS OF FOOD ACCESS AND NEIGHBORHOOD WALKABILITY WITH URINARY RISK FACTORS FOR KIDNEY STONE DISEASE

You have accessJournal of UrologyCME1 May 2022MP26-14 ASSOCIATIONS OF FOOD ACCESS AND NEIGHBORHOOD WALKABILITY WITH URINARY RISK FACTORS FOR KIDNEY STONE DISEASE Joseph Crivelli, David Redden, Naim Maalouf, Kyle Wood, Dean Assimos, and Gabriela Oates Joseph CrivelliJoseph Crivelli More articles by this author , David ReddenDavid Redden More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , Kyle WoodKyle Wood More articles by this author , Dean AssimosDean Assimos More articles by this author , and Gabriela OatesGabriela Oates More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Differences in nutrition and lifestyle can explain some differences in 24-hour urine measurements among kidney stone formers. Socioeconomic aspects of these factors underlying stone formation require further investigation. We evaluated associations of neighborhood indices of food access and walkability with 24-hour urine measurements among patients with kidney stone disease (KSD). METHODS: We performed a retrospective analysis of adult patients with KSD evaluated with 24-hour urine collection (2001-2020). Based on the Food Access Research Atlas, low-income neighborhoods >0.5 miles (urban areas) or >10 miles (rural areas) from a full-service grocery store met the definition of low food access. Using the National Walkability Index (NWI), we identified neighborhoods with low walkability (NWI ≤5.75). We then assessed associations of these measures of food access and walkability with groupings of 24-hour urine abnormalities (stone risk factors and dietary factors, as defined by a commercial vendor; see Table) through multivariable logistic regression, as well as individual 24-hour urine measurements through analysis of covariance (ANCOVA) with adjustment for multiple testing. RESULTS: Among 1,119 patients with KSD and at least one adequate 24-hour urine collection based on urinary creatinine, 173 (15.5%) were from neighborhoods with low food access and 516 (46.1%) were from neighborhoods with low walkability. Using multivariable logistic regression (Table), patients from neighborhoods with low food access had higher odds of multiple (>1) stone risk factors (odds ratio: 1.78, 95% confidence interval: 1.03 to 3.09), but not multiple dietary factors. Patients from neighborhoods with low walkability did not have increased odds of multiple stone risk factors or dietary factors. Using ANCOVA, neighborhoods with low food access and or low walkability were not associated with significant differences in individual 24-hour urine measurements. CONCLUSIONS: Among patients with KSD, residence in a neighborhood with low food access was associated with multiple stone risk factors on 24-hour urine testing, though there were no significant differences in individual urinary measurements. The contribution of other sociodemographic factors to 24-hour urine abnormalities should be evaluated. Source of Funding: NIH 5P20DK119788 (DA) and 5K08DK115833 (KW) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e445 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Crivelli More articles by this author David Redden More articles by this author Naim Maalouf More articles by this author Kyle Wood More articles by this author Dean Assimos More articles by this author Gabriela Oates More articles by this author Expand All Advertisement PDF DownloadLoading ...

Water Stress, Peri-Urbanization, and Community-Based Water Systems: A Reflective Commentary on the Metropolitan Area of Mexico City

With a population of over 22 million, Mexico City's metropolitan area is facing enormous water security challenges. Its supply heavily relies on overdraft of groundwater and import from neighboring basins, leading to problems such as subsidence and raising concern over its sustainability. The impacts of the water stress in Mexico City are highly unequal across the metropolitan area and particularly severe in low-income peri-urban neighborhoods. This paper will first review the current water stress in Mexico City, its impacts on vulnerable communities, as well as some existing technical and institutional approaches aiming to tackle these challenges. We will then focus on the community-based water management systems in Mexico City's peri-urban areas, based on the case of Tecámac, one of the 59 municipalities that form the conurbation area. We will discuss the local water politics in the municipality, the historical evolution of the community-based water system, SAPTEMAC, as well as its current agenda. This essay highlights the importance of incorporating the community-based water systems in the development toward a solution to the water crisis in megacities like Mexico City: not only do they serve as provider of potable water to a considerable number of households, but they also represent a collective resistance against the speculation-driven (peri) urbanization and can make substantial contribution to the promotion of a comprehensive water reform in the country.

Lay Health Promoters Empower Neighbourhoods-Results From a Community-Based Research Programme in Southern Sweden.

This article focuses on the role of lay health promoters in the Lindängen initiative, a community-based participatory research (CBPR) programme for health promotion that started 2016 in a low-income neighbourhood in the outskirts of Malmö, southern Sweden. The programme aimed to support equitable health and develop an innovative model for community health promotion. The purpose of this article is to describe the role of the lay health promoters in the initiative and discuss the challenges of their position mediating between residents of the neighbourhood and the established institutions, using interviews, meeting notes and focus groups sessions with the health promoters and local stakeholders. Lay health promoters' role and function developed in a collaborative process of networking with local stakeholders and citizens in local meeting places. Their work was based on their credibility in their role, in combination with the use of a CBPR model that was open to innovation, with a strong focus on actively engaging members of the community. This allowed the lay health promoters to take political and social stances towards various issues, and to start to concretely address the social determinants of health in the community, as well as express recommendations to policymakers. Based on these experiences, the lay health promoters gained clearer insights into the institutional and structural conditions that impact their community. The position they had in the process of the programme resulted in empowerment and a new local association for health promotion; LindängenKraft (LindängenPower) driven by the health promotors and community members.

More visible greenspace, stronger heart? Evidence from ischaemic heart disease emergency department visits by middle-aged and older adults in Hubei, China

Awareness is increasing that greenspace is beneficial for people’s heart health. While a plethora of studies have focused on the relationship between neighbourhood greenspace and cardiovascular diseases in the general population, scant attention has been given to ischaemic heart disease (IHD) emergency department visits for middle-aged and older adults. This study aimed to systematically explore the association between residential street view greenspace (SVG) exposure and IHD emergency department visits for middle-aged and older adults in Chinese cities. The IHD mortality and recovery time of surviving patients were treated as dependent variables. We used street view data to assess residential SVG, and we also distinguished between trees (SVG-tree) and grasses (SVG-grass) when calculating SVG. The results showed that SVG-grass is negatively associated with IHD mortality and recovery time from IHD. However, there is no evidence that SVG-tree is related to IHD. Hence, the stratified analysis indicates that that the effect of SVG on IHD varies significantly by individual demographic and socioeconomic characteristics. Male patients, older patients and patients living in low-income neighbourhoods can benefit more from SVG exposure. Our findings suggest the necessity of providing sufficient residential visible vegetation, especially grassland, to promote heart health in Chinese urban settings.

Health-Seeking Behaviour for Childhood Ailments in Caregivers of Under-Five Children in an Urban Resettlement Colony in Delhi, India

This explorative qualitative study assesses the health-seeking behaviour for childhood ailments in caregivers of under-five children in a low-income neighbourhood in Delhi, India during July-September 2021. A total of 17 caregivers (mothers) of eight male and nine female under-five children were enrolled, with the mother being the caregiver in most (94%) cases.Caregivers consulted on common childhood ailments from multiple sources, including family, neighbours, healthcare providers (both licensed and unlicensed), frontline workers, and local pharmacists. The internet was often used as a source of child health information due to its ease of access but often "confused" caregivers due to the presence of too much information.Health-seeking behaviour of caregivers for childhood ailments could range from self-medication, local pharmacist dispensing, and private and public healthcare providers. Factors that influenced preference for the healthcare facility or provider were accessibility issues (waiting time, queuing), perceived physician competence, and associated out-of-pocket expenses. Caregivers reported dissatisfaction with government health facilities because of shorter operational hours, overcrowding, suboptimal sanitation, queuing with limited seating arrangements, and occasionally discourteous health staff. Self-medication and over-the-counter use of antibiotics was high due to a lack of awareness of the challenges of antibiotic resistance or any perceived side effects.Preference for unlicensed practitioners for medical treatment was low and based on long-term familial beliefs and acceptance. However, traditional practitioners enjoyed a high level of trust in the community from shared cultural values, enjoining attenuation of the perceived non-biological agents of childhood illnesses through non-medical supernatural interventions.

Perceptions of Good Health and Impact of COVID-19 Among Adolescents in a Low-Income Urban Agglomerate in Delhi, India: A Qualitative Study.

Adolescents constitute 16% of the global population and are susceptible to adverse health and illness from substance abuse, unhealthy diet, physical inactivity, and high-risk sexual behaviors. We conducted this study to assess the perceptions of good health, health-seeking behavior, and health service utilization among adolescents living in a low-income urban neighborhood after the second wave of the COVID-19 pandemic. A total of 23 adolescents, including 12 males and 11 females, were interviewed. Adolescents' perceived body image and size considerations apart from functioning at an optimum physical capacity as the principal attributes of good health, which was possible through the intake of a healthy diet and exercise. Adolescents were likely to be aware of the addiction potential and risk of cancer from using tobacco and alcohol, but attitudes towards eschewing their use were ambivalent. Adolescents perceived themselves as lacking access to reliable, adequate, and validated sources of sexual and reproductive health information. Knowledge and utilization of adolescent health services in this area were negligible, suggestive of the need to strengthen these services and improve the program outreach.