Associations Between Food Insufficiency and Health Conditions Among New York City Adults, 2017-2018

Food insecurity, a critical social determinant of health, has been measured nationwide in the United States for years. This analysis focuses on food insufficiency, a more severe form of food insecurity, in New York City (NYC) and its association with self-reported physical and mental health conditions. Data from the 2017-2018 NYC Community Health Survey were used to estimate the prevalence of food insufficiency citywide, by neighborhood, and across selected socioeconomic characteristics. Multivariable logistic regression was used to explore the associations between food insufficiency and hypertension, diabetes obesity, and depression, adjusting for selected sociodemographic characteristics. Approximately 9.4% (95% CI:8.8-10.0%]) of adult New Yorkers aged 18 + reported food insufficiency, with neighborhood variation from 1.7% (95% CI:0.5-6.2%) to 19.4% (95% CI:14.2-25.8%). Food insufficiency was more prevalent among Latinos/as (16.9%, 95% CI:15.5-18.3%, p < 0.001), Black (10.1%, 95% CI:8.8-11.5%, p < 0.001) and Asian/Pacific Islanders (6.6%, 95% CI:5.4-8.1%, p = 0.002) compared to White New Yorkers (4.2%, 95% CI:3.5-5.1%). Prevalence of food insufficiency was higher among NYC adults with less than a high school education, (19.6%, 95% CI:17.7-21.6%), compared to college graduates (3.8%, 95% CI:3.2-4.4%, p < 0.001). In the adjusted logistic regression model, food insufficiency was associated with diabetes (OR = 1.36; 95% CI:1.12-1.65), hypertension (OR = 1.58; 95% CI:1.32-1.89]) and depression (OR = 2.98; 95% CI:2.45-3.59), but not with obesity (OR = 0.99; 95% CI:0.84-1.21). Our findings highlight food insufficiency at an important intersection of inequity and disease burden which is critical to informing public health interventions in the context of a large, densely populated metropolis like NYC.

A Study of Households with Children and Firearms in Baltimore, Maryland

Firearm injuries are the leading cause of death among children and adolescents in the US. Safe storage of firearms in the home is one of the most effective ways of preventing firearm injuries in children. This feasibility study was conducted in both the pediatric and general Emergency Departments of a large urban academic medical center in a community with high rates of firearm injuries in children. The objective was to pilot a survey seeking to describe sociodemographic characteristics, firearm specific risk factors, and firearm storage practices of households with children in the community. One hundred participants completed a survey containing items regarding participant demographics, household features, firearm ownership, firearm characteristics, and storage practices. Descriptive statistics were used to define sociodemographic characteristics of the enrolled population, comparing those with firearms to those without, and to describe firearms and storage practices of firearm owners in households with children. Of 100 participants, 30 lived in households with firearms and children. Most firearms in homes with children were stored locked and unloaded most of the time; however, 30% of participants with firearms and children in the home reported not consistently storing a firearm locked and unloaded. The most common reason given for not storing a firearm in the safest manner possible was that storing a firearm locked and unloaded would make it difficult to access quickly. Engaging families with children in discussions around firearm prevention during Emergency Department visits is feasible and may have implications for future efforts to promote safe firearm storage practices.

Barriers and Facilitators to HIV Service Access among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in Metropolitan Atlanta-a Qualitative Analysis

Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. Interviews were audio recorded, transcribed, and translated, if needed. Initial data analyses were conducted rapidly in the field to inform public health actions. We then conducted additional analyses including line-by-line coding of the interview transcripts using a thematic analytic approach. We identified four main themes. First, inequity in language access was a predominant barrier. Second, multiple social and structural barriers existed. Third, HLMSM encountered intersectional stigma. Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population.

Mapping pandemic responses in urban Indigenous Australia: Reflections on systems thinking and pandemic preparedness

OBJECTIVES

We investigate some of the strengths and challenges associated with Covid-19 responses in urban Indigenous communities in Brisbane, Australia. Our research reflects on the interconnected dynamics that impact health outcomes and mitigate or exacerbate the risk of Covid-19 spreading within urban Indigenous communities.

METHODS

Three systems thinking workshops were held in 2021 with Indigenous and non-Indigenous stakeholders (N15/workshop) from State and Federal services, along with Aboriginal Community Controlled Health Organisations. All worked in the urban Indigenous health sector. Stakeholders produced a Causal Loop Diagram (CLD) incorporating the critical feedbacks determining the dynamics influencing health outcomes. The aim of the research was to help stakeholders' build awareness of how the structure of the system influences health outcomes.

RESULTS

Stakeholders identified 6 key dynamics which have a negative or positive impact on mitigating risks of Covid-19 infection. By mapping these dynamics within a CLD, 7 intervention points were identified.

CONCLUSIONS

Systems thinking provides a useful tool in identifying the complexities associated with navigating health challenges, but further research is needed to develop frameworks that work in conjunction with Indigenous Australian methodologies.

IMPLICATIONS FOR PUBLIC HEALTH

Indigenous voices and communities must lie central to health responses/policies for Indigenous peoples. When systems thinking is done by or in collaboration with stakeholders it provides a visual language that can help design public health policy. What can be ascertained is that their effectiveness is predicated on systems thinking's integration with Indigenous methodologies that acknowledges Indigenous self-determination and challenges Eurocentric representations of health and Indigeneity.

Demystifying normalized difference vegetation index (NDVI) for greenness exposure assessments and policy interventions in urban greening

Most nature and health research use the normalized difference vegetation index (NDVI) for measuring greenness exposure. However, little is known about what NDVI measures in terms of vegetation types (e.g., canopy, grass coverage) within certain analysis zones (e.g., 500 m buffer). Additionally, exploration is needed to understand how to interpret changes in average NDVI (e.g., per 0.1 increments) exposure in relation to changes in vegetation amount and types. In this study, we aimed to explore what vegetation types and amounts best explain the average NDVI and how changes in average NDVI values indicate changes in different vegetation coverages. We used spatial modeling to sample mean NDVI and percentages of vegetation for sample locations within the Greater Manchester case study area. We fitted linear, nonlinear, and mixed multivariate and univariate generalized additive models (GAMs) for multiple spatial scales to identify the relationships between NDVI and vegetation amount and types. Our results showed that the relationships between NDVI and individual vegetation types mostly follow nonlinear trends. We found that canopy and shrubs coverage exhibited a greater influence on mean NDVI exposure values than grass coverage at 300 and 500 m indicating that NDVI values are sensitive to certain types and amounts of vegetation within various buffer zones. We also identified increment in mean NDVI exposure values at lower, mid, and high ranges might be associated with varying changes in total greenspace percentage and individual vegetation types. For instance, at 300 m buffer, an increment of mean NDVI in the lower range (e.g., from 0.2 to 0.3) is associated with an about 17% increase in greenspace percentage. Overall, interpreting changes in NDVI values for urban greening interventions would require careful evaluation of the relative changes in types and quantities of vegetation for different buffer zones.

Urbanicity-Perspectives from Neuroscience and Public Health: A Scoping Review

Urban residency is associated with exposure to environmental factors, which can influence health in many ways. Neuroscientific research, as well as Public Health research, aim towards broadening evidence in the field of Urban Health. However, it is unclear whether the association between urban living and mental illnesses is causal rather than explainable by other selective effects. This review seeks to gather information on the current evidence regarding urban living and neurological outcomes to demonstrate how Public Health and Neuroscience could complement each other in the field of Urban Health. A scoping review was conducted in four electronic databases according to the PRISMA-statement guidelines. 25 empirical studies were included. Outcomes such as schizophrenia and psychotic disorders, social and cognitive functioning were scrutinised. Evidence was found for alteration of brain functioning and brain structure. Most studies researching cognitive functioning or cognitive decline displayed possible protective effects of urban living compared to rural living. The different study designs in Public Health and Neuroscience could profit from each other. Although the comparability of studies is limited by the inconsistent assessments of urbanity. Synergies and potentials to combine aspects of Public Health and Neuroscience in the field of Urban Health to improve population health became apparent.

Risk of Thromboembolic Events Following COVID-19 Diagnosis Without Hospitalization

Current research shows no increased risk of thromboembolic events with mild COVID-19 but does not account for comorbidities. The aim of this study was to examine the incidence of thromboembolic events, including pulmonary embolism, cerebral infarction, and deep vein thrombosis, in nonhospitalized patients diagnosed with COVID-19 while accounting for comorbidities such as diabetes, asthma, COPD and cancer. METHODS: We completed a large retrospective observational analysis of adult patients within a large urban health system. RESULTS: Using a logit framework (with and without propensity score weighting), there was no increased risk of thromboembolic events among patients positive for SARS-CoV-2 who did not require hospitalization for COVID-19. CONCLUSION: This data suggest prophylactic anticoagulation is likely not warranted in the outpatient setting.

Examining the Impact of COVID-19 on Upper Manhattan Community-Based Organizations: A Qualitative Analysis of Employee Focus Groups

Community-based organizations (CBOs) play a key role in assisting local communities, especially those in under-resourced areas, through their deep knowledge of the community's needs and available resources. We examined perceptions of COVID-19's impact on health-related services in CBOs located in Upper Manhattan, New York City (serving East Harlem, Central Harlem, Morningside Heights and Hamilton Heights, and Washington Heights and Inwood). Three focus groups were conducted on Zoom in November 2020; focus groups were composed of participants employed at CBOs in this catchment area. Deidentified interview transcripts were evaluated using an iterative process of thematic content analysis. We identified five major themes related to the impact of COVID-19 on community needs: 1) increased mistrust and decreased service utilization, 2) breakdowns in communication, 3) shift in need, 4) increased risk factors for negative health outcomes among staff and community, and 5) decreased funding and an uncertain future. Because of the pandemic, CBOs have pivoted to cater to the immediate and changing needs of the community and, in doing so, revised their menu of services as well as their service delivery model. In trying to maintain connectivity with and the trust of community members, participants had to construct novel strategies and develop new outreach strategies; participants also recognized the role strain of trying to balance community needs with home responsibilities. Given these findings, concern arises around the long-term health and well-being of community members and participants. The government must provide the necessary resources to ensure the viability of CBOs and create a stronger infrastructure for future emergencies.

Using mHealth Technologies to Promote Public Health and Well-Being in Urban Areas with Blue-Green Solutions

European and International cities face crucial global geopolitical, economic, environmental, and other changes. All these intensify threats to and inequalities in citizens' health. The implementation of Blue-Green Solutions in urban and rural areas have been broadly used to tackle the above challenges. The Mobile health (mHealth) technologies contribution in people's well-being has found to be significant. In addition, several mHealth applications have been used to support patients with mental health or cardiovascular diseases with very promising results. The patients' remote monitoring can be a valuable asset in chronic diseases management for patients suffering from diabetes, hypertension or arrhythmia, depression, asthma, allergies and others. The scope of this paper is to present the specifications, the design and the development of a mobile application which collects health-related and location data of users visiting areas with Blue-Green Solutions. The mobile application has been developed to record the citizens' and patients' physical activity and vital signs using wearable devices. The proposed application can also monitor patients physical, physiological, and emotional status as well as motivate them to engage in social and self-caring activities. Additional features include the analysis of the patients' behavior to improve self-management. The "HEART by BioAsssist" application could be used as a health and other data collection tool as well as an "intelligent assistant" to monitor and promote patient's physical activity.

Pervasive Monitoring of Public Health and Well-Being in Urban Areas with Blue-Green Solutions

The urban environment seems to affect the citizens' health. The implementation of Blue-Green Solutions (BGS) in urban areas have been used to promote public health and citizens well-being. The aim of this paper is to present the development of an mHealth app for monitoring patients and citizens health status in areas where BGS will be applied. The "HEART by BioAsssist" application could be used as a health and other data collection tool as well as an "intelligent assistant" to monitor and promote patient's physical activity in areas with Blue-Green Solutions.

Using cause-effect graphs to elicit expert knowledge for cross-impact balance analysis

Cross-impact balance (CIB) analysis leverages expert knowledge pertaining to the nature and strength of relationships between components of a system to identify the most plausible future ‘scenarios’ of the system. These scenarios, also referred to as ‘storylines’, provide qualitative insights into how the state of one factor can either promote or restrict the future state of one or multiple other factors in the system. This paper presents a novel, visually oriented questionnaire developed to elicit expert knowledge about the relationships between key factors in a system, for the purpose of CIB analysis. The questionnaire requires experts to make selections from a series of standardized cause-effect graphical profiles that depict a range of linear and non-linear relationships between factor pairs. The questionnaire and the process of translating the graphical selections into data that can be used for CIB analysis is described using an applied example which focuses on urban health in Latin American cities.•

A questionnaire featuring a set of standardized cause-effect profiles was developed.

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Cause-effect profiles were used to elicit information about the strength of linear and non-linear bivariate relationships.

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The questionnaire represents an intuitive visual means for collecting data required for the conduct of CIB analysis.

Immigration and use of public spaces and food stores in a large city: A qualitative study on urban health inequalities

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In the low- and middle-SES neighbourhoods there were a difficult coexistence with immigrants.

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Some of the interviewees and participants in FGs identified the immigrants who lived in their neighbourhoods as a threat, specially in the use of the public space.

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The food stores managed by immigrants were rejected and denounced by scarce quality of their foods.

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Demand for small traditional food stores in all neighbourhoods.

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The lack of social contact can be harmful for the health of immigrants and native residents.

The analysis of urban health transformations must include the study of how neighbourhoods are influenced by demographic changes such as immigration. The objective of this study was to analyse how the relationship between native and immigrant residents in neighbourhoods with different socio-economic levels influenced the use of urban health assets, such as public spaces and food stores. Three Madrid neighbourhoods of different socio-economic levels were selected and studied by conducting 37 semi-structured interviews and 29 focus groups. Data analysis was based on qualitative sequential discourse.

The main finding was that the presence of immigrants in Madrid neighbourhoods, especially with low and medium socio-economic levels, was perceived negatively, affecting the use of public spaces and food stores. This negative perception unfolded in three dimensions: (1) difficulties for natives and immigrants to live together; (2) limitations on using public spaces caused by a feeling of insecurity; (3) criticism of immigrant food stores, especially Chinese-run food stores. Our findings showed a worrisome lack of social contact between immigrants and native residents, which affected the use of urban health assets, such as public spaces and food stores.

Spatial inequalities of retail food stores may determine availability of healthful food choices in a Brazilian metropolis

OBJECTIVE

To examine the association between economic residential segregation and food environment.

DESIGN

Ecological: Food stores categorised according to the NOVA classification were geocoded, and absolute availability was calculated for each neighbourhood. Segregation was measured using local Gi* statistic, a measure of the sd between the economic composition of a neighbourhood (the proportion of heads of households in neighbourhoods earn monthly income of 0 to 3 minimum wages) and larger metropolitan area, weighted by the economic composition of surrounding neighbourhoods. Segregation was categorised as high (most segregated), medium (integrated) and low (less segregated or integrated). A proportional odds models were used to model the association between segregation and food environment.

SETTING

Belo Horizonte, Brazil.

PARTICIPANTS

Food stores.

RESULTS

After adjustment for covariates, neighbourhoods characterised by high economic segregation had fewer food stores overall compared with neighbourhoods characterised by low segregation (OR = 0·56; 95 % CI (0·45, 0·69)). In addition, high segregated neighbourhoods were 49 % (OR = 0·51; 95 % CI (0·42, 0·61)) and 45 % (OR = 0·55; 95 % CI (0·45, 0·67)) less likely to have a high number of food stores that predominantly marketed ultra-processed foods and mixed food stores, respectively, as compared with their counterparts.

CONCLUSIONS

Economic segregation is associated with differences in the distribution of food stores. Both low and high segregation territories should be prioritised by public policies to ensure healthy and adequate nutrition as a right for all communities. The former must continue to be protected from access to unhealthy commercial food outlets, while the latter must be the locus of actions that limit the availability of unhealthy commercial food store.

Political Economies of Acute Childhood Illnesses: Measuring Structural Racism as Mesolevel Mortgage Market Risks

Objectives

Health studies of structural racism/discrimination have been animated through the deployment of neighborhood effects frameworks that engage institutionalist concerns about sociopolitical resources and mobility structures. This study highlights the acute illness risks of place-based inequalities and neighborhood-varying race-based inequalities by focusing on access to and the regulation of mortgage markets.

Design

By merging neighborhood data on lending processes from the Home Mortgage Disclosure Act with individual health from the Project on Human Development in Chicago Neighborhoods, this article evaluates the acute childhood illness risks of four mutually inclusive, political economies using multilevel generalized linear models.

Setting

Chicago, IL, USA.

Participants

Youth aged 0 to 17 years.

Main Outcome Measures

The prevalence of 11 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis, skin infection, pneumonia, urinary tract infections, fungal disease, mononucleosis) and the past-year frequencies of 6 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis) are evaluated.

Methods

Multilevel logistic regression.

Results

The most theoretically consistent predictor of illness is a measure identifying neighborhoods with above-city-median levels of racial disparities in the regulation of loans - a mesolevel measure of structural racism. In areas with high levels of minority-White differences in less-regulated credit, youth are more likely to have a range of acute illnesses and experience them at more frequent intervals in the past year.

Conclusions

This article highlights the substantive and methodological importance of focusing on multidimensional representations of institutionalized political economic inequalities circumscribed and traversed by the power relations established by institutions and the state.

Implementing Prevention against Tobacco Dependence (PAD) "Toward the Tobacco-Free Schools, Neighborhoods, and Cities": Study Protocol

Background: Although tobacco consumption in Iran has decreased in recent years, in 2010, the exposure to cigarette smoke was the fifth leading risk factor for death in Iran. This article is presenting the protocol for the prevention against tobacco dependence (PAD) project, an initiative planned and implemented by the Iranian Anti-Tobacco Association (IATA) of Iran in the city of Varamin.

Study design: A prospective cohort study.

Methods: This project is carried out based on a participatory community-oriented approach and an action research method. It includes four inter-related, prospective studies phases; pilot, tobacco-free school (TFS), tobacco-free neighborhood (TFN), and tobacco-free city (TFS). The measuring tools for each phase were designed primarily using CDC and WHO guidelines and preliminary details were identified. Each phase is a combination of different methods (including systematic observation, questionnaire, heuristic interview, and structured interview). The studies will examine twelve goals and meet 9 project objectives in a comprehensive evaluation of ongoing progress with TFS, TFN, and TFC.

Discussion: This project seeks to achieve indicators of tobacco-free schools, neighborhoods, and cities through direct and indirect education of all the target groups in the community. Participation of stakeholders and supporters in problem-solving can increase the effectiveness and influence of the project. The outcomes of the first two phases will be expanded to the wider settings.

Hygienic Requirements of Urban Living Environment in the Russian Federation and in Italy: a comparison

AIM

Urban planning tries to contain and regulate the uncontrolled growth of cities, encouraging their sustainable development at environmental, social and health levels. In the present work, the authors compare the regulatory frameworks of the Russian Federation and of Italy, with particular attention paid to the urban aspects of living spaces.

METHODS

Considering the extant normative production in the two countries, the authors examine national legislation for Italy and federal legislation for Russia, mainly taking into account the following aspects: urban planning tools and environmental and sanitary protection of living spaces.

RESULTS

Hygienic-sanitary requirements regarding living environment in Russia are essentially expressed by two regulatory systems (SNiP and SanPiN), while in Italy they are regulated by the D.M. 07/05/1975. The main principles of urban planning in Russia are expressed by federal standards, while in Italy they are incorporated in the Municipal General Plan (PRG) and in the various local regulations, where all the superordinate regulations are summarized. Finally, aspects related to environmental quality in both countries are governed by various specific laws (federal and state); a complex system of rules that take into account potential impacts on health and the environment.

CONCLUSIONS

The authors reckon that clear and updated regulatory tools should be developed, especially in Italy that lags behind, regarding the building and urban hygiene, relying on the most recent acquisitions of international scientific literature in order to guarantee the highest standards in Public Health safeguard.

Measuring the expected increase in cycling in the city of Milan and evaluating the positive effects on the population's health status: a Community-Based Urban Planning experience

BACKGROUND

It's scientifically known that inactivity is one of the major risk factors for Non-Communicable Diseases. One of the elements affecting the choice of transport mode, regarding circulation in the city, is the cities' urban morphology, i.e. the infrastructural facilities for the slow mobility service. Cyclability, in fact, can help to increase daily physical activity level, therefore becoming a protective factor for individual health.

METHODS

After a literature review about the state of the art regarding the correlation between built environment, active transport and quantification of the physical activity level, we have developed a specific questionnaire to collect information about current and forecast use of bicycle, in case of improvement and implementation of the cycling network. The questionnaire also investigated social and health aspects concerning the anamnesis of the interviewees (age, gender, health status, sport activity performed, etc) and users' opinions about existing infrastructure and planned interventions, designed to promote cycling mobility. Aim of the research was to quantify the increase of physical activity people would have realized in front of an improvement of the specific infrastructures, and the expected positive effects in terms of health.

RESULTS

The collected data (343 interviewed in a district of Milan, named "Zona 7") demonstrate that through the implementation of the cycle network, there would be more cyclists to practice the 150 minutes weekly of physical activity recommended by WHO: time spent in cycling, indeed, would increases by 34.4% compared to the current level of cyclability, as detected by our survey.

CONCLUSIONS

The investigation confirmed that urban interventions, especially those in small-scale, could play a key role in the promotion of healthy lifestyles, inducing therefore important positive effects on the population health. It was also carried out an application of the WHO "Health Economic Assessment Tool" to evaluate the benefits in terms of Non-Communicable Diseases' reduction, specifically a provisional quantification of deaths saved.

Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter

The Erice 50 Charter titled "Strategies for Diseases Prevention and Health Promotion in Urban Areas" was unanimously approved at the conclusion of the 50th Residential Course "Urban Health. Instruments for promoting health and for assessing hygienic and sanitary conditions in urban areas", held from 29th March to 2nd April 2017 in Erice, at the "Ettore Majorana" Foundation and Centre for Scientific Culture and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group "Building Hygiene" of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). At the conclusion of the intense learning experience during the Course, with more than 20 lectures, workshops and long-lasting discussions between Professors and Students, the participants identified the major points connecting urban features and Public Health, claiming the pivotal role of urban planning strategies for the management of Diseases Prevention and Health Promotion activities. The Erice 50 Charter is configured as a Decalogue for Healthy Cities and as a Think Tank for designing effective strategic actions and best practices to develop urban regeneration interventions and improve the urban quality of contemporary cities. The Decalogue is structured into the following key strategic objectives: 1. Promoting urban planning interventions that address citizens towards healthy behaviours; 2. Improving living conditions in the urban context; 3. Building an accessible and inclusive city, with a special focus on the frail population; 4. Encouraging the foundation of resilient urban areas; 5. Supporting the development of new economies and employment through urban renewal interventions; 6. Tackling social inequalities; 7. Improving stakeholders' awareness of the factors affecting Public Health in the cities; 8. Ensuring a participated urban governance; 9. Introducing qualitative and quantitative performance tools, capable of measuring the city's attitude to promote healthy lifestyles and to monitor the population's health status; 10. Encouraging sharing of knowledge and accessibility to informations. Finally, all the participants underlined that a multidisciplinary team, composed of Physicians specialized in Hygiene, Preventive Medicine, Public Health and Technicians as Architects, Urban planners and Engineers, is needed to deepen the research topic of Urban Health.

Public health and urban planning: a powerful alliance to be enhanced in Italy

Urban planning has played and still plays a key role in improving urban health and indoor health. The authors sketch out the historical evolution of the relationships between Public Health and urban planning, in particular to what happened in Italy during the past 150 years. The authors suggest some lines for further research, but also describe some interventions that could obtain practical results in terms of health gains for the population.

Needed: Global Collaboration for Comparative Research on Cities and Health

Over half of the world's population lives in cities and United Nations (UN) demographers project an increase of 2.5 billion more urban dwellers by 2050. Yet there is too little systematic comparative research on the practice of urban health policy and management (HPAM), particularly in the megacities of middle-income and developing nations. We make a case for creating a global database on cities, population health and healthcare systems. The expenses involved in data collection would be difficult to justify without some review of previous work, some agreement on indicators worth measuring, conceptual and methodological considerations to guide the construction of the global database, and a set of research questions and hypotheses to test. We, therefore, address these issues in a manner that we hope will stimulate further discussion and collaboration.

The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal

Background

While the initiation of breastfeeding is universal in Nepal, little has been reported on formula feeding practices. This study aimed to report the prevalence of, and factors associated with, the use of infant formula as supplementary feeds in the Western region of Nepal.

Methods

A community-based cohort study was conducted to collect infant feeding information among 735 postpartum mothers using structured questionnaires. Complete formula feeding data were collected from 711 women in the first, fourth and sixth month postpartum. Factors independently associated with formula feeding were investigated using multiple logistic regression.

Results

All mothers were breastfeeding their infants at the time of recruitment. The prevalence of formula feeding was 7.5 % in the first month and 17 % in the sixth month. About a quarter of mothers (23.8 %) reported providing infant formula at least once during the first six months of life. Infant formula was used commonly as top-up food. Stepwise logistic regression showed that infants born to families residing in urban areas (adjusted odds ratio (aOR): 2.14; 95 % confidence interval (CI): 1.37 to 3.33), mothers with higher education (aOR: 2.08; 95 % CI: 1.14 to 3.80), and infants born by caesarean section (aOR: 1.96; 95 % CI: 1.21 to 3.18) were at greater risk of formula feeding.

Conclusion

The current findings indicate that health workers should support mothers to initiate and continue exclusive breastfeeding particularly after caesarean deliveries. Furthermore, urban health programs in Nepal should incorporate breastfeeding programs which discourage the unnecessary use of formula feeding. The marketing of formula milk should be monitored more vigilantly especially in the aftermath of the April 2015 earthquakes or other natural disasters.

Shanghai rising: health improvements as measured by avoidable mortality since 2000

Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai's healthcare system by analyzing "Avoidable Mortality" (AM) - deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000-10 and compare Shanghai's experience to other mega-city regions - New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai's population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai's establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities - both in China and worldwide - can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status.