Mahasin S. Mujahid

Urban community-based gun violence prevention programs engage those with the greatest risk of perpetrating violence and provide them with services and supports to help them change their behaviors. Empirical studies of this public-health-oriented strategy, called community violence intervention (CVI), have been mixed, and few have reported which risk factors are most prevalent among participants. We offer detailed descriptive data about the risks and protective factors that participants in one CVI program, called Advance Peace, displayed at the onset of the intervention. Advance Peace operates in 13 cities and had over 1000 participants, or “fellows,” between January 2021 and December 2024. We found that almost 34% of fellows were under 18 years old, 70.6% were African American, and over 90% were male. More than half (52.4%) reported poor mental health, 76.7% entered with four or more Adverse Childhood Experiences (ACEs), and over 30% had over 7 ACEs; more than 56% had been shot at, and almost half had a prior firearm-related arrest and a family member killed by a gun. We found that 49.2% had both four or more ACEs and at least two-gun violence exposures. Among program participants, only 17% were receiving any social services at enrollment. We also found that more than 62% wanted to change their lifestyle, and more than half had assets and strengths that could be protective or buffering factors that might prevent future gun use. We conclude that CVI programs should capture both the risks and strengths of program participants to ensure violence prevention interventions are trauma informed and healing centered.

Background: Studies have demonstrated neighborhood structural inequities are associated with cardiovascular outcomes among breast cancer survivors. We investigated the associations between bias in mortgage lending practices (contemporary redlining and racial lending bias) and cardiovascular outcomes in women with breast cancer. Methods: Using the SEER (Surveillance, Epidemiology, and End Results)–Medicare database, we identified 51 007 Black and White women diagnosed with breast cancer between 2010 and 2014 with follow‐up through 2020. We used Home Mortgage Disclosure Act data to calculate census‐tract contemporary redlining index and racial lending bias index, and assessed indices continuously and categorically (low, moderate, or high). We used Cox proportional hazards regression to estimate multivariable‐adjusted, cause‐specific hazard ratios (HRs) for major adverse cardiovascular events, ischemic heart disease, heart failure, stroke, and cardiovascular death. Results: In the overall population, a 10%‐unit increase in redlining was associated with increased risk of major adverse cardiovascular events (HR, 1.04 [95% CI, 1.02–1.06]). Among Black women, those in high redlining neighborhoods had an increased heart failure risk compared with those in low redlining neighborhoods (HR, 1.22 [95% CI, 1.05–1.41]). Similarly, White women in high redlining neighborhoods had an increased risk of ischemic heart disease (HR, 1.23 [95% CI, 1.15–1.30]) and stroke (HR, 1.09 [95% CI, 1.03–1.16]). Black women in high racial lending bias neighborhoods had reduced cardiovascular mortality risk compared with those in low racial lending bias neighborhoods (HR, 0.69 [95% CI, 0.54–0.90]). Conclusions: We identified associations between contemporary redlining and cardiovascular outcomes among breast cancer survivors. High racial lending bias was associated with reduced cardiovascular mortality risk among Black women. Bias in mortgage lending practices may serve as a structural driver of cardiovascular disparities.

Background: Atrial fibrillation (AF) is the most common arrhythmia, affecting up to 6 million in the United States, and is associated with significant morbidity and mortality. Despite higher rates of AF clinical and social risk factors, underrepresented racial and ethnic group individuals have lower AF incidence. Structural factors, such as neighborhood‐level racial and ethnic residential segregation, have been associated with incident cardiometabolic disease, particularly among underrepresented individuals. However, as data on segregation and incident AF are sparse our objective was to examine the association of segregation on AF. Methods: Data from MESA (Multi‐Ethnic Study of Atherosclerosis; baseline 2000–2002) were used to identify those with a diagnosis of AF during follow‐up. Own‐group racial and ethnic segregation was defined by local Gi* statistic, which compares the percentage of each racial and ethnic group in a current census tract to the surrounding area. Racial‐ and ethnic‐stratified Cox proportional hazard models were used to estimate hazard ratios comparing across segregation levels. Models were adjusted for demographic, participant, and neighborhood level socioeconomic, and clinical factors. Results: Our cohort comprised 5375 participants (31% Black, 25% Hispanic/Latino, 44% White). During a median follow‐up of 16.6 years, 1035 participants (19.3%) were diagnosed with AF. Black and Hispanic/Latino participants had the highest prevalence of AF risk factors at baseline and were more likely to reside in segregated neighborhoods than White participants. After adjusting for demographic, socioeconomic, and clinical factors, neighborhood segregation was not found to be associated with AF across racial and ethnic groups. Conclusions: In this longitudinal analysis we did not observe an association between residential segregation and AF incidence for Black, Hispanic/Latino, or White participants in fully adjusted models. Further research is needed to understand how individual factors may intersect with clinical, health care, and structural factors to drive previously described differential risk of AF.

BACKGROUND: Historical redlining may contribute to racial inequities in cardiovascular health. Longitudinal studies are needed to investigate the influence of historical redlining on blood pressure (BP) and its changes over time, and to understand the role contemporary residential segregation plays in this relationship. METHODS: Using the MESA (Multi-Ethnic Study of Atherosclerosis), this study examined associations between redlining, measured using 1930s Home Owners’ Loan Corporation grades, and repeated BP measures. We used race/ethnicity-stratified 3-level mixed-effects models to assess associations between redlining and average BP, as well as changes in BP, across 6 follow-up examinations from 2000 to 2018, accounting for time-varying sociodemographic and health factors. RESULTS: The sample included 4774 adults with a mean baseline age of 61.9 years; the racial/ethnic composition was 26.7% Black, 23.9% Hispanic, 13.3% Chinese, and 36.1% White. Independent of sociodemographic factors, Black participants in redlined neighborhoods graded D had 7.26 mm Hg higher average systolic BP (95% CI, 0.99–13.54) and 3.62 mm Hg higher average diastolic BP (95% CI, 0.64–6.60), compared with those in non-redlined tracts graded A . Contemporary residential segregation modified this association such that the increase was larger in currently segregated Black neighborhoods. When assessing BP changes, we found that the difference in systolic BP for participants in D -graded neighborhoods decreased among Black participants over follow-up. There was no statistically significant association with average BP or BP changes in other racial/ethnic groups. CONCLUSIONS: These findings demonstrated that historical discriminatory policies may have a harmful impact on BP outcomes among Black adults in the United States.

Community Violence Intervention (CVI) involves recruiting likely gun violence offenders using street outreach and offering mentorship, social services and other supports to discourage future firearm violence. Grounded in public health, CVI interventions identify an individual’s risk factors and work to enhance protective and buffering factors that can help prevent a client from offending. This paper reviews evaluations of CVI interventions to understand how participants’ risk factors are defined and measured. We used keywords to identify 38 published evaluations of 32 different CVI interventions that recruited community members and used street-outreach as the primary mode of engagement. We then used the PRISMA scoping review methodology to identify categories of risk and protective factors to screen each published evaluation for whether and how they measured participants’ risk, protective and buffering factors at program onset. We found that 56% (18/32) of evaluations included some demographic information about participants and 44% (14/32) provided additional details about their educational or employment status. The criminal justice history was reported in 59% (19/32) and gang or group affiliation in 47% (15/32) of the evaluations we reviewed. The CVI participants’ history related to gun violence was documented in 53% (17/32). Far fewer evaluations documented potential assets, buffering or protective factors of CVI participants: only 16% (5/32) reported on whether any clients were receiving social services at intake and only 6% (2/32) documented any clients’ strengths or protective factors. We also found that no two programs captured the same information about gang, criminal justice, gun violence or social risk factors. Preliminary findings suggest that many CVI programs may not be capturing whether clients face known risk factors for future gun use, and that these programs rarely capture potential protective and buffering factors that might inform program service delivery and potentially enhance the likelihood that interventions will help prevent future gun use. This study aims to support the emerging field of CVI as it works to build evidence that these interventions successfully address the specific needs of urban young people and prevent them from engaging in firearm offending.

Background: Severe maternal morbidity (SMM) and its racial and ethnic inequities are the result of a mixture of risk factors ranging from clinical comorbidities to socio‐economic contexts. One under‐explored dimension is neighbourhood contexts. Objectives: In order to understand the impact of neighbourhood contexts on SMM, this study investigates the relationship between a 20‐year history of neighbourhood poverty and SMM among 8.6 million births in California from 2000 to 2018 and assesses effect measure modification by race/ethnicity and nativity. Methods: Data include hospital live births in California from 2000 to 2018 from the California Department of Public Health. The final sample for this study consisted of 8,632,436 live births. Mixed‐effects logistic regression models accounting for area‐level clustering were used to compare the odds of SMM across neighbourhood poverty histories, adjusting for sociodemographic and pregnancy‐related factors and comorbidities. Results: The prevalence of SMM was 1.2%. In fully adjusted models, neighbourhoods with persistent high poverty had 32% higher odds of SMM (OR 1.32, 95% confidence interval [CI] 1.28, 1.37), and those with persistent moderate poverty had 9% higher odds (OR 1.09, 95% CI 1.06, 1.12), compared to neighbourhoods with a persistent low poverty history. The odds of SMM were also higher in neighbourhoods with increasing poverty; 23% higher for early increase (OR 1.23, 95% CI 1.19, 1.27) and 13% higher for late increase (OR 1.13, 95% CI 1.09, 1.16). In contrast, neighbourhoods with early decreasing poverty had 11% lower odds of SMM (OR 0.89, 95% CI 0.84, 0.94) compared to persistent lowpoverty neighbourhoods. Conclusions: The findings indicate that persistent high poverty in neighbourhoods is associated with higher odds of SMM, independent of individual sociodemographic and clinical factors. The strongest associations were found among Asian, Hispanic, Pacific Islander and white birthing people. These results underscore the significance of neighbourhood poverty histories and their impact on maternal health.

Ethnic enclaves are neighborhoods formed through discriminatory policies that concentrate disadvantage in marginalized communities. Living in these neighbo

Background: To address the maternal health crisis in the United States, it is important to closely examine the epidemiologic trends of and racial and ethnic disparities in maternal cardiovascular health. Methods: We used statewide birth hospitalization and vital statistics records from California (2007–2019; N=6 117 886) to examine the prevalence, trends, and racial and ethnic disparities of hypertensive disorders of pregnancy overall (ie, chronic hypertension, gestational hypertension/preeclampsia, or eclampsia), and chronic hypertension and gestational hypertension/preeclampsia separately. We also examined a construct indicating ideal cardiovascular health before and during pregnancy using the subset of data with information available on clinical cardiovascular health indicators (ie, hypertension, diabetes, smoking, body mass index [kg/m ² ], and gestational weight gain adjusted for gestational age; N=5 636 185). To quantify racial and ethnic disparities, we used modified Poisson regression models (with robust standard errors), controlling for sociodemographic characteristics, pregnancy‐related factors, and year fixed effects. Results: The age‐standardized prevalence of adverse outcomes worsened over time for all racial and ethnic groups. Compared with non‐Hispanic White (White) individuals, non‐Hispanic Black mothers had higher risk of hypertensive disorders of pregnancy (risk ratio [RR], 1.60 [95% CI, 1.59–1.62]), including chronic hypertension (RR, 2.34 [95% CI, 2.29–2.38]) and gestational hypertension/preeclampsia (RR, 1.50 [95% CI, 1.49–1.52]). American Indian/Alaska Native mothers were less likely to have ideal cardiovascular health both before (RR, 0.66 [95% CI, 0.65–0.67]) and during pregnancy (RR, 0.80 [95% CI, 0.78–0.81]) compared with White mothers. These differences persisted throughout the study period. Conclusions: Our findings reveal stark racial and ethnic disparities in maternal cardiovascular health, highlighting the urgent need to investigate and address their structural determinants.

Background: Gun violence is a critical public health issue, contributing to the disproportionate burden of health inequities among racially and economically marginalized populations. Advance Peace, a community-driven gun reduction program that integrates street outreach workers to interrupt conflicts with trauma-informed programming to provide mentorship and support for young people at the center of urban gun violence, may be a strategy to reduce gun violence and build healthy communities. We assessed whether the implementation of Advance Peace in Fresno, California was associated with a reduction in gun-related violence, including homicides and assaults. We hypothesized that post-implementation of Advance Peace, there would be a reduction in both gun-related homicides and assaults. Methods: Leveraging crime statistics from the Fresno Police Department on gun-related homicides and assaults between January 2014 and June 2023, we evaluated the impact of Advance Peace programming, implemented beginning in July 2021, on gun violence in Fresno. Descriptive analysis assessed average gun violence rates over time. We used interrupted time series models to assess the rates of gun violence associated with the implementation of Advance Peace in Fresno. Results: In Fresno, there was evidence of a reduction in crime rates following the introduction of Advance Peace intervention. Two years post-intervention, there was a 46% decrease in the rate of all gun-related crimes, including both homicides and assaults (rate ratio: 0.54, 95% CI: 0.36–0.81). The intervention was also associated with a reduction in the rate of gun-related homicides (RR = 0.45, 95% CI: 0.21–0.95) and the rate of gun-related assaults (RR = 0.58, 95% CI: 0.38–0.89). Conclusion: Findings from this study demonstrate that Advance Peace may be an effective strategy to reduce gun violence.

Background: Peripartum cardiomyopathy (PPCM) is a rare medical condition presenting as idiopathic heart failure. The aim of this study was to (1) examine the contribution of neighborhood disinvestment to PPCM risk and to racial and ethnic disparities in PPCM; (2) examine the extent to which sociodemographic factors and chronic hypertension explain these outcomes; and (3) describe severe maternal morbidity cases and the timing of PPCM. Methods: We conducted an observational cohort study using vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997 to 2019. Using the Neighborhood Deprivation Index as a proxy measure for neighborhood disinvestment, we sequentially adjusted multivariable logistic regression models to estimate the association of Neighborhood Deprivation Index and race and ethnicity with PPCM. Results: Our study included 7 354 662 births and 918 (0.012%) PPCM cases. Those residing in neighborhoods with higher disinvestment had an increased odds of PPCM (OR [95% CI] Quartile 2: 1.2 [1.0–1.5]; Quartile 3: 1.7 [1.4–2.1]; Quartile 4: 1.5 [1.2–1.9]). When considering the contribution of Neighborhood Deprivation Index to racial and ethnic disparities in PPCM, the odds ratio slightly decreased for Non‐Hispanic Black births from 3.8 (3.1–4.6) to 3.4 (2.8–4.1). For chronic hypertension in Non‐Hispanic Black births there was a slight decrease in odds from 3.4 (2.8–4.1) to 3.1 (2.6–3.8). The severe maternal morbidity indicator with the highest frequency was pulmonary edema/acute heart failure. Conclusions: Our results show that neighborhood deprivation and pre‐pregnancy hypertension partially explain PPCM risk but does not explain the racial or ethnic disparity. Future research should examine the impact of specific measures of neighborhood deprivation on the racial and ethnic disparity in outcomes such as PPCM.