Wenna Xi

Climate-amplified extreme heat events are particularly dangerous for city dwellers. Nature-based solutions such as urban greening may serve as an effective preventative strategy against extreme heat. Driven by historical injustices such as redlining, disadvantaged communities often face limited green space and a heightened risk of vulnerability to extreme heat in urban environments. This paper investigates community engagement strategies for heat-vulnerable community participation in urban greening research as a part of a broader transdisciplinary environmental research praxis focused on multistakeholder co-creation. We conducted semi-structured interviews with community leaders in heat-vulnerable neighborhoods in New York City to explore community co-creation in the design and implementation of tree planting, and compared these themes with interviews with urban tree professionals and other community groups. Overall, the participants agreed on broad themes of environmental justice, intergenerational engagement, community building, and socioecological relationships, although community leaders differed in both a greater emphasis of experiential knowledge and reduced focus on volunteer community stewardship. The findings inform our research process and associated community engagement, including building online resources and addressing community-specific concerns during the research process. We conclude by recommending future steps for facilitating multistakeholder conversations to build inclusive and equitable urban greening heat-adaptive strategies.

Introduction: Suicide among Black youth has become a public health concern. To better understand the rapid increase in Black youth suicide, we aimed to determine whether there had been changes in the risk correlates and their impacts on suicidality among Black youth over the past three decades.Methods: We analyzed four suicide‐related outcomes—ideation, planning, attempts, and attempt‐related injuries—using Black youth's responses from the 1991–2021 Youth Risk Behavior Survey (survey‐adjusted n = 31667.12). Potential correlates considered were demographics, sexuality, injury, violence, bullying, diet, physical activity, mental health, substance use, school connectedness, and exposure to community violence. Correlate‐by‐year interactions were included to allow for time‐varying effects of factors. Missing data were imputed five times, and logistic LASSO regressions were used to select important factors.Results: Rates of suicidal ideation decreased from 22% (1991) to 12% (2005), then increased to 22% (2021). Suicide planning and attempts had similar trends, whereas rates of injuries remained stable (ranging from 2% to 4%). Correlates identified for all four outcomes were similar and consistent over time, including violent behaviors, substance use, body image concerns, and sex. All correlates' effects remained unchanged over time.Conclusion: Although trends of suicidality in Black youth changed over time, correlates associated with them remained stable.

Climate change has amplified the effects of extreme heat events (EHEs), exacerbating heat-related morbidity and mortality, particularly in cities due to the urban heat island effect. While a long-term solution to mitigating heat exists via urban greening, less is known about how to implement an urban greening plan co-designed by community members that addresses heat-related health outcomes. To examine the current state of urban greening interventions focused on communities and heat mitigation, we conducted a scoping review of papers at the nexus of urban greening/forestry, heat-related health outcomes, and community engagement. We then evaluated 46 eligible papers using a conceptual framework informed by the literature with the following criteria: (1) identification of urban green space/trees for climate change-amplified heat mitigation with quantifiable benefits; (2) association between objective heat-related health outcomes/health equity and urban greening intervention design; and (3) sustainable and ongoing community engagement and/or community co-creation. We found multiple differences between study methods. Most papers lacked objective heat-related health outcomes data and instead focused on subjective thermal comfort/heat stress measures. Additionally, almost all papers utilized one-time community engagement methods such as surveys or interviews to inform urban greening recommendations or study findings. Our findings have useful implications for urban greening decision-making, further emphasizing the importance of transdisciplinary cooperation and long-term community engagement, so an equitable, context-dependent urban greening and health intervention can be effectively co-produced by city planners, public health officials, and community members.

Background: Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele‐Paramedicine (CTP) program to perform in‐home fall risk assessment and mitigation after ED discharge. Methods: High falls‐risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED‐discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. Results: Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty‐one (59%) patients received an initial CTP visit, 48 (79%) a follow‐up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high‐risk medications (36%), or need for outpatient follow‐up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall‐related ED visit, and one patient was admitted secondary to a fall. Conclusions: A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

Background: Health misinformation shared on social media can have negative health consequences; yet, there is a dearth of field research testing interventions to address health misinformation in real time, digitally, and in situ on social media. Objective: We describe a field study of a pilot program of “infodemiologists” trained with evidence-informed intervention techniques heavily influenced by principles of motivational interviewing. Here we provide a detailed description of the nature of infodemiologists’ interventions on posts sharing misinformation about COVID-19 vaccines, present an initial evaluation framework for such field research, and use available engagement metrics to quantify the impact of these in-group messengers on the web-based threads on which they are intervening. Methods: We monitored Facebook (Meta Platforms, Inc) profiles of news organizations marketing to 3 geographic regions (Newark, New Jersey; Chicago, Illinois; and central Texas). Between December 2020 and April 2021, infodemiologists intervened in 145 Facebook news posts that generated comments containing either false or misleading information about vaccines or overt antivaccine sentiment. Engagement (emojis plus replies) data were collected on Facebook news posts, the initial comment containing misinformation (level 1 comment), and the infodemiologist’s reply (level 2 reply comment). A comparison-group evaluation design was used, with numbers of replies, emoji reactions, and engagements for level 1 comments compared with the median metrics of matched comments using the Wilcoxon signed rank test. Level 2 reply comments (intervention) were also benchmarked against the corresponding metric of matched reply comments (control) using the Wilcoxon signed rank test (paired at the level 1 comment level). Infodemiologists’ level 2 reply comments (intervention) and matched reply comments (control) were further compared using 3 Poisson regression models. Results: In total, 145 interventions were conducted on 132 Facebook news posts. The level 1 comments received a median of 3 replies, 3 reactions, and 7 engagements. The matched comments received a median of 1.5 (median of IQRs 3.75) engagements. Infodemiologists made 322 level 2 reply comments, precipitating 189 emoji reactions and a median of 0.5 (median of IQRs IQR 0) engagements. The matched reply comments received a median of 1 (median of IQRs 2.5) engagement. Compared to matched comments, level 1 comments received more replies, emoji reactions, and engagements. Compared to matched reply comments, level 2 reply comments received fewer and narrower ranges of replies, reactions, and engagements, except for the median comparison for replies. Conclusions: Overall, empathy-first communication strategies based on motivational interviewing garnered less engagement relative to matched controls. One possible explanation is that our interventions quieted contentious, misinformation-laden threads about vaccines on social media. This work reinforces research on accuracy nudges and cyberbullying interventions that also reduce engagement. More research leveraging field studies of real-time interventions is needed, yet data transparency by technology platforms will be essential to facilitate such experiments.