Prior research examining neighbourhood effects on cardiovascular diseases (CVDs) has focused on the impact of neighbourhood socio-economic status or a few selected environmental variables. No studies of cardiovascular disease outcomes have investigated a broad range of urban planning related environmental factors. This is the first study to combine multiple neighbourhood influences in an integrated approach to understanding the association between the built and social environment and CVDs. By modeling multiple neighbourhood level social and environmental variables simultaneously, the study improved the estimation of effects by accounting for potential contextual confounders. Data were collected using a cross-sectional survey (n = 2411) across 87 census tracts (CT) in Toronto, Canada, and commercial and census data were accessed to characterize the residential environment. Multilevel regressions were used to estimate the associations of neighbourhood factors on the risk of CVD. Exposure to violent crimes, environmental noise, and proximity to a major road were independently associated with increased odds of CVDs (p < 0.05) in the fully adjusted model. While reduced access to food stores, parks/recreation, and increased access to fast food restaurants were associated with increased odds of CVDs in partially adjusted models (p < 0.05), these associations were fully attenuated after adjusting for BMI and physical activity. Housing disrepair was not associated with CVD risk. These findings illustrate the importance of measuring and modeling a broad range of neighborhood factors— exposure to violent crimes, environmental noise, and traffic, and access to food stores, fast food, parks/recreation areas— to identify specific stressors in relation to adverse health outcomes. Further research to investigate the temporal order of events is needed to better understand the direction of causation for the observed associations.

Objectives We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness. Methods Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years. Results The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p<0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use. Conclusions HF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services. Trial registration number ISRCTN42520374.

Gentrification, a process of transforming working-class areas into middle-class use, is a pervasive process in many cities around the world. Although researchers recognize the dangers of displacement in this process, the magnitude of dislocation is highly contested. Literature on gentrification offers little guidance with regard to understanding the timing of displacement in a gentrifying neighborhood. Moreover, evictions have been neglected as a form of gentrification-led displacement, which may have led to underestimating displacement effects. This study sheds light on the geography of displacement through an analysis of 59,415 eviction applications in the City of Toronto from 1999 to 2001, which are compared with the timing of gentrification at the census tract level (n = 502). The study finds that evictions are positively associated with (1) neighborhoods in early stages of gentrification, and (2) “pre-gentrified neighborhoods” that are beginning to be marked by changes in social composition, that is, an increasing number of artists and people with higher education, but no significant increase yet in aggregate income or the number of owner-occupied dwellings. By illuminating the timing and magnitude of displacement in gentrifying neighborhoods, this study fosters a better understanding of gentrification outcomes that may inform policies to ameliorate its negative impacts.

Background: News media coverage of antimask protests, COVID-19 conspiracies, and pandemic politicization has overemphasized extreme views but has done little to represent views of the general public. Investigating the public’s response to various pandemic restrictions can provide a more balanced assessment of current views, allowing policy makers to craft better public health messages in anticipation of poor reactions to controversial restrictions.Objective: Using data from social media, this infoveillance study aims to understand the changes in public opinion associated with the implementation of COVID-19 restrictions (eg, business and school closures, regional lockdown differences, and additional public health restrictions, such as social distancing and masking).Methods: COVID-19–related tweets in Ontario (n=1,150,362) were collected based on keywords between March 12 and October 31, 2020. Sentiment scores were calculated using the VADER (Valence Aware Dictionary and Sentiment Reasoner) algorithm for each tweet to represent its negative to positive emotion. Public health restrictions were identified using government and news media websites. Dynamic regression models with autoregressive integrated moving average errors were used to examine the association between public health restrictions and changes in public opinion over time (ie, collective attention, aggregate positive sentiment, and level of disagreement), controlling for the effects of confounders (ie, daily COVID-19 case counts, holidays, and COVID-19–related official updates).Results: In addition to expected direct effects (eg, business closures led to decreased positive sentiment and increased disagreements), the impact of restrictions on public opinion was contextually driven. For example, the negative sentiment associated with business closures was reduced with higher COVID-19 case counts. While school closures and other restrictions (eg, masking, social distancing, and travel restrictions) generated increased collective attention, they did not have an effect on aggregate sentiment or the level of disagreement (ie, sentiment polarization). Partial (ie, region-targeted) lockdowns were associated with better public response (ie, higher number of tweets with net positive sentiment and lower levels of disagreement) compared to province-wide lockdowns.Conclusions: Our study demonstrates the feasibility of a rapid and flexible method of evaluating the public response to pandemic restrictions using near real-time social media data. This information can help public health practitioners and policy makers anticipate public response to future pandemic restrictions and ensure adequate resources are dedicated to addressing increases in negative sentiment and levels of disagreement in the face of scientifically informed, but controversial, restrictions.

Background: There is growing evidence that lesbian, gay, and bisexual (LGB) adults experience more sleep problems than the general population. As LGB individuals experience a significantly greater risk of family rejection and low family support, our study investigates the role of family support as a potential determinant of LGB sleep problems over a prolonged period, and whether friend support (i.e. chosen family) can mitigate the effect of low family support. Given the importance of sleep on mental and physical health, study results may help shed light on persistent health disparities across sexual orientations.Methods: Our sample included 1703 LGB individuals from theUK Household Longitudinal Study (UKHLS). Mixed-effect logistic regressions were used to estimate the effect of family and friend support on the development of sleep problems after 24 months while controlling for potential confounders. A modified Pittsburgh Sleep Quality Index was used to measure 1) presence of any sleep problems, 2) short sleep duration, and 3) poor sleep quality.Results: Family support at baseline was independently associated with all sleep problems in our study after 24-months: 1 SD increase in family support was associated with a 0.94 times lower risk of sleep problems (95% C.I = 0.90-0.98), a 0.88 times lower risk of short sleep duration (95% C.I = 0.81-0.95), and a 0.92 times lower risk of sleep quality (95% C.I = 0.93-0.98). Support from one’s chosen family (proxied by friend support) did not mitigate the effects of low family support on sleep problems.Conclusions: Our study found a consistent effect of family support across all sleep outcomes along with evidence of a persistent effect after 24 months. Our findings point to the importance of targeting family support in designing interventions aimed at reducing LGB sleep problems.