The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations.

Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression.

Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5–10.3), 10.8% (95% CI: 10.4–11.2) and 6.9% (95% CI: 6.6–7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9–9.3 v. 10.7%; 95% CI: 10.2–11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4–12.1 v. 11.3%; 95% CI: 10.8–11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77–0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78–0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57–0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66–0.79) and other (adjusted OR: 0.63; 95% CI: 0.45–0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes.

Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.

It has been well known that air pollution and sleep deprivation individually have impacts on human health; however, the association between the two has not been well researched. The aim of this study was to investigate this relationship at a community level.

We collected sleep outcomes from the Korean Community Health Survey between years of 2008 and 2016. The data contained 1 130 080 selected adults aged ⩾ 19 years, from 141 communities. As sleep outcomes, annual chronic sleep deprivation (% of people who sleep ⩽ 5 h per day on average) and average values of daily mean sleep duration were used. Community-specific annual averages of particulate matter with a diameter ⩽ 10 μm (PM10), nitrogen dioxide (NO2) and carbon monoxide (CO) were collected and then applied to a linear mixed effects model to estimate the association between air pollution over the past 4 years and sleep outcomes. Population density, green space, health behaviour, and gross regional domestic product per capita variables were considered as confounders in all mixed effect models.

From the linear mixed effect models, we found that the chronic sleep deprivation % was positively associated with PM10 (0.33% increase with 95% CI 0.05–0.60; per 10 μg/m3) and NO2 (0.68% with 95% CI 0.44–0.92; per 10 ppm). Higher PM10 and NO2 were also associated with shorter sleep duration, with a reduction of 0.37 min (95% CI −0.33 to 1.07 min; per 10 μg/m3) and 2.09 min (95% CI 1.50–2.68 min; per 10 ppm), respectively. The associations between PM10 and sleep outcomes were higher in females than males and in the older age groups (⩾ 60-years) than in younger age groups (19–39 and 40–59 years). However, the association between NO2 and sleep outcomes were more higher in males than in females and in the younger age groups (19–39 years) than other age groups.

Our findings provide epidemiological evidence that long-term interventions to reduce air pollutions are anticipated to provide improvements in sleep deficiency.

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

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.

Belo Horizonte, Brazil.

Food stores.

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.

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.

The current study aimed to understand how moderate and severe food-insecure people living with HIV (PLHIV) in the Dominican Republic perceive a healthy diet and explore facilitators and barriers to engaging in healthy dietary behaviours as a means of HIV self-management.

We conducted semi-structured interviews with PLHIV. We generated codes on food insecurity among PLHIV and used content analysis to organise codes for constant comparison between and within participants.

Two urban HIV clinics in the Dominican Republic.

Thirty-two PLHIV participated in the interviews.

Factors that contributed to dietary behaviours include individual factors, such as knowledge of nutrition, views and attitudes on healthy dietary behaviours, beliefs about dietary needs for PLHIV and diet functionality. Interpersonal factors, including assistance from family and peers in providing food or funds, were deemed critical along with community and organisational factors, such as food assistance from HIV clinics, accessibility to a variety of food store types and the availability of diverse food options at food stores. Policy-level factors that influenced dietary behaviours were contingent on respondents’ participation in the labour market (i.e. whether they were employed) and consistent access to government assistance. Food insecurity influenced these factors through unpredictability and a lack of control.

PLHIV who experience food insecurity face various barriers to engaging in healthy dietary behaviours. Their diets are influenced at multiple levels of influence ranging from individual to structural, requiring multi-level interventions that can address these factors concurrently.

To examine associations between economic residential segregation and prevalence of healthy and unhealthy eating markers.

Cross-sectional. A stratified sample was selected in a three-stage process. Prevalence of eating markers and their 95 % CI were estimated according to economic residential segregation: high (most segregated); medium (integrated) and low (less segregated or integrated). Segregation was measured at the census tract and assessed using the Getis–Ord local $G_i^{\rm{\ast}}$ statistic based on the proportion of heads of household in a neighbourhood earning a monthly income of 0–3 minimum wages. Binary logistic regression using generalized estimating equations were used to model the associations.

Belo Horizonte, Brazil.

Adults (n 1301) residing in the geographical environment (178 census tracts) of ten units of the Brazilian primary-care service known as the Health Academy Program.

Of the 1301 participants, 27·7 % lived in highly segregated neighbourhoods, where prevalence of regular consumption of fruit was lower compared with more affluent areas (34·6 v. 53·2 %, respectively). Likewise, regular consumption of vegetables (70·1 v. 87·6 %), fish (23·6 v. 42·3 %) and replacement of lunch or dinner with snacks (0·8 v. 4·7 %) were lower in comparison to more affluent areas. In contrast, regular consumption of beans was higher (91·0 v. 79·5 %). The associations of high-segregated neighbourhood with consumption of vegetables (OR = 0·62; 95 % CI 0·39, 0·98) and beans (OR = 1·85; 95 % CI 1·07, 3·19) remained significant after adjustments.

Economic residential segregation was associated with healthy eating markers even after adjustments for individual-level factors and perceived food environment.

This study analyzed the management of intestinal parasitic infections in the Family Health Strategy covering Brazilian urban slums.

The Family Health Strategy is the preferred strategy for providing public, community-based primary health care in the Brazilian Unified Health System (SUS). Through this strategy, Family Health teams are responsible for the health of residents of a defined territory, including health promotion, health education and control of neglected tropical diseases such as intestinal parasitic infections.

Knowledge, attitudes and practices surveys were applied with Family Health team members (n=58) and patients (n=571) of an agglomeration of Brazilian urban slums in Rio de Janeiro.

The management of intestinal parasitic infections and health promotion were limited. Health education was not considered an essential aspect of team members’ work and did not include environmental or social determinants of health. Community health workers and urban slum residents presented similar knowledge, attitudes and practices regarding intestinal parasitic infections.

Multiple, competing demands promote prioritization of the aspects of care where curative, biomedical activities predominate over prevention and an integral approach to health. However, the complex processes involving the cycle of poverty and disease go beyond the biomedical, limiting the potential for health in urban slums. Implications include a need to better prepare health professionals for primary health care services through reflection on local concerns and the social determinants of health, highlighting the importance of territorialized care and permanent education.

To gain a deeper understanding of the retail food environment by investigating similarities and differences between objective measures and residents’ perspectives.

The study incorporated Geographic Information System (GIS)-based measures, in-store surveys and the results from a larger photovoice project. We combined these data using a convergent parallel mixed-methods approach.

We conducted this study in a low-income neighbourhood in Madrid (Spain) in 2016.

We assessed healthy food availability, accessibility and affordability using GIS-based measures and in-store audits. We also analysed the photographs and discussions from twelve participants who engaged in a photovoice project on their food environment.

Quantitative results depicted a widely served and highly accessible retail food environment, in which supermarkets scored highest in terms of healthy food availability (36·5 out of 39) and 98·9 % of residents could access a healthy food store within a walking travel distance of less than 15 min. Qualitative results showed that participants preferred small local businesses over supermarkets, and revealed built environment obstacles for elderly residents. They also highlighted how the socio-economic context constrained residents’ food choices.

People’s experienced retail food environment is different from the one quantitatively analysed. Results show the potential of using a mixed-methods approach to enrich food environment research and enhance public health interventions.

Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers.

Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment.

Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison.

Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the “frequent flyer problem” (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called “hitting their bottom.” Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers’ current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building.

Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore.

Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study. Prehosp Disaster Med. 2017;32(2):148–155.

Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment.

Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases.

Intercepts were collected at 192 corner stores in Philadelphia, PA, USA.

Participants were adult, adolescent and child corner store shoppers.

Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2·2 (sd 2·1) items (1·3 (sd 2·0) foods and 0·9 (sd 0·9) beverages) that cost $US 2·74 (sd $US 3·52) and contained 2786·5 (sd 4454·2) kJ (666·0 (sd 1064·6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65·9 % of intercepts and accounted for 39·2 % of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66·2 g of sugar, 921·1 mg of sodium and 2·5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy.

Urban corner store shoppers spent almost $US 3·00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.

A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.

A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.

Fifty-eight households, with at least one child living in the home.

During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.

At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.