Climate change has led to an increase in extreme weather events. Adverse weather conditions limit outdoor activities, reduce step counts, and negatively affect health. Malls offer a possible alternative for walking in such weather; however, their step-loss mitigating role remains unexplored. We analyzed data from 18,666 individuals aged ≥ 18 years (mean ± standard deviation: 48.0 ± 12.6; women: 71.5%), tracking daily step counts over a year using a smartphone application. Step count data were collected via devices owned by the participants and then transferred to the program database through the application. Multilevel mixed-effects linear regression was used to estimate the associations between daily step counts and various interaction terms, focusing on two-way interactions between mall visits and weather, and three-way interactions involving sociodemographic factors. On days with maximum temperatures of < 15 °C or ≥ 35 °C, as well as during rain, deep snow depth, or strong winds, step counts were lower. However, on days when malls were visited, step counts were 1,269 higher compared with those on non-visit days. This difference was more pronounced during adverse weather: < 15 °C, ≥ 35 °C temperature, 0.1-4.9 and > 5 mm precipitation, snow depth > 3 cm, and wind speeds > 2.50 m/s. Mall visits mitigated weather-related step count reductions, particularly among older adults, women, and low-density area residents who generally take fewer steps. These findings underscore the role of weather-independent spaces, such as malls, in mitigating step count reductions during adverse weather. Improving access to and promoting their use are essential for maintaining physical activity in such conditions.

Noise pollution is a persistent stressor in urban settings, which affects all segments of the population. Its neurological impacts are less studied than those of hypertension, heart disease, or mental health, but there is evidence suggesting that neurological health is affected by noise pollution. We searched six databases (PubMed, EBSCO, Semantic Scholar, Web of Science, Embase, and Scopus) for studies published post-2000 that report residential noise exposure and its neurological effects. We mapped studies based on geographical location, exposure measurement, and study results. Two researchers independently screened and extracted data, and 117 distinct studies from 100 publications were included. European countries and high-income countries dominate the evidence base, and noise is most commonly modeled as 24-h exposure through L-metrics (e.g., Lden). Included studies showed mostly positive associations between noise exposure and adverse neurological outcomes, such as stroke events and mortality, neurodegenerative diseases, cognitive decline, and poorer cognitive performance in schoolchildren. There was no overall relationship between noise exposure and brain structure. While noting the heterogeneity in our included studies, it is clear that long-term noise exposure has neurological impacts. Further research is needed to understand the impact of all-source noise and how noise exposure affects the brain. Further, infrastructure for monitoring noise and population health in developing countries is needed to remedy the global imbalance in data.

While research has highlighted discrimination and its health impacts, whether and how housing-related discrimination is related to the health of public housing residents remains understudied. This paper places discrimination in the public housing context to disentangle the relationship between discrimination and health outcomes, and the moderating role of gender in such a link to fill knowledge gaps. Using an individual-level longitudinal dataset in Seoul, Korea, this paper employed individual fixed effects models and also included interaction terms to estimate how such associations differ by gender. First, about 7% of public housing residents experience housing discrimination. Second, individuals who experience housing-related discrimination report significantly higher levels of stress. Discrimination is linked to an increase in unhealthy behaviors, including smoking initiation and alcohol drinking. Also, the effect of discrimination on stress is significantly greater for women. In contrast, there are no significant gender differences in the effect of discrimination on smoking initiation or the frequency of alcohol consumption. This paper not only confirmed the negative effect of housing discrimination on stress and unhealthy behaviors but also gender differences in the negative association between housing discrimination and stress. The findings highlight the need for gender-sensitive interventions to address the health impacts of discriminatory housing experiences.

This study examined the cross-sectional and longitudinal associations between neighborhood socioeconomic disadvantage and frailty in middle-to-older-aged adults. Data were obtained from a cohort study conducted in Brisbane, Australia, with 3966 participants (mean age 58.2 years; female 57.6%) included in cross-sectional analysis and 2846 in longitudinal analysis (3-year follow-up). A frailty index (FI), a composite score consisting of 32 items, was used continuously (range 0-1) and categorized into frail (FI > 0.35) and non-frail. Neighborhood disadvantage was measured using the Index of Relative Socioeconomic Disadvantage, an area-level composite index, and was categorized into tertiles. Two-level mixed-effects linear and logistic regression models were fitted, accounting for area-level clustering through random intercepts for areas and adjusting for demographic variables and individual-level socioeconomic status. In the cross-sectional analysis, 11% of participants were frail. Compared to residents of low disadvantage neighborhoods, those in middle and high disadvantage neighborhoods had higher levels of frailty and greater odds of being frail (OR = 1.54 [95% CI 1.13, 2.09] and OR = 2.86 [2.11, 3.88], respectively). In the longitudinal analysis, residing in middle and high disadvantage neighborhoods was significantly associated with increases in FI scores, relative to low disadvantage neighborhoods. Incident frailty was observed in 5% of participants at the follow-up. Residing in high disadvantage neighborhoods showed significantly higher odds of incident frailty (OR = 1.75 [1.08, 2.86]). Mid-to-older-aged residents of disadvantaged neighborhoods are more likely to be frail and to become frail over 3 years, compared to those in advantaged neighborhoods. Community-level interventions to reduce frailty should target disadvantage neighborhoods.

Incarceration is a recognized risk factor for homelessness. However, most research focuses on the relationship between homelessness and prison incarceration. Jail incarceration is more common compared to prison incarceration, but little data exists on its impact on housing. The objective of this study is to examine the occurrence of housing loss after jail incarceration among individuals without prior evidence of homelessness and the associated risk of reincarceration. In this retrospective cross-sectional study, we identified adults without evidence of homelessness who became unhoused within 6 months of jail incarceration. We compare pre-incarceration emergent and urgent health and social services utilization among housed and unhoused individuals, as well as the risk of reincarceration. Data are from the San Francisco (SF) Department of Public Health Coordinated Care Management System linked with SF City and County criminal justice data during fiscal years 2015-2018. We find that a quarter (25.1%) of individuals lost housing after jail incarceration, with a median incarceration length of 4 days in both the housed and unhoused groups. Compared to those without evidence of housing loss, more unhoused individuals had pre-incarceration substance use and mental health diagnoses and related service utilization. Unhoused individuals had 1.9 greater odds of reincarceration. In conclusion, we find that a significant number of individuals had evidence of housing loss after even a short jail incarceration; behavioral health diagnoses were more common among this group. Housing loss was associated with subsequent reincarceration. Given our findings, jail re-entry programs would benefit from incorporating housing assistance and housing loss mitigation strategies.

While neighborhood socioeconomic status (NSES) significantly impacts health outcomes, its measurement often assumes that the social and economic mechanisms that drive NSES operate similarly across the urban-rural continuum. This study aimed to develop a census-tract-level NSES measure that accounts for differences across community type and assesses its measurement invariance. Using data from 71,908 census tracts in the contiguous United States, we employed exploratory and confirmatory factor analyses to derive a one-factor NSES construct consisting of five variables: percent below the poverty line, households receiving public assistance, population unemployed, households without cars, and population with less than a high school education. Measurement invariance analysis revealed that while the overall NSES structure is consistent across urban and rural community types, factor loadings varied significantly. The percentage of the population living below poverty was the most reflective indicator across all community types, while other indicators, such as car access and unemployment, exhibited context-specific variability. These findings highlight the importance of incorporating urbanicity into NSES measures in health disparity research and to improve the effectiveness of public health interventions.

Previous studies have established that neighborhood environments influence mental health (MH), but the mediating role of physical activity in this relationship remains underexplored. Additionally, there is a lack of longitudinal research that investigates how neighborhood environments affect MH through physical activity pathways. We aimed to (1) analyze the cross-sectional relationships and longitudinal changes between neighborhood environments and MH, considering the mediating role of physical activity, and (2) investigate the urban-rural disparities in these associations. Data came from 15,470 adults in the 2010 and 2014 waves of the China Family Panel Studies. We applied multilevel structural equation modeling to examine cross-sectional and longitudinal relationships between neighborhood environments and MH via the pathway of physical activity. Cross-sectional results indicated that environmental aesthetics were positively associated with MH. The count of leisure facilities and environmental aesthetics were indirectly and positively associated with MH through participating in more physical activities. Meanwhile, there was no strong evidence on the association between longitudinal changes in neighborhood environments and longitudinal changes in MH. We also observed notable urban-rural variations in how neighborhood environments relate to MH. Environmental aesthetics were positively associated with MH in rural China, and physical activity did not mediate these associations. These findings suggested that improving access to sports and exercise facilities and enhancing environmental aesthetics and encouraging more physical activities could improve MH, especially in rural Northern China.

As populations age globally, ensuring equitable healthcare access and social support for older adults in underserved urban areas has become increasingly critical. Elderly residents in low-income districts face challenges, including poor living conditions, social isolation, and healthcare access barriers. Community health workers (CHWs) are vital in bridging these gaps, yet their effectiveness is often Limited by resources and training. This qualitative study explores the healthcare and social needs of elderly residents receiving community services, identifies gaps in support systems, and examines the challenges faced by CHWs in delivering care in an underserved urban district. The study took place in Sham Shui Po, a district in Hong Kong with a high concentration of economically disadvantaged elderly residents. Data were collected through 17 semi-structured interviews with older residents and non-governmental organization (NGO) staff, alongside three focus group discussions with CHWs, and were analyzed using thematic analysis. The results showed that senior residents faced poor living conditions, chronic illnesses, and mobility issues, exacerbated by financial constraints and limited healthcare access. Long wait times, transportation challenges, and language barriers hindered medical service use. Many struggled with digital healthcare tools, limiting their ability to manage health independently. CHWs provided vital support but encountered physical strain, inadequate training, and logistical difficulties, highlighting the need for structured training and better resources. Addressing elderly care challenges requires integrated healthcare models, expanded financial and digital literacy programs, and enhanced CHW training and support. Strengthening these areas can improve health outcomes and well-being for aging populations in low-income urban settings.

Summer heat and air pollution may pose a great threat to public health in the context of climate warming, however, their interactive effects on deaths from chronic ischemic heart disease (CIHD) have not been evaluated in existing investigations. This study aims to assess the associations of concurrent heatwave and ozone pollution with CIHD mortality in Chinese population. We carried out a province-wide, individual-level case-crossover study by analyzing 33,770 CIHD deaths occurring in warm season (May-September) across Jiangsu, eastern China, between 2016 and 2019. Spatially resolved estimates of maximum 8-h average ozone concentrations and air temperatures were estimated on case days and control days at the residential address. Heatwave events were defined using multiple temperature thresholds (percentiles 90-97.5) and durations (2-4 days). Conditional logistic regression model was employed to assess the odds ratio (OR) and its 95% confidence interval (CI) of CIHD death associated with heatwave and ozone exposure. Stratified analyses were performed to compare ozone-related risks on heatwave days versus non-heatwave days, and heatwave-related risks on low-ozone days versus high-ozone days. Additive interactive effects were testified using multiple metrics including relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (SI). In the overall population, the odds of CIHD mortality were 1.010 (95% CI, 1.007-1.014) for a 10-µg/m rise in warm-season ozone at lag-01 day and ranged from 1.20 (95% CI, 1.15-1.25) to 1.64 (95% CI, 1.54-1.73) for heatwaves under various definitions. Stratified analyses showed intensified ozone-related CIHD risks on heatwave days compared to non-heatwave days and higher heatwave-related risks on high-ozone days than low-ozone days. We observed significant synergistic interactive effects of heatwave and high-level ozone on CIHD mortality (SI > 1), where the excess risk was elevated by 10-19% (REOI > 0) under co-exposure scenarios, and 8-11% (AP > 0) of the odds could be attributed to the additive interaction. Excess fractions of CIHD deaths attributable to heatwave and high-level ozone among overall populations ranged from 4.73% (95% CI, 3.21-6.25%) to 6.43% (95% CI, 4.33-8.45%) under different heatwave definitions. In stratified analyses, we observed similar synergistic effects across age groups and among female subgroups only in multiple heatwave definitions. This study provided novel evidence for the synergistical effects of short-term exposure to heatwave and ozone in elevating CIHD death risk and burden. Our findings highlighted the public health urgency of collective response to climate warming crisis and ambient ozone pollution.

Project VITAL (Vacant Lot Improvement to Transform Adolescent Lives) is a study designed to evaluate the impact of revitalized vacant lots on adolescent health in Baltimore, Maryland. We implemented a mixed-methods research approach, which included surveys of 14- to 19-year-olds, observations of nearby vacant lots, and street block assessments during 2023-2024. The aim was to understand how greening vacant lots affected adolescent mental health, experiences of violence, and food insecurity. Linear regression models were used to examine the association between living near a maintained vacant lot and various outcomes. Effect size was measured for each significant association using Cohen's f. Out of the 313 survey participants with geo-coded addresses, 50.2% resided within 0.20 mi of a maintained lot. Proximity to these maintained green spaces was associated with greater happiness (p = 0.01, f = 0.04) and reduced food insecurity among adolescents, although the latter did not achieve statistical significance (p = 0.08, f = 0.06). No significant link was found between the proximity to green spaces and either depressive symptoms or experiences of weapon-related violence. These findings highlight the complexity of the effects of urban greening, indicating that while it may not address all negative outcomes, it can modestly improve certain positive aspects of adolescent well-being. Public health initiatives focusing on these efforts could help address urban decay and promote long-term health equity.

Prior research links violence inside the home to reduced dental care utilization, yet little is known about how community firearm violence affects dental care behaviors. The current study used data from wave V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), linked to census tract-level fatal and nonfatal shooting data from the American Violence Project for the 100 largest cities in the United States. The analytic sample included 1925 respondents aged 33-42. The primary outcome was self-reported dental care use in the past year. Firearm violence exposure was categorized as 0, 1, or 2 + shootings in a respondent's census tract over a 2-year period. Logistic regression models were used to estimate the relationship between shootings and dental care use, adjusting for individual sociodemographic factors, prior dental use, violence exposure, and contextual variables including poverty and dentists per capita. Respondents exposed to multiple shootings had significantly lower odds of past-year dental care use (OR = 0.625, 95% CI: 0.418-0.934) compared to those with no exposure, after adjustment. These findings provide new evidence that suggests exposure to neighborhood violence may reduce dental care use, net of key confounding variables. Public health and dental initiatives may consider violence exposure when designing interventions to increase care utilization.

Air pollutants have been known as the most persistent environmental risk factors of elevated blood pressure (BP). However, most of the existing studies measured resting BP only, which is not accurate as ambulatory BP. This study investigated the effects of short-term exposure to air pollutants on ambulatory BP. Wearable devices were used to measure personal ambulatory systolic BP (ASBP) and diastolic BP (ADBP) and movement trajectories of 172 participants for one week, with a 1-min interval. Daily concentrations of the six major air pollutants were estimated at a spatial resolution of 1 km. Linear mixed-effect models and distributed lag non-linear models estimated the associations between air pollutant exposure and ambulatory BP. ASBP was positively associated with PM (β = 0.010 [95% CI: 0.005, 0.015]), PM (β = 0.006 [0.005, 0.008]), and SO (β = 0.046 [0.021, 0.071]), and negatively with NO (β = -0.009 [-0.017, -0.001]); ADBP was positively associated with PM (β = 0.008 [0.005, 0.010]) and PM (β = 0.003 [0.002, 0.004]), and negatively with NO (β = -0.008 [-0.012, -0.004]), O (β = -0.002 [-0.004, -0.001]), and CO (β = -0.366 [-0.652, -0.081]). At 14-h lag, ASBP and ADBP were positively associated with PM and O, and negatively with NO. The cumulated exposure to PM and CO was associated with ambulatory BP at all levels of concentration, while SO was associated with ambulatory BP only when the concentration was over 15 μg/m. The findings have important implications for BP management and hypertension prevention, by providing solid evidence for developing cost-effective strategies of minimizing adverse environmental exposure and improving health equity.

While the number of state legislative changes to relaxed concealed firearm carrying laws continues to increase, research examining the impact of these laws on changes in criminal behavior, particularly in urban contexts, has not kept pace. To enhance our understanding of the potential impact of permitless carry legislative changes, we examined the temporal association between legislative changes and changes in illegal and dangerous behavior most likely to be associated with firearms violence and arrests in Lexington (KY), Oklahoma City (OK), and Tulsa (OK). We use statistical controls to account for a major temporal confounder: the disruption of social order that occurred during and after the global COVID-19 pandemic in 2020. Our findings show violent criminal offenses did not shift in the post-permitless carry period. However, there were consistent and robust statistically significant increases in illegal possession of a firearm, as well as an upward shift in threatening firearm behavior (i.e., brandishing a gun/pointing a firearm), net of controls and confounders. We also find significant and sizeable increases in stolen and recovered firearms in Lexington (KY), the lone setting that collected this outcome measure during our study period. We conclude by discussing how the findings can inform policy, forthcoming legislative initiatives, and future research.

A growing body of research has revisited the social costs of U.S. interstate highways. In Kansas City, U.S. Highway 71 (Bruce R. Watkins Drive) was built through the city's East Side over nearly two decades, displacing residents, destroying community institutions, and raising safety and health concerns. Using Opportunity Atlas data, we compare long-term outcomes-income, economic mobility, incarceration, and teen birth-for the 1978-1983 cohorts by childhood residence: census tracts along the Highway 71 corridor versus other tracts in Kansas City. At age 35, those who grew up along the Highway 71 corridor had approximately 45% lower household incomes and 29% lower individual incomes than those from other parts of the city. They were more than twice as likely to be incarcerated and had substantially higher teenage birth rates. Disparities persisted in subgroup analyses of children from low-income families and remained statistically significant after adjusting for pre-existing neighborhood characteristics.

Telehealth offers an avenue for older adults to access providers, discuss care needs, and have serious illness conversations. However, telehealth is embraced by some and not by others. Urban-dwelling, low-income older adults have unique challenges in accessing continuous care, engaging with the healthcare system and receiving support to address serious illness care needs. To investigate telehealth acceptance in low-income older adults, we conducted individual semi-structured qualitative interviews with 46 residents of three Medicaid-funded assisted living facilities (MALFs) which provide social, functional, and clinical support to underserved populations. Interview transcripts were analyzed using conventional content analysis. Four qualitative themes describing telehealth acceptance in low-income assistant living communities were identified. Benefit: Telehealth offers convenience-participants highlighted how telehealth facilitates access to healthcare appointments, making it easier to receive care. Barrier: Technology fluency and access is not universal-many described physical and technological barriers that limit their ability to use telehealth effectively. Preference: general distaste for telehealth-this theme captures participants' overall attitudes and gut reactions to telehealth, ranging from enthusiasm to skepticism. Concern: mistrust in clinical connection-patients expressed concerns about trust, security, and the ability to build meaningful connections with providers through telehealth. While telehealth can make care more convenient, telehealth encounters may hinder trust in the therapeutic relationship between urban-dwelling low-income older adults and providers. For telehealth conversations discussing serious illness, additional efforts are needed to support engagement, foster trust, and provide patient-centered care in populations that have been historically marginalized.

The economic disruption of the COVID-19 pandemic combined with a pre-existing housing affordability crisis to threaten a wave of evictions from rental housing in the United States. Eviction and housing loss were associated with a range of adverse outcomes even prior to the pandemic; during the public health emergency, housing instability could have additionally increased opportunities for viral spread. Mitigating eviction risk was therefore an important form of prevention. We evaluate one federal policy response to the potential eviction crisis, the Emergency Rental Assistance program (ERA). Under ERA, approximately $47 billion was transferred to state and local governments to establish programs to financially assist at-risk renter households. We examine the relationship between receipt of rental assistance and rental housing stability, both overall and for higher-risk groups defined by presence of children and respondent racial and ethnic identity. Our analysis used U.S. Census Bureau Household Pulse Survey data (July, 2021-April, 2023) and two analytical techniques. First, we created matched treatment and comparison groups using applicants awaiting a decision and coarsened exact matching (n = 18,329) to examine the relationship between rental assistance and 1) whether the household was in rental arrears and 2) perceived risk of housing loss from eviction. Second, we estimated recursive bivariate probit models simultaneously modeling rental assistance receipt and rental arrears in a larger sample (n = 160,443). We found rental assistance receipt substantially reduced the risk of being in arrears and perceived risk of eviction. Effects on arrears were somewhat larger for households with children and for Black households compared to others in the matching analysis.

Ethnic enclaves are neighborhoods formed through discriminatory policies that concentrate disadvantage in marginalized communities. Living in these neighborhoods has important implications for maternal health; however, few studies have assessed this concerning severe maternal morbidity (SMM). We examined the relationship between residence in an ethnic enclave, comparing three methods of classification and SMM among 7 million births to Asian, Black, and Hispanic people in California from 1997 to 2018. SMM was constructed using the CDC's SMM index. We considered three methods of measuring ethnic enclaves (racial composition, location quotient, and the Gi* statistic) at the census tract level. Race-stratified mixed-effects logistic regression models accounting for area-level clustering were used to compare the odds of SMM in ethnic enclaves compared to average neighborhoods, adjusting for sociodemographic and pregnancy-related clinical factors and comorbidities. Among Hispanic birthing people, mixed results were found for ethnic enclave measures. Adjusted models showed lower odds of SMM for those in ethnic enclaves defined by Gi* (aOR 0.96, 95%CI 0.94, 0.98) and location quotient (aOR 0.90, 95%CI 0.88, 0.92) but higher odds using racial composition (aOR 1.03, 95%CI 1.01, 1.06). Black birthing people had higher odds of SMM in ethnic enclaves across all measures. Effect modification by nativity showed that US-born Black birthing people in enclaves had higher odds of SMM, while immigrant Black birthing people had lower odds. Overall, residence in ethnic enclaves is associated with SMM among Asian, Hispanic, and Black birthing people, with variations by ethnic enclave measure and nativity.

While both individual- and neighborhood-level factors play a role in the progression from gestational diabetes mellitus (GDM) to type 2 diabetes mellitus (T2DM), few studies have simultaneously examined these two sets of factors. In this retrospective cohort study of 3567 women with a history of GDM, we used multilevel survival analysis to quantify T2DM risk associated with patient-level and neighborhood-level factors. During a mean follow-up of 2.2 years, 195 women (5.5%) developed T2DM. Statistically significant risk factors of T2DM progression included Black or Asian race, preeclampsia, family history of diabetes, and overweight or obesity. Importantly, residing in neighborhoods with a top tertile social deprivation index was also associated with increased risk (HR = 1.78, 95% CI: 1.01-3.14). In addition, after accounting for other factors, the residual clustering associated with neighborhoods conferred a 19% higher risk. Interventions addressing both individual- and neighborhood-level factors, including socioeconomic disparities, are critical to reducing the risk of T2DM in women with GDM.

Gayborhoods are urban neighborhoods characterized by a high concentration of LGBTQ + residents, businesses, community spaces, and subcultures. Living in gayborhoods may foster a sense of community and belonging that can be particularly beneficial for sexual minority men. However, existing research on gayborhoods has predominantly centered on the experiences of White gay men. The extent to which gayborhoods serve as an inclusive space for ethnically diverse sexual minority men remains largely unexplored. This paper examines the associations of gayborhood residence with LGBTQ + community connectedness, psychological distress, and substance use among ethnically diverse sexual minority men. Utilizing data from the 2023 Gay Asian Men Survey, this paper included 1071 cisgender sexual minority men of Asian backgrounds in Australia. The results indicated that older, middle-class, and gay men were more likely to live in gayborhoods than their younger, lower-class, and bisexual counterparts. The mediation analysis revealed the coexistence of positive and negative impacts of living in gayborhoods. Specifically, gayborhood residence was positively associated with LGBTQ + community connectedness, which was in turn associated with reduced levels of psychological distress but heightened levels of alcohol and drug use. The findings have significant implications for community organizing, mental health support, and substance use prevention. While leveraging gayborhoods to foster support networks and improve mental health among Asian sexual minority men is beneficial, it is equally crucial to address the pressures associated with conforming to community norms, particularly regarding social drinking and recreational drug use.

The escalating threat of depression demands urgent action from the research community. As a policy that prioritizes a people-centered approach, the New-type Urbanization Policy (NTU) holds promise for alleviating depression. However, whether and how NTU positively affects individual mental health remains underexplored. This study draws on three waves of data from the China Health and Retirement Longitudinal Survey (CHARLS) and employs the difference-in-differences (DID) method as a quasi-natural experiment to empirically analyze the effects of NTU on individual depression. The results indicate that NTU significantly reduces depression, with environmental pollution serving as a mediator in this relationship. Moreover, NTU's impact on depression reduction is more pronounced in non-resource-based cities and those with lower population concentration. Additionally, the ecosocial theory emphasizes that health arises from the biological embodiment of structural exposures embedded in social and ecological environments. Based on this theory, it serves as a theoretical framework for analyzing NTU's impact on depression. This study expands the existing research on pilot policies related to individual health and provides concrete policy recommendations for mitigating depression in the context of NTU implementation.