Green space is linked with fewer gun-related homicides — but not everywhere

Study uses Google Street View and AI to measure greenery at the scene of fatal shootings

Ohio State University

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COLUMBUS, Ohio — Our physical surroundings affect everything from personal well-being to a neighborhood’s safety. A new study from The Ohio State University finds that when it comes to preventing gun violence in a community, green space can help, but its location makes a big difference.

A growing body of research shows that urban green spaces — parks and other areas lined with plants, grass and trees — improve community and individual health outcomes by encouraging physical activity, reducing stress and improving air quality. They’ve also been associated with reduced gun violence and other violent crimes, but the relationship is complex, and not fully understood.

While attending a recent conference, the study’s lead author, Gia Barboza-Salerno, made a point that resonated with fellow researchers who study urban greenery and violence prevention: When it comes to the effects of green space on communities, local context matters.

“It’s not as simple as planting a tree and thinking that alone will solve it,” said Barboza-Salerno, an associate professor in Ohio State’s colleges of social work and public health. “Even though we know urban greenery is a great prevention measure for a lot of reasons, we don’t understand how or whether there’s an interaction between where this greenery is — the local context in which the greenery sits — and a subsequent reduction in violence.”

That question became the basis for a study published this month in Urban Forestry & Urban Greening. Barboza-Salerno’s team looked at how green space, neighborhood disadvantage and gun violence intersect in Cook County, Illinois, which reported the most homicides in the U.S. in 2022.

“Firearm-related violence is a public health crisis in this country, and it disproportionately affects young Black males,” Barboza-Salerno said. According to research cited in the study, racial and ethnic disparities in violence are often linked to factors such as poverty, limited educational and employment opportunities, economic inequality and residential segregation. Urban green spaces may offer protective benefits, but no previous study had specifically investigated greenery near the locations of firearm-related deaths as it would be seen from the street level, from a pedestrian’s point of view, according to the study.

“We really wanted to show in this paper that urban planning is a critical part of public health prevention by evaluating the quality of streets that people traverse daily in their activity spaces,” Barboza-Salerno said.

As director of Ohio State’s Investigating Spatial Structures in Urban Environments (ISSUES) Lab, Barboza-Salerno leads a research group that uses advanced spatial statistics, geospatial artificial intelligence (GeoAI) and machine learning to understand how neighborhood environments shape health, safety and social well-being.

For this study, the team examined 899 firearm homicides and 2,256 natural deaths in the county in 2023 and compared them with natural deaths of people similar in age, sex and race who died nearby. By using Google Street View images and machine learning tools, they measured the amount and types of greenery a person would actually see from the street where each death occurred.

The study found that more visible greenery, tree canopy and green space along walkable streets were linked to lower odds that a death in that location was a firearm-related homicide. But the benefits of green space aren’t universal. Tree cover and greenery offered the most protection in less disadvantaged neighborhoods, while in the most disadvantaged neighborhoods, being closer to a park was actually linked to a higher risk of firearm homicide.

The researchers attribute this finding to multidimensional measures of social deprivation, including poverty, structural housing disadvantage, economic inequality, family structure and income, having a stronger impact than a neighborhood’s green spaces.

“Green space is very important and critical for violence prevention, but not all green space matters equally,” Barboza-Salerno said. “Basically, if you lived in a socially advantaged environment, having green space mattered more for reducing violence than in a socially disadvantaged area. Green space should be thought of as a violence-prevention intervention, yet the green space that does the most protective work tends to be concentrated in more advantaged neighborhoods. That’s a double inequity: disadvantaged areas get less quality green space, and the green space they get is less protective without other supports.”

When parks in disadvantaged neighborhoods aren’t well-maintained or used regularly, they can become more of an eyesore than a protective factor, Barboza-Salerno said. Whereas in neighborhoods with more resources, well-kept parks have a beautification effect that can improve how people feel, and strengthen neighbors’ willingness to look out for one another.

“In these very [disadvantaged] areas, there’s a lot of economic disinvestment, and that is the association with violence, not the park per se,” Barboza-Salerno said.

The researchers caution that the study looked only at environments, not individuals. “We only looked at the location of death for the person in the context of the environment at that moment,” said Taylor Harrington, a doctoral candidate in public health and a co-author of the study. “It doesn’t encapsulate their whole lived experience or exposure throughout life up until that point.”

Barboza-Salerno has seen green space work as part of a broader effort. As the lead researcher at the Violence Prevention Collaborative in Boston and Director of Research for the Dudley Street Neighborhood Initiative (DSNI), Barboza-Salerno partnered with youth development organizations that employed young people to fix up local parks. The work gave them new skills and changed how neighbors perceived them.

Among other things, parks can provide safe places for children to play, socialize and have positive reciprocal interactions. Alongside housing and food security, “it’s one part of a comprehensive community-building approach that needs to be scaled to see effective violence prevention in this country,” Barboza-Salerno said. “If we think carefully about where green spaces are placed and why they make a difference, this could be huge.”

Other Ohio State co-authors of the study are Balaji Ramesh and Jeffrey Wing of the College of Public Health.

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Contact: Gia Barboza-Salerno, barboza-salerno.1@osu.edu

Written by Elizabeth Weinstein, weinstein.137@osu.edu

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Journal

Urban Forestry & Urban Greening

DOI

10.1016/j.ufug.2026.129597

Method of Research

Imaging analysis

Subject of Research

Not applicable

Article Title

Street-view measures of urban greenness, area-level deprivation, and the risk of firearm-related homicide: A matched case-control study

Article Publication Date

15-Oct-2026

 

Long-term viral hepatitis control and changing patterns of liver cancer mortality in Japan

Hiroshima University

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image: 

Long-term trends in cancer-specific mortality in Japan between 1958 and 2022, by sex. Mortality rates for major cancers among males and females, including liver (blue, including both viral- and non-viral-related liver cancer), stomach (orange), pancreatic (grey), lung (yellow), colon (black), breast (light blue), and uterine cancers (green). Liver cancer mortality increased until the early 2000s and subsequently declined, contrasting with continuing increases in mortality from several other major cancers. (Junko Tanaka, et al. The Lancet Regional Health - Western Pacific. August 17, 2026) 

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Credit: Junko Tanaka, et al. The Lancet Regional Health - Western Pacific. August 17, 2026

Over decades of sustained, integrated national viral hepatitis control, Japan has seen substantial reductions in HBV- and HCV-related disease burden and hepatocellular carcinoma mortality.

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major causes of liver cirrhosis and hepatocellular carcinoma (HCC). Due to the public health burden of viral hepatitis, Japan enacted systematic, nationwide countermeasures, starting with improvements in blood safety and reductions in healthcare-associated transmission (from the 1970s onward); prevention of mother-to-child transmission (from 1986 onwards); and institutionalization of hepatitis control through legal and financial frameworks and expanded access to antiviral treatment (from the 2000s onwards).

A review paper by a research team at Hiroshima University investigated how coordinated policy frameworks and robust epidemiological infrastructure have been associated with reductions in viral hepatitis–related HCC in Japan, and what gaps remain toward achieving hepatitis elimination. In doing so, they highlight transferable lessons for countries seeking to eliminate viral hepatitis.

The review was published in the journal The Lancet Regional Health - Western Pacific on August 17, 2026.

“This study examines how the epidemiology of viral hepatitis and liver cancer in Japan has changed over nearly five decades of national hepatitis control measures, and what challenges remain as the country approaches the WHO 2030 hepatitis elimination targets,” says Tomoyuki Akita, lecturer at Hiroshima University’s Graduate School of Biomedical and Health Sciences. “Understanding the long-term population impact of [Japan’s viral hepatitis control] measures is important not only for evaluating Japan’s progress toward hepatitis elimination, but also for identifying the next priorities for liver cancer prevention.”

The researchers collected peer-reviewed research articles related to HCC, liver cancer, viral hepatitis, liver cirrhosis, and Japan, published between January 1970 and January 2026, through online searches of the PubMed database. They also manually searched government reports for additional sources, included data from their Epidemiological Research Group on Viral Hepatitis and its Long-term Course (VH-Epi), and incorporated data from national vital statistics and multiple large-scale statistics and surveillance databases.

Decades of hepatitis control have brought Japan closer to elimination ...

The prevalence of HBV and HCV has fallen drastically across Japan. In first-time blood donors—generally considered a healthy population—Hepatitis B surface antigen (HBsAg, a positive marker of HBV infection) fell from 0.63% in 1995–2000 to 0.13% in 2017–2021; in the same period, HCV antibody (anti-HCV, a positive marker of HCV infection) fell from 0.49% to 0.16% over the same periods. Among residents aged ≥40 years at health checkups, HBsAg fell from 1.16% in 2002 to 0.55% in 2021, while anti-HCV fell from 1.16% to 0.21% in the same period. The incidence of newly acquired HBV and HCV infections in blood donors representing historically low levels in Japan, at 2.38 per 100,000 person-years for HBV and 0.4 per 100,000 person-years for HCV.

“One particularly striking finding is that among pregnant women born in or after 2000, HBsAg-positive individuals have become extremely rare, illustrating the intergenerational impact of Japan’s HBV mother-to-child transmission prevention program since 1986,” says Akita.

Viral hepatitis remains an important concern among several high-risk populations in Japan, including persons who inject drugs (PWID), men who have sex with men (MSM), migrants from regions where HBV is endemic, and incarcerated populations. Addressing viral hepatitis among these populations remains an important challenge as Japan moves toward elimination.

... while reshaping the landscape of liver cancer

At the same time, the decline in viral hepatitis-related HCC has reshaped the relative distribution of liver cancer causes in Japan. The proportion of HCC deaths attributed to non-viral causes increased from 6.8% in 1992 to 56.0% in 2019. This shift largely reflects the substantial decline in viral hepatitis-related HCC, rather than a comparable increase in the absolute burden of non-viral HCC. “In other words,” Akita says, “more than half of hepatocellular carcinoma deaths in Japan are now attributable to non-viral causes—a dramatic reversal from the era when viral hepatitis dominated the country’s liver cancer burden.”

Non-viral causes include alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD). As Japan approaches viral hepatitis elimination, maintaining the achievements of hepatitis control remains essential, while liver cancer prevention will also need to address these emerging non-viral causes. “Japan’s long-term, integrated hepatitis control strategy has substantially reduced HBV and HCV infections and related liver cancer deaths, bringing the country closer to hepatitis elimination,” Akita says. “The next step is to achieve and sustain viral hepatitis elimination while adapting liver cancer prevention to Japan’s changing disease landscape.”

The study was co-authored by Junko Tanaka, Ko Ko, Aya Sugiyama, Chanroth Chhoung, Akemi Kurisu and Tomoyuki Akita at Hiroshima University; Masahiro Satake at the Japanese Red Cross; and Tatsuya Kanto and Takaji Wakita at the Japan Institute for Health Security. Junko Tanaka and Tomoyuki Akita are corresponding authors.

This work was supported by the Ministry of Health, Labour and Welfare (MHLW) Policy Research for Hepatitis Measures Program (JPMH 22HC1001, JPMH 25HC1001).

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About Hiroshima University 
Since its foundation in 1949, Hiroshima University has striven to become one of the most prominent and comprehensive universities in Japan for the promotion and development of scholarship and education. Consisting of 12 schools for undergraduate level and 5 graduate schools, ranging from natural sciences to humanities and social sciences, the university has grown into one of the most distinguished comprehensive research universities in Japan. English website: https://www.hiroshima-u.ac.jp/en

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Journal

The Lancet Regional Health - Western Pacific

DOI

10.1016/j.lanwpc.2026.101900

Method of Research

Systematic review

Subject of Research

Not applicable

Article Title

Liver cancer in Japan: epidemiological transition, viral hepatitis control, and emerging challenges

Estimated number of individuals living with chronic hepatitis B virus (orange) and hepatitis C virus (blue) infection in Japan between 2000 and 2020, with projected future trends to 2050. (Junko Tanaka, et al. The Lancet Regional Health - Western Pacific. August 17, 2026)

Credit

Junko Tanaka, et al. The Lancet Regional Health - Western Pacific. August 17, 2026

Temporal changes in total hepatocellular carcinoma (HCC) mortality and mortality associated with HBsAg-positive, HCVAb-positive, HBsAg-negative, and non-B non-C (NBNC) liver disease. HCV-related HCC mortality increased markedly during the late 20th century and subsequently declined, whereas the proportion of NBNC-HCC progressively increased over time, indicating an epidemiological transition toward non-viral causes. (Junko Tanaka, et al. The Lancet Regional Health - Western Pacific. August 17, 2026)

Credit

Junko Tanaka, et al. The Lancet Regional Health - Western Pacific. August 17, 2026

 

Females with autoimmune diseases ‘less likely to be believed’ than males and face longer diagnostic delays

University of Cambridge

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Females with autoimmune diseases are significantly more likely than males to have their autoimmune disease misdiagnosed as a psychiatric or psychosomatic condition, according to a study of more than 6,600 patients.

In an international study published today in The Lancet’s eClinicalMedicine, researchers analysed the reported diagnostic experiences of 6,607 people with autoimmune diseases. The research, led by the University of Cambridge and University of East Anglia (UEA), also found that females were more likely to face delays in getting a correct diagnosis, and hence the right treatment.

The study found that 43% of females reported that their autoimmune symptoms had previously been misattributed to a psychiatric cause, compared with 33% of males. They were also more likely to report having their symptoms misdiagnosed as being ‘psychosomatic’ – in other words, that physical symptoms were caused or worsened by psychological factors – with this reported by 34% of females compared with 22% of males.

Autoimmune diseases occur when the immune system mistakenly attacks the body’s own tissues. They include conditions such as rheumatoid arthritis, lupus and multiple sclerosis. Many autoimmune diseases are more common in females.

Diagnosis can be challenging because many autoimmune diseases initially cause symptoms such as fatigue, pain, sleep disturbance or low mood, which are common in the general population. Symptoms can also affect multiple parts of the body and change over time.

After taking account of factors including age, disease group, continent and household finances, the researchers found that females were almost 50% more likely to report having received a psychiatric misdiagnosis and nearly 75% more likely to report a psychosomatic misdiagnosis than males.

Interestingly, reports of being misdiagnosed with a different physical disease was slightly higher among males than females (48% vs 44%). 

The research was co-designed with patients, charities and clinicians and uncovers important parts of the diagnostic journey that are often not recorded in medical records.

Shaista Tayabali, co-author and patient partner, said: “The differences between the sexes in misdiagnoses for people with autoimmune diseases is stark. The fact that females reported higher rates of psychiatric and psychosomatic misdiagnoses than males, yet reported lower misdiagnoses for other physical diseases, suggests that historical gender biases remain a challenging aspect of the diagnostic journey.

“Although labels such as hysteria are outdated, and fortunately rarely used nowadays, as women we still often have a harder time having our symptoms believed and therefore addressed accurately.”

The researchers also found that females reported longer periods between the onset of symptoms and receiving their diagnosis, as well as more healthcare consultations. Among males, the most frequently reported time to diagnosis was less than three months, whereas among females it was one to two years.

Dr Melanie Sloan from the Department of Public Health and Primary Care at the University of Cambridge, and Norwich Medical School, University of East Anglia said: “Patients with autoimmune diseases can present with symptoms that can initially be difficult to explain medically, and sometimes it can take months or years before a diagnosis becomes clear.

“Our findings highlight that psychological or mental health explanations can be given too soon. This is true for both sexes, but our study suggests that females may be particularly vulnerable to these types of misdiagnoses.”

The high rates of reported psychiatric, psychosomatic and alternative physical misdiagnoses among both sexes reflects the difficulty of diagnosing autoimmune diseases, especially those which have few visible signs or results that show in blood tests.

The team is calling for doctors to consider autoimmune diseases before any psychiatric or psychosomatic diagnoses are given.

Professor David D’Cruz, Consultant Rheumatologist at Guy’s Hospital, said: “This is not about saying that a psychiatric diagnosis is never correct. People can have both autoimmune and psychiatric conditions, and it is increasingly understood that psychiatric symptoms can be part of an autoimmune disease, especially in diseases like lupus which can directly affect the brain. They can also be a very natural response to living with life-changing illnesses.

“The important message is that when symptoms persist, evolve or involve multiple systems, clinicians must be open minded and consider whether there is an underlying autoimmune disease that has not yet been recognised – and to listen to patients”.

Listening to patients

Unlike studies based solely on medical records, this research focused on patients’ own accounts of their diagnostic journeys. Participants were asked about the time from symptom onset to diagnosis, the number of healthcare consultations they had, and the types of diagnoses they reported receiving before their autoimmune diagnosis.

The researchers say patient perspectives are particularly important in diseases where symptoms may not be easily visible or where there is no definite diagnostic test.

Wendy Diment, patient partner in the study, said: “Most studies use medical records, but these are very one-sided as patient’s views are very rarely recorded and we often have different views on what is causing our symptoms to our doctors. They also don’t always record when we first became unwell and the difficulties in getting our diagnosis, and they’re very unlikely to be corrected when a psychosomatic ‘in your head’ type diagnosis is then found to be wrong.”

Improving diagnosis

The researchers say clinicians may benefit from acknowledging diagnostic uncertainty, providing clear advice about when patients should seek further assessment, and revisiting previous diagnostic decisions when new symptoms or information emerge.

They also highlight the importance of continuity of care and listening carefully to patients, particularly when there is not yet a clear explanation for their symptoms.

Dr Sloan said: “Ultimately, we need to understand why these differences occur before we can design effective solutions. Our next step is exploring the experiences and voices behind these numbers and working with patients and clinicians to identify ways of reducing diagnostic delays and improving care. Listening to and valuing people’s accounts and views should always be part of research and the diagnostic process.”

The study was funded by The Lupus Trust, Vasculitis UK, Sjögren’s UK, Lupus UK and SRUK.

Reference

Sloan, M, et al. Sex and disease differences in patients’ diagnostic experiences in autoimmune diseases: an international cross-sectional study. eClinMed; 13 Oct 2026; DOI: 10.1016/j.eclinm.2026.104259

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Journal

EClinicalMedicine

DOI

10.1016/j.eclinm.2026.104259

Method of Research

Survey

Subject of Research

People

Article Title

Sex and disease differences in patients’ diagnostic experiences in autoimmune diseases: an international cross-sectional study

Article Publication Date

13-Oct-2026

 

Are young women receiving delayed care for breast cancer?

Study reveals that especially young patients and those with lower income are most likely to experience delays

Wiley

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In an analysis of data on adolescents and young adults with breast cancer, lower income and younger age were linked with delays in care. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, also found that women who experienced delays in cancer diagnoses tended to have later stages of disease.

Breast cancer diagnosed before the age of 40 years—which is before the recommended age of screening—often carries a poor prognosis, along with unique treatment and psychosocial challenges. Because younger women tend to not undergo screening and may face delays in response to breast cancer–related symptoms due to potential biases that they are not old enough to have cancer, investigators conducted a study to understand the impact of patient and tumor characteristics on delays in care and tie impact of delays on cancer outcomes.

In the analysis of data on 1,071 individuals enrolled in the Young Women’s Breast Cancer Study, a multi-site prospective cohort of young women diagnosed with breast cancer by 40 years of age, the team identified 153 presentation delays, 120 diagnostic delays, and 228 treatment delays. Presentation delays were defined as ≥90 days from time of first patient-reported symptom(s) to presentation to a clinician, diagnostic delays were ≥90 days from first health care visit for symptom(s) to date of biopsy with a diagnosis with breast cancer, and treatment delays were considered ≥60 days between the time of diagnosis to time of first treatment.

After adjusting for influencing factors, lower annual income was associated with higher odds of presentation delay, while pregnancy at diagnosis, family history of breast cancer, and triple-negative breast cancer were associated with lower odds of presentation delay. Presentation delays were also associated with later stage disease in women with certain HER2-positive tumors. Odds of diagnostic delay were higher for younger patients and lower for those with triple-negative tumors. Those who experienced a delay in breast cancer diagnosis were more likely to have late-stage disease. Patients with more aggressive tumor types were less likely to have treatment delays.

Fortunately, delays were not associated with cancer-free or overall survival, but the authors noted that later stage at diagnosis may require more extensive surgery, radiation, or systemic therapy that can impact quality of life and other outcomes.

“Our study reveals continued issues in care delay among patients with young-onset breast cancer and emphasizes a need to improve both patient and provider understanding of young-onset breast cancer risk factors and symptoms to decrease disease burden among these patients,” said senior author Kristen D. Brantley, PhD, MPH, of the Dana-Farber Cancer Institute.

 

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

Full Citation:
“Delays in breast cancer presentation, diagnosis, and treatment in young women.” Bessie X. Zhang, Tal Sella, Yue Zheng, Gregory J. Kirkner, Kathryn J. Ruddy, Shoshana M. Rosenberg, Virginia F. Borges, Lidia Schapira, Steven E. Come, Jeffrey M. Peppercorn, Laura Collins, Ann H. Partridge, and Kristen D. Brantley. CANCER; Published Online: October 12, 2026 (DOI: 10.1002/cncr.70594). 
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.70594

Author Contact: John W. Noble, Dana-Farber Cancer Institute Media Relations Manager in the Department of Communications, at johnw_noble@dfci.harvard.edu or +1 703-407-9416

About the Journal      
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer, and stay up to date with the American Cancer Society Journals on Instagram, LinkedIn, and YouTube.

About Wiley       
Wiley is a global leader in authoritative content and research intelligence for the advancement of scientific discovery, innovation, and learning. With more than 200 years at the center of the scholarly ecosystem, Wiley combines trusted publishing heritage with AI-powered platforms to transform how knowledge is discovered, accessed, and applied. From individual researchers and students to Fortune 500 R&D teams, Wiley enables the transformation of scientific breakthroughs into real-world impact. From knowledge to impact—Wiley is redefining what's possible in science and learning. Visit us at Wiley.com and Investors.Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram. 

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Journal

Cancer

DOI

10.1002/cncr.70594

Article Title

Delays in breast cancer presentation, diagnosis and treatment in young women

Article Publication Date

12-Oct-2026