{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:59:24Z","timestamp":1790611164386,"version":"4.1.0"},"reference-count":50,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Urban communities affected by chronic violence face persistent challenges in accessing primary health care (PHC). Although violence is widely recognized as a determinant of health inequities, there exists limited evidence on how direct exposure to violent events is related to individuals\u2019 perceptions of difficulty in accessing PHC services in highly vulnerable urban environments.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The study aims to examine how sociodemographic characteristics and exposure to violent events are associated with perceived difficulty in accessing PHC in standardized hypothetical mental health scenarios among residents of a community affected by chronic urban violence in Rio de Janeiro.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A cross-sectional survey was conducted between October 8 and November 1, 2024, with 1006 adult residents who completed 4 PHC vignettes and reported past-year exposure to violent events. Participants completed a structured questionnaire that included sociodemographic information, past-year exposure to interpersonal violence, and evaluations of 4 hypothetical vignettes describing different clinical or social situations. Vignette responses were recorded using an ordinal Likert-type scale ranging from \u201cvery easy\u201d to \u201cextremely difficult.\u201d Descriptive analyses were performed for all variables, and associations between sociodemographic characteristics and violence indicators were examined using Pearson chi-square tests, with effect sizes estimated using the\n \u03c6<\/jats:italic>\n coefficient or Cram\u00e9r\n V<\/jats:italic>\n , as appropriate, and their respective 95% CIs. Differences in vignette ratings across sociodemographic groups were assessed using Kruskal-Wallis tests. To explore the underlying relationships among violence indicators, vignette responses, and sociodemographic variables, exploratory factor analysis and multiple correspondence analysis were conducted.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Violence exposure was frequent. Threats of harm were reported by 27.7% (157\/567) of Black participants and 30.5% (72\/236) of non-Black participants. Slapping was reported by 20.8% (118\/567) of Black individuals and 28% (66\/236) of non-Black individuals, while being pushed or restrained affected 21.2% (50\/236) and 26.7% (63\/236), respectively. Significant sex differences emerged for being punched or kicked (female 17.2% [75\/435] vs male 23.9% [88\/368];\n P<\/jats:italic>\n =.02). Kruskal-Wallis tests indicated few differences in vignette-based perceptions across groups, except for race in the alcohol-dependence vignette (\n \u03c7<\/jats:italic>\n \u00b2\n 1<\/jats:sub>\n =7.384,\n P<\/jats:italic>\n =.006). Factor analysis identified 2 dimensions: violence variables loaded strongly on one factor (0.83\u20100.96) and vignette responses on another (0.66\u20100.83). Multiple correspondence analysis results showed that forms of violence contributed mainly to Dimension 1 (9%\u201015%) and vignette categories to Dimension 2 (7%\u201012%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Exposure to violence was widespread, with differences in some forms of violence observed between men and women. Violence-related variables and vignette-based perceptions of difficulty accessing PHC were predominantly represented by distinct dimensions in the exploratory multivariate analyses. Strengthening PHC in violence-affected urban settings requires addressing structural barriers that shape residents\u2019 access to health care.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/94922","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:30:07Z","timestamp":1787563807000},"page":"e94922-e94922","source":"Crossref","is-referenced-by-count":0,"title":["Perceived Difficulty Accessing Primary Health Care and Its Associations With Sociodemographic Factors and Exposure to Violence in a Violent Urban Community in Rio de Janeiro, Brazil: Cross-Sectional Study"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1400-1472","authenticated-orcid":false,"given":"Ana Paula da","family":"Cunha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5007-1590","authenticated-orcid":false,"given":"Jurema Corr\u00eaa","family":"da Mota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5970-8896","authenticated-orcid":false,"given":"Francisco Inacio","family":"Bastos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"Suppl 1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X1994000500002","article-title":"Social violence from a public health perspective","volume":"10","author":"Minayo","journal-title":"Cad Saude Publica"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1007\/s10591-020-09546-6","article-title":"\u201cA larger system is placing people in this predicament\u201d: a qualitative exploration of living amongst urban violence and the impact on mental health and relationships in the Black community","volume":"42","author":"Hollie","journal-title":"Contemp Fam Ther"},{"issue":"10","key":"R3","doi-asserted-by":"publisher","first-page":"8176","DOI":"10.1007\/s12144-021-02141-4","article-title":"Violence exposure and mental health consequences among urban youth","volume":"42","author":"Borg","journal-title":"Curr Psychol"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-11167-z","article-title":"Interpersonal violence in a deprived Scottish urban area with aggregations of physical health risks and psychiatric morbidity: an ecological study","volume":"21","author":"Coid","journal-title":"BMC Public Health"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2022.2103581","article-title":"A scoping review of how exposure to urban violence impacts youth access to sexual, reproductive and trauma health care in LMICs","volume":"18","author":"Green","journal-title":"Glob Public Health"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1590\/0102-311XEN058123","article-title":"Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people","volume":"40","author":"P\u00e9rez-Sastr\u00e9","journal-title":"Cad Saude Publica"},{"issue":"Supplement_4","key":"R7","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckaf161.1420","article-title":"Urban violence and its effect on primary health care","volume":"35","author":"Vieira-Meyer","journal-title":"Eur J Public Health"},{"issue":"15-16","key":"R8","doi-asserted-by":"publisher","first-page":"5504","DOI":"10.1177\/08862605251356234","article-title":"A city under siege: time-series analysis of shootouts and the association with health and living conditions in Rio de Janeiro, Brazil, 2017 to 2022","volume":"41","author":"da Cunha","journal-title":"J Interpers Violence"},{"key":"R9","unstructured":"Perlman J . 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