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Oh H, Nicholson HL, Koyanagi A, Jacob L, Glass J. Urban upbringing and psychiatric disorders in the United States: A racial comparison. Int J Soc Psychiatry 2021; 67:307-314. [PMID: 32820966 DOI: 10.1177/0020764020950781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States. METHODS We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately. RESULTS The majority (58.97%) of the White sample grew up in the 'other' category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders. CONCLUSIONS Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Harvey L Nicholson
- Sociology and Crimininology & Law, University of Florida, Gainesville, FL, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Joe Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Telionis PA, Corbett P, Venkatramanan S, Lewis B. Methods for Rapid Mobility Estimation to Support Outbreak Response. Health Secur 2020; 18:1-15. [PMID: 32078419 DOI: 10.1089/hs.2019.0101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
When pressed for time, outbreak investigators often use homogeneous mixing models to model infectious diseases in data-poor regions. But recent outbreaks such as the 2014 Ebola outbreak in West Africa have shown the limitations of this approach in an era of increasing urbanization and connectivity. Both outbreak detection and predictive modeling depend on realistic estimates of human and disease mobility, but these data are difficult to acquire in a timely manner. This is especially true when dealing with an emerging outbreak in an under-resourced nation. Weighted travel networks with realistic estimates for population flows are often proprietary, expensive, or nonexistent. Here we propose a method for rapidly generating a mobility model from open-source data. As an example, we use road and river network data, along with population estimates, to construct a realistic model of human movement between health zones in the Democratic Republic of the Congo (DRC). Using these mobility data, we then fit an epidemic model to real-world surveillance data from the recent Ebola outbreak in the Nord Kivu region of the DRC to illustrate a potential use of the generated mobility estimation. In addition to providing a way for rapid risk estimation, this approach brings together novel techniques to merge diverse GIS datasets that can then be used to address issues that pertain to public health and global health security.
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Affiliation(s)
- Pyrros A Telionis
- Pyrros A. Telionis, PhD, is a postdoctoral research assistant, Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA, and Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA. Patrick Corbett is an undergraduate research assistant; Srinivasan Venkatramanan, PhD, is a Research Scientist; and Bryan Lewis, PhD, is a Research Associate Professor; all in Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Patrick Corbett
- Pyrros A. Telionis, PhD, is a postdoctoral research assistant, Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA, and Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA. Patrick Corbett is an undergraduate research assistant; Srinivasan Venkatramanan, PhD, is a Research Scientist; and Bryan Lewis, PhD, is a Research Associate Professor; all in Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Srinivasan Venkatramanan
- Pyrros A. Telionis, PhD, is a postdoctoral research assistant, Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA, and Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA. Patrick Corbett is an undergraduate research assistant; Srinivasan Venkatramanan, PhD, is a Research Scientist; and Bryan Lewis, PhD, is a Research Associate Professor; all in Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Bryan Lewis
- Pyrros A. Telionis, PhD, is a postdoctoral research assistant, Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA, and Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA. Patrick Corbett is an undergraduate research assistant; Srinivasan Venkatramanan, PhD, is a Research Scientist; and Bryan Lewis, PhD, is a Research Associate Professor; all in Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
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Smart City and High-Tech Urban Interventions Targeting Human Health: An Equity-Focused Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072325. [PMID: 32235594 PMCID: PMC7177215 DOI: 10.3390/ijerph17072325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
Urban infrastructure systems responsible for the provision of energy, transportation, shelter, and communication to populations are important determinants of health and health equity. The term “smart city” has been used synonymously with other terms, such as “digital city”, “sustainable city”, and “information city”, even though definitional distinctions exist between terms. In this review, we use “smart cities” as a catch-all term to refer to an emerging concept in urban governance practice and scholarship that has been increasingly applied to achieve public health aims. The objective of this systematic review was to document and analyze the inclusion of equity considerations and dimensions (i.e., a measurement, analytical, or dialectical focus on systematic disparities in health between groups) in smart city interventions aimed to improve human health and well-being. Systematic searches were carried out in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information Database (PsycINFO), the PubMed database from the National Center for Biotechnology Information, Elsevier’s database Scopus, and Web of Science, returning 3219 titles. Ultimately, 28 articles were retained, assessed, and coded for their inclusion of equity characteristics using the Cochrane PROGRESS-Plus tool (referring to (P) place of residence, (R) race, (O) occupation, (G) gender, (R) religion, (E) education, (S) socio-economic status (SES), and (S) social capital). The most frequently included equity considerations in smart city health interventions were place of residence, SES, social capital, and personal characteristics; conversely, occupation, gender or sex, religion, race, ethnicity, culture, language, and education characteristics were comparatively less featured in such interventions. Overall, it appears that most of intervention evaluations assessed in this review are still in the early testing phases, and thus did not include or feature robust evaluative designs or commercially available technologies
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Bennett JM, Reeves G, Billman GE, Sturmberg JP. Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases. Front Med (Lausanne) 2018; 5:316. [PMID: 30538987 PMCID: PMC6277637 DOI: 10.3389/fmed.2018.00316] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023] Open
Abstract
Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work-system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.
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Affiliation(s)
- Jeanette M. Bennett
- Department of Psychological Science, StressWAVES Biobehavioral Research Lab, The University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Glenn Reeves
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - George E. Billman
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
| | - Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Foundation President, International Society for Systems and Complexity Sciences for Health, Delaware, United States
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Updates on the risk factors for latent tuberculosis reactivation and their managements. Emerg Microbes Infect 2016; 5:e10. [PMID: 26839146 PMCID: PMC4777925 DOI: 10.1038/emi.2016.10] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/19/2022]
Abstract
The preventive treatment of latent tuberculosis infection (LTBI) is of great importance for the elimination and control of tuberculosis (TB) worldwide, but existing screening methods for LTBI are still limited in predicting the onset of TB. Previous studies have found that some high-risk factors (including human immunodeficiency virus (HIV), organ transplantation, silicosis, tumor necrosis factor-alpha blockers, close contacts and kidney dialysis) contribute to a significantly increased TB reactivation rate. This article reviews each risk factor's association with TB and approaches to address those factors. Five regimens are currently recommended by the World Health Organization, and no regimen has shown superiority over others. In recent years, studies have gradually narrowed down to the preventive treatment of LTBI for high-risk target groups, such as silicosis patients, organ-transplantation recipients and HIV-infected patients. This review discusses regimens for each target group and compares the efficacy of different regimens. For HIV patients and transplant recipients, isoniazid monotherapy is effective in treating LTBI, but for others, little evidence is available at present.
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Singleton JL, Raunig M, Brunsteter H, Desmond M, Rao D. Identity, Physical Space, and Stigma Among African American Men Living with HIV in Chicago and Seattle. J Racial Ethn Health Disparities 2015; 2:548-55. [PMID: 26863561 DOI: 10.1007/s40615-015-0103-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/04/2015] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
African American men have the highest rates of HIV in the USA, and research has shown that stigma, mistrust of health care, and other psychosocial factors interfere with optimal engagement in care with this population. In order to further understand reducing stigma and other psychosocial issues among African American men, we conducted qualitative interviews and focus groups with African American men in two metropolitan areas in the USA: Chicago and Seattle. We examined transcripts for relationships across variables of stigma, anonymity, self-identity, and space within the context of HIV. Our analysis pointed to similarities between experiences of stigma across the two cities and illustrated the relationships between space, isolation, and preferred anonymity related to living with HIV. The men in our study often preferred that their HIV-linked identities remain invisible and anonymous, associated with perceived and created isolation from physical community spaces. This article suggests that our health care and housing institutions may influence preferences for anonymity. We make recommendations in key areas to create safer spaces for African American men living with HIV and reduce feelings of stigma and isolation.
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Affiliation(s)
- Judith L Singleton
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- School of Urban Public Health, Hunter College, City University of New York (CUNY), New York, NY, USA
| | - Manuela Raunig
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Halley Brunsteter
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Michelle Desmond
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA.
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Shi C, Tian J, Wang Q, Petkovic J, Ren D, Yang K, Yang Y. How equity is addressed in clinical practice guidelines: a content analysis. BMJ Open 2014; 4:e005660. [PMID: 25479795 PMCID: PMC4265087 DOI: 10.1136/bmjopen-2014-005660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/23/2014] [Accepted: 11/18/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Considering equity into guidelines presents methodological challenges. This study aims to qualitatively synthesise the methods for incorporating equity in clinical practice guidelines (CPGs). SETTING Content analysis of methodological publications. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Methodological publications were included if they provided checklists/frameworks on when, how and to what extent equity should be incorporated in CPGs. DATA SOURCES We electronically searched MEDLINE, retrieved references, and browsed guideline development organisation websites from inception to January 2013. After study selection by two authors, general characteristics and checklists items/framework components from included studies were extracted. Based on the questions or items from checklists/frameworks (unit of analysis), content analysis was conducted to identify themes and questions/items were grouped into these themes. PRIMARY OUTCOMES The primary outcomes were methodological themes and processes on how to address equity issues in guideline development. RESULTS 8 studies with 10 publications were included from 3405 citations. In total, a list of 87 questions/items was generated from 17 checklists/frameworks. After content analysis, questions were grouped into eight themes ('scoping questions', 'searching relevant evidence', 'appraising evidence and recommendations', 'formulating recommendations', 'monitoring implementation', 'providing a flow chart to include equity in CPGs', and 'others: reporting of guidelines and comments from stakeholders' for CPG developers and 'assessing the quality of CPGs' for CPG users). Four included studies covered more than five of these themes. We also summarised the process of guideline development based on the themes mentioned above. CONCLUSIONS For disadvantaged population-specific CPGs, eight important methodological issues identified in this review should be considered when including equity in CPGs under the guidance of a scientific guideline development manual.
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Affiliation(s)
- Chunhu Shi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Quan Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The First Clinical Medicine School, Lanzhou University, Lanzhou, China
| | | | - Dan Ren
- The First Clinical Medicine School, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yang Yang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Krieger N. Discrimination and Health Inequities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:643-710. [DOI: 10.2190/hs.44.4.b] [Citation(s) in RCA: 429] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: ( a) briefly reviews definitions of discrimination, illustrated with examples from the United States; ( b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; ( c) concisely summarizes extant evidence—both robust and inconsistent—linking discrimination and health; and ( d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
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Woods-Jaeger BA, Sparks A, Turner K, Griffith T, Jackson M, Lightfoot AF. Exploring the social and community context of African American adolescents' HIV vulnerability. QUALITATIVE HEALTH RESEARCH 2013; 23:1541-50. [PMID: 24108089 DOI: 10.1177/1049732313507143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
There is an increasing call for HIV prevention programs that target social determinants of HIV. The purpose of this study was to examine the experiences and perceptions of 12 African American adolescents to identify important social and community targets for HIV prevention. We used photovoice methodology to engage adolescents in a critical analysis of their experiences to arrive at a deeper understanding of the social determinants of HIV and determine specific action steps to reduce HIV risk. Analyses revealed a variety of social and environmental factors that affect the lives of African American adolescents by creating conditions that put them at greater risk for HIV. Study findings support mobilizing community action through raising awareness and advocating for increased neighborhood resources and institutional support. We conclude with research and practice implications for community-relevant HIV prevention among African American youth.
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Tempalski B, Pouget ER, Cleland CM, Brady JE, Cooper HLF, Hall HI, Lansky A, West BS, Friedman SR. Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007. PLoS One 2013; 8:e64789. [PMID: 23755143 PMCID: PMC3673953 DOI: 10.1371/journal.pone.0064789] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992-2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations. METHODOLOGY We calculated the number of PWID in the US annually from 1992-2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models. RESULTS PWID per 10,000 persons aged 15-64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002-2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated--the mean prevalence was 90 to 100 per 10,000 youth in 1992-1996, but increased to >120 PWID per 10,000 youth in 2006-2007. CONCLUSIONS Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes.
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Affiliation(s)
- Barbara Tempalski
- Institute for AIDS Research, National Development and Research Institutes, Inc.-NDRI, New York, New York, United States of America.
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Garvin E, Branas C, Keddem S, Sellman J, Cannuscio C. More than just an eyesore: local insights and solutions on vacant land and urban health. J Urban Health 2013; 90. [PMID: 23188553 PMCID: PMC3665973 DOI: 10.1007/s11524-012-9782-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vacant land is a significant economic problem for many cities, but also may affect the health and safety of residents. In order for community-based solutions to vacant land to be accepted by target populations, community members should be engaged in identifying local health impacts and generating solutions. We conducted 50 in-depth semi-structured interviews with people living in Philadelphia, Pennsylvania, a city with high vacancy, about the impact of vacant land on community and individual health and safety, as well as ideas for solutions to vacant land. Participants described a neighborhood physical environment dominated by decaying abandoned homes and overgrown vacant lots which affected community well-being, physical health, and mental health. Vacant land was thought to affect community well-being by overshadowing positive aspects of the community, contributing to fractures between neighbors, attracting crime, and making residents fearful. Vacant land was described as impacting physical health through injury, the buildup of trash, and attraction of rodents, as well as mental health through anxiety and stigma. Participants had several ideas for solutions to vacant land in their community, including transformation of vacant lots into small park spaces for the elderly and playgrounds for youth, and the use of abandoned homes for subsidized housing and homeless shelters. A few participants took pride in maintaining vacant lots on their block, and others expressed interest in performing maintenance but lacked the resources to do so. Public health researchers and practitioners, and urban planners should engage local residents in the design and implementation of vacant land strategies. Furthermore, municipalities should ensure that the health and safety impact of vacant land helps drive policy decisions around vacant land.
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Affiliation(s)
- Eugenia Garvin
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Tudor Hart J. Commentary: Sir James Mackenzie (1853-1925): An ambiguous pioneer for research in primary care. Int J Epidemiol 2013; 41:1525-31. [DOI: 10.1093/ije/dys196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Burns PA, Snow RC. The built environment & the impact of neighborhood characteristics on youth sexual risk behavior in Cape Town, South Africa. Health Place 2012; 18:1088-100. [PMID: 22704913 DOI: 10.1016/j.healthplace.2012.04.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/24/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
Youth sexual risk behavior is often described in social terms, and there has been limited attention to date on how measures of the built environment, including access to municipal services, impact sexual risk behavior, particularly in resource-limited countries. Using the Cape Area Panel Study, we assessed the impact of neighborhood conditions (six single items and a built environment index (BEI)), net of individual socio-demographic factors. The results suggest that built environment factors are associated with sexual risk behavior. Also, the magnitude of associations between built environment factors and sexual risk behavior was more pronounced for females than for males.
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Affiliation(s)
- Paul A Burns
- Population Studies Center, University of Michigan, USA.
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Abstract
Generalized language-of-thought arguments, appropriate, in the sense of Dretske, to interacting cognitive modules, permit exploration of how disease states interact with medical treatment, given an embedding context of structured psychosocial stress. The interpenetrating feedback between treatment and response creates a kind of idiotypic hall of mirrors generating a synergistic pattern of efficacy, treatment failure, adverse reactions, and patient noncompliance which, from a Rate Distortion perspective, embodies a distorted image of externally-imposed structured stress. For the US, accelerating spatial and social spread of such stress enmeshes both dominant and subordinate populations in a linked system of pathogenic social hierarchy which will express itself, not only in an increasingly unhealthy society, but in the diffusion of therapeutic failure, including, but not limited to, drug-based treatments.
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Affiliation(s)
| | - DEBORAH WALLACE
- Joseph L. Mailman School of Public Health, Columbia University, USA
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Lòpez-De Fede A, Stewart JE, Hardin JW, Mayfield-Smith K, Sudduth D. Spatial visualization of multivariate datasets: an analysis of STD and HIV/AIDS diagnosis rates and socioeconomic context using ring maps. Public Health Rep 2011; 126 Suppl 3:115-26. [PMID: 21836744 DOI: 10.1177/00333549111260s316] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES We used existing data systems to examine sexually transmitted disease (STD) and HIV/AIDS diagnosis rates and explore potential county-level associations between HIV/AIDS diagnosis rates and socioeconomic disadvantage. METHODS Using South Carolina county data, we constructed multivariate ring maps to spatially visualize syphilis, gonorrhea, chlamydia, and HIV/AIDS diagnosis rates; gender- and race-specific HIV/AIDS diagnosis rates; and three measures of socioeconomic disadvantage-an unemployment index, a poverty index, and the Townsend index of social deprivation. Statistical analyses were performed to quantitatively assess potential county-level associations between HIV/AIDS diagnosis rates and each of the three indexes of socioeconomic disadvantage. RESULTS Ring maps revealed substantial spatial association in STD and HIV/AIDS diagnosis rates and highlighted large gender and racial disparities in HIV/AIDS across the state. The mean county-level HIV/AIDS diagnosis rate (per 100,000 population) was 24.2 for males vs. 11.2 for females, and 34.8 for African Americans vs. 5.2 for white people. In addition, ring map visualization suggested a county-level association between HIV/AIDS diagnosis rates and socioeconomic disadvantage. Significant positive bivariate relationships were found between HIV/AIDS rate categories and each increase in poverty index category (odds ratio [OR] = 2.03; p=0.006), as well as each increase in Townsend index of social deprivation category (OR=4.98; p<0.001). A multivariate ordered logistic regression model in which all three socioeconomic disadvantage indexes were included showed a significant positive association between HIV/AIDS and Townsend index categories (adjusted OR=6.10; p<0.001). CONCLUSIONS Ring maps graphically depicted the spatial coincidence of STD and HIV/AIDS and revealed large gender and racial disparities in HIV/AIDS across South Carolina counties. This spatial visualization method used existing data systems to highlight the importance of social determinants of health in program planning and decision-making processes.
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Affiliation(s)
- Ana Lòpez-De Fede
- University of South Carolina, Institute for Families in Society, Policy and Research Unit on Medicaid and Medicare, Columbia, SC 29208, USA.
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16
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Chatterjee S, Tempalski B, Pouget ER, Cooper HLF, Cleland CM, Friedman SR. Changes in the prevalence of injection drug use among adolescents and young adults in large U.S. metropolitan areas. AIDS Behav 2011; 15:1570-8. [PMID: 21739288 DOI: 10.1007/s10461-011-9992-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Young injection drug users (IDUs) are at risk for acquiring blood-borne diseases like HIV and Hepatitis C. Little is known about the population prevalence of young IDUs. We (1) estimate annual population prevalence rates of young IDUs (aged 15-29) per 10,000 in 95 large U.S. metropolitan statistical areas (MSAs) from 1992 to 2002; (2) assess the validity of these estimates; and (3) explore whether injection drug use among youth in these MSAs began to rise after HAART was discovered. A linear mixed model (LMM) estimated the annual population prevalence of young IDUs in each MSA and described trends therein. The population prevalence of IDUs among youths across 95 MSAs increased from 1996 (mean = 95.64) to 2002 (mean = 115.59). Additional analyses of the proportion of young IDUs using health services suggest this increase may have continued after 2002. Harm reduction and prevention research and programs for young IDUs are needed.
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17
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Freudenberg N. HIV in the epicenter of the epicenter: HIV and drug use among criminal justice populations in New York City, 1980-2007. Subst Use Misuse 2011; 46:159-70. [PMID: 21303236 DOI: 10.3109/10826084.2011.521460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
During the 1990s, some of the highest rates of HIV infection in the United States were found among inmates in the New York City jail and prisons systems. This article traces the history of drug use and HIV infection among populations incarcerated in New York City jails and New York State prisons between 1980 and 2007. It describes and analyzes the policies and programs that were initiated to respond to these epidemics and assesses the lessons learned from almost three decades of experience with HIV among populations in New York's correctional facilities.
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Affiliation(s)
- Nicholas Freudenberg
- School of Public Health, Hunter College, City University of New York, New York, New York 10010, USA.
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18
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Bruneau J, Daniel M, Kestens Y, Abrahamowicz M, Zang G. Availability of body art facilities and body art piercing do not predict hepatitis C acquisition among injection drug users in Montreal, Canada: Results from a cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:477-84. [DOI: 10.1016/j.drugpo.2010.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 05/11/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
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19
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Généreux M, Bruneau J, Daniel M. Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:49-55. [DOI: 10.1016/j.drugpo.2009.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 01/22/2009] [Indexed: 11/25/2022]
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Singh Setia M, Quesnel-Vallee A, Curtis S, Lynch J. Assessing the role of individual and neighbourhood characteristics in HIV testing: evidence from a population based survey. Open AIDS J 2009; 3:46-54. [PMID: 19920885 PMCID: PMC2778013 DOI: 10.2174/1874613600903010046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 08/12/2009] [Accepted: 08/23/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Individuals living in deprived neighbourhoods have poor health outcomes, including human immunodeficiency virus (HIV) infection mortality. We assessed the association between individual and neighbourhood characteristics, and HIV testing across Canada. METHODS We used logistic regression modelling to evaluate this association in 2219 men and 2815 women, aged 18-54 years, in Canada, using data from the National Population Health Survey (1996/7),. Socio-economic characteristics and presence of a sexually transmitted infection (STI) were the individual level characteristics. Small area of residence was classified according to categories of material and social deprivation; these were the 'neighbourhood' variables in the model. RESULTS Ethnic minority women were less likely to report an HIV test than white women (OR 0.44, 95% CI: 0.23 to 0.86). Women without a regular doctor were significantly less likely to report ever having had an HIV test (OR 0.57, 95% CI: 0.35 to 0.93). Adjusting for individual level characteristics, we found that men and women living in the most materially deprived neighbourhoods were slightly less likely to report HIV testing than those living in the least deprived neighbourhoods (Men - OR 0.61, 95% CI: 0.34 to 1.08; Women - OR 0.62, 95% CI: 0.38 to 1.00). DISCUSSION Thus, living in poor neighbourhoods was associated with poor uptake of an HIV test. These economic disparities should be taken in account while designing future prevention strategies. Ethnic minority women were less likely to go for HIV testing and culturally appropriate messages may be required for prevention in ethnic minorities.
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Affiliation(s)
- Maninder Singh Setia
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
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21
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Cooper HLF, Brady JE, Friedman SR, Tempalski B, Gostnell K, Flom PL. Estimating the prevalence of injection drug use among black and white adults in large U.S. metropolitan areas over time (1992--2002): estimation methods and prevalence trends. J Urban Health 2008; 85:826-56. [PMID: 18709555 PMCID: PMC2587642 DOI: 10.1007/s11524-008-9304-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 06/16/2008] [Indexed: 02/04/2023]
Abstract
No adequate data exist on patterns of injection drug use (IDU) prevalence over time within racial/ethnic groups in U.S. geographic areas. The absence of such prevalence data limits our understanding of the causes and consequences of IDU and hampers planning efforts for IDU-related interventions. Here, we (1) describe a method of estimating IDU prevalence among non-Hispanic Black and non-Hispanic White adult residents of 95 large U.S. metropolitan statistical areas (MSAs) annually over an 11-year period (1992--2002); (2) validate the resulting prevalence estimates; and (3) document temporal trends in these prevalence estimates. IDU prevalence estimates for Black adults were calculated in several steps: we (1) created estimates of the proportion of injectors who were Black in each MSA and year by analyzing databases documenting injectors' encounters with the healthcare system; (2) multiplied the resulting proportions by previously calculated estimates of the total number of injectors in each MSA and year (Brady et al., 2008); (3) divided the result by the number of Black adults living in each MSA each year; and (4) validated the resulting estimates by correlating them cross-sectionally with theoretically related constructs (Black- and White-specific prevalences of drug-related mortality and of mortality from hepatitis C). We used parallel methods to estimate and validate White IDU prevalence. We analyzed trends in the resulting racial/ethnic-specific IDU prevalence estimates using measures of central tendency and hierarchical linear models (HLM). Black IDU prevalence declined from a median of 279 injectors per 10,000 adults in 1992 to 156 injectors per 10,000 adults in 2002. IDU prevalence for White adults remained relatively flat over time (median values ranged between 86 and 97 injectors per 10,000 adults). HLM analyses described similar trends and suggest that declines in Black IDU prevalence decelerated over time. Both sets of IDU estimates correlated cross-sectionally adequately with validators, suggesting that they have acceptable convergent validity (range for Black IDU prevalence validation: 0.27 < r < 0.61; range for White IDU prevalence: 0.38 < r < 0.80). These data give insight, for the first time, into IDU prevalence trends among Black adults and White adults in large U.S. MSAs. The decline seen here for Black adults may partially explain recent reductions in newly reported cases of IDU-related HIV evident in surveillance data on this population. Declining Black IDU prevalence may have been produced by (1) high AIDS-related mortality rates among Black injectors in the 1990s, rates lowered by the advent of HAART; (2) reduced IDU incidence among Black drug users; and/or (3) MSA-level social processes (e.g., diminishing residential segregation). The stability of IDU prevalence among White adults between 1992 and 2002 may be a function of lower AIDS-related mortality rates in this population; relative stability (and perhaps increases in some MSAs) in initiating IDU among White drug users; and social processes. Future research should investigate the extent to which these racial/ethnic-specific IDU prevalence trends (1) explain, and are explained by, recent trends in IDU-related health outcomes, and (2) are determined by MSA-level social processes.
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Affiliation(s)
- Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA.
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22
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Reis CT, Czeresnia D, Barcellos C, Tassinari WS. A interiorização da epidemia de HIV/AIDS e o fluxo intermunicipal de internação hospitalar na Zona da Mata, Minas Gerais, Brasil: uma análise espacial. CAD SAUDE PUBLICA 2008; 24:1219-28. [DOI: 10.1590/s0102-311x2008000600003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 10/08/2007] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo foi analisar o processo de interiorização da epidemia de AIDS e investigar o acesso aos serviços em HIV/AIDS, entre 1988-2002, na Zona da Mata, Minas Gerais, Brasil. Realizou-se estudo ecológico, com abordagem têmporo-espacial. Construiu-se um fluxo de internação hospitalar, tendo como referência pacientes maiores de 15 anos, internados pelo Sistema Único de Saúde, nos anos de 1996 e 2004, residentes nos municípios da região. Foram registrados 2.469 casos de AIDS em maiores de 15 anos no período; as taxas médias de incidência e mortalidade foram calculadas e reestimadas pelo estimador bayesiano empírico local para representar de maneira mais clara os municípios com maior concentração de casos e de óbitos. Verificou-se a interiorização da epidemia. Juiz de Fora é o município com maior número de casos e provável centro difusor da AIDS na região. A assistência hospitalar dos casos de AIDS da Zona da Mata está concentrada nesse município. Destaca-se necessidade de investigações adicionais sobre causas da não-participação de hospitais de referência em outros municípios da região na gerência e prestação de cuidados aos pacientes que vivem com HIV/AIDS.
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Brady JE, Friedman SR, Cooper HLF, Flom PL, Tempalski B, Gostnell K. Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992 to 2002. J Urban Health 2008; 85:323-51. [PMID: 18344002 PMCID: PMC2329751 DOI: 10.1007/s11524-007-9248-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 11/29/2007] [Indexed: 11/30/2022]
Abstract
This paper estimates the prevalence of current injection drug users (IDUs) in 96 large U.S. metropolitan statistical areas (MSAs) annually from 1992 to 2002. Multiplier/allocation methods were used to estimate the prevalence of injectors because confidentiality restrictions precluded the use of other commonly used estimation methods, such as capture-recapture. We first estimated the number of IDUs in the U.S. each year from 1992 to 2002 and then apportioned these estimates to MSAs using multiplier methods. Four different types of data indicating drug injection were used to allocate national annual totals to MSAs, creating four distinct series of estimates of the number of injectors in each MSA. Each series was smoothed over time; and the mean value of the four component estimates was taken as the best estimate of IDUs for that MSA and year (with the range of component estimates indicating the degree of uncertainty in the estimates). Annual cross-sectional correlations of the MSA-level IDU estimates with measures of unemployment, hepatitis C mortality prevalence, and poisoning mortality prevalence were used to validate our estimates. MSA-level IDU estimates correlated moderately well with validators, demonstrating adequate convergence validity. Overall, the number of IDUs per 10,000 persons aged 15-64 years varied from 30 to 348 across MSAs (mean 126.9, standard deviation 65.3, median 106.6, interquartile range 78-162) in 1992 and from 37 to 336 across MSAs (mean 110.6, standard deviation 57.7, median 96.1, interquartile range 67-134) in 2002. A multilevel model showed that overall, across the 96 MSAs, the number of injectors declined each year until 2000, after which the IDU prevalence began to increase. Despite the variation in component estimates and methodological and component data set limitations, these local IDU prevalence estimates may be used to assess: (1) predictors of change in IDU prevalence; (2) differing IDU trends between localities; (3) the adequacy of service delivery to IDUs; and (4) infectious disease dynamics among IDUs across time.
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Affiliation(s)
- Joanne E Brady
- Institute for AIDS Research, National Development and Research Institutes, Inc. (NDRI), 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
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24
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Tempalski B, Cooper HL, Friedman SR, Des Jarlais DC, Brady J, Gostnell K. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19 Suppl 1:S47-58. [PMID: 18295468 PMCID: PMC2706511 DOI: 10.1016/j.drugpo.2007.11.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/01/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented. In the context of preventing infectious diseases, 100% syringe coverage - that is, one sterile syringe per injector for each injection - is a public health goal. Notably, we know little about variations in syringe coverage within the U.S. and elsewhere, or about the social and political factors that might determine this coverage. METHODS Using data from Holmberg (1996), the 1990 United States Census, the 2000 Beth Israel National Syringe Exchange Survey (n=72), and estimates of IDUs in metropolitan areas (MSAs); (Friedman et al., 2004), we explore the impact of (1) political factors (ACT UP, outreach, early syringe exchange programme (SEP) presence, men who have sex with men (MSM) per capita, drug arrests, and police per capita); (2) local resources for SEPs; and (3) indicators of socioeconomic inequality on SEP coverage. We define "syringe coverage" as the ratio of syringes distributed at SEPs to the number of syringes heroin injectors need in a year. We calculated the number of syringes heroin injectors need in a year by multiplying an estimate of the number of IDUs in each MSA by an estimate of the average number of times heroin injectors inject heroin per year (2.8 times per day times 365 days). In this analysis, the sample was limited to 35 MSAs in which the primary drug of choice among injectors was heroin. RESULTS SEP coverage varies greatly across MSAs, with an average of 3 syringes distributed per 100 injection events (S.D.=0.045; range: 2 syringes per 10 injection events, to 3 syringes per 10,000 injection events). In bivariate regression analyses, a 1 unit difference in the proportion of the population that was MSM per 1000 was associated with a difference of 0.002 in SEP coverage (p=0.052); early SEP presence was associated with a difference of 0.038 in coverage (p=0.012); and having government funding was associated with a 0.040 difference in SEP coverage (p=0.021). CONCLUSIONS This analysis suggests that longer duration of SEP presence may increase syringe distribution and enhance successful programme utilization. Furthermore, MSAs with greater proportions of MSM tend to have better SEP coverage, perhaps providing further evidence that grassroots activism plays an important role in programme implementation and successful SEP coverage. This research provides evidence that government funding for SEPs contributes to better syringe coverage.
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Affiliation(s)
- Barbara Tempalski
- National Development and Research Institutes, Inc., New York, NY, USA.
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25
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Uusküla A, McNutt LA, Dehovitz J, Fischer K, Heimer R. High prevalence of blood-borne virus infections and high-risk behaviour among injecting drug users in Tallinn, Estonia. Int J STD AIDS 2007; 18:41-6. [PMID: 17326862 PMCID: PMC2925660 DOI: 10.1258/095646207779949907] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The HIV epidemic in Estonia is rapidly expanding, and injection drug users (IDUs) are the major risk group contributing to the expansion. A convenience sample of 159 IDUs visiting syringe-exchange programmes (SEPs) was selected to quantify the association of HIV-risk behaviours and blood-borne infections. A high prevalence of HIV, hepatitis B core antibody (HBVcore), hepatitis B surface antigen (HbsAg) and hepatitis C virus antibodies (56, 85.1, 21.3, and 96.2%, respectively) was associated with high-risk injections, unsafe sexual behaviour and alcohol abuse. These findings emphasize the importance of evidence-based secondary prevention among the HIV-infected, especially given the uncertain sustainability of antiretroviral and substance abuse treatments.
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Affiliation(s)
- Anneli Uusküla
- Department of Public Health, University of Tartu, Estonia.
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26
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Wallace R, Wallace D, Ahern J, Galea S. A failure of resilience: Estimating response of New York City's public health ecosystem to sudden disaster. Health Place 2007; 13:545-50. [PMID: 17029997 DOI: 10.1016/j.healthplace.2006.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 07/24/2006] [Accepted: 07/24/2006] [Indexed: 11/23/2022]
Abstract
Adapting methodology from resilience theory in ecology, we develop an empirical model of the response of the New York City public health ecosystem to sudden disaster. Contrary to cultural expectation, 'good' and 'bad' neighborhoods-starkly differentiated by public health status reflecting longstanding economic and racial segregation-respond similarly to challenge. This suggests that the difference in health between neighborhoods is primarily predicated on the extent to which they have been, and continue to be, exposed to differing patterns of stressors and affordances, rather than to any difference in underlying socio-economic vulnerability. Paradoxically, then, these urban neighborhoods constitute a single, highly interdependent, health ecosystem, despite substantial socioeconomic and racial segregation.
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Affiliation(s)
- Rodrick Wallace
- New York State Psychiatric Institute, Epidemiology of Mental Disorders Research Department, Box 47, 1051 Riverside Drive, New York 10032, USA.
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27
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Wallace RM, Fullilove MT, Fullilove RE, Wallace DN. Collective consciousness and its pathologies: understanding the failure of AIDS control and treatment in the United States. Theor Biol Med Model 2007; 4:10. [PMID: 17324268 PMCID: PMC1820776 DOI: 10.1186/1742-4682-4-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 02/26/2007] [Indexed: 11/19/2022] Open
Abstract
We address themes of distributed cognition by extending recent formal developments in the theory of individual consciousness. While single minds appear biologically limited to one dynamic structure of linked cognitive submodules instantiating consciousness, organizations, by contrast, can support several, sometimes many, such constructs simultaneously, although these usually operate relatively slowly. System behavior remains, however, constrained not only by culture, but by a developmental path dependence generated by organizational history, in the context of market selection pressures. Such highly parallel multitasking – essentially an institutional collective consciousness – while capable of reducing inattentional blindness and the consequences of failures within individual workspaces, does not eliminate them, and introduces new characteristic malfunctions involving the distortion of information sent between workspaces and the possibility of pathological resilience – dysfunctional institutional lock-in. Consequently, organizations remain subject to canonical and idiosyncratic failures analogous to, but more complicated than, those afflicting individuals. Remediation is made difficult by the manner in which pathological externalities can write images of themselves onto both institutional function and corrective intervention. The perspective is applied to the failure of AIDS control and treatment in the United States.
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Affiliation(s)
- Rodrick M Wallace
- The New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Mindy T Fullilove
- The New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Robert E Fullilove
- Joseph L. Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY, 10032, USA
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Abstract
Urbanization is probably the single most important demographic shift world-wide throughout the past and the new century and represents a sentinel change from how most of the world's population has lived for the past several thousand years. As urban living becomes the predominant social context for the majority of the world's population, the very ubiquity of urban living promises to shape health directly and to indirectly affect what we typically consider risk factors or determinants of population health. Although a growing body of research is exploring how characteristics of the urban environment may be associated with health (e.g. depression) and risk behaviours (e.g. exercise patterns), relatively little research has systematically assessed how the urban environment may affect drug use and misuse. In this paper we will propose a conceptual framework for considering how different characteristics of the urban environment (e.g. collective efficacy, the built environment) may be associated with drug use and misuse, summarize the existing empiric literature that substantiates elements of this framework, and identify potential directions for future research.
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Affiliation(s)
- Sandro Galea
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA.
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29
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Liburd LC, Jack L, Williams S, Tucker P. Intervening on the social determinants of cardiovascular disease and diabetes. Am J Prev Med 2005; 29:18-24. [PMID: 16389121 DOI: 10.1016/j.amepre.2005.07.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 06/20/2005] [Accepted: 07/07/2005] [Indexed: 02/08/2023]
Abstract
Heart disease, cerebrovascular diseases, and type 2 diabetes ranked first, third, and sixth, respectively, among the leading causes of death and disability in the United States in 2000. Racial and ethnic communities (i.e., African Americans, Hispanic-Latino Americans, Native Americans and Alaska Natives, and Asian Americans and Pacific Islanders) disproportionately suffer from these chronic conditions. Traditional behavior change strategies have had some positive, but limited effects and will not likely be sufficient to eliminate these health disparities at the population level. In this commentary, the authors argue for greater intervention research directed at the social determinants of cardiovascular disease and diabetes if we are to reverse current trends in chronic disease prevalence in communities of color. The authors also call for new research questions and study designs that will increase our understanding of the social, policy, and historic context in which disparities are created as a necessary first step in developing interventions aimed at social-contextual and psychosocial risk factors. Promising programs supported by the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH 2010) program and the Division of Diabetes Translation are highlighted.
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Affiliation(s)
- Leandris C Liburd
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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30
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Drukker M, Buka SL, Kaplan C, McKenzie K, Van Os J. Social capital and young adolescents’ perceived health in different sociocultural settings. Soc Sci Med 2005; 61:185-98. [PMID: 15847971 DOI: 10.1016/j.socscimed.2004.11.041] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 11/17/2004] [Indexed: 11/24/2022]
Abstract
We conducted a cross-national study to examine the association between neighbourhood socioeconomic deprivation, social capital and child health in two countries and multiple ethnic groups. For our analysis we used data from (1) the Project on Human Development in Chicago Neighborhoods (PHDCN), USA and (2) the Maastricht Quality of Life study (MQoL), the Netherlands. Both the PHDCN and the MQoL collected data on objective neighbourhood socioeconomic deprivation, subjective neighbourhood social capital (i.e. informal social control, ISC, social cohesion and trust, SC&T), and children's perceived health. For the present analyses, 11- and 12-year olds were selected. Multilevel analyses were conducted using both neighbourhood level and individual-level data. Lower socioeconomic deprivation scores and higher levels of ISC as well as SC&T were associated with higher levels of children's perceived health, in both Maastricht and the Chicago Hispanic subsample, but not in the Chicago non-Hispanic samples. The results suggest that associations between the wider social environment and health outcomes vary across different populations and cross-national contexts.
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Affiliation(s)
- Marjan Drukker
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
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31
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Domínguez-Berjón MF, Borrell C, López R, Pastor V. Mortality and socioeconomic deprivation in census tracts of an urban setting in southern Europe. J Urban Health 2005; 82:225-36. [PMID: 15888637 PMCID: PMC3456560 DOI: 10.1093/jurban/jti047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In southern European cities, research on deprivation and mortality inequalities using small-area analysis is recent. In many countries, the census tract (CT) is the smallest territorial unit for which population data are available. The aim of this study was to examine the association between mortality from all causes and socioeconomic deprivation in CTs in Barcelona (Spain). A cross-sectional ecologic study was carried out using mortality data for 1987-1995 and 1991 census variables. Mortality data were obtained from death certificates. Socioeconomic deprivation indicators were drawn from the census and included unemployment, inadequate education, and low social class. They were correlated, and a deprivation index was elaborated with them. The analysis was descriptive, and multivariate Poisson regression models were adjusted. The most deprived CTs tend to present higher mortality (49.7% of CT in the quartile associated with greatest deprivation were included in the top male mortality quartile and 40.4% in the top female mortality quartile), whereas the less deprived ones present lower mortality. For male mortality, the risk of dying among those in the quartile representing most deprivation is from 25 to 29% higher (depending on the indicator chosen) than the least deprived quartile, and for women, it is from 12 to 14% higher. We concluded that the mortality from all causes in the CT of a southern European city has shown a clear positive association with a variety of socioeconomic deprivation indicators drawn from the census. Studies of this nature may help to orient more specific studies in which CTs are grouped together as a function of particular population and/or health characteristics.
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32
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Gomez MB, Muntaner C. Urban redevelopment and neighborhood health in East Baltimore, Maryland: The role of communitarian and institutional social capital. CRITICAL PUBLIC HEALTH 2005. [DOI: 10.1080/09581590500183817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cooper H, Friedman SR, Tempalski B, Friedman R, Keem M. Racial/ethnic disparities in injection drug use in large US metropolitan areas. Ann Epidemiol 2005; 15:326-34. [PMID: 15840545 DOI: 10.1016/j.annepidem.2004.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 10/19/2004] [Indexed: 11/21/2022]
Abstract
PURPOSE Because blacks and Latinos bear a disproportionate burden of injection-related health problems compared with whites, we sought to describe black/white and Latino/white disparities in injecting drugs in 94 US metropolitan statistical areas (MSAs) in 1998. METHODS Using US Census data and three databases documenting injectors' use of different healthcare services (drug treatment, HIV counseling and testing, and AIDS diagnoses), we calculated database-specific black/white and Latino/white disparities in injecting in each MSA and created an index of black/white and Latino/white disparities by averaging data across the three databases. RESULTS The median black/white injecting disparity in the MSAs ranged from 1.4 to 3.7 across the three databases; corresponding median Latino/white injecting disparities ranged from 1.0 to 1.1. Median black/white and Latino/white index disparity values were 2.6 and 1.0, respectively. CONCLUSIONS Although whites were the majority of injectors in most MSAs, database-specific and index black/white disparity scores indicate that blacks were more likely to inject than whites. While database-specific and index disparity scores indicate that Latinos and whites had similar injecting rates, they also revealed considerable variation in disparities across MSAs. Future research should investigate these disparities' causes, including racial/ethnic inequality and discrimination, and study their contributions to the disproportionate burden of injection-related health problems borne by blacks and Latinos.
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Affiliation(s)
- Hannah Cooper
- Medical and Health Research Association of New York City, Inc., NY, USA.
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Lobato MN, Reves RR, Jasmer RM, Grabau JC, Bock NN, Shang N. Adverse Events and Treatment Completion for Latent Tuberculosis in Jail Inmates and Homeless Persons. Chest 2005. [DOI: 10.1016/s0012-3692(15)34480-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention.
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Affiliation(s)
- Sandro Galea
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, NY 10029, USA.
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Uusküla A, Nygård JF, Kibur-Nygård M. Syphilis as a social disease: experience from the post-communist transition period in Estonia. Int J STD AIDS 2004; 15:662-8. [PMID: 15479502 PMCID: PMC2925675 DOI: 10.1177/095646240401501006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased incidence of sexually transmitted diseases (STD) and radical social changes have taken place at the same time in Estonia. Our aim was to study the trends in syphilis incidence, selected sociodemographic factors and health status indicators during the economic transition. Associations were estimated by the ordinary least square regression method for change in and actual values of syphilis and tuberculosis incidence rate (IR), percentage of non-ethnic Estonians and urban population, homicides rate, unemployment rate and, birth rate. The analysis was performed by counties at three different time periods. Syphilis IR significantly correlated with the proportion of non-ethnic Estonians, urban population, tuberculosis IR and birth rate. Change of syphilis IR correlated significantly with concurrent changes in unemployment rate and tuberculosis IR. Our findings support the theory that syphilis is a social disease, thus emphasizing the importance of social factors in the occurrence of STDs.
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Affiliation(s)
- Anneli Uusküla
- Department of Public Health, University of Tartu, Ravila str. 19, Tartu 50411, Estonia.
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Almog M, Curtis S, Copeland A, Congdon P. Geographical variation in acute psychiatric admissions within New York City 1990-2000: growing inequalities in service use? Soc Sci Med 2004; 59:361-76. [PMID: 15110426 DOI: 10.1016/j.socscimed.2003.10.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The paper analyses geographical variations in use of acute psychiatric inpatient services within New York City and how these have changed from 1990 to 2000. We review literature suggesting reasons for the variations observed. Data from the New York State Department of Health Statewide Planning Research and Cooperative System were combined with population census data to produce age standardized ratio indicators of admissions and of bed days, as measures of use of general hospitals for psychiatric conditions, by males aged 15-64, in Zip Code Areas of New York City, in 1990 and 2000. Geographical variations in hospital use were related to proximity to general hospitals with psychiatric beds and to socio-economic status of local populations (as recorded in the 1990 and 2000 population censuses). Areas close to psychiatric hospitals areas show high admission levels. Controlling for this, Zip Code Areas with higher concentrations of poverty, of African American residents or of persons living alone were associated with relatively high admission ratios. These relationships vary somewhat between diagnostic groups. Area inequalities in standardized admission ratios persisted and widened between 1990 and 2000, and the highest hospital admission ratios were increasingly concentrated where social and economic disadvantage was greatest. Various possible reasons for this trend are explored. We conclude that increasing intensity of poverty in disadvantaged areas is not likely to provide an explanation and that the trends are more likely to result from changes in hospital management and funding affecting access to hospital services.
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Affiliation(s)
- Michael Almog
- Wagner Graduate School of Public Service, New York University, USA
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Wallace R, Wallace D, Wallace RG. Coronary heart disease, chronic inflammation, and pathogenic social hierarchy: a biological limit to possible reductions in morbidity and mortality. J Natl Med Assoc 2004; 96:609-19. [PMID: 15160975 PMCID: PMC2640658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We suggest that a particular form of social hierarchy, which we characterize as "pathogenic", can, from the earliest stages of life, exert a formal analog to evolutionary selection pressure, literally writing a permanent developmental image of itself upon immune function as chronic vascular inflammation and its consequences. The staged nature of resulting disease emerges "naturally" as a rough analog to punctuated equilibrium in evolutionary theory, although selection pressure is a passive filter rather than an active agent, like structured psychosocial stress. Exposure differs according to the social constructs of race, class, and ethnicity, accounting in large measure for observed population-level differences in rates of coronary heart disease across industrialized societies. American Apartheid, which enmeshes both majority and minority communities in a social construct of pathogenic hierarchy, appears to present a severe biological limit to continuing declines in coronary heart disease for powerful as well as subordinate subgroups: "Culture"--to use the words of the evolutionary anthropologist Robert Boyd--"is as much a part of human biology as the enamel on our teeth".
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Corburn J. Confronting the challenges in reconnecting urban planning and public health. Am J Public Health 2004; 94:541-6. [PMID: 15053998 PMCID: PMC1448291 DOI: 10.2105/ajph.94.4.541] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2003] [Indexed: 11/04/2022]
Abstract
Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.
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Affiliation(s)
- Jason Corburn
- Urban Public Health Program, Hunter College, City University of New York, NY 10010, USA.
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Meyers T, Leonard L, Ellen JM. The clinic and elsewhere: illness, sexuality, and social experience among young African American men in Baltimore, Maryland. Cult Med Psychiatry 2004; 28:67-86. [PMID: 15074551 DOI: 10.1023/b:medi.0000018098.97210.f9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper is concerned with how disclosure becomes self-production for young adults within the setting of the sexually transmitted disease (STD) clinic. The STD clinic is a special medical environment where the process of disclosure is not just a way of accessing treatment; it is also a process through which illness, sexuality, and social experience become entangled in telling. Illness according to medical categories is reshaped in the social world, bringing a different set of criteria to bear on the definition of illness. The concern we raise regards how meaning is secured simultaneously through the experience of illness and social relations. Using data from a series of clinic-based ethnographic interviews, we examine the narratives of three young men. Together, the narratives demonstrate the interrelatedness of illness and self-production in various forms. In one case the tension between interpersonal violence and self-preservation is central. In another, the place of knowledge in family relationships renders the entire picture of the social unstable. The paper signals a number of issues absent in clinical and epidemiological depictions of vulnerability, particularly in the context of the urban United States.
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Affiliation(s)
- Todd Meyers
- Johns Hopkins University School of Arts & Sciences, Department of Anthropology, Baltimore, MD 21218, USA.
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Tomazelli J, Czeresnia D, Barcellos C. [Distribution of AIDS cases in women in Rio de Janeiro, Brazil, 1982-1997: a spatial analysis]. CAD SAUDE PUBLICA 2003; 19:1049-61. [PMID: 12973570 DOI: 10.1590/s0102-311x2003000400027] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The AIDS epidemic has spread and reached various population groups differently. The epidemic's dynamics have also differed according to the characteristics of different areas within cities, related to the principal modes of spread. This study analyzes the AIDS epidemic in women in the city of Rio de Janeiro using the space referential. The epidemic is on the rise among women, particularly in the Northern and Western Zones of the city. In this group it constitutes a "sub-epidemic", to the extent that it displays different characteristics in terms of clinical presentation, access to health services, and knowledge of risks. There was a high proportion of unknown transmission category among the women, thus revealing ignorance of their own risk situation. In addition, the high proportion of unknown level of schooling emphasizes the implications of the investigative system on quality of data recorded for women.
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Affiliation(s)
- Jeane Tomazelli
- Secretaria de Estado de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, 20031-142, Brasil.
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Melchior M, Niedhammer I, Berkman LF, Goldberg M. Do psychosocial work factors and social relations exert independent effects on sickness absence? A six year prospective study of the GAZEL cohort. J Epidemiol Community Health 2003; 57:285-93. [PMID: 12646546 PMCID: PMC1732420 DOI: 10.1136/jech.57.4.285] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES The objective of this prospective cohort study was to determine whether psychosocial work characteristics and social relations exert independent effects on the incidence of sickness absence in a population of middle aged French employees over six years of follow up. DESIGN This study included 9631 men and 3595 women participating in the French GAZEL cohort. Social relations (social networks, personal social support, and social relations satisfaction) were measured in 1994 by self report. Psychosocial work characteristics (decision latitude, psychological demands, and social support at work) were ascertained in 1995. Sickness absence data were collected independently. The authors studied the incidence of short (>7 days), intermediate (7-21 days), and long (>21 days) spells of absence from 1995 to 31 December 2001. Rate ratios associated with psychosocial exposures, adjusted on sociodemographic characteristics, and health behaviours, were calculated by means of log-linear Poisson regression. SETTING A cohort of 20000 employees of France's national gas and electricity company (the GAZEL study). MAIN RESULTS Among men and women, levels of decision latitude and personal social support below the median predicted 17% to 24% increases in absence rates. Low satisfaction with social relations and low social support at work lead to a 10% to 26% excess in sick leaves among men. No interactive effects were found between the variables under study. CONCLUSIONS The quality of the work environment and of social relations affect sickness absence over an extended period of follow up. This study supports the hypothesis of independent, not interactive effects.
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Affiliation(s)
- M Melchior
- Harvard School of Public Health, Department of Health and Social Behavior, Boston, MA, USA.
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Cohen DA, Mason K, Bedimo A, Scribner R, Basolo V, Farley TA. Neighborhood physical conditions and health. Am J Public Health 2003; 93:467-71. [PMID: 12604497 PMCID: PMC1447765 DOI: 10.2105/ajph.93.3.467] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored the relationship between boarded-up housing and rates of gonorrhea and premature mortality. METHODS In this ecological study of 107 US cities, we developed several models predicting rates of gonorrhea and premature death before age 65 from all causes and from specific causes. We controlled for race, poverty, education, population change, and health insurance coverage. RESULTS Boarded-up housing remained a predictor of gonorrhea rates, all-cause premature mortality, and premature mortality due to malignant neoplasms, diabetes, homicide, and suicide after control for sociodemographic factors. CONCLUSIONS Boarded-up housing may be related to mortality risk because of its potential adverse impact on social relationships and opportunities to engage in healthful behaviors. Neighborhood physical conditions deserve further consideration as a potential global factor influencing health and well-being.
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45
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Acevedo-Garcia D, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health 2003; 93:215-21. [PMID: 12554572 PMCID: PMC1447719 DOI: 10.2105/ajph.93.2.215] [Citation(s) in RCA: 307] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2002] [Indexed: 11/04/2022]
Abstract
The authors examine the research evidence on the effect of residential segregation on health, identify research gaps, and propose new research directions. Four recommendations are made on the basis of a review of the sociological and social epidemiology literature on residential segregation: (1) develop multilevel research designs to examine the effects of individual, neighborhood, and metropolitan-area factors on health outcomes; (2) continue examining the health effects of residential segregation among African Americans but also initiate studies examining segregation among Hispanics and Asians; (3) consider racial/ethnic segregation along with income segregation and other metropolitan area factors such as poverty concentration and metropolitan governance fragmentation; and (4) develop better conceptual frameworks of the pathways that may link various segregation dimensions to specific health outcomes.
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Affiliation(s)
- Dolores Acevedo-Garcia
- Department of Health and Social Behavior, Harvard School of Public Health, Boston, Mass 02115, USA.
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Abstract
BACKGROUND The public health problem-solving paradigm is a comprehensive method not previously applied to preventive interventions for personality disorder. AIMS To present an overview for clinical psychiatrists. METHOD Review of epidemiological research into DSM-IV Axis Il disorders and application to the paradigm. RESULTS Personality disorder affects a substantial proportion of the population. Burdens on health care, social and criminal justice agencies have yet to be accurately quantified. Debates continue over case definition, but there is increasing information on prevalence using 'broad' definitions and aetiology. A conceptual framework, based on development, suggests preventive interventions should be targeted in childhood. The public health approach also requires monitoring of risk factors operating at the population level. CONCLUSIONS Services in England and Wales for persons with personality disorder are currently inadequate. The problem-solving paradigm suggests new preventive interventions. Psychiatrists should renegotiate their relationship with policy-makers and reconsider their preventive role.
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Affiliation(s)
- Jeremy Coid
- Forensic Psychiatry Research Unit, St Bartholomew's Hospital, London ECIA 7BE, UK
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Abstract
Why are some societies healthier than others? The consensus in development economics is that the health achievement of nations has to do with their levels of economic development. Higher per capita incomes, through steady and stable economic growth, increase a nation's capacity to purchase the necessary economic goods and services that promote health. In this paper, we review the conceptual and empirical linkages between poverty and poor health in both developing and developed countries. The empirical evidence is overwhelming that poverty, measured at the level of societies as well as individuals, is causally related to poor health of societies and individuals, respectively. Recent macroeconomic research has also drawn attention to the role of health as a form of human capital that is vital for achieving economic stability. In particular, attention has been drawn toward the ways in which unhealthy societies impede the process of economic development. However, the reciprocal connection between economic prosperity and improved health is neither automatic nor universal. Other features of society, such as the equality in the distribution of the national wealth, seem to matter as well for improving average population health and especially for reducing inequalities in health. We conclude by arguing for a need to reexamine the way in which health is conceptualized within the macroeconomic development framework.
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Affiliation(s)
- S V Subramanian
- Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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48
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Subramania SV, Kawachi I, Kennedy BP. Does the state you live in make a difference? Multilevel analysis of self-rated health in the US. Soc Sci Med 2001; 53:9-19. [PMID: 11380164 DOI: 10.1016/s0277-9536(00)00309-9] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper investigates the different sources of variation between US states in self-rated health using multilevel statistical procedures. The different sources that are considered are based on individual- and state-level factors. Data for the analysis comes from the 1993-94 Behavioral Risk Factor Surveillance System and the 1986-90 General Social Surveys. Results show that individual-level factors (such as low income, being black, smoking) are strongly associated with self-rated poor health. Significant variation, however, remain between states after allowing for individual characteristics. Crucially, between-state variation in self-rated health is different for different income groups. State-level contextual effects are found for per-capita median-income and 'social capital'. While not strong, there seems to be a differential impact of state income-inequality on high-income groups, such that the affluent report better health from living in high inequality states. The paper substantiates the need to connect individual health to their macro socioeconomic context. Importantly, it is argued that without adopting an explicitly multilevel approach, the debate on linkages between individual health and income-inequality/social capital cannot be adequately addressed.
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Affiliation(s)
- S V Subramania
- Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA.
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Freudenberg N. Health promotion in the city: a review of current practice and future prospects in the United States. Annu Rev Public Health 2001; 21:473-503. [PMID: 10884962 DOI: 10.1146/annurev.publhealth.21.1.473] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To achieve its health goals, the United States must reduce the disproportionate burden of illness and poor health borne by urban populations. In the 20th century, patterns of immigration and migration, changes in the global economy, increases in income inequality, and more federal support for suburbanization have made it increasingly difficult for cities to protect the health of all residents. In the last 25 years, epidemics of human immunodeficiency virus infections and substance abuse and increases in homelessness, lack of health insurance, rates of violence, and concentrations of certain pollutants have also damaged the health of urban residents. Several common strategies for health promotion are described, and their relevance to the unique characteristics of urban populations is assessed. To identify ways to strengthen health promotion practices in U.S. cities, lessons have been taken from five related fields of endeavor: human rights, church- and faith-based social action, community economic development, youth development, and the new social movements. By integrating lessons from these areas into their practice, public health professionals can help to revitalize the historic mission of public health, contribute to creating healthier cities, and better achieve national health objectives.
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Affiliation(s)
- N Freudenberg
- Program in Urban Public Health, Hunter College School of Health Sciences, City University of New York, New York 10010, USA.
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Akukwe C. The need for an urban HIV/AIDS policy in the United States. JOURNAL OF HEALTH & SOCIAL POLICY 2001; 12:1-15. [PMID: 11146980 DOI: 10.1300/j045v12n03_01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Urban centers in America are the hardest hit areas by the HIV/AIDS epidemic. The incidence of HIV/AIDS is higher in these areas because of high levels of poverty, sexually transmitted diseases, injection drug use, and the limited participation of urban residents in the design and delivery of health services. This article argues that a new urban HIV/AIDS policy is needed to focus on the vigorous implementation of risk reduction activities, linking HIV reduction with poverty alleviation programs, and the implementation of neighborhood health services.
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Affiliation(s)
- C Akukwe
- George Washington University School of Public Health and Health Sciences, Washington, DC 20035, USA
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