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Adolescent and Child Health
P01–01 A needs-base approach to fight HIV/AIDS among vulnerable youth in urban areas in Guyana - How are the health, social and environmental needs of disadvantaged children and adolescents met and what strategies exist to address this?
M.A. Bassier-Paltoo1, L.M. Costa Monteiro2, D.L. Ramsammy3
1Ministry of Health, Guyana, Adolescent Health, Georgetown, Guyana, 2FIOCRUZ Brasil and Ministry of Health Guyana Collaboration, Georgetown, Guyana, 3Ministry of Health, Guyana, Georgetown, Guyana
HIV/AIDS poses a significant socio-economic challenge for Guyana. Current epidemiological data confirms the impact of HIV/AIDS epidemic among youth mainly in the urban, most populated areas. It is a developmental issue and since Guyana is recovering from decades of under-development, HIV/AIDS represent a major barrier to overcoming it. Social economic disadvantage, including poverty and lack of employment and/or skills and the increasingly migration to urban centres create a disabling environment for youth, increasing vulnerability to sexual exploitation and gender-based violence and empowering the vicious cycle of the HIV/AIDS epidemic. Collaborative efforts with other ministries and external partners led to new contracts signed by the MOH and the development of age-sensitive policies. Teachers were empowered through the Health and Family Life Education (HFLE) programme and Sexual and Reproductive Health was included in the curriculum of both primary and secondary schools. Seventy-four youth, especially young vulnerable women, were empowered through a Job Skills Training Programme delivered in collaboration with the Board of Industrial Training, Ministry of Labour. Seven youth-friendly spaces at the community level and 19 youth-friendly health services (YFHS), with trained professionals to deliver age-related services were launched, supported by a multi-agency task force. Reproductive Health and VCT were also provided through outreaches, targeting depressed communities and vulnerable population. Lessons learned/conclusion: HIV/AIDS is predominant in urban areas and is empowered by poverty and lack of knowledge. Migration, lack of job opportunities, gender-based violence and abuse are among the causes to maintain it. Political will, coordinated efforts, knowledge and availability of health services are paramount, but to successfully fight HIV/AIDS is important to break the cycle at the individual level. The rescue of family values/support and the social economical empowerment of vulnerable youth, mostly young women, given them independence and self-esteem are essential.
P01–02 A review of alternative education programs in BC
A. Smith1, M. Peled1
1McCreary Centre Society, Vancouver, Canada
Background: The purpose of the study was to gain a better understanding of the experiences of high-risk youth who attend alternative education programs in BC communities where there is a high prevalence of youth street-involvement and sexual exploitation. The study examined the challenges to education that these youth face, and explored how alternative education programs address these challenges and meet the academic, vocational and psycho-social needs of their students.
Methods: Quantitative and qualitative data were gathered from three sources: A survey administered to 339 youth (49% female, 51% male) attending alternative education programs; interviews with 62 adult community stakeholders; and further analyses of existing data from McCreary’s (2007) survey of marginalized and street-involved youth. A total of nine school districts, located in communities that had participated in the marginalized and street-involved youth study, were invited to participate. Seven participated in the youth survey and stakeholder interviews, one participated in only the interviews, and one declined participation.
Results: Findings indicated that many of the youth faced multiple challenges to their education (e.g., 29% experienced precarious housing; 51% were physically abused; 28% sexually abused; 50% used marijuana yesterday). However, these vulnerable youth are still attending school, report feeling engaged in their education (e.g., the majority reported liking their current program and skipping school significantly less than they used to) and have positive outlooks on life and their future.
Conclusions: It appears that alternative education programs in BC are predominantly succeeding in helping youth academically, as well as psycho-socially and vocationally.
P01–03 Addressing youth homelessness: A web-based strategy for knowledge transfer
S.A. Kidd1, J. Karabanow2, S. Miner3, D. Patterson4, D. Talbot4
1McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada,
2Dalhousie University, Social Work, Halifax, Canada,
3Street Outreach Services, Toronto, Canada,
4ARK Outreach, Halifax, Canada
Issues: The scope of youth homelessness as a social concern, with its many corollaries including the loss of human and social capital, health service utilization, criminal justice system involvement, mortality, victimization, marginalization and exclusion, and urban aesthetics, has become immediately evident to service providers, the public, and policy makers. While there exists a large body of research literature examining homelessness among youth, there remains a marked disconnect with respect to knowledge transfer between researchers, service providers, policy makers and the public. This disconnect is also geographical, with few avenues for reciprocal knowledge transfer internationally.
Description: The website www.streetconnect.org was developed to facilitate knowledge sharing between all stakeholders: youths, service providers, policy makers, parents/guardians, and the general public. This website, the first of its kind for this population, incorporates concise easy-to-read summaries of the research literature, a wide array of resources for youth, information for parents, and responses by homeless youths to common questions posed by the public and policy makers. Its development involved an active collaboration between researchers, service providers, and youths.
Lessons learned: The process of site development highlighted the benefits of active collaboration across both disciplines and stakeholder groups in generating a widely accessible knowledge-base that provides clear direction for action.
Next steps: Further efforts are needed to
(i) make stakeholders aware of the site internationally,
(ii) address translation of the site content into languages other than English,
(iii) engage in a continuing dialogue regarding how the site content can be optimized, and
(iv) maintain youth involvement.
P01–04 Adolescent and child health
1Family Counsellor, Vancouver, Canada
This proposal is based on work done by family counselors while providing support to parents of young children and adolescents. The two main programs/services that are being referenced here are: Project Parent in Surrey through Family Services of Greater Vancouver and Parent-Teen Mediation through Family and Youth Services Society in Langley, two suburbs of Greater Vancouver in British Columbia, Canada.
The nature of these services is that families are referred to the two programs by the Ministry of Children and Family Development, (MCFD), a branch of the government that is responsible for the safety and well being of children up to the age of 18. Quite often, these families have received services or intervention from MCFD due to health and safety concerns and these families are seen as in need of additional support from social service agencies so that the children can remain with their families and are not taken in government care or put into foster homes.
Objectives: The writer has been providing family support to such families for the past 8 years and prior to that, has been working with women in abusive relationships. The issues that arise quite often with these families are those of poverty, lack of affordable housing, drug and alcohol misuse, family violence, crime, poor and inadequate food choices, insufficient transportation, long waiting lists for qualified and licensed daycare facilities, isolation and no community support and inadequate formal support services, such as mental health counseling, innovative educational programs and recreational facilities, particularly for youth who have few social outlets other than ‘hanging out’ with their friends. The objective of this submission is to generate a discussion about creating safe and healthy communities for children and youth and a supportive environment for families. The aim would be to create action plans arising from the discussion, which may be task forces or advisory committees. It is also an effort to bring community partners, such as social service agencies, government bodies and community minded individuals and donors to take action in filling these gaps.
Lessons learned: What has been observed with the families needing parenting support is that they are struggling with their children, not just because of a lack of parenting skills, but due to a multitude of reasons. Quite often, the referring body, MCFD, may make recommendations to the family, such as ensuring that the parents are providing a safe and healthy environment for their children. This would mean that at least the basics necessities of food and shelter are provided by the parents to their children. However, in several urban areas, these basic requirements are not guaranteed to individuals, especially those with multiple barriers, such as individuals with drug and mental health issues, immigrants and refugees and women living in abusive relationships. Such families may not have access to affordable housing and may have to live in ghettoized neighbourhoods, which have their own problems of crime and violence. Good quality, healthy food is not inexpensive, so families have to settle for cheaper junk food which results in health issues such as exacerbation of ADHD symptoms for children, diabetes and obesity.Take the example of a woman who is living with an abusive partner. She may be told by the Child Protection worker, to leave the abuser, who may be the father of the children, and go into a transition house for women, for a period of time and that she cannot return to her partner, unless the abuser has made significant changes in his behaviour. The responsibility to safeguard her children is placed on the woman, so that she has to find a way of supporting herself and her children on her own. If she is an immigrant woman, she may not have the language skills, family support or any financial means to provide for her family, yet there is no cohesive plan in urban centres which would support families facing such challenges. She may want to find work but there are not enough daycare facilities that would take care of her children while she would work, and quite often, their cost is prohibitive despite government subsidies. If she decided to go on a government assistance plan or welfare, the welfare rates are not enough for safe and affordable housing or for nutritious food for the children.
Conclusions and implications of the project: The implication is that children and adolescents have a right to health, safety and security and to be nurtured and loved by their parents. However, most urban centres tend to focus on big businesses, big money and maintaining certain infrastructures with insufficient regard for social and community needs. The services that are put in place are often stop gap measures which do not address the issues in a cohesive manner.
Next steps: To encourage dialogues with government and not-for-profit agencies to promote collaboration in the provision of streamlined and appropriate services. To bring together community partners who recognize these issues as global issues that affect the wellbeing and health of vulnerable individuals so that action plans can be formulated and implemented.
P01–05 Childhood injury: A study of neighbourhood socioeconomic influences in Toronto, Ontario
1University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada
Background: Toronto neighbourhoods can be divided into three distinct categories based on neighbourhood socioeconomic change over time: Neighbourhoods that have been improving over the past 30 years, declining over the past 30 years, and those displaying mixed trends (Hulchanski et al., 2006). Children living in lower SES neighbourhoods face a higher injury death and morbidity rate than more well-off children, probably as a result of increased exposure to injury-producing environments (Faelker et al., 2000). This study explores whether rates of injury to children aged 0–6 vary depending on socioeconomic category of neighbourhood in Toronto, Ontario.
Methods: In this study, 515 Toronto census tracts are referred to as neighbourhoods. 2001 census data on the socioeconomic characteristics of Toronto neighbourhoods (declining, improving, and mixed trends) was used. Hospital-based data from 2000–2006 provided the incidence of injuries to children age 0–6 in the various neighbourhoods. Rates of injury of different types, including intentional and unintentional injuries, were calculated and provided the outcome data. Analysis of variance was the main method of analysis.
Results: Results suggested significant variability occurs for both overall and specific injuries among all three neighbourhood categories. In addition to the variation among neighbourhood category, results suggest there was variation within neighbourhood category. For example, in some declining neighbourhoods, many children experienced falls. In other declining neighbourhoods, falls were less common.
Implications: Information on unique community socioeconomic characteristics is important to understand the occurrence of injuries to children age 0–6. This information could be used to inform individuals working in policy and community planning in health and social service agencies and neighbourhood organizations. Community-based injury prevention strategies can be consequently illuminated.
P01–06 Dietary patterns of urban children of India: A bio-chemical analysis & behavioural management
R. Nigam1, P. Rishi2
1Paramedical Institute of JLN Cancer Hospital, Pathology and Bio Chemistry, Bhopal, India, 2Indian Institute of Forest Management, HRM, Bhopal, India
Background: Owing to the impact of media and modern social environment of schools and neighbourhoods, convincing children to follow a nutritious diet is a big challenge for today’s urban children.The pace for urban teens and children is fast and getting faster. Added to the pressures of school and increasing competitiveness, participation in sports and extra activities changes the nutritional demand and eating patterns of children. Owing to that, this study considers the dietary patterns and nutritional status of children using physical and bio-chemical parameters.
Methods: A sample of 156 children was selected from urban settlements of Bhopal city of India. A comprehensive dietary schedule was used by the investigator consisting of demographic profile, physical profile, biochemical profile, dietary profile and cognitive profile.
Results: The total caloric intake of the sample was found to be below normal, however, calories from fat and proteins were relatively high owing to high junk food diet. This may be explained by the increased access to media advertised fast foods and packaged foods, more exposure to junk foods, lack of parental quality time, increasing fussiness of children, reducing physical activity levels due to computers, television, video games etc. Incidence of iron deficiency and serum cholesterol levels above acceptable limits were also found putting children at high risk of developing hypercholesterolemia in later life.
Conclusions: Recommendations for excess fat management, iron deficiency management, total diet management, life style management and dietary behaviour management were made.
P01–07 Epidemiology of traffic injuries among children and adolescents in urban areas, Newfoundland and Labrador, Canada
R. Alaghehbandan1, K.C. Sikdar1, D. MacDonald1, K.D. Collins1, A.M. Rossignol2
1Newfoundland & Labrador Centre for Health Information, Research and Evaluation Department, St. John’s, Canada, 2Oregon State University, Department of Public Health, Corvallis, United States
Background: Traffic injury is a major cause of childhood death, hospitalization, and disability throughout the world. This study describes epidemiologic patterns and associated factors of severe traffic injuries requiring hospitalization among children and adolescents in urban areas in Newfoundland and Labrador (NL), Canada.
Methods: Hospital discharge data for NL residents aged 0–19 years with a traffic injury code were analyzed for the six-year period from April 1995 to March 2001. Annual rates of traffic injury by age, gender, and cause of injury were calculated.
Results: Over the study period, traffic injuries were a leading cause of severe childhood injury, accounting for 22.4% of the injuries, second only to falls. Overall rate of traffic injuries was 126.6 per 100,000 child-years (C-Y), with males having a higher rate than females (169.2 vs. 82.1 per 100,000 C-Y) (P<0.001). Motor vehicle occupant and bicyclists related-injuries were the most frequent traffic injuries requiring hospitalization (44.1 and 35.9 per 100,000 C-Y). Age-specific rates showed peak incidence of motor vehicle occupant injuries among 15–19 year old adolescents (89.9 per 100,000 C-Y) and bicyclist injuries among 10–14 year old children (57.3 per 100,000 C-Y). Children aged 0–4 years were at least risk of traffic injuries (P<0.0001).
Conclusions: Child traffic injuries, particularly those involving motor vehicle occupants, are a major public health problem in urban areas in NL. Certain age groups and gender (male) were at greater risk of certain type of traffic injuries. These data can be used for childhood traffic injury prevention strategies as well as a benchmark against future progress and raise awareness about traffic injury as a public health problem.
P01–08 HIV/STD risk and substance use in a cohort of Bronx youth
B. Chabon1, E. Alderman2
1Montefiore Medical Center/ Albert Einstein College of Medicinen, Psychiatry and Behavioral Sciences, Bronx, United States, 2Montefiore Medical Center/ Albert Einstein College of Medicinen, Pediatrics/ Adolescent Medicine, Bronx, United States
Background: Screening is needed to identify youth who might be at risk for future exposure to HIV/STDs. The Problem Oriented Screening Instrument for Teens (POSIT) is a validated screening instrument designed to identify risk for problems in 10 areas: Substance Use, Physical Health, Mental Health, Family Relationships, Peer Relationships, Educational Status, Vocational Status, Social skills, Leisure Recreation, and Aggressive Behavior/Delinquency.
Objective: To assess HIV/STD risk among a sample of Bronx youth using the new HIV/STD future risk subscale for the POSIT.
Methods: A snowball sample of 309 youth (13–19 years) were recruited from Montefiore Medical Center’s Adolescent Medicine Clinic for this NIDA funded multi-site project. Survey items were administered via audio-computer-assisted self-interview (A-CASI). Data for this sample were analyzed using Chi-sq and Forward multiple regression.
Results: Most youth were experienced with both sex (72%) and AOD (60%), 23% combined sex and AOD. Condoms were not used by 32% of youth during their last sexual encounter. For younger males (12–15 yrs), future HIV/STD risk was associated with alcohol and marijuana use, aggressive behavior/delinquency, and peer relations (R2=.59); for males (16–19 yrs) problem areas were aggressive behavior/delinquency, club drug use and family relations (R2=.47). For young females, peer relations, substance use and social skills were significant (R2=.65); among older females, peer relationships, aggressive behavior/delinquency, social skills and alcohol use were significant (R2=.53).
Conclusions: Targeted prevention and intervention strategies in primary care and community based settings for HIV/STD risk screening needs to be gender and age specific.
P01–09 Inconsistencies in self-reporting of sexual activity among the young people in Nairobi (Kenya)
D. Beguy1, C. Kabiru1, E. Nderu1, M. Ngware1
1African Population and Health Research Center, Nairobi, Kenya
Background: Adolescents’ sexual behavior has been widely studied; however, scant attention has been paid to accuracy and reliability of self-reported sexual behavior by adolescents. Due to social disapproval of premarital sex, adolescents may be less willing to admit sexual activity. Yet, accurate and reliable data on prevalence of adolescents’ sexual behavior are paramount for effective intervention. In urban informal settlements, levels of adolescent sexual activity are believed to be high; hence analyzing consistency of self-reported sexual experience is important.
Methods: The objective of this paper is to assess consistency of self-reported sexual activity among adolescents in slum and non-slum settlements in Nairobi, Kenya. We examine two forms of inconsistencies, ‘reborn’ virgins and inconsistent timing of sexual debut, during two rounds of survey. Factors influencing inconsistent reporting are explored through logistic regression.
Results: Out of 2,324 participants, 469 (20%) adolescents gave inconsistent information on whether they had ever had sex (n=190) or timing of first intercourse (n=279). Individuals giving inconsistent reports were, on average, older, more likely to be male, live in slum areas, out of school, and more likely to report delinquent behavior and drug use. They also differed from those providing consistent reports on psychosocial variables.
Conclusions: Many studies examining inconsistencies in self-reported data are derived from studies on prevalence and consequences of risk behavior. This study finds significant differences between adolescents based on contextual and demographic attributes. There needs to be more directed research on ways to improve reliability of self-reporting, taking into account social and demographic contexts.
P01–10 Initial gynecological health care experiences of urban African American adolescent girls - Implications for providers
L. Warren-Jeanpiere1, K. Miller1, A. Warren2
1Centers for Disase Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States, 2Wayne State University, College of Education, Detroit, United States
Background: The American College of Obstetricians and Gynecologists (ACOG) recommends that adolescent girls have their initial gynecological visit between age 13–15 to establish rapport with a provider, and acquire education and preventive services prior to the onset of sexual debut and/or the occurrence of reproductive health problems. Little is known about the first gynecological health care experiences of young African American (AA) women and factors that may enhance or impede the patient/provider relationship.
Objective: This study examined the characteristics of AA women’s’ first visit to the gynecologist, with regard to age, knowledge of gynecological health care, decision to seek care, reason for first visit, and feelings prior to the exam.
Methods: Using snowball sampling techniques, AA women who had experienced at least one gynecological exam were recruited from a large mid-western city. In-depth interviews were conducted with 17 women (ages 20–55) to elicit retrospective narrative accounts regarding their initial gynecological experiences.
Results: Mean age of participants at first visit was 17.4. Many participants indicated that (N=12) their initial visit was not preventive and 41% (N=7) were already sexually active. Participant perceptions (N=7) of being unfairly judged or treated poorly by providers impeded patient/provider communication.
Conclusion: Findings suggest that the experiences of AA women examined do not align with ACOG recommendations regarding preventive adolescent gynecology. Ensuring that all girls, especially those disproportionately impacted by negative health outcomes have appropriate and satisfactory linkages with the health care system prior to the arrival of problems and/or their sexual debut will optimize their health and health care encounters.
P01–11 Knowledge and attitude towards utilization of cervical cytology screening among women in Ibadan, Nigeria
O.O. Adetule1, O.O. Adetule2
1University College Hospital, School of Nursing, Ibadan, Nigeria, 2University of Ibadan, Dept. of EMSEH, Ibadan, Nigeria
Background: Worldwide, cervical cancer comprises approximately 12% of all cancer in women. It is the second most common cancer among women. Millions of women worldwide never undergo cervical cancer screening, and hundreds of thousands die prematurely without ever knowing why they were ill (Ferlay et al 1998). This preventable disease kills an estimated 274,000 women every year affecting the poorest and most vulnerable women. The main underlying cause is the human papilomavirus (HPV), a sexually transmitted infection that is often without symptoms.
Method: The study investigated the relationship between knowledge of and attitude towards utilization of cervical cytology screening among women in Ibadan, Nigeria. Three hospitals were selected within the metropolis and a self structured questionnaire was administered to 50 women from antenatal clinic in each hospital.
Results: The results show that 61.5% of the women interviewed have heard of the test while only 18.2% of the respondent have gone for screening. In addition, greater proportions of adequate knowledge and attitude towards the test were found among women with high level of education.
Conclusion: The analysis of the data collected shows that many factors are responsible for the low level of utilization of the cervical cytology screening such as ignorance, non availability of services and financial incapability. Health institutions and the government should assist the women in the utilization of the cervical cytology screening.
Keywords: cervical cytology screening, human papilomavirus, Ibadan, knowledge, attitude.
P01–12 Knowledge and attitudes of students towards HIV/AIDS
1SADA, NGo, Quetta, Pakistan
This study was designed to assess the awareness, and attitudes, of medical students towards human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). A cross-sectional study among 175 fresh entrants and 160 second year medical students of Nishter Medical College, Multan Pakistan was conducted using a structured questionnaire.
The variables accessed were related to their knowledge of HIV/AIDS regarding etiology, modes of transmission, preventive strategies and their attitudes towards the HIV infected.
Results showed that a large majority of medical students surveyed believed that HIV/AIDS is a major health crisis.
Misconceptions and lack of knowledge regarding transmission and laboratory diagnosis of HIV/AIDS were reported. However the number of medical students who observed positive attitudes towards care for HIV infected individuals was very high. The study highlighted that information is the first step in prevention of HIV/AIDS.
The results of this survey show that medical students correctly perceive the risk posed by HIV/AIDS. However there is a need for greater sexual health education for the future doctors. Inclusion of programmes/learning experiences in the medical curriculum, designed to enhance the awareness and right attitudes towards HIV/AIDS seems to be essential. Information and health education campaigns for medical students on HIV/AIDS should be incorporated from the commencement of the medical programme.
P01–13 Meeting the needs of young people for sexual and reproductive health information in Ghana
E.K.M. Darteh1, A. Kumi-Kyereme1
1University of Cape Coast, Population and Health, Cape Coast, Ghana
HIV/AIDS Messages have gone through at least four phases since the campaigns started in the country in the early 1980s. These are the scare messages of the early period, the behavioural change approach and now messages to promote compassion among non-infected persons and positive living among those living with the virus. For young people, considered to be within the window of hope, the view is that they should not die out of ignorance, hence programmes and activities for young people especially those in urban areas. The objective of this paper is to assess the knowledge and concerns of young people about sexual and reproductive health vis-à-vis the messages targeting them.
The paper is based on a nationally representative survey conducted in 2004, as well as focus group discussions and in-depth interviews among urban young people 12–19 in two selected districts in Ghana.
Over 95% of young people aged 12–19 years were aware of HIV/AIDS, only 39% of females and 43% of males had heard about other STI. The main sexual and reproductive health concern of both males and females from the qualitative data was pregnancy rather than HIV/AIDS.
The results indicate the inadequate knowledge about other STI although it is a co-factor in HIV/AIDS infection and mismatch between the concerns of young people and SRH campaigns. To ensure that young people are safe, programmes for them should be comprehensive taking into consideration their concerns and aspirations.
P01–14 Monitoring child growth: Challenges, lessons and findings from the Nairobi urban health and demographic surveillance system
J.C. Fotso1, N. Madise2
1African Population & Health Research Center (APHRC), Nairobi, Kenya, 2University of Southampton, School of Social Sciences, Southampton, United Kingdom
Background: Inappropriate feeding practices, nutritional deficiencies and growth faltering of infant and children, coupled with recurrent episodes of infections are one of the main public health concerns in developing countries. Poor nutrition contributes to about 53% of deaths associated with infectious diseases among children aged under five in developing countries. Children bear a disproportionate burden of the urban health crisis as emerging evidence demonstrates that urban poor children exhibit poorer health and nutritional outcomes than children from better-off urban households or even those from rural areas. The goals of this study are
1) to document the challenges and lessons learnt in collecting longitudinal child anthropometric data
2) describe child growth patterns in poor urban communities.
Methods: This research uses data from a Maternal and Child Health project being implemented in the informal settlements of Nairobi, Kenya since January 2007. From the demographic surveillance system, all women who give births are enrolled in the project and administer a questionnaire which includes anthropometric measurements of their children. The children are then followed up every four months for a period of three years. Height-for-age, weight-for-age and weight-for-height z-scores are computed using the WHO/NCHS reference.
Preliminary results: One of the key challenges faced during data collection related to the refusal of mothers to have their baby weighted. Explaining to mothers the health benefits of the growth chart helped to overcome the reluctance. Preliminary data from the first three rounds show that about 28% of children had low birth weight. Among children with low birth weight, only 34% were able to catch-up after a period of eight to 12 months.
Conclusions: Designing and implementing a longitudinal program to monitor child growth in urban poor areas is feasible and can be used a tool to identify children at risk of death.
P01–15 Nargileh and cigarette smoking practices among urban school students: Results from Beirut- Lebanon
B. Al-Sahab1, H. Tamim1
1York University, Toronto, Canada
Background: Nargileh, a form of smoking, has become a common behavior practiced by different family members of all ages in Middle Eastern culture. With the rise of nargileh smoking in the region, the present study aimed to determine the prevalence and predictors of smoking nargileh and/or cigarette among urban school students in the city of Beirut, Lebanon.
Methods: Proportionate random sample of 2,443 students from 13 public and private schools in Beirut were selected and asked to fill self-administered anonymous questionnaires. Three stepwise logistic regression models were performed with the dependent variables being smoking only cigarettes, smoking only nargileh and smoking both cigarettes and nargileh and the independent variables being socio-demographic characteristics, health risk behaviors and social indicators.
Results: The prevalence of smoking cigarette only, nargileh only, and smoking both was 2.5%, 25.6% and 6.3% respectively. While smoking cigarette only was common among males, alcohol drinkers and internet users, smoking nargileh only was prevalent among children with less educated mothers, alcohol drinkers, internet users, television watchers, children having problems with their parents and children of smoking parents.
Conclusions: Nargileh smoking is more culturally accepted than cigarette smoking. Nargileh tailored interventions should rise to the same level of importance as interventions targeting cigarette smoking. Increasing awareness towards the hazards of the misconceived harmless effects of nargileh smoking and illegalizing nargileh smoking in public places are warranted.
P01–16 Teenage pregnancy in Stevenage - Reducing the inequalities
A. Mathew1, R. Jankowski2, S. Beck3, C. Oker3, S. Gupta2
1University of Cambridge, Cambridge, United Kingdom, 2Hertfordshire Primary Care Trust, Hertfordshire, United Kingdom, 3Hertfordshire Children’s Trust Partnership, Hertfordshire, United Kingdom
Issue: Stevenage is an urban area in Hertfordshire with a population of 79,715. Population growth is expected to remain low. The population of teenage girls aged 15–19 years is 2579 Hertfordshire Teenage Pregnancy Strategy1
Hertfordshire has a 10-year Teenage Pregnancy Strategy, developed in 2001 to reduce under 18 teenage conception rates and ensure better outcomes for young people and young parents in the county. The strategy was developed jointly with health and other relevant partners, in line with Government requirement for every top tier Local Authority in England to develop a 10-year strategy (2001 – 2010) to reduce under 18 teenage conception rates.
Description: This poster informs about the significant reduction in teenage pregnancy rate in Stevenage and the interventions which lead it to being achieved
Year Conception rate (numbers)
1998 53.5 (76)
2005 28.7 (47) change - 46.3%
Rates per 1000 girls aged 15–17
Source: ONS & TPU (2007), under 18 teenage conceptions numbers & rates
Lessons learned: Interventions-Policy and people
Conclusion: Strong joined up working with a “can do approach” was at the heart of the successful work and partnership in Stevenage - which lead to a reduction of 46.3% in teenage pregnancy rates in 7 years.
References: 1.Hertfordshire Teenage Pregnancy Strategy -Accelerating Progress Action Plan 2007 – 2008
P01–17 The impact of heavy adolescent smoking on adult educational attainment among African Americans: Using propensity score matching method
C. Strong1, H.-S. Juon1, M.E. Ensminger1
1Johns Hopkins University, Bloomberg School of Public Health, Baltimore, United States
Background: Prior research has found that adolescent cigarette smoking was associated with various adverse adult outcomes. We examined the long-term relationship between regular adolescent smoking and later education attainment among an epidemiologically defined community sample of African Americans followed from first grade through age 42.
Methods: Using propensity score methods we match individuals on early confounding factors of cigarette smoking (SES, childhood behavior, mother’s smoking). We used multinomial logistic regression to determine the association between adolescent smoking and adult educational attainment on a sample of 276 individuals (n=138 each group) after 1–1 nearest matching.
Results: About 29% of the sample was classified as regular smokers in adolescence. Logistic regression results on the sample matched on gender, early sociodemographic and behavioral variables showed that adolescent regular smoking was associated with later educational attainment. Regular smoking in adolescence was negatively associated with having high school degree or some college degree (−.81, p<.05) or being college graduates (−1.22, p<.05).
Conclusions: The impact of regular adolescent smoking on adult educational attainment was confirmed using a different statistical analysis approach on a longitudinal dataset. This association remained significant even after considering various potential confounding.
P01–18 The nicotine dependence experiences of urban African American youth
C.S. Fryer1, P. Pelmon2
1University of Pittsburgh Graduate School of Public Health, Behavioral and Community Health Sciences, Pittsburgh, United States, 2Centers for Healthy Hearts and Souls, Pittsburgh, Pennsylvania, United States
Background: There is a paucity of effective adolescent tobacco cessation interventions targeting urban, minority youth. Empirical research has focused on adolescent cigarette acquisition and smoking initiation, yet relatively less consideration has been paid to factors that impede smoking cessation among this group. Tobacco control literature demonstrates that nicotine dependence is the most formidable impediment to quitting smoking among adolescents. The need for and the importance of understanding nicotine dependence during adolescence is based on: evidence that young people desire to quit smoking; low rates of cessation among youth; evidence of nicotine withdrawal occurring even before the onset of daily smoking; and evidence of the link between tobacco use and major chronic tobacco-related illness. Despite the recognition of the central role of nicotine dependence in smoking cessation, there is a paucity of information about how nicotine dependence is expressed among young smokers.
Methods: In an effort to address this gap in knowledge, a qualitative exploratory study was conducted utilizing focus groups to examine adolescent nicotine dependence experiences and symptoms of withdrawal. This study explored how young people defined and described their experiences with the overall aim to develop a psychosocial model for cessation interventions targeting urban African-American youth.
Results: Preliminary data show that the experiences of urban minority youth are associated with unique challenges they face within their community, including disproportionate targeted tobacco advertising and unmet cessation resources.
Conclusions: These findings will inform practitioners of critical factors to address in the design of effective tobacco cessation interventions targeting urban, minority youth.
P01–19 Vulnerability of street children to sexually transmitted diseases and HIV infection in Kathmandu, Nepal
1Community Health Development Society Nepal, Community Health and Research, Kathmandu, Nepal
Objective: Kathmandu is a home to large number of adolescents who runaway from home and are involved in rag picking, substance abuse, working in massage centers and dance restaurants. They are easily forced into substance abuse and high risk sexual behavior due to peer pressure from senior street children. This study is designed to examine the health problem of these children.
Methods: Kathmandu Municipality runs health posts at 5 different wards in Kathmandu. It provides primary health care, counseling, referral and shelter facilities. The data are based on records of the health post in 8 months period from August 2007 to March 2008. Those children visiting the health posts between August and March 2008 were asked to fill in a questionnaire and a nurse based interview was conducted.
Results: During the six month period, 488 children visited the health post. 27% were girls and 73% were boys. Of these 115 (23.56%) were treated for sexually transmitted illness (STI) and 30 were tested for HIV. Only 1 was found to be HIV positive. 55% of children reported history of high risk sexual behavior. 45% reported poverty and 28% reported negligence by the parents as the push factor to motivate them to run away from home. 71% reported that they are unaware of various facts about HIV/AIDS and STI.
Conclusion: The risk of HIV infection is high among these street children. They require sex education to reduce the risk of infection, health care and rehabilitation efforts in order to protect their lives.
Aging and Health in Urban Settings
P02–01 Assessing domestic fall risk among independently living older adults in NYC
1Georgia State University, Institute of Public Health, Atlanta, United States
Background: Falls are common among the elderly and a leading cause of morbidity and mortality. Many risk factors for falls are modifiable - including: lack of physical activity, muscle weakness, impaired balance and vision, inappropriate medication use, and environmental hazards. The purpose of this study is to assess the feasibility of recruiting urban-dwelling older adults into a falls prevention pilot.
Methods: The aim of this study is to pilot a multi-dimensional screening program for adults aged 60 and older who live a Naturally Occurring Retirement Community [NORC] in NYC. The 3 month program involves 3 visits to a participant’s apartment made by a multidisciplinary team to screen for falls risks, assess self-efficacy related to fall avoidance, and evaluate participant change and satisfaction.
Results: To date, 28 NORC residents have enrolled in the falls prevention pilot study (average age 80, 79% female). On average, residents received 6 participant recommendations and 2 physician-based recommendations. At 3-month follow-up, 90% of participants agreed or strongly agreed that they were satisfied with the program and changes made in their home environment. Each participant made at least one recommendation implementation, and percentage of recommendation implementation ranged from 25 to 73%. Additionally, t-test statistics demonstrated that mean FES-I scores significantly improved from baseline to 3-month follow-up [37 to 30.5, p=.000].
Conclusion: Results from this study demonstrate the feasibility of implementing a comprehensive falls prevention pilot program for urban-dwelling older adults. Furthermore, lessons learned from this study can inform larger, more rigorous falls prevention research.
P02–02 Digital storytelling in the arts health and seniors project; The independence, narratives and health in older adults
1University of British Columbia, Centre for Cross Faculty Inquiry in Education, Vancouver, Canada
This presentation looks at the use of narrative and digital storytelling and its connection to the health and well being of a group of seniors who are currently participating in a three year community arts and research project called the Arts Health and Seniors Project. The Digital Storytelling project is one site in Arts Health and Seniors Project where four distinct urban communities of seniors in East Vancouver and the North Vancouver, B.C. are engaged in community arts practices. The overall research component of this project is looking at the connections between creative work and health and is affiliated with the UBC School of Nursing. This project is based on a larger research project; Creativity and Aging; the Impact of Professionally Conducted Cultural Programs on Older Adults, (Cohen, 2006). The presenter is the senior artist and researcher of the Digital Storytelling site as well as the coordinator of the entire Arts Health and Seniors project. There is a growing body of research that points to the positive intervention effects of community based art programs that points to true health promotion (Cohen 2006). This presentation will look at how the function of relating personal narratives play in the overall health and well being of the seniors. The participants in this digital story telling work describe changes to their sense of identity and their sense of well being. The ability to narratively construct a digital document and thereby concretely ‘bearing witness’ to their lives appears to be supporting a strong sense of independence in the participants that may have impacts for future healthcare. This presentation will argue in favour the important work of expressing narratives to the general health and well being of aging adults. This research will be based on the qualitative research methods, primarily interviews from the participants.
P02–03 Edutainment in urban centers
E.N. Maina1, R.W. Nyambere2
1Nyam Health Promoters, Administrator, Nairobi, Kenya, 2Nyam Health Promoters, Secretary, Nairobi, Kenya
In most countries including my country KENYA, health in urban centers especially to the aged, is not looked into.
Primary health care service should be done door to door by the government ministries in every country globally.
Old age people are less cared for mostly those who live in urban slums as I with members of NYAM HEALTH PROMOTERS (NYP) which is registered in the ministry under the Department of Social Services, have been voluntarily in the forefront visiting these aged people, providing medication door to door and while in this process, we have noted their security is worse and it needs a quick action.
Our organization has created a new project run by 15 council members under the banner ‘NYAM AGE CARE’ (NAC).
To enhance quality of life to these old age people, Non-government organizations, Community Based Organizations e.t.c. should take hand and team-work to see the quality of these aged people with food, medicine and good environment.
As we are having an entertainment department in NYAM HEALTH PROMOTERS, we do visit them where perform (edutainment) just to make them more friendly with the organization as for their age to be active.
P02–04 Gender differences in depressive symptoms of aging Chinese in urban Jiangsu in China
A. Guo1, D.W.L. Lai2
1Nanjing Normal University, Ginling Women’s College, Nanjing, China, 2University of Calgary, Faculty of Social Work, Calgary, Canada
Background: Very little research has examined gender differences in depression of aging adults in Mainland China. This study investigates gender difference in depression and its correlates.
Method: Data were collected using a face-to-face questionnaire interview in a provincial survey with aging Chinese 60 years or older in Jiangsu province in China, identified through proportional probability sampling in four urban centres. Data from 497 older Chinese (235 males and 262 females) residing in urban centres were used for this analysis. Depressive symptoms were measured by a Chinese version of the 15-item Geriatric Depression Scale.
Results: Females reported significantly more depressive symptoms than males (4.87 vs. 4.17). A higher proportion (48.9%) of females reported to be depressive than males (37.9%). Stepwise multiple regression was used to examine the correlates of depressive symptoms. For male respondents, needing help with more self-caring tasks, more financially inadequate, more worries, more chronic illness, being unmarried, and having a lower education level were significant correlates of more depressive symptoms. For female respondents, needing help with more self-caring tasks, more financially inadequate, more worries, and more chronic illnesses correlated significantly with more depressive symptoms.
Conclusion: Aging Chinese females were more vulnerable to being depressive. Differences in financial inadequacy could be the key reason. For dealing with the gender disparities in depressive symptoms, policies and programs should gear toward addressing their financial needs.
P02–05 Meaning attributed to grandparents by children
M.A.S. Paredes Moreira1, K.K. Gonçalves2, A.O. Silva2, K.K. Gonçalves Pereira2, M.B. Camacho Cardoso3, M.A. Coler2
1Universidade Estadual do Sudoeste da Bahia, Saude, Joao Pessoa, Brazil, 2UFPB, Joao Pessoa, Brazil, 3ENSP, Lisboa, Portugal
The elderly have an important role in the relation between generations as the holders of wisdom and knowledge collected throughout their years. They form a link with the past and projects the continuation of the community to which they belong. The elderly and the child are perceived between a past and a future that makes their present an enigma for themselves and for the society in which they live. The study’s purpose was to identify the psycho-affectionate experiences shared between these two generations associated with social representation of grandparents, elderly and old age according to forty children from a public school and a public health service in João Pessoa, Paraiba, Brazil. Their ages ranged from 6 through 11 years old including both genders, all consented to participate in the study by their parents or legal representatives. Three stimuli were utilized to comprehend social representation: grandparents, old age and elderly. It was requested that the children draw a picture for each stimulus talking about the drawing made. The children drew the elderly and described them as their grandparents or people close to them with meanings correlated to objects such as: cane, walker and eye glasses, amongst other things.
P02–06 The strive for healthy cities’ impact on the ageing, lifespan and health status of the fourth world populations
J. Hill1, L. Jackson Pulver1, T. Broe2
1University of New South Wales, School of Public Health and Community Medicine, Sydney, Australia, 2Prince of Wales Medical Research Institute, Sydney, Australia
Urban sprawl has caused the rapid expansion of metropolitan areas leading to a complex matrix of land use, transportation, social and economic development. New trends in development are encouraging higher density development within the city centre with the goal of promoting migration of the middle class populations from the suburbs to the city. All of this is for the purpose of promoting the creation of ‘healthy cities’ thus increasing the potential for ‘healthy ageing’ of the people within the city and for positive impacts on the environment.
However, trends for the improvement to one sector of the population may be detrimental to other sectors of the population. While it is now established that premature illness from systemic diseases severely influence the healthy ageing of the fourth world, the study of ‘healthy ageing’ of the fourth world members in relation to “later in life” diseases has not been performed especially in the context of modern urban planning trends. These concepts are in the framework for the current study of certain fourth world urban aboriginal communities in the State of New South Wales in Australia. This paper builds on research that suggests that ‘later in life’ diseases such as dementia manifest themselves earlier in fourth world populations. The aim is to contribute to the discussion about ‘healthy ageing’ within the context of our modern cities. This will include deconstructing the theoretical principles that underlie the construction of ‘healthy cities’ including exploring the concepts of displacement and social justice and the impact of urban life experiences of racism, early childhood trauma, and lack of education on the ageing of fourth world populations within these modern cities. The question will become whether we are actually creating ‘healthy cities’ or merely furthering the marginalization of the fourth world by ignoring their rights to ‘healthy aging’.
Best Practices in Meeting Urban Health Challenges
P03–01 A pilot study on life style among urban dwellers
N. Cilingiroglu1, M.S. Yardim1
1Hacettepe University Faculty of Medicine, Public Health Department, Ankara, Turkey
Background: Population-health trends in urban areas is an important topic for research since life-style related health determinants that are linked to number of major health problems are affecting the inhabitants. Main objective of the study is to investigate the risk factors related to life style, examine the relationship between socio-demographics and these factors and life style among urban-dwellers.
Methods: This descriptive research is conducted at a primary-health-care-center on 15-years and over population in Ankara. During a one working-week period, people who attended the health center for any purpose and accepted to participate the study (162 persons) were interviewed. Rate of inclusion was 82.1%. Last year medical students measured blood pressure; body weight and calculated body-mass-index.
Results: Of the participants, 69.1% women, 39.5% below age 35, 79.6% married, 17.9% poorly educated, 90.7% has health insurance, 82.3% perceives their economic status as middle and high, 82.1% sleep more than 6 hours daily, 56.8% health status perception is bad. Basic fat source was declared as olive-oil 95.1% and high salt consumption was declared by 8% of the participants.The statistically significant relationships:Men (54%) were significantly consuming more milk products than women (p=0.022). Perceived economic-status and meat-eggs-legumes consumption (p=0.000). Educational status and cereal consumption (p=0.001). Alcohol, smoking and making physical-exercise between men compared to women (p=0.000). Age and hypertension and obesity (p=0.000). Better-educated people less likely being obese (p=0.01). Obese participants found more likely to have chronical-disease (p=0.000). Perceived health status and not having a chronical-disease (p=0.000).Of the chronically-ill participants 70.5% declared that they changed their life-style after diagnose, although 16.9% were not using their recommended medication regularly.
Conclusions: Urbanisation is occurring globally and urban-health is a growing field of research internationally. Our findings showed that it is necessary to improve economic-status and education of the urban-dwellers in order to adopt healthy-life-style.
P03–02 Addressing Inequities: Translating knowledge into practice
C. Phung1, T. Bruce2
1Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada, 2Vancovuer Coastal Health, Population Health Team, Vancouver, Canada
Issues: Despite Canada’s professed universal healthcaren system, there exist significant differences in health outcomes between sectors of society. Social determinants such as gender, ethnicity, aboriginality, religion, poverty, and education intersect in a complex interplay to detriment the health of segments of the population. It is obvious that health involves more than health care; yet, it appears that there is little focus on the broader influences on health. This could be attributed to the current lack of knowledge about the determinants of health, both within society and he health care system. This is due to the discourse between the generation of knowledge around the social determinants of health, the combination of this knowledge with other learning, and the application of the knowledge into practice and policy.
Description: This objective of this project was to translate current knowledge on the determinants of inequitable health, to health sector staff to engage them to act on and advocate for reducing inequities in health. The knowledge was brokered through a toolkit, consisting of a framework emphasizing an evidence-based social approach to providing healthcare. The toolkit also provided examples of current best practices of interventions aimed at identifying and reducing health inequities.
Next steps: The next steps for the toolkit will be to implement it into practice. It is envisioned that this toolkit will be the basis of a workshop related to educating health services teams about population health and the role of the health sector in addressing inequities.
P03–03 Addressing the non-medical determinants of health: A Canadian perspective of regional health authorities and their partners
J. Frankish1, G. Moulton1, R. Labonte2, B. Evoy1, A. Carson3, A. Casebeer4, J. Eyles5, J. Gerbrandt1, C. Pryce6, S. Tirone7
1UBC, Centre for Population Health Promotion Research, Vancouver, Canada, 2University of Ottawa, Ottawa, Canada, 3University of Victoria, Victoria BC, Canada, 4University of Calgary, Calgary, Canada, 5McMaster University, Hamilton, Canada, 6Calgary Health Region, Calgary, Canada, 7Dalhousie University, Halifax, Canada
Health policy discourse has expanded to include “whole of government” interventions on the non-medical (or social) determinants of health. The non-medical determinants of health [NMDH] “refer to the social, economic and cultural factors that influence individual and population health both directly and indirectly, through their impact on psychosocial factors and biophysiological responses. The purpose of our research was to:
The research was conducted in interrelated steps. A quantitative survey instrument was developed and validated that focused on health regions’ degree of action on NMDH. Health region representatives were interviewed based on the results of their self-reported levels of action (both high and low) for various determinants. Finally, documents were examined and partners were interviewed on their experiences working on NMDH, and specific determinants for which health regions had indicated high levels of action. Our data will highlight shifts in RHA policy directions with attempts to address more distal determinants of health. We will also present and discuss reasons why RHAs prioritized some NMDH over others. One lesson embedded in our case findings is that health and other sectors whose policies and programs can affect NMDH have numerous opportunities for innovative action. We discuss the need for stronger policy rhetoric on the importance of reducing inequities in NMDH, notably for income and other material resources for health. We will argue a need for more detailed comparative studies that provide insight into the policies and programs, at micro, meso and macro levels of social organization, that show impact in reducing these inequities.
P03–04 An inner city orthopaedic unit’s successful implementation of an osteoporosis assessment and treatment program after fragility fracture
E.R. Bogoch1, V.I.M. Elliot-Gibson2, D.E. Beaton2, A. Baburam2, S.A. Jamal3, R.G. Josse3
1St,. Michael’s Hospital, Department of Surgery, Toronto, Canada, 2St. Michael’s Hospital, Mobility Program Clinical Research Unit, Toronto, Canada, 3St. Michael’s Hospital, Department of Medicine, Toronto, Canada
Background: We evaluated adherence with osteoporosis (OP) assessment and treatment after fragility fracture in an orthopaedic unit.
Methods: Inclusion criteria: males ≥50 years, females ≥40 years, with fragility fracture of the wrist, humerus, hip, vertebrae; plus patients referred by orthopaedic surgeons. A chart audit measured adherence at one year in patients screened from December 2002 to November 2003 (n=430).
Results: Bone density tests (BMD) were completed by 158/208 patients. Eighteen patients had normal BMD; 58 were osteoporotic; 81 were osteopenic; one unknown. Inpatients (n=154): 10 died; 6 refused intervention; 43 were already on appropriate OP care; 16 were referred to family physician (FP). Sixty-one were referred to OP Clinic; 47 attended and were prescribed appropriate care, of which at least 24 were still on treatment, 1 was non-adherent; 19 followed up with FP or not at all (no chart data) at 1 year. Outpatients (n=276): 13 with normal BMD were not referred; 9 refused intervention; 87 were on appropriate care; 28 were referred to FP. 136 were referred to the OP Clinic; 100 (74%) attended; 94 received appropriate care; 6 refused medication. At least 48/94 were adherent to prescribed medication, 9 were non-adherent, 34 followed up with FP or not at all. Due to physical and mental health issues, 23 patients were not referred.
Conclusions: This program identified and referred fragility fracture patients for OP assessment and treatment. Adherence was over 50% at one year, which is likely underestimated through the chart audit methodology.
P03–05 Building evidence for a local leadership model for urban health in Bangladesh
I. Rasul1, S. Jahan1, D. Pyle2, E. Sarriot3, M. Kouletio4
1Concern Worldwide, Bangladesh, Dhaka, Bangladesh, 2John Snow International, District of Columbia, United States, 3Macro International, Beltsville, United States, 4Concern Worldwide US, Inc., New York, United States
Background: From 1998–2006, Concern Worldwide developed a model for urban health that builds on local political leadership, community mobilization, technical coordination among public-private service providers, and holding local authorities accountable for reaching the most disadvantaged households. This rights based approach model was originally developed in two municipalities at $5.52 per beneficiary/year. With start-up investments made, the model has been replicated in seven additional municipalities in Rajshahi Division protecting 319,000 women of reproductive age and children under-five at the cost of $1.37 per beneficiary/year.
Methods: Comparative household health surveys in 1999, 2004, 2005, and 2007 on 13 key health outcomes, capacity assessments in 2001, 2004 and 2006 of ward health committees and Municipal authorities; a prospective cost analysis study assessing six components across each of the municipalities; a three-year post-intervention sustainability assessment. The Lives Saved Calculator and Principle Components Analysis were used to estimate child mortality adverted and health outcomes’ equity.
Results: Externally led evaluations in original and replication areas demonstrated significant improvements in health outcomes as well as strengthening of structure and capacity of municipal and ward levels despite a difficult political environment and following a major reduction of external resources. There was also an association between active involvement in community health activities and re-election of local political leaders. To date, an estimated 658 child lives have been saved. Gains in most health indicators have been greatest among the poorest households. Initial gains in health outcomes and capacity were maintained to a large degree three-years post-intervention following a 98% reduction in external resources.
Conclusions: A low cost, replicable model for urban health has been documented, a learning center tested, and an operations manual developed. Political and monetary commitment from the Ministry of Local Government and the donor community will however be necessary for national uptake to be achievable.
P03–06 Case management: The acute care medicine solution to urban health challenges
C. Valentini1, K. Grooveld1
1St. Michael’s Hospital, Toronto, Canada
Issues: The provision of health care delivery to a population with diverse and complex disease management and social aspects was identified as an increased challenge for the General Internal Medicine Unit at St. Michael’s Hospital, Toronto, Ontario, Canada.
Description: In response to the identified challenge the introduction of a Case Management model on the General Internal Medicine unit was initiated. This is the first acute care medical unit in the City of Toronto to initiate a Case Management model of care. The Case Managers have developed innovative pathways based on theoretical frameworks, evidence based literature, and best practice guidelines. The Case Management model support patients and their families in navigating the health care system, decreases the fragmentation of services, encourages health team communication, and contributes significantly to patient satisfaction, patient safety, quality of life, and cost efficient management of limited resources.
Lessons learned: The Case Management model has been in place for 5 years. It has proved successful in achieving positive outcomes in the following domains:
Next steps: Development of a defined model of Case Management for General Internal Medicine with best practice guidelines is planned. The guidelines will be available for other programs to positively contribute to health care delivery.
P03–07 Green programmes in Nigerian schools and climate change
O.O. Adetule1, O.O. Olabode2, C. Abiamiri2
1University of Ibadan, Department of EMSEH, College of Medicine, Ibadan, Nigeria, 2University of Ibadan, Department of EMSEH, Ibadan, Nigeria
Issues: Climate change is one of the most critical global challenges of our time. Its impacts will range from affecting agriculture- further endangering food security, sea-level rise and the accelerated erosion of coastal zones, increasing intensity of natural disasters, species extinction and the spread of vector-borne diseases. In order to combat climatic changes, Green programmes were encouraged in both primary and high schools in Nigeria. These were championed by the Environmental Health Students Association through the Youth Environmental Scout (YES) Club Programme, which was established to create awareness and introduce to students to environmental health issues.
Description: Ten schools with average population ≥ 500 students per school located in the Ibadan metropolis were selected for the implementation of Green programmes.Tree planting and environmental education were taught and encouraged in these schools.The environmental health student association members taught this programme for a period of one year and the curriculum was the same for all the ten schools.
Lessons learned: Tree planting programme in the schools started yielding result.About 20 trees were planted in each schools most of which were Teak trees. Thus, the tree planting programme practised in these schools could help in reducing the amount of carbon(iv) oxide in the atmosphere thereby reducing the effect of global warming.
Next steps: The Environmental Health Student Association members are looking forward to incorporate other green programmes in these schools such as renewable energy production from biodegradable waste.
P03–08 Healthy public policy: Lessons from the past from the health of towns and Gutenberg to today
1York University, Multidisciplinary Dept. - Health & Environment Studies Program/Hygeia Healthy Communication Saine Inc., Toronto, Canada
What can we learn from that experience? or Track 11: Urban Health from a Global Perspective.How can the history of public health in the urban setting inform 21st century challenges for the quality of life in cities world-wide?
Going back to the roots of healthy cities in Victorian England on one hand, and revisiting the impact of the Gutenberg printing press on the other, this paper will draw a parallel between challenges and resulting healthy public policies innovations of the past and current global issues.
From local health to global health, from rural to urban environments, from natural resources to human resources, from environmental pollution to social tensions, from globalization to local impacts, from trade/finance to labour, this paper will aim to provide some context to current 21st century challenges, based on some past policy solutions to similar challenges, albeit at a different scale.Indeed, past deep social, economic, ecological and urban changes on the one hand, and tremondous shifts in western thought, following radically different overall intellectual property and knowledge distribution on the other, new technologies have profoundly affected the quality of life of citizens, then, and now.
Overall this paper will address the following questions: What are the 21st centuries echoes of the profound changes the industrial revolution and the Gutenberg revolutionbrought about? What insights can these bring to contemporary cities around the world faced with their own transformations and the sustainability challenge, i.e. striking economic, social and ecological balance for a better quality of life?Indeed, a better understanding of the current nexus of forces influencing urban health/quality of life in cities, and reflecting on past challenges and solutions, current urban health promoters, health professionals, municipal staff and community groups members would be better equipped to nurture their own contemporary healthy public policy solutions.
P03–09 Hearing protection use in an urban population: Preliminary data
R. Gershon1, R. Neitzel1, M. Sherman1, M. Zeltser1, S. Samar1, M. Akram1, J. Spitzer1
1Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, New York, United States
Background: Noise induced hearing loss (NIHL) is the most common health problem in industrial societies. While occupational exposure to excessive noise is the most common risk factor, high rates of noise induced hearing loss continue, even though occupational standards have been in place for decades. Non-work sources of excessive noise exposure, such as recreational activities and mass transit, are increasingly of interest. Poor compliance with use of personal hearing protection (PHP) on and off the job has been considered as one of the reasons for the high prevalence and incidence of NIHL. To assess the use of PHP to limit noise exposure, an anonymous survey of an urban population was conducted in 2007.
Methods: A four-page survey self-administered survey was completed by a convenience sample of adult community members attending neighborhood street fairs.
Results: There were 1,045 individuals in the sample. Thirteen percent worked in high-noise occupations (e.g., construction, farming, mining); of these, 1/3 reported consistent use of hearing protection at work. With respect to leisure-type activities, 15% reported frequent participation in high noise non-work activities (loud music, lawnmowers, firearms, etc.) and only 3% reported consistent use of PHP during these activities. More than 75% of the sample reported subway and other mass transit ridership. Of these, only 4% reported consistent use of PHP while riding.
Conclusions: Participants reported extremely low rates of use of PHP on and off the job. Efforts to encourage use of PHP, especially in urban environments, may protect the hearing health of urban dwellers.
P03–10 Intersectoral collaboration in the area of urban health: Results of a qualitative research in selected healthy cities in Poland
B. Balcerzak1, J. Haluszka2
1Jagiellonian Institute of Public Health, Department of Environment and Health, Kraków, Poland, 2Institute of Public Health, CM, Jagiellonian University, Health and Environment, Krakow, Poland
Background: The recognition of the influence environmental factors have on health has lead many people to advocate intersectoral collaboration between public health professionals and environmentalists. However, it is reported that a little formal work has been done in the field to translate the concern over environmental conditions into health policy. One of the objectives of the presented research project is to describe the factors influencing intersectoral collaboration in the field of environmental health at local level.
Methods: The qualitative research was carried out in three Healthy Cities in Poland. The sampling was purposeful and theory driven. The sample consisted of 50 informants representing organisations in different sectors. The data was collected by means of semistructured interviews. Their transcripts were analysed with the use of Microsoft Word tools.
Results: At the strategic level the organisations representing the health sector and the sector of environmental protection hardly acted together or exchanged information. More examples of intersectoral collaboration were found at on the operational level. It might be asserted this would have happened anyway, without the Healthy Cities Project, as a consequence of existing policy and routine activities. However, a positive role of the individuals involved in the project in the launching of intersectoral collaboration was also confirmed.
Implications: On the basis of my analysis I described the pattern of factors influencing intersectoral collaboration. An awareness of some of those factors may be useful in reinforcing the joint action of environmentalists and public health practitioners. This issue will be discussed during the presentation.
P03–11 Intersetoral action for health: Promoting health in urban communities through intersectoral collaboration, participatory approaches, and effectiveness evaluation
A. Matida1, A.M. Sperandio2, D.G. Rocha3, F.C. Dias4, H. Monteiro5, S.T. Moysés6, R. Bodstein7, R.P. Franco de Sá8, R. Magalhães7
1ABRASCO, Rio de Janeiro, Brazil, 2UNICAMP, Campinas, Brazil, 3UFGO, Goiânia, Brazil, 4Municipal Government of Sobral, Sobral, Brazil, 5CPHA, São Paulo, Brazil, 6Pontifical Catholic University of Paraná, Curitiba, Brazil, 7ENSP, Rio de Janeiro, Brazil, 8NUSP/UFPE, Recife, Brazil
Issues: This abstract presents a collaborative project involving technical exchanges on intersetoral action for health between Canadian and Brazilian public health communities. Coordinated in Canada by the Canadian Public Health Association (CPHA) and in Brazil by ABRASCO (Brazilian Public Health Association) and ENSP (National School of Public Health), this project supports the experience undertaken by six cities across Brazil to strengthen local capacities to implement and evaluate intersectoral interventions for promoting the health and quality of life at the local level.
Description: Exchanging knowledge and experiences, the project have been reinforced that local governments must adopt intersectoral actions to tackle inequalities and promote local sustainable development. The key points guiding the local interventions include: equity, participatory assessment and planning, intersectoral collaboration and, monitoring and evaluation.
Lessons learned: The lessons learned pointed out that health promotion initiatives are complex interventions intrinsically linked to the local sustainable development of the area, marked by the presence of multiple actions, projects and stakeholders. Intersectoral actions generates many challenges, such as acknowledging partnerships and the socio-technical networks, demanding capacity building on dealing with controversies and facilitating translation. In this context, collaborative approaches, including community participation/empowerment, social networks, and intersectoral collaboration are fundamental.
Next steps: The results of this project have the potential to reach and be replicated by a significant number of cities throughout the country, mostly through the already established networks.
P03–12 Knowledge development and application in a regional health organization: Pitfalls and prospects in the Edmonton area
1Alberta Health Services - Capital Health, Population Health & Research, Edmonton, Canada
Regional health organizations are challenged to develop and apply population health knowledge to reduce chronic disease and injury. In this “issues” discussion, we consider the benefits and limits of health knowledge development and application within Capital Health (based in Edmonton, Alberta). We emphasize that Edmonton’s built and social environments, as well as the changing burden of disease in the region, require new perspectives and action in knowledge development and application.The Capital Health region in Alberta comprises an area slightly larger than the Edmonton Census Metropolitan Area, and is growing rapidly. Health disparities among subpopulations and geographies within the region are well documented through the collection of health system utilization data, but these data mainly tell us about the back end of population health problems from the service provider’s perspective.
In the Edmonton area, chronic disease and injury are “multiple exposures, multiple effects” phenomena. Built and social environments are strongly implicated in their etiology. Current ways of developing and applying knowledge need to be reformed if rates of chronic disease and injury in the region are to be substantially reduced. Best practices in knowledge development and application need to be identified and adopted.
Development of indicators of built and social environment determinants of health in the Edmonton area is proceeding. Systematic reporting of these indicators in parallel with traditionally reported health measures is needed. Next steps include development and integration of more systemic etiological knowledge into regional policy development, implementation, and evaluation, and formation of novel and even seemingly unlikely alliances for improving the development and application of urban health knowledge.
P03–13 Participatory research and evaluation: Collective community action for urban health programming
1Kathmandu Medical College Teaching Hospital, Medicine and Research, Kathmandu, Nepal
Introduction: This program aims at building social infrastructure and linking slum communities by participating them in health programs. Participants will understand how potential of slum communities can be utilized for effective implementation of health programs by engaging them in planning process, forming linkage with service providers and building capacity of community groups for improving health service utilization.
Methods: slum based networks and health care providers helped in identifying unaccounted slum areas and in understanding health seeking behavior of the slum population. The hidden strength of community members and the disadvantaged population living in the slum areas were recognized and they were encouraged to participate in awareness programs and sensitization work in the slums.
Results: 35 health care providers and 15 community health workers worked in 12 different slum areas around Kathmandu Valley. The work team members were successful in empowering slum families to adopt healthy behaviors and avail health services. The data indicates increase in TT immunization from 29.23% to 75.98%, timely initiation of breast feeding from 27% to 79%; between November 2006 to February 2008. The health team members negotiated with government officials and elected representatives to access health services and basic services like water. Members also organized drama based informative programs to encourage more people to participate.
Conclusions: This program is focused on strengthening social infrastructure in slums by stabilizing community level institutions and linking them with city level programs. This program is considered as one of the most effective urban health programs.
P03–14 Partnership working to meet urban health challenges in the UK: The Manchester blood borne virus research team
W.J.R. Morton1, K.L. Harrison1, L. Patterson1, G. Clough1, A. Verma1
1University of Manchester, Manchester Urban Collaboration on Health, Manchester, United Kingdom
Issues: Multi-agency partnership working is essential but becomes vital when dealing with vulnerable groups such as intravenous drug users, homeless people, prisoners, immigrants and asylum seekers. This is particularly true for blood borne viruses (BBV) which affect many vulnerable groups.
Description: The prevalence of BBV within the Greater Manchester urban area is estimated to be considerably above the average for England and continues to rise. This increase is partly explained by the large numbers of people in the high risk groups for BBV, with intravenous drug use remaining a high risk factor. In addition to the difficulties common to all individuals with BBV infection, (e.g. stigmatization), individuals from vulnerable groups diagnosed with a BBV often face additional problems such as access to care, acceptance onto treatment programmes and difficult follow-up arrangements.
Specifically commissioned by Manchester City Council Drug and Alcohol Strategy Team (DAST), the BBV Research Team (BBVRT) is a multiagency partnership created to address these issues by undertaking an epidemiological healthcare needs assessment at local authority level. It incorporates an evidence-based systematic methodology to map and evaluate the prevention services available including a gap analysis.
Lessons learned: The multiagency work operates within a unique model of partnership between the University of Manchester, Greater Manchester Health Protection Unit, Manchester DAST and Manchester Primary Care Trust. This approach is essential to provide a comprehensive map of all services and identify health needs in order reduce inequalities and improve health outcomes.
Next steps: The work is hypothesis-generating and will facilitate research into BBV and how to address the inequalities in healthcare.The BBVRT has successfully recruited a number of local, national and international experts in this field to help with the work for the benefit of the local population. By ensuring generalisability, other populations outside of Manchester will benefit from our work.
P03–15 Patient safety and systematic reviews: Finding papers on MEDLINE and EMBASE
A.A. Tanon1, F. Champagne1, A.-P. Contandriuopoulos1, M.-P. Pomey1, H. Nguyen1, A. Vadeboncoeur2
1Université de Montréal, Montréal, Canada, 2Institut de Cardiologie de Montréal, Montréal, Canada
Patient Safety has became an important issue for urban health. Following the release of the IOM report “To Err is human”, the number of patient safety publications has increased substantially. Accessing those publications is a key factor in improving and maintaining patient safety. A large proportion of these publications is available through electronic databases like MEDLINE and EMBASE. But retrieving information in those databases is not very easy. Most of the time searches identify too many irrelevant papers.
This study aims to help people working on patient safety, identify relevant papers on the subject. It will present the search strategies we build, to find papers on patient safety in MEDLINE and EMBASE, as well as their performances in terms of sensitivity, precision and specificity.
Results: We found strategies with sensitivities in the range of 95% to 100%, with precision in the range of 40% to 60% as well as very balanced strategies (the product of sensitivity by precision is in the range of 30% to 40% for all three databases,) and the internal validity is very good.
Funding: Canadian Institutes of Health Research (CIHR).Scholarship: Analyse et Évaluation des Interventions en Santé (Aneis), Groupe Interuniversitaire de recherche sur les Urgences (GIRU), Social Sciences and Humanities Research Council (SSHR).
P03–16 Policy-influencing practices among non-profits: Knowledge for health authorities seeking engagement with non-profits to reduce health inequities
F. Gagnon1, V. Morrison1
1National Collaborating Center for Healthy Public Policy, Montréal, Canada
Background: In Canada, some regional health authorities are already partnering with non-profits in order to promote healthy public policies that address health inequities in urban settings. Little is yet known, however, about the ways that non-profits go about influencing public policies. The objective of our research effort is to analytically describe the policy influencing practices of these organizations so that regional health authorities might reflect on the relative strengths and limitations of these and orient their partnerships accordingly.
Methods: We have conducted five case studies with non-profits across Canada which situate them in their pragmatic context, and produce descriptive analyses of their public policy influencing practices, including: their conceptions of health; their use of knowledge produced by health authorities and researchers; the social determinants of health they seek to act upon. We carried out the case studies by analyzing relevant documentation from the organizations and by conducting interviews with key members. Results. All of the organizations adopt a broad definition of health - that is, a definition compatible with that mobilized by the WHO Commission on Social Determinants of Health. Also, few seemed to systematically use knowledge produced by health authorities and researchers. Finally, most of the organizations aim to influence what the WHO calls the intermediary determinants of health.
Conclusions: Their practices being congruent with a broad definition of health, non-profits would appear to be important partners to engage with if regional health authorities are to reduce health inequities in the populations they are responsible for. However, health authorities and researchers would be well advised to more thoroughly engage them in their research processes so that health knowledge is more central to their policy influencing practices. Also, support by health authorities would mean that they may be in a better position to act upon the structural determinants of health.
P03–17 Social determinants and possibilities for participation in public policy
A. Sánchez Cabezas1, N. Castelnuovo1, C. Balenzano1
1Grupo Surco, Community Health, Don Torcuato, Argentina
Background: Our paper examines factors that facilitate or impede access to avenues of participation in the public policy process. We propose to present the analysis of selected representations of community participation and organization that various social actors expressed in regards to the clientele of health services at different sites where we provide community health promotion programs.
Methods: Our study draws on surveys, in-depth interviews, and focus groups carried out with educators, residents, and healthcare personnel in northern Argentine provinces between 2003 and 2005. In these cases, residents themselves identified social determinants relating to the role of the state, forms of participation, health and access to healthcare services.
Results: An in-depth look at these determinants allows us to examine—on the one hand—underlying assumptions regarding groups that are often labelled as “in need,” “vulnerable,” “marginalized groups” or “poor.” And, on the other, it allows us to increase our understanding of how a reliance and emphasis on concepts such as “marginality,” and “exclusion” tend to create a disregard for the kinds of relationships that they produce on a day-to-day basis.
Conclusions: In this sense -and in light of the data collected- it is possible to show that the representations made by doctors, educators and other service providers regarding their clientele as being “passive,” “dependent,” “liable,” and “lazy” are in fact closely tied to concepts that, in turn reproduce the conditions which they ought to be changing.
P03–18 Stroke public awareness project for the elderly and marginalized population in downtown Toronto (S-PAP)
V.L. Ash1, P.B. Kostyrko2, M. Pilarta2
1St. Michael’s Hospital, Brampton, Canada, 2St. Michael’s Hospital, Toronto, Canada
Issues: Certain cohorts such as the elderly and marginalized groups are more susceptible to stroke. Access to health promotion/prevention programs is challenging for reasons such as communication, discrimination, and socioeconomic status.
Description: Guided by Logic Model Framework, we ventured into the community to provide stroke risk factor screening and health promotion/prevention support for a diverse, underserved group of people in downtown Toronto. The program involves monthly blood pressure clinics, discussion of diagnosed risk factors, and distribution of Heart and Stroke brochures.
Lessons learned: Participants became more proactive in changing lifestyle behaviors, i.e. pharmacy BP checks, frequent attendance at the monthly ‘Senior Social Afternoon’ program, inviting friends and relatives to the program, change of smoking habits, increase use of Sherbourne Health Bus, Street Health Nurse Clinics, and family physicians. Implications of this program are numerous, but most notably, the development of a strong sense of value and empowerment that may transcend across many stratums of their lives.
Next steps: Vulnerable groups need a ‘safe place’ to discuss health issues without fear of being judged or neglected. Therefore, it is crucial that health care providers collaborate with community partners and family physicians. Future plans are currently under-way incorporating dementia screening, diabetes education and promoting similar events with local church groups, cultural restaurants, community and drop-in centers to provide BP screenings and initiate other health promotion and prevention strategies using these same principles. Accessibility and sustainability of the program depend on ongoing exposure and financial support from government or charitable agencies.
P03–19 Supporting nicotine addicted patients in a non-smoking environment
J. McCall1, R. Baird1, D. Mirau1, N. Hay1, J. Foreman1
1St. Paul’s Hospital, Providence Health Care, 10C, Vancouver, Canada
The HIV inpatient unit at St. Paul’s Hospital in Vancouver, Canada serves a diverse and challenging population, many of whom are street involved and live in a core urban area. This population is being additionally challenged by the establishment of a non-smoking policy at the hospital and the city at large. The interdisciplinary staff on the unit, who are aware of the issues that this smoking policy creates for the patients, have developed a multi-faceted program to help patients cope with their constrained ability to smoke and to encourage them to consider smoking reduction or cessation. This presentation will outline the approaches that have been initiated and review successes and challenges since the smoking policy has been instituted.
P03–20 The East Toronto Hepatitis C Program: An innovative, interdisciplinary, community-based treatment program for Hepatitis C positive drug users
J. Altenberg1, Z. Dodd2, A. Egger3, S. Gazeley3, D. Hodgson1, F. Lo1, S. Woolhouse1, C. Henschell3, E. O’Reilly4
1South Riverdale Community Health Centre, Urban Health Team, Toronto, Canada, 2Street Health, Toronto, Canada, 3Regent Park Community Health Centre, Toronto, Canada, 4South Riverdale Community Health Centre, Toronto, Canada
Issue: Hepatitis C (HCV) is a chronic disease that continues to be a significant medical and economic burden to Canadians. Predictions are that by 2022, the number of Hepatitis C-related deaths will increase by one-third. Almost all new Hepatitis C infections in Canada are in illicit drug users (IDUs); however, it is estimated that only 10% of HCV positive IDUs receive treatment. IDUs face many barriers to treatment including: discrimination from health care providers, poverty, violence and mental illness.
Description: This program is a collaboration of the South Riverdale Community Health Centre, Regent Park Community Health Centre, and Street Health in Toronto. The Program has created a unique access point for IDUs by minimizing barriers to health care and maximizing the wellness of HCV positive IDUs. In 2007–2008 thirty-five HCV positive individuals completed the program.The program consists of weekly group sessions and HCV clinics run by interdisciplinary teams (social service worker, family physician, nurse practitioner, nurse, infectious disease specialist and psychiatrist) at the two community health centres. Harm reduction and peer education principles guide the program, which directly addresses barriers by providing low threshold access to free treatment and care, coordination of services, remuneration for participation, healthy food and acceptance of active substance use.
Lessons learned: Chart audits, member surveys and focus group data clearly demonstrate the program’s sucess in provide high quality education, support and treatment to HCV infected drug users. Program successes include interdisciplinary collaboration with diverse partners; incidental decrease in drug use in members and stabilization during group; increased knowledge of HCV among members; empowerment of group members; increased quality of life; and increased use of HCV viral RNA’s to confirm HCV clearance. Challenges include: instability in clients’ lives, finding specialists to support primary care providers.
Next steps: Ongoing evaluation, model replication and scaling up.
P03–21 The healthy public policy journey: A communication, health & environment model
1York University/Hygeia Healthy Communication Saine Inc., Multidisciplinary Dept. - Health & Environment Studies Program, Toronto, Canada
Alternative Subitle: The Healthy Public Policy Process for DummiesHow are communities enabled to increase control over and improve their health?Achieving healthy public policy is a process involving many different parameters that can make this journey to improved urban health appear daunting at best, too complex to embark on at worst.This model attempts to present visually the journey to a healthier urban setting in a systems thinking, multidimensional and multidisciplinary framework.
The healthy public policy process is illustrated as a system of 16 different parameters (interacting in 216 different combinations, i.e. 6×4×3×3), including health, environment, economy, governance and the role of information (mass media).
This paper will also highlight several interactions between these 16 different factors relating to urban environmental health, with a specific focus on media advocacy, from a community standpoint as well as from a municipal staff/health promoter perspective, to map out possible avenues to improve health at the local level.
P03–22 The nursing role in an interdisciplinary outpatient HIV clinic: The whole is greater than the sum of its parts
L. Beech1, J. McCall1, L. Kirkpatrick1
1St. Paul’s Hospital, Providence Health Care, Immunodeficiency Clinic, Vancouver, Canada
The OPD HIV clinic at St. Paul’s hospital in Vancouver serves a diverse and challenging population, many of whom are street involved and live in a core urban setting. Nurses are an integral part of the interdisciplinary team, providing a range of services to these clients, including education about HIV/HepC transmission and treatment, vaccination, vaginal and anal PAP smears, hep C treatment and followup and support for people who are struggling with addiction. But the whole is greater than the sum of its parts. Nurses are the lynchpin of the clinic, providing a consistent presence that the clients have come to rely on in a chaotic world. This presentation will describe in detail the range of services that the nurses offer and the impact on the health and well-being of the clients.
P03–23 Urban planners’ knowledge of health and well-being issues: A New Zealand perspective
K. Duncan1, G. Pollock2
1Public Health Advisory Committee, New Zealand Ministry of Health, Wellington, New Zealand, 2Beca Carter Hollings & Fernier Ltd., Business Director - Planning, Wellington, New Zealand
New Zealand’s Public Health Advisory Committee (PHAC) provides independent advice to the Minister of Health on public health issues, the promotion of public health, and the monitoring of public health. In developing its advice to the Minister, the PHAC commissioned a nationwide survey of urban planners to explore their understanding of health and well being issues.
The on-line survey attracted 234 participants from across the country representing a response rate of just over 30%. The sample was recruited by self-selection with the survey link sent out to a total of 774 members of the urban planners’ and transport planners’ associations and networks.
Planners overwhelmingly agreed (96%) that they have influence over the healthy design of urban environments. However only a minority of planners (36%) ever consider health more than occasionally in the process. 85% of participants do not work with public health professionals or organisations.Participants provided suggestions for how they can help create healthier communities. Good urban design was suggested by 60% of respondents. Additional comments reflected themes such as the facilitation of active commuting modes and infrastructure (13%) and accessible socially connected public and open spaces (11%). A large majority (80%) of respondents agreed that inequalities are important to consider in planning, yet only 46% indicated willingness or ability to take such issues into account.
Six key areas for action were identified, indicating the need for ongoing cooperation between planning and health professionals. This work has identified that a key relationship between planning and public health has been neglected. There is a need for both sets of professionals to understand the other’s work and priorities in order to speak the same language. Achieving this promises greater potential for health gains arising from an urban environment that is developed with people in mind.
Community Approaches to Urban Health
P04–01 A commitment to our community: Integrating a multidisciplinary home visit component into an urban family medicine residency curriculum
H. Klusaritz1, P.F. Cronholm1, T. Dougherty1, R.A. Neill1
1University of Pennsylvania, Family Medicine and Community Health, Philadelphia, United States
Issue: Impoverished urban neighborhoods experience limited access to healthcare and poor health outcomes due to multiple barriers including under-insurance, stressed safety-nets, public transportation dependence, and spatial mismatch between provider location and patient communities. Academic medical centers located in urban centers have a responsibility to respond to the needs of the surrounding communities, however face challenges in countering barriers. Clinical services delivered in traditional practices have not addressed the myriad needs of marginalized populations. Family Medicine practices are uniquely suited to respond to these challenges through the discipline’s commitment to treating patients in the context of family and community and an emphasis on disease prevention and health promotion.
Description: Against this backdrop, a multidisciplinary home visit program that bridges continuity gaps was integrated with family medicine physician training. The curriculum component emphasizes culturally sensitive collaborative care, understanding of socio-cultural determinants of health, and social services education. The patient care component emphasizes coordination and continuity of care as patients transition between the home/community and the office/hospital. Home visits are made by a team comprised of a family medicine resident, pharmacy student, attending faculty member, and social worker.
Lessons learned: Since implementation, 13 residents and 15 students have participated in 55 home visits including newborn/postpartum evaluations, home hospice care, elderly long term care needs assessments, inpatient discharge transitions, polypharmacy and medication adherence evaluations, home care needs and safety assessments, and insurance counseling. Qualitative feedback was positive, demonstrating an increased likelihood of incorporating home visits into future practice and improved understanding of the divide between the office and patients’ homes/neighborhoods. Quantitative outcomes indicate increased understanding of access barriers, environmental and socio-cultural influences on health, and social service programs.
Next steps: We plan to evaluate resident educational progress and satisfaction; and develop evaluation tools for patient outcomes, including disease-specific indicators, medication adherence, and patient satisfaction.
P04–02 A community-based intervention to reduce inappropriate use of 911 for non-emergency care in Atlanta’s neighborhood planning unit-V
H.A. Wilkin1, M. Marcus2, K. O’Quin2, K. Stringer1, K. Hunt2, M. Hooker3, T. Leslie3
1Georgia State University, Communication, Atlanta, United States, 2Georgia State University, Public Health, Atlanta, United States, 3Georgia State University, Community Health Worker, Atlanta, United States
Issue: Researchers have reported that up to half of all calls for emergency medical services (EMS) are from patients that do not have a medical emergency. These calls increase the potential for traffic crashes, increase monetary costs, and divert resources from true emergencies.
Description: Our project, funded by the Healthcare Georgia Foundation, is a pilot study to test the efficacy of a community-based strategy in an inner-city, low-income neighborhood. The program provides residents alternatives to using EMS/ED for non-emergency reasons, including vouchers for office visits. Focus groups and mock patient analysis led to recommendations to a federally-funded health center (SMC) about how to become a “healthcare home” for residents. Community health fairs enabled people to enroll for SMC’s services, qualify for our healthcare assistance program, and receive free medical screenings.
Lessons learned & next steps: While promoting the health fairs, informal conversations with residents demonstrated that we need to offer more than free screenings. Many knew they had health problems, but could not afford to address them. Future projects need to not only get money to help pay for office visits, but also for the medical procedures, laboratory work, and medicines. As we complete the pilot program, we will evaluate our efforts, explore community beliefs about what qualifies as an “emergency,” and make recommendations for how to reduce 911 misuse in other locations. Our evaluation will help inform an educational campaign about the importance of primary care.
P04–03 A Community-based participatory approach to a social marketing campaign that raises hepatitis B awareness in Asian American communities: Methodological issues and best practices for formative data collection
L. Hom1, S. Kwon1, H. Pollack2, T. Tsang3, J. Park4, N. Islam1, M. Rey2
1NYU Center for the Study of Asian American Health, New York, United States, 2NYU School of Medicine, New York, United States, 3Charles B. Wang Community Health Center, New York, United States, 4Korean Community Services, New York, United States
Issues: Hepatitis B (HBV) is a health disparity in Asian Pacific Islanders (API), affecting an estimated 10–15% of APIs compared to 0.3% of the general U.S. population. HBV primary affects recent immigrants where infection is endemic and vaccinations are not widely available.
Description: The Center for the Study of Asian American Health, NYU School of Medicine and its community partner coalition was designated as a CDC Center of Excellence for the Elimination of Disparities (CEED). B Free CEED will serve as a national center on eliminating HBV disparities among APIs by developing and disseminating multi-level, evidence-based best practices and activities. Using a community-based participatory approach (CBPA), a social marketing campaign will be developed to raise awareness on HBV in the NYC Korean and Chinese immigrant communities. Formative data collection that were considered included randomized telephone surveys, focus groups, and street intercept surveys. A literature review was conducted to evaluate the cultural and social appropriateness of different data collection methods; Coalition Partners identified best strategies that have been successful among APIs.
Lessons learned: Utilizing a CBPA and mixed methods approach can inform a social marketing campaign targeting a ‘hard to reach’ population. Randomized telephone surveys may be an ineffective method to reach our target group while street intercept surveys can be effective in reaching and drawing a representative sample.
Next steps: Effectiveness of street intercept surveys compared to randomized telephone survey in APIs will be evaluated to inform future CBPA social marketing campaigns.
P04–04 Barriers to accessing health care in hepatitis C infected individuals using services for the homeless in Toronto
A. Ganeshalingam1, S. Gazeley2
1University of Toronto, Toronto, Canada, 2Regent Park Community Health Centre, Toronto, Canada
Background: The prevalence of hepatitis C in clients using Street Health, a non-profit community organization serving the homeless, substance-using, poor and socially marginalized, is disproportionately higher than the national average. To improve hepatitis C management in this population, this study investigated the barriers to accessing health care faced by hepatitis C individuals using Street Health.
Methods: A qualitative research study using semi-structured interviews was conducted with participants recruited from Street Health. Participants were asked about their experiences with receiving medical care. Thematic analysis was performed on the transcribed data.
Results: Eight participants (5 men, 3 women) completed the interviews. Four themes were identified. Patient barriers to seeking care included low priority of hepatitis C, substance abuse, unstable housing and a lack of trust in providers. At the provider level, factors leading to decreased confidence and trust in the therapeutic relationship was described as a barrier. At the system level, the inadequacy of current health care delivery models affected by a lack of access to primary care physicians and provider lack of time was revealed by the data. Finally, peer support arose as a facilitator to enhancing access.
Conclusions: The study findings suggest that the complex care needs of this population cannot be met within the current patient-driven, fragmented health care delivery model. Instead, a multidisciplinary approach to hepatitis C management that includes a peer-support program is preferable based on results from a pilot project at our centre as well as from a similar model in British Columbia.
P04–05 Building the capacity of community health workers to address Filipino heart health in New York City and New Jersey
R. Ursua1, N. Abesamis-Mendoza2, R. Foz1, H. Soliveres1, P. Ranka Manis2, M. Rey3
1NYU Center for the Study of Asian American Health, New York, United States, 2Kalusugan Coalition, New York, United States, 3Institute of Community Health and Research, New York, United States
Background: Community Health Workers (CHWs) are widely used to provide care for a broad range of health issues. However, there are few studies that document the efficacy of CHWs for managing high blood pressure; the effectiveness of CHW training; or best practices for CHW service delivery. Project AsPIRE, an NIH-sponsored program, provides a culturally- and linguistically-appropriate community health worker intervention to reduce the risk of cardiovascular disease in the Filipino American community.
Methods: To build the capacity of CHWs to address cardiovascular health, an extensive training curriculum was developed by a Community Health Nurse and Training Coordinator, with guidance from all members of the Project AsPIRE team. The curriculum includes core competencies, research skills, immigrant access issues, hypertension control, and navigation of the healthcare system. The curriculum is intended to build on the CHWs existing strengths to carry out their roles in outreach and community organizing, case management, health education, and data collection.
Results: Project AsPIRE Community Health Workers will develop and conduct a presentation about
P04–06 Community based tracking and monitoring for improving health outcomes in Agra
K. Srivastava1, S. Agarwal1, C. Johri1, U. Das1, A. Agnihotri1, R. Kumar1, N. Ali1, S. Verma1, N. Kumar1, S. Kaushik1
1Urban Health Resource Centre, New Delhi, India
Issue: It is pertinent to track service coverage for better program outcomes. Agra urban health program endeavors to strengthen maternal and child health services and care seeking by building capacity of community based organizations (CBO) and Community Link Volunteers (CLV, anchoring CBO activities).
Description: CBO members’ capacity was built to maintain records of service coverage. As slum women are illiterate, groups prepared maps of slums and demarcated households. They maintain records in their areas and track beneficiaries by pasting coloured dots on maps to identify houses of beneficiaries Some CBOs put markings on walls outside houses of eligible women and children to track services received. Registers are compiled by CLV, from information provided by CBO members and household surveys. They systematically record vital events and service coverage following a life cycle approach, beginning with date of identification of beneficiary to date of receipt of complete services. Efforts are made to ensure timely receipt of services. Data from CLV register is entered on electronic formats from which reports are generated by Community Organizer (coordinating CBO and CLV activities in a cluster of 5–7 slums) and NGO.
Lessons learned: Community based monitoring records aid performance assessment and strengthens program efficiency. Through such efforts percentage of pregnant women consuming 100 IFA tablets has increased from 4.2% (baseline data) to 47% (monitoring data) between November 2005 and December 2007. Similar trends have been noted for ANC, immunization and breastfeeding initiation.
Next steps: Ongoing community based tracking and monitoring of service coverage ensures program effectiveness.
P04–07 Community-based Intervention (healthy cities approach) a major tool for adolescent sexual health problems a case study of Kyotera Town Council
S.M. Mbidde1, S. Ddungu1, N.C. lrene1
1Rural-Urban Change Initiative, Kampala, Uganda
Issues: Traditional intervention strategies to prevent sexual health problems among young people promote changes that reduce risks related to adolescent behavior however they do not combine action at many levels through a community intervention.
Description: The programs focused on empowering young people identify and address their own sexual reproductive health problems. Social actors were motivated and involved to mobilize resources, strengthen and publicize adolescent health services in public clinics, schools, community based organizations (CBOs) and diverse youth groups. A campaign for youth sexual health called “you are free to choose....” Was designed and implemented. This healthy cities approach enhanced strategic advocacy and participatory planning.
Lessons learned: The program had the following lessons drawn:
Next steps: Augmentation of youth involvement and committed community participation incorporating the healthy cities approach ought to be enhanced to close the gaps.
P04–08 Health and mental health needs of trauma survivors: Implications for community-based research and advocacy
D.N. Le1, D. Nguyen2, C. Chhoum3, M.J. Rey4
1NYU Langone Medical Center, Center for the Study of Asian American Health, New York, United States, 2NYU Silver School fo Social Work, New York, United States, 3CAAAV: Organizing Asian Communities, Youth Leadership Project, New York, United States, 4NYU Langone Medical Center, Institute of Community Health and Research, New York, United States
Background: Trauma related to war, migration, and resettlement create multilayered health and mental health needs for Southeast Asian in the U.S.. However, research on urban Southeast Asian communities has focused on their initial transition to the U.S. rather than changes in health and mental health status over time.
Methods: The NYU Center for the Study of Asian American Health and community partners developed a health justice campaign to advocate for linguistically and culturally accessible health services for Southeast Asians living in New York City (NYC). The collaborative conducted a self-administered health needs assessment (N=200) that examined issues of health status, mental health, and healthcare access. The instrument was presented in English, Khmer and Vietnamese. CBPR methods addressed challenges commonly faced while conducting research with small populations by engaging community stakeholders in the research process, which aided participant recruitment in this linguistically and socially isolated community.
Results: Nearly three-quarters of the sample were foreign born, and most had lived in the U.S. for over 20 years. Results indicate low levels of English language proficiency and socioeconomic status, and elevated risks for poor health and mental health outcomes among the majority of respondents.
Conclusions: Results suggest the need for culturally and linguistically appropriate health and mental health services for Southeast Asian in NYC. Community partners have contributed to understanding results and formulating recommendations. Results have facilitated resource development and planning in collaboration with institutions such as hospitals to ensure equitable access to comprehensive and quality healthcare for this community.
P04–09 Healthy urbanization project - Early lessons for community and multisectoral participation
F. Armada1, J. Lapitan1, J. Kumaresan1
1Center for Health Development WHO (WKC), Kobe, Japan
Issues: The Knowledge Network of Urban Settings (KNUS) of the WHO Commission on Social Determinants of Health drew attention to the varied factors influencing urban health and to the need for a multisectoral and community-based approach to interventions. Additionally, the WHO Centre for Health Development is conducting a research/capacity-building project on Healthy Urbanization (HUP) in five urban sites (Kobe, Japan; Bangalore, India; Ariana, Tunisia; San Joaquin, Chile; and Suzhou, China).
Description: HUP identifies and promotes interventions that optimize the impact of social determinants of health on exposed populations in urban settings. A research/action methodology was implemented in each city. Over a period of six months to a year, a participatory process was conducted with the involvement of community representatives and organizations; staff from local government and several other governmental agencies in charge of public policy, as well as academic institutions.
Lessons learned: The project helped identify strengths and weaknesses of working within the social determinants framework for urban health. Knowledge exchange with the community identified how and where to intervene for health and equity. The project has also shown the value of providing an environment for multisectoral exchange. Finally, recommendations for further research on urban health are raised.
Next steps: Further development of the project will shed light on the process of implementing the interventions in different contexts. Second, it will provide an opportunity to gather evidence on the specific nature of each intervention and its impact, while documenting the process of health governance.
P04–10 Improving heart health access for Filipino Americans using innovative outreach strategies and research methodologies (a community-based participatory research project)
D. Aguilar1, R. Ursua1, M. Rey2
1NYU Center for the Study of Asian American Health, New York, United States, 2Institute of Community Health and Research, New York, United States
Background and significance: Filipino Americans exhibit higher rates of hypertension compared to White and other Asian American communities. Few interventions, however, have focused on controlling hypertension and other risk factors for cardiovascular disease in Filipino Americans. Moreover, existing studies have primarily targeted communities on the West Coast.
Methods: Using innovative outreach and research methodologies, Project AsPIRE (Asian American Partnerships in Research and Empowerment) is a community-based participatory research project to improve health access and cardiovascular health status for Filipinos in New York City (NYC) and Jersey City (JC), New Jersey. This presentation will highlight preliminary findings from community-based screenings of 1000 Filipinos. Participants were screened for blood pressure and serum glucose and cholesterol levels. An interviewer administered survey was used to assess participants’ personal/family history of CVD, health utilization, insurance status, medication intake, and sociodemographic characteristics. Data was analyzed using SPSS 15.0 and ArcGIS technology.
Results: Preliminary findings show that 70% of Filipinos screened in JC and 54% of Filipinos screened in NYC had elevated blood pressure. Among hypertensive Filipinos, 33% in JC and 54% in NYC were uninsured. 29% of the entire Filipino sample had elevated cholesterol levels and 22% had elevated glucose levels. ArcGIS maps will be presented which illustrate rates of hypertension by geographic location and the location of available resources (such as clinics and hospitals) relative to large concentrations of Filipino residents. We will conclude with a description of the community health worker intervention offered to screened participants and present findings assessing intervention efficacy.
P04–11 Managing up! Making a difference through strategic policy action
1Alberta Health Services - Capital Health, Population Health & Research, Edmonton, Canada
Organizational culture and capacity play a significant role in fostering particular practices, levels of innovation, and approaches to social change. In this presentation, a brief description of a small Population Health Team, with responsibilities to improve chronic disease and injury outcomes for a population of approximately one million residents, will be offered. The team’s location within the Public Health Division of a large regional health authority with nearly 30,000 employees, in the Edmonton urban area, embedded within a stable political context, will be articulated. This sets the stage for an exploration of the question: how can we be effective?
Drawing on the diverse knowledge and skills of the multi-disciplinary team, and using three key strategies - building evidence and knowledge, identifying, framing and communicating issues, and, advocating for policy change within the organization and externally at the municiapl and provincial levels - the team has achieved a level of success. One key element of the approach taken by the team can be described as ‘managing up’. This role - fulfilled primarily by the team manager - will be highlighted. This pivotal approach affords the team opportunities to foster direct and timely action by key health leaders. When policy opportunity ‘windows’ present, direct action can be taken. Lessons learned over eight years, along with critical reflections drawn from current literature will inform current practices.
P04–12 Preferences of indoor sex workers for accessing sexual health care and information
S. Levine1, Y. Winsor1, F. Gold1, L. James2, D. Taylor2, G. Ogilvie2
1BC Centre for Disease Control (BCCDC), STI/HIV Prevention and Control, Vancouver, Canada, 2BC Centre for Disease Control (BCCDC), Vancouver, Canada
Background: Indoor commercial sex work places workers at occupational risk for sexually transmitted infections (STIs) including HIV. However, legal issues, stigma, and the clandestine nature of sex work can create barriers to accessing sexual health care for some. Here we describe the preferences of indoor sex workers for accessing sexual health care and education.
Methods: A 61-item pilot-tested questionnaire (English or Chinese) was self-administered to a convenience sample of 38 female sex workers in massage parlours who volunteered between Nov. 2005 - Sept. 2006. Descriptive analysis was conducted on demographic information and information related to access to sexual health care and education.
Results: Of the 38 volunteers, (ages 15–50), 21 (55.5%) were new citizens or immigrants to Canada. Twenty five (65.8%) stated their health care provider does not know they work in a massage parlour. HIV/STI and sexual health knowledge was received most frequently from a family doctor (55%), friends (44.7%), and/or Outreach Nurse delivering care in the massage parlour (55.3%). Thirty (79%) of respondents agreed that there is a need for a health clinic and/or information centres designated for massage parlour workers. Afternoons (47%) or evenings (52.6%) would be the best hours for these clinics.
Conclusions: Opportunities exist to improve current health services for indoor sex workers. Family physicians could be offered increased sensitivity training on working with sex workers, and provided guidance regarding making their services more accessible. In addition, alternative services in a venue that meet the unique needs of this high risk population could be developed.
P04–13 Professional burnout syndrome in a province of Argentina
A. Sánchez Cabezas1, G. Guzman1, E. Luther1
1Grupo Surco, Community Health, Don Torcuato, Argentina
Background: Teachers in impoverished areas have a great impact on the health of communities, including teaching basic literacy, influencing healthy choices and promoting community solidarity. The objective of this study was to measure the prevalence of professional burn-out syndrome in one of the poorest provinces in Argentina. The goal was to provide provincial authorities with data necessary to improve relationships and supports for educators as important promoters of community health.
Methods: Participants completed the Maslach survey, a short, self-administered survey measuring 3 categories of the syndrome: emotional exhaustion, de-personalization, and personal fulfillment. Educators, principals, and management personnel from the Provincial Ministry of Education completed 5263 surveys. Focus groups and semi-structured interviews supplemented the survey; 60% of all principals in the province (n=609) participated. Discussions were transcribed and coded by lexemes, and comparative analyses were carried out.
Results: Analysis of survey results revealed that at least 25% of principals presented symptoms of burnout. 26% reported symptoms of emotional exhaustion ‘almost every day’, and 18% reported symptoms of depersonalization ‘almost every day’, while 24% reported experiencing personal fulfillment ‘only a few times a year’ or ‘never.’ Analysis of interviews and focus groups revealed the dominant sentiments expressed among educators were feelings of powerlessness, exhaustion, dejection, and distress. The social and economic inequalities that participants must work with were signaled as important causal factors.
Conclusions: During the years leading up to this study, educators went on strike more than 10 times. There is a lack of precedent for the provincial government inviting educators to discuss their problems and participate in solutions. After being presented with study results, authorities have begun to see possibilities for working with distressed educators without conflict or confrontation. Grupo Surco has been authorized to extend its work with educators and their supervisors to find cooperative solutions.
P04–14 Promoting cardiovascular health: Shifting focus from individuals to community
H.C. Ho-Asjoe1, S. Wong2, W. Chin3, J. Ah-Yune4, C. Cho5, W. Chung2, R. Lee6, P. Lau2, W. Wang7
1NYU Langone Medical Center, Center for the Study of Asian American, New York, United States, 2Chinese American Healthy Heart Coalition, New York, United States, 3Chinese American Medical Society, New York, United States, 4Chinese American Planning Council, New York, United States, 5Bellevue Hospital Center, New York, United States, 6Charles B. Wang Community Health Center, New York, United States, 7New York Downtown Hospital, New York, United States
Community partnerships are often used to address issues and disparities in the community. Heart disease and stroke are the first and third leading causes of death among Asian Americans over the age of 65. In response to the emerging needs for evidence-based, culturally appropriate interventions to decrease cardiovascular disease (CVD) disparities among Chinese Americans, the Chinese American Healthy Heart Coalition (Coalition) was established in 2000 to address the need for CVD, stroke and diabetes through prevention and education in New York City. The Coalition has grown from 4 partner agencies at inception to a collaboration of over 30 organizations from the community. The goal is to develop and implement a comprehensive, culturally and linguistically appropriate community-based invention to increase awareness of CVD and its risk factors. The Coalition embraced the key concepts of the asset-based community development models:
The Coalition has developed a comprehensive network to create culturally-appropriate health education and prevention programs as well as a valuable resource for the community. The presentation will discuss strategies used in creating community partnerships and synergies to address cardiovascular health disparities among the Chinese American community and share the process involved in sustaining and managing a coalition as well as lessons learned through this collaborative venture.
P04–15 Remote telemedicine in urban settings: Prognostic value of chest pain - Minas telecardio project
C.S. Cardoso1, W.T. Caiaffa2, G.L. Oliveira3, M.B.M. Alkmim4, G. Ribeiro4, A.L. Ribeiro4
1Universidade Federal de Minas Gerais, Grupo de Pesquisa em Epidemiologia, Observatório de Saúde Urbana, Belo Horizonte, Brazil, 2Universidade Federal de Minas Gerais, Grupo de Pesquisa em Epidemiologia, Observatório de Saúde Urbana, Belo Horizonte, Minas Gerais, Brazil, 3Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia, Belo Horizonte, Brazil, 4Universidade Federal de Minas Gerais, Hospital das Clinicas, Belo Horizonte, Brazil
There is lack of studies on electrocardiogram (ECG) value performed where there is no specialized cardiological care. This study aims to investigate the value of chest pain and of the ECG alterations in patients that were taken care through a telemedicine project. A telecardiology system was implemented in 82 towns in Brazil with a population < 10.500 inhabitants. The patient is examined and the ECG is transmitted by internet to analysis in universities. A cohort sub-study is conducted in this project, including patients with suspect or diagnosis of cardiovascular disease (CVD) measuring clinical evolution, quality of life (QOL), satisfaction with care and prognostic value of the alterations in the ECG. Descriptive and univariate analysis have been performed. In 18 months the project has carried out 32.626 ECGs. 3.098 patients have been eligible for follow up; in 95% of them the ECG was done to investigate chest pain and 35% felt pain during the examination. In 50%, the intensity of the pain has varied from 5 to 10 (1–10). The initial ECG showed some alteration in 48,3%. The first follow up was performed in 2.388 patients, being 60% females, 50 years old average. Guidance to specialized care was carried out for 25% and, 10% have reported the confirmation of CVD. The QOL (WHOQOL) was 59,3 for physical domain as well as psychological and environmental, and 72,2 for social relations. Satisfaction with the medical care was 4,1, evaluated from CARDIOSATIS scale (1–5). A total of 35 patients died, with an average survival of 39 days after the first medical care and 85,0% of the relatives reported that the patient received adequate medical care. Pain at the moment of ECG was associated to confirmation of CVD and death (p<0,05). Preliminary results point out the effectiveness of the project on early diagnosis of CVD.
P04–16 Research, policy and program innovation for urban health in Ontario: Case studies from the Ontario Ministry of Health and Long-Term Care
S. Caldwell1, D. Embuldeniya1
1Ontario Ministry of Health and Long-Term Care, Health System Planning and Research Branch, Strategy Division, Toronto, Canada
With an increased imperative to use research and evidence to inform policy, the Ontario Ministry of Health and Long-Term Care (MOHLTC) is addressing urban and population-based health using an ecological definition of health research, with a focus on dialogue and collaboration between researchers, community organizations and policy and decision-makers.
Gaps and disparities in the health of urban populations have been shown to correlate to the social determinants of health; to explore these gaps, health services and systems researchers funded by the MOHLTC are being encouraged to work in collaborative networks to share knowledge and better practices. This approach is yielding promising and innovative practices, better policy and governance, and improved health outcomes (service delivery, access, etc.) for diverse populations across urban environments. The early focus of these networks has been on seniors and aging at home, mental health and addictions, aboriginal and equity.
Using case studies from Ontario, this paper will:
As these collaborative networks are still new, the process is undergoing constant evaluation, monitoring and refinement. The presentation would include a description of how the shift in policy development and perception of urban populations came about, what steps are being taken for sustainability, growing pains, and the early results (successes) of bringing together academe, community and policy.
P04–17 Stories of resiliency rather than “illness”: Urban aboriginal women living with HIV
1UBC, Centre for Cross Faculty Inquiry, Richmond, Canada
Background: Using an interpretive descriptive approach, my qualitative research focuses explicitly on understanding the experiences and perceptions of four urban Aboriginal women living with HIV/AIDS in Vancouver, British Columbia. Within the existing body of HIV/AIDS literature, women’s voices and concerns are rarely given the forum to be told, let alone shared and heard. Therefore, this study brings to light the participant women’s otherwise silenced voices and marginalized lives. Stigmatizing attitudes and language towards Aboriginal women impose serious impacts upon the women’s lives.
Methods: The methodology and findings of my research are the focus of this paper. I view the women’s stories through a Health Narrative Topography (Frank, 1995, The Wounded Storyteller: Body, Illness, and Ethics). The women’s stories are explored in terms of Frank’s three thematic genres of Restitution, Chaos, and Quest, while being cognizant of the limitations of this framework and open to the possibility of exploring new and cross-cultural genres and discourses inclusive of, or legitimated by, Indigeneity.
Conclusions: Three overarching themes are illuminated by the women’s stories:
P04–18 Street survival, transition and dealing with core issues: A community-based research project with young urban homeless women
P. La Boucane-Benson1, B.E. Munro2, L. Ruttan3
1Native Counseliing Services of Alberta, Bear Paw Research, Edmonton, Canada, 2University of Alberta, Human Ecology, Edmonton, Alberta, Canada, 3Canadian Circumpolar Institute, Research Associate, Edmonton, Alberta, Canada
Native Counselling Services of Alberta and the University of Alberta recently conducted a community-based longitudinal study with 18 young women (9 of whom were Aboriginal) who were either homeless or transitioning out of homelessness in Edmonton, Alberta. The findings of this study illuminate issues young homeless women face when forced to survive on the street, the barriers they confront when trying to transition back into urban homefullness, as well as the support they received that contributed to the successes they have realized. These research finding inform key policy recommendations that municiple, provencial and federal governments, as well as not-for-profit agencies can employ to enhance programs and services made available to this vulnerable population.
P04–19 The street health report 2007: Community-based research and advocacy on the health status and health care access of homeless people in Toronto
E. Khandor1, K. Mason1
1Street Health, Toronto, Canada
Background: Street Health is a community-based organization providing health and outreach services to homeless people in Toronto. Advocacy addressing issues of homelessness and poverty is central to our work. Last winter Street Health conducted a study to examine health status and access to health care among single homeless persons in Toronto to establish a comprehensive base of evidence for our advocacy efforts.
Methods: A representative, random sample of 368 homeless adults in Toronto were interviewed at 26 different meal programs and shelters across Toronto. The study involved extensive collaboration with community and academic partners, and employed peer researchers with lived experience of homelessness.
Results: 73% of respondents identified as male, 26% as female and 1% as trans. Respondents had been homeless an average of 4.7 years and 36% had incomes of $200 a month or less. The study found that overall, homeless people have significantly worse health than the general population. 74% reported at least once serious physical health condition. Although only 9% of the general population of Toronto does not have a family doctor, 59% of homeless people reported the same. Despite Canada’s system of universal health insurance, 28% of all respondents had been refused health care in the past year because they did not have a government health insurance card. Within the last 12 months, 40% reported a health care visit in which they felt they were judged unfairly or treated with disrespect.
Conclusions: Homeless people’s poor health and access to health care reveal that Canada’s social programs and policies need to be re-examined. Study findings were used to develop and advocate on a series of 13 targeted recommendations to improve the health of homeless people and ultimately end homelessness.
P04–20 The VANDU women clinic action research for empowerment study: Participatory action research as a strategy to address stigma and discrimination in primary healthcare
A. Salmon1, J. Ham1, A. Pederson2, &. VANDU Women’s Group3
1BC Centre of Excellence for Women’s Health, Addictions Program, Vancouver, Canada, 2BC Centre of Excellence for Women’s Health, Vancouver, Canada, 3Vancouver Area Network of Drug Users, Vancouver, Canada
Background: In 2006, the VANDU (Vancouver Area Network of Drug Users) Women’s Group initiated a research partnership with university-, hospital- and community-based researchers to respond to stigma and discrimination in primary healthcare. The VANDU Women CARE study is a community-driven, Participatory Action Research (PAR) project examining the primary health care experiences of women who use illicit drugs in Vancouver’s Downtown Eastside.
Methods: The research goals of the VANDU Women’s Group were: to improve clinic care for women with addictions; to contribute new knowledge on primary health care experiences of women who use drugs; and to promote women’s health, well-being and community leadership. Research partners at the BC Centre of Excellence for Women’s Health (BCCEWH) and the University of British Columbia’s School of Nursing provided technical assistance throughout the research process, resources and training in research methods for peer interviewers, and took a lead role in data analysis.
Results: We will discuss how stigma and discrimination impacts the health of women with addictions and the healthcare they receive. We will also discuss the team’s future plans for action and advocacy, including the different advocacy strategies and roles undertaken by both community and academic partners.
Conclusions: We found that women who use illicit drugs are the people most able to do this research if the research design was flexible, consistent, supportive and accountable. Developing research practices that could accommodate the complex realities of peer interviewers’ and interviewees’ lives generated rich and comprehensive information that can credibly inform future advocacy and action.
P04–21 The women’s health information project: Locating and translating evidence for women who use drugs in the downtown eastside
A. Salmon1, P. Allen1, J. Ham1, A. Pederson2, K. Bell3, L.H. Malcoe4
1BC Centre of Excellence for Women’s Health, Addictions Program, Vancouver, Canada, 2BC Centre of Excellence for Women’s Health, Vancouver, Canada, 3BC Cancer Agency, Sociobehavioural Research Centre, Vancouver, Canada, 4Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
Background: There is a pressing need for evidence-based health information resources for women with addictions. Ensuring that these resources are accessible to women with addictions and reflect the realities of their lives necessitates community-driven knowledge synthesis and knowledge translation.
Methods: Academic researchers partnered with 3 peer-led community organisations to conduct 3 community forums in 2007 with women in Vancouver’s Downtown Eastside (‘Canada’s poorest postal code’) to determine their health information priorities. Research syntheses of the available evidence were conducted on topics women identified as their key health information priorities and the findings from the research syntheses will be disseminated in partnership with peer health educators.
Results: The most urgent health priorities identified by women with addictions were: housing, violence, drug use, mental health, advocacy and rights (e.g. discrimination), access to Medicare and medications, reproductive health and infectious diseases. Women relied on peers, community organisations, research projects, street nurses, doctors and health clinics for health information. The most effective dissemination methods identified by participants were: word of mouth, community meetings, stipended workshops, the Internet, and posters and pamphlets.
Conclusions: Although women in the Downtown Eastside are among the most heavily researched populations in Vancouver, it was a challenge locating relevant evidence that answered residents’ health information needs. We will discuss the implications of these gaps in current health research agendas. A top-down research agenda driven solely by researchers may continue to marginalise Downtown Eastside residents rather than improve health outcomes by meeting the health information needs of residents.
P04–22 Using interventionist media in inner-city health: A case study
J.C. Walsh1, N. Read2, E. Marchildon3, I. Dawe1, K. Cizek4
1St. Michael’s Hospital, Psychiatric Emergency Service, Toronto, Canada, 2St. Michael’s Hospital, Mental Health Service, Toronto, Canada, 3St. Michael’s Hospital, MCIT (Psychiatric Emergency Service), Toronto, Canada, 4National Film Board of Canada, Toronto, Canada
St. Michael’s Hospital (SMH) in Toronto, Ontario Canada was the site of a groundbreaking experiment with film and media. Until Dec. 2007, award-winning documentary filmmaker Katerina Cizek teamed up with frontline health care workers in the Filmmaker-in-Residence project sponsored by the National Film Board of Canada.
Collaborative and community-based, the project puts media creation into the hands of citizens so they can participate and become agents of social change. Throughout the two-year pilot project, Cizek joined doctors, nurses, researchers and patients at the frontlines of Canadian health care in projects that focused on issues both local and global.
The Mobile Crisis Intervention Team (MCIT) is a joint initiative with Toronto Police Services Divisions 51 and 52 and the Psychiatric Emergency Service (PES) of SMH. The overall aim of the MCIT is to provide front-line mental health expertise to a designated two-officer unit that responds to emotionally disturbed persons (EDP) calls within the “Inner City” of Toronto, Ontario Canada.
The Interventionists is a half hour vérité film that follows the days and nights of the Mobile Crisis Team as they respond to EDP calls. Excerpts from the film will be screened.
Using interventionist media, not just to document, but to contribute to a deeper understanding of community will be discussed. Lessons learned from collaboration with unconventional human resources - such as filmmakers - will be proposed. How can community and traditional knowledge be harnessed using media to play a role in Global Health?
Participants will be invited to provide input.
At the end of this session participants will:
P04–23 Walking in the community-participative experiences of Tainan healthy city project
L. Lin1, P.-H. Han2, M. Lo3
1National Chen Kung University, Tainan, Taiwan, Republic of China, 2Tainan City Health Bureau, Tainan, Taiwan, Republic of China, 3Kun Shan University, Tainan, Taiwan, Republic of China
Issues: Walking is a popular and readily accessible form of moderate intensity physical activity, suitable for almost all the sedentary population. The purpose of this project was to promote the health of the citizen by walking intervention in community health build up in Tainan city.
Description: There were 13 communities, 372 people participated in this plan. This project used the supports of citizen delegates, localized walking organizations, and community residents participation to make the walking appointment. Everybody agreed to walk together in community at least three times a week for six months. The interested walking and qualified residents became the community leaders. The body weight and waistline were collected before /after the project. The paired t-test was used for data analysis.
Lessons learned: After the implementation of community walking empowerment, the committee members had significantly improved their perception of community environment and connection. The body weight (9%) and waistline (2%) were decreased significantly (P<0.05) improved after 6-months walking intervention program.
Next steps: The citizens need more walking pathway and in the community well-organized training program to increase their self-efficacy in order to improve their participations in community health activities. This Experience can provide the related information or policy makers to public health office in order to build the healthy public policies.
Diversity and Urban Health
P05–01 A new measure of quality of life: Results from a pilot study of the health section of the quality of life for homeless and hard-to-house individuals (QoLHHI) survey
L.B. Russell1, A. Gadermann2, A.M. Hubley2, A. Palepu3
1University of British Columbia, Vancouver, Canada, 2Univerisity of British Columbia, Vancouver, Canada, 3St. Paul’s Hospital, Providence Health Care & University of British Columbia, Vancouver, Canada
Background: Homeless or hard-to-house individuals (HHIs) face significant deficits in many areas of their lives, including health. However, little research has examined the relationships among homelessness, health, and quality of life (QoL), and there is a paucity of instruments designed to measure QoL in HHIs. The new Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) instrument, which is based on Michalos’ (1985) Multiple Discrepancies Theory, evaluates the QoL of HHIs through respondents’ satisfaction ratings, as well as how they compare their current situation to that of others and to their own wants and expectations. We pilot-tested the Health section of the QoLHHI in a study conducted in Ottawa, Toronto, and Vancouver.
Method: Sixty HHIs (71.7% male, mean age=46.5 years) participated in the study. Most were single (65.0%), White (71.7%), and had experienced homelessness (90.0%); 28% had completed high school and 38.3% reported some post-secondary education.
Results: Overall, participants were slightly dissatisfied with their health, which they described as “fair”. They rated their health as slightly worse than other people’s and slightly worse than the best health they had ever experienced or the health that they had expected they would have at this point in their lives. They also felt that their health was worse than they deserved, needed, or wanted. On average, participants expected that their health would remain the same over the next 5 years, although 58.4% anticipated some improvement.
Most items on the QoLHHI Health Scale correlated significantly with the physical and mental health summary measures of the SF-12. However, the moderate size of these correlations (max r=.497) suggests that the SF-12 and the QoLHHI measure different aspects of health.
Conclusions: The QoLHHI can provide information about HHIs’ subjective views on health that serves as an important complement to health status information.
P05–02 Access to postpartum depression care in Buffalo, NY: Racial considerations
K. Zittel-Palamara1, J.R. Rockmaker2, K.M. Schwabel3, W.L. Weinstein4, S.J. Thompson5
1Buffalo State College, Social Work, Buffalo, United States, 2AmeriCorp, Buffalo, United States, 3Creativision, Buffalo, United States, 4Buffalo Medical Group, Psychiatry, Williamsville, United States, 5University of Texas at Austin, School of Social Work, Austin, United States
Background: Despite the urgent need to address postpartum depression(PPD) access to care(ATC) is limited. This study examines ATC for PPD in Erie County, NY by race.
Methods: 45 women over age18 who had/currently experienced PPD were surveyed by telephone.
Results: Women were between the ages of 18 and 48 (M=29.8). Non-Caucasians and Caucasians were almost equally represented. The majority of non-Caucasians lived in an urban-setting and used Medicaid health insurance, whereas most Caucasians lived in a suburban-setting and used private health insurance coverage.ATC:15.6%(n=7) were unsure who to speak to, the same number tried to find help, but were unable. 13.3%(n=6) reported lack of education, the same number said her symptoms made it difficult to “take action”, pressure from family/friends, and comments from professionals prevented ATC. 20(44.4%) reported fair-poor ATC and 26.7%(n=12) needed care when interviewed.
Non-Caucasians:Most Valued Care (in-order-of-preference):individual counseling, spiritual assistance/direction, in-person support group, hospitalization, medication, and online support group.
Most Frequent Care Received:individual counseling treatment, medication, hospitalization, spiritual assistance/direction, and online/in-person support groups.
Caucasians: Most Valued Care:individual counseling, medication, in-person/online support groups, hospitalization and spiritual assistance/direction. Most Frequent Care Received:medication, spiritual assistance/direction, individual counseling, in-person and online support groups.
Conclusions: Non-Caucasians, impoverished, women living in urban-areas had the most difficulty getting care. Professionals and legislators need education on PPD symptoms, the impact of untreated PPD on families/society, and ways to increase ATC.
Study limitations: Generalizability of study results is limited due to recruitment procedures, small sample size, and location.
P05–03 Access to primary care among homeless people within a system of universal health insurance
S.W. Hwang1, S. Chiu1, J. Ueng1, G. Tolomiczenko2, A. Kiss3, L. Cowan4, W. Levinson5, D. Redelmeier6
1St. Michael’s Hospital, Centre for Research on Inner City Health, Toronto, Canada, 2Crohn’s & Colitis Foundation of Canada, Toronto, Canada, 3Sunnybrook Health Sciences Centre, Research Design and Biostatistics, Toronto, Canada, 4Street Health, Toronto, Canada, 5University of Toronto, Department of Medicine, Toronto, Canada, 6Sunnybrook Health Sciences Centre, Toronto, Canada
Background: Homeless persons encounter barriers to accessing primary care, but few studies have examined this issue within a system of universal health insurance. The goal of this study was to determine the proportion of homeless people in Toronto, Canada, who do not have a primary care provider, in comparison to the general population.
Methods: A representative sample of 602 single men, 303 single women, and 265 women with dependent children were surveyed at 60 homeless shelters and 18 meal programs in 2005 (73% response rate). Participants were asked whether they had a usual source of health care. Those who identified the emergency room as their usual source of care were considered to not have a primary care provider. Comparable data for the general population of Toronto in 2005 were obtained from the Canadian Community Health Survey, cycle 3.1.
Results: Homeless single men were most likely to lack a primary care provider (42.5%), followed by single women (22.4%), and women with dependent children (18.1%) (p<0.0001). In the general population of Toronto, 20.0% of single men, 10.6% of single women, and 5.5% of women with dependent children did not have a primary care provider (p<0.0001 for all comparisons of homeless to general population groups).
Conclusions: Lack of a primary care provider was most prevalent among homeless single men in Toronto. Even within a system of universal health insurance, homeless individuals are two to three times more likely to lack a primary care provider than individuals in the general population.
P05–04 Challenges in the development of new instruments for non-mainstream populations: Some examples from the QoLHHI impact survey
L.B. Russell1, A.M. Hubley1, A. Gadermann1, A. Palepu2
1University of British Columbia, Vancouver, Canada, 2St. Paul’s Hospital, Providence Health Care & University of British Columbia, Vancouver, Canada
Issues: The development of new instruments is filled with challenges. Some, such as ensuring that items reflect the construct being measured, are well-known. Others, such as the subtle effects of language or response format, have received less attention. The development of the Quality of Life in Homeless and Hard-to-House Individuals (QoLHHI) Impact Survey provides several illuminating examples of the challenges involved in creating new measures, particularly for non-mainstream populations.
Description: The QoLHHI Impact Survey assesses how different life areas (e.g., health) affect homeless and hard-to-house individuals (HHIs) by measuring the impact of different aspects of that area (e.g., physical health, pain) on their lives. Challenges included ensuring the relevance of both item content and language to HHIs, developing a response format that acknowledges that some things (e.g., medication) might simultaneously have both positive and negative impacts, and ensuring that the QoLHHI assesses impact within each person’s experience (e.g., currently in pain, no longer in pain, never in pain). To meet these challenges, items were based on information provided by HHIs, we developed a new dual-scale response format, and we tried to incorporate a range of experiences.
Lessons learned: Pilot testing of the QoLHHI Impact Survey showed that many HHIs relate to the item content. In terms of the new dual-scale response format, although several participants felt it was good way to capture their feelings, many struggled with the concept of mixed impact. Furthermore, while many participants could identify positive and negative aspects of health-related elements (e.g., drug use), they had difficulty focusing on the impact of these elements on their quality of life.
Next steps: Revision and pilot testing of the QoLHHI Impact Survey continues, but we have already learned some valuable lessons about key issues that arise when developing new measures for non-mainstream populations such as HHIs.
P05–05 Development of an intimate partner violence intervention for urban HIV positive women
J. Burke1, A. Gielen2, K. Mcdonnell3, P. Mahoney2
1University of Pittsburgh Graduate School of Public Health, Behaviora and Community Health Sciences, Pittsburgh, United States, 2Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 3George Washington School of Public Health, Washington, United States
Background: Women living in impoverished urban areas, including those who are HIV positive, experience high rates of intimate partner violence (IPV). This research was the preliminary testing of an intervention to assist HIV positive women moving towards ending their abusive relationship. The intervention, developed by our research team, is an advocate delivered one-on-one counseling program.
Methods: To obtain feedback on the counseling program from women it is intended to serve, we tested it with 12 HIV positive abused women recruited from an HIV clinic in Baltimore, MD.
Results: The women were 41.5 years (SD=4.15) on average, 10 were African-American and 2 Caucasian, 7 (58%) had less than a high school education, most (92%) had children. Women who completed the counseling sessions were found to have increases in stage of change, mental health, self-efficacy and decisional balance and significant changes (p<0.05) were found in the areas of perceived control, perceived empowerment, and social support. They were also found to have significant decreases in IPV experienced compared to their pre-intervention assessment (3.08 events compared to 0.50). No adverse events occurred as a result of women’s participation and their feedback on the counseling sessions was extremely positive.
Conclusions: A large intervention trial to empirically evaluate the effectiveness of the intervention is warranted. If effective, such an intervention will offer new tools to health care providers who are increasingly being encouraged or required to screen for IPV, but who typically have limited or no resources for women who screen positive.
P05–06 Diversity in health challenges across cities in India: Need for context specific response
S. Agarwal1, R. Kumar1, A. Srivastava1, S. Kaushik1, P. Banerjee1
1Urban Health Resource Centre, New Delhi, India
Background: Health status of slum dwellers varies across cities. There are multiple factors which influence health outcomes including demographic characteristics of slum population, availability of health care and basic services, municipal governance and migration in the city. This paper analyzes reasons for variation in health indicators across different cities and concludes that localized strategies to be adopted to address the diversity.
Methods: The Indian DHS, 2005–06 collected data on health indicators in the slums of eight cities. Data indicates considerable variation in health conditions within these cities. The infant mortality rates in three metropolitan cities- Chennai, Mumbai and Delhi are 31.7, 28.5 and 50.9 respectively. Percentage of institutional deliveries among slum dwellers in these cities is 97.5, 83.3 and 33.4%.
Results: Reasons behind variations include:
Conclusion: Urban diversity warrants city specific planning and strategies for responding effectively to local challenges. National programmes such as the proposed National Urban Health Mission have taken cognizance of this diversity and have built-in flexibility to respond to the diverse challenges in Indian cities.
P05–07 Increasing access to language appropriate medication information for immigrant New Yorkers: A pilot intervention study
J. Gass1, L. Weiss1
1The New York Academy of Medicine, CUES, New York, United States
Issues: Language access is a key component of quality health care for limited English proficient (LEP) patients. The impact of language barriers on medication use is particularly important, given the complexity of instructions, patient responsibility for self-management of medications, and the serious implications of error. Pharmacies, despite their essential role in the dissemination of medication instructions, have been slow to incorporate language access services, such as translated medication labels and use of trained interpreters, into their service delivery systems.
Description: To identify and promote practices that may facilitate improved pharmacy-based language services, we implemented pilot interventions in 8 NYC community-based and outpatient pharmacies that serve high numbers of LEP patients. Following on-site needs assessments, interventions were offered that met the specific needs and capabilities (e.g. populations served, staff language capacity, dispensing software capability) of participating pharmacies. These interventions included phone-based interpretation, signage advertising language services, multilingual patient information, and interpreter training and assessment for bilingual staff. In order to evaluate pilot interventions, surveys focusing on changes in practice, and satisfaction with language services, were conducted at baseline and following implementation of the interventions.
Lessons learned: Pharmacists working in multiethnic neighborhoods recognized the need for language access services, but generally lack the resources to provide them. Pharmacists participating in the study were most interested in utilizing phone-based interpretation services, language appropriate signage, and multilingual patient education materials. Although time and resources are required to provide these services, pharmacists were motivated by potential improvements in patient care and an expanded customer base.
Next steps: In the final phase of the study, we will continue to assess changes in language access among pilot pharmacies and broadly disseminate project findings to promote replication of promising practices.
P05–08 Lesson’s learned, Rainbow Services: Queer addiction programming, activism and models of treatment
J. Cullen1, T. Guimond1, C. Courbasson2
1University of Toronto and the Centre for Addiction and Mental Health, Rainbow Services, Toronto, Canada, 2University of Toronto and the Centre for Addiction and Mental Health, Concurrent Disorders, Toronto, Canada
Rainbow Services (RS) are located in the Centre for Addiction and Mental Health (CAMH), Canada’s largest mental health and addiction facility in the heart of Toronto, Canada’s most populace city. Toronto is home to a sizable queer community similar to many large urban centers around the world. RS is an inpatient and outpatient queer specific program that serves community members who struggle with addiction and addiction/mental health concerns. When created 10 years ago Rainbow Services was unique since services where often diagnostically based as opposed to population specific. Since its inception the program has changed to meet the needs of the community and has noted changing patterns of substance use and risky behaviour. This presentation will examine shifting patterns of drug use/mental health concerns and treatment approaches that have been modified and adjusted to meet these changing trends.
Description: An overview and historical analysis of the services will be presented and data from a 3 year period will be examined that includes; patterns of substance use (e.g. 30% increase in stimulant abuse) and mental health diagnosis (70% of clients present with mood disorders), treatment models (Cognitive behavioural therapy and Horticultural therapy as examples) rationale for intervention strategies, and future directions for population specific programming.
Lessons learned: Challenges in providing population specific services will be addressed including diversity concerns within the queer community itself and barriers to services for some groups (such as les/bi women and transgender populations. Adaptation of treatment models to shifting concerns such as crystal methamphetamine will be examined.
Next steps: Further program expansion of concurrent treatment as well as knowledge transfer and consultation services and medical residencies will be discussed.
P05–09 Moving justice for “some” back to “and justice for all...”
L. Dow y Garcia Velarde1, A.R. Clithero1
1University of New Mexico Health Sciences Center, Family & Community Medicine, Albuquerque, United States
Issues: Many, if not most, of health problems have as their root cause social determinants. Public health education is essential to prepare a different sector of the physician workforce. Physicians have a social responsibility to address poverty and its deleterious effects on individual and population health. The goal of integrating a required Public Health Certificate (PHC) into the University of New Mexico School of Medicine (UNM-SOM) by 2010 will provide public health skills and knowledge to all future physicians, ultimately, broadening the workforce capable of addressing community health needs and disparities.
Description: Institutionalization of a public health curriculum in all phases of the UNM-SOM curriculum required merging two distinct and sometimes rival disciplines. Identification of public health competencies and examination of where and how they can be integrated into the existing curriculum was an exercise in negotiation. A comprehensive review of institutional policies was undertaken and barriers identified and overcome through networking and collaboration with stakeholders. A partnership with the state Department of Health to expand opportunities for students to learn public health in practice was also critical to our progress.
Lessons: Integration of public health and medicine into a medical school curriculum without additional time beyond four years is possible but not easy. Understanding the history of each discipline is critical to having a productive dialogue. Respecting the culture in which public health and medical clinicians are trained will facilitate understanding the context in which decisions are made.
Next steps: Remaining steps include ongoing identification of resources, faculty development and evaluation. Beyond 2010, work will include determining and measuring actual behaviors we want to achieve. For example, how will PHC graduates practice medicine differently from other medical school graduates? The PHC will undoubtedly undergo more transitions within the next 2 years as we adapt to unforeseen hurdles and opportunities.
P05–10 Subjective age, age satisfaction, and self-rated health in adults who are homeless or vulnerably housed
A.M. Hubley1, A. Gadermann2, L.B. Russell2, A. Palepu3
1University of British Columbia, Dept of ECPS, Vancouver, Canada, 2University of British Columbia, Vancouver, Canada, 3St. Paul’s Hospital, Providence Health Care & University of British Columbia, Vancouver, Canada
Background: Subjective age (SA) refers to the age that one feels relative to chronological age. A key variable that contributes to SA is health, with poorer health associated with older SAs. Most SA research has been conducted with relatively healthy samples; little research has focused on disadvantaged individuals who often experience health challenges. The purpose of this study was to (a) examine SA and age satisfaction, as well as their correlations with health, in a sample of homeless or vulnerably housed (HVH) adults, and (b) compare these results to an age and education matched sample from the general community (GC).
Method: This preliminary sample consisted of 60 predominantly White HVH adults (71.2% men) aged 22–74 years (M=46.5) and 60 GC adults (66.7% men) of nearly identical ethnicity, age, and educational levels.
Results: Preliminary results showed that HVH adults felt slightly younger physically and mentally, and thought they looked slightly younger, than their chronological ages; there were no significant differences between HVH and GC adults. Overall, HVH adults were slightly satisfied with being their age, but were significantly less satisfied than were GC adults. On a new quality of life measure for this group, HVH adults described their health as “fair” and “slightly worse” than that other people. However, on the SF-12/SF-36 self-rated health item, they actually rated their health slightly, but significantly, better than did the GC adults. In both groups, self-rated health correlated negatively with age felt physically and positively with satisfaction with age; it did not correlate significantly with age felt mentally or the age one looked.
Conclusions: Contrary to expectations, HVH adults felt slightly younger than their ages and reported very similar SA results to GC adults. Moreover, similar relationships were found between self-rated health and both SA and age satisfaction in both groups.
P05–11 Using GIS to map intervention conditions across diverse urban locations
1University of British Columbia, Pharmaceutical Sciences, Vancouver, Canada
Issue: While maps that illustrate sexual health inequities across locations are useful in pointing out where potential interventions might most be needed, we also need to elucidate the socio-cultural and structural conditions that might enhance or detract from interventions in order to be effective.
Description: This paper will illustrate how data linkage, in combination with GIS/Mapping tools, can be used to plan and tailor interventions across diverse urban locations (e.g., metropolitan areas, remote and urban cities, and towns drawn from the BC Youth Sexual Health Atlas Project). We will describe our experience of gathering local contextual knowledge about the conditions that exist in a community where we are currently engaged in action research to improve youth sexual health. We also have gathered data about whether and how local intervention conditions vary according to temporality - since features of space and place are dynamic entities.
Lessons learned: Our “maps” locate and illustrate how youth’s interactions within their community might vary during 24-hour periods and how those daily life patterns might vary according to the day of the week and the season. We also show how our analyses of youth’s social and structural locations augment our understandings of their physical locations (as illustrated through conventional mapping) and ultimately how a combination of social, material, and psychological forces “get under the skin” of young people to enhance or detract from interventions designed to improve their sexual health.
Drug use, Mental Health, and the Urban Environment
P06–01 Association between parental factors and adolescent initiation of marijuana and alcohol among heroin, crack and cocaine users in New York City, 2006–2007
C. Fuller1, K. Jones2, D.C. Ompad2, D. Vlahov1
1New York Academy of Medicine/Columbia University, New York, United States, 2New York Academy of Medicine, New York, United States
Background: While several studies have examined risk of adolescent alcohol/marijuana use highlighting the importance of parental influences, few studies provide evidence of an association between parental influence and adolescent initiation of heroin, crack or cocaine (HCC) use due to limited sample sizes of heavy drug users. The purpose of this analysis is to examine correlates of adolescent initiation of marijuana and/or alcohol (MJ-Alc) among a sample of young adult HCC users.
Methods: Using baseline data from the START cohort study conducted among HCC users recruited via respondent-driven sampling, we examined the relationship between adolescent initiation of MJ-Alc (≤13 years of age vs. >13) and individual and parental characteristics using chi-square tests and logistic regression.
Results: Of 233 participants aged 18–40, mean age was 33 years, 68% male, 55% black, 33% Hispanic, 14% injected drugs, and 87% reported past homelessness. Adolescent MJ-Alc initiates were more likely to report younger age of first sex (p<.01), report their mother had used HCC (p<.01), come from a single-parent home (p<.01), and report their parents were often unaware of their whereabouts after school/evenings/weekends (p<.02) compared with older MJ-Alc initiates. After adjustment, adolescent MJ-Alc were more likely to report their mother had used HCC (AOR=2.4) and younger age at first sex (AOR=2.3) than older MJ-Alc initiates. Mean age of HCC was also younger among adolescent MJ-Alc initiates (17; sd=4) compared with older initiates (19; sd=4, p<.003).
Conclusion: These data support the importance of parental drug abuse in adolescent initiation of MJ-Alc and early onset of HCC use in this high risk sample. These findings also emphasize the importance of substance abuse prevention among youth and women of childbearing age. Factors unexplored in this dataset (eg. peer and social influences) should also be examined among individuals who initiate early and those who delay onset of MJ-Alc.
P06–02 Compassion clubs: Quasi-legal community-based medical cannabis distribution and harm reduction
1Centre for Addictions Research of British Columbia, Vancouver, Canada
Issue: Cannabis has been demonstrated to effectively treat symptoms associated with many critical and chronic illnesses including HIV/AIDS, Hepatitis C, Cancer, and Multiple Sclerosis. Its effectiveness in the control of pain allows people to reduce or replace their use of prescription and non-prescription opiate-based drugs.
Cannabis is legal in Canada for medical purposes only under very limited circumstances. Due to the legal status of cannabis, the vast majority of medical cannabis users face harms from the procurement of unknown quality medicine from unaccountable sources, often coming into contact with hard drugs. Others are unable to access this medicine at all.
Description: Compassion Clubs provide access to high quality cannabis in a safe setting to over 10,000 medical cannabis users across the country. These organizations educate clients on the safe and effective use of cannabis, provide social capital, and engage in advocacy and research. They have developed operational standards by which they self-regulate. While operating outside the law, their work has been recognized by the Canadian Senate, courts of law, and the communities in which they operate.
Lessons learned: Compassion clubs are a successful model of community-based medical cannabis distribution, serving an important role in addressing the needs of those who could benefit from the use of cannabis. These organizations are able to provide higher quality cannabis at a lower cost to more people than the federal government program.
Next steps: Compassion Clubs are a proven model of community-based medical cannabis distribution that can be applied internationally to medical cannabis and other health care and harm reduction services. In Canada, these organizations are striving to attain legal recognition primarily through court challenges.
P06–03 Correlates of infrequent HIV testing among drug users in NYC
K. White1, K. Jones1, E.O. Benjamin1, N.D. Crawford1, C.M. Fuller1
1New York Academy of Medicine, NYC, United States
Background: HIV testing plays a prominent role in HIV prevention and early intervention approaches. Availability of rapid testing has highlighted public health messages urging frequent testing among high-risk populations such as injection drug users (IDUs) and non-injection drug users (NIDUs) to counsel on risk reduction and help identify individuals newly infected with HIV to facilitate care. In this analysis, we identified correlates associated with infrequent HIV testing.
Methods: Recently initiated IDUs (injecting heroin/crack/cocaine ≤ 3 years) and NIDUs (heroin/crack/cocaine use ≥1 year), age 18–40, were recruited through respondent driven sampling and targeted street outreach in ethnographically mapped NYC neighborhoods. Sociodemographics, sexual and drug behavior, and information about HIV testing were collected through interviewer-administered questionnaires conducted from 2006–2007. Infrequent HIV testing was defined as testing < 3 times over lifetime. Chi-square or t-tests and logistic regression were used to identify infrequent testers.
Results: Of 215 participants: median age 33; 32.5% female; 56.7% Black; 33.0% Hispanic; and 11.2% IDU. A majority of participants (96%) reported prior HIV testing, while 52.2% reported infrequent testing. Older age, race/ethnicity and men who sleep with men/women who sleep with women (MSM/WSW) behavior was positively associated with infrequent testing. After adjustment, only MSM/WSW behavior (AOR:3.5;95%CI 1.3–9.5) was independently associated with infrequent testing. There were no differences in testing frequency by injection status.
Conclusions: These findings suggest that intervention efforts should encourage frequent testing among NIDUs and IDUs, particularly individuals who are MSMs/WSWs, who are less likely to be tested frequently. Future studies should explore the challenges associated with frequent HIV testing among drug-using subgroups.
P06–04 Effect of genetic polymorphisms in the protease gene on the virologic response to HAART regimens including ritonavir-boosted protease inhibitors (PIs)
B. Conway1, H.K. Tossonian1, J.D. Raffa2, J. Grebely1, S. DeVlaming3
1University of British Columbia, Anesthesiology, Pharmacology and Therapeutics, Vancouver, Canada, 2University of Waterloo, Statistics and Actuarial Science, Waterloo, Canada, 3Pender Community Health Centre, Vancouver Coastal Health, Vancouver, Canada
Background: Defined rates of virologic breakthrough have been documented in PI-based regimens. It may be that such events are associated with genetic polymorphisms, which, although not conferring measurable resistance may modulate responses to therapy.
Methods: We have enrolled a cohort of injection drug users (IDUs) in a prospective, observational study of HAART administration within a directly observed therapy program. We identified 68 who have received PIs for whom serial genotypic resistance testing at the time of a detectable viral load while on PIs was available.
Results: We included 44 males and 24 females. All were treated with 2 nucleoside analogues with atazanavir (35) or lopinavir (33), with 41 patients previously treated with other PIs. At baseline, a median of 3 polymorphisms were present (66 with ≥1) mainly 63P, 93L and 35D, with 7 occurrences of primary PI mutations (30N, 46I, 47V, 54L, 84V, 90M). Over a follow-up period of 17 months, there were 24 subjects that did not respond to treatment, the other 44 showing low (14) or high (30) level virologic breakthrough. A single occurrence of a new major PI mutation was documented. However, the number of polymorphisms increased (median 4, range 0–9), affecting the measured PI susceptibility in 5 cases.
Conclusions: In our cohort of IDUs, we documented significant evolution of PI mutations. If sustained virologic breakthrough occurs in this setting, tipranavir or darunavir may be more appropriate choices as subsequent regimens, due to their higher threshold for the development of resistance in the presence of genetic polymorphisms.
P06–05 Effective, user-driven harm reduction programming
R. Balian1, J. Altenberg2
1South Riverdale Community Health Centre, COUNTERfit Harm Reduction Program, Toronto, Canada, 2South Riverdale Community Health Centre, Urban Health Team Manager, Toronto, Canada
Issue: For illicit drug users (iDUs), HIV/HCV prevention is a significant concern but not a priority. Availability, price, and money for drugs take precedence, followed by violence prevention, fooling urine-tests, and avoiding prison. Harm reduction programs rarely deal with any of these issues. We cannot tell our service users how to beat a piss-test, or buy their heroin the local conscientious dealer.
If we believe that iDUs must be involved in program design, development and evaluation, we must take their priorities seriously least we lose credibility.
Description: COUNTERfit is an award winning program, staffed by iDUs, delivering these services without compromising its credibility. Instead of introducing iDUs to “good” drug dealers, COUNTERfit provides space for the community to exchange information about dealers, drug potency, and harm reduction strategies. To minimize arrests and imprisonment, we orient and train the local police. We train service users to establish secondary exchanges for iDUs who won’t or cannot access harm reduction programs. Finally, COUNTERfit staff educate iDUS about issues relevant to their lives, such as half-lives of drugs and their rights. COUNTERfit is now one of the busiest and most dynamic harm reduction program in the world.
P06–06 Intensive case management for adults with severe addictions, mental illness and involvement in the corrections system: A qualitative study of therapeutic agents of change
M. Patterson1, K. Bell2, S. Rezansoff2, J. Somers2
1CARMHA, Health Sciences, Vancouver, Canada, 2CARMHA, Vancouver, Canada
Background: Individuals with severe addictions and mental illness who are involved in the corrections system are among the most challenging populations to serve. These individuals tend to cycle through multiple aspects of the social service system with staggering costs and minimal benefit. The Vancouver Intensive Supervision Unit (VISU) is a multidisciplinary team in Vancouver’s Downtown East Side which provides intensive case management in an effort to stabilize the lives of their clients. While intensive case management is reported to be effective for people with severe mental illness, its effectiveness with heavily addicted and justice-involved clients as well as the therapeutic agents remains unclear. This poster explores therapeutic agents of change from staff, administrative and client perspectives.
Methods: A focus group was held with six VISU staff members, as well as individual interviews with staff, key administrative stakeholders, and 10 clients. Transcripts were independently analzyed by three coders based on thematic content using Grounded Theory Analysis. The final set of themes was determined by discussion and consensus.
Results: In focus group and individual interviews, Building Relationships emerged as the linchpin of effective service delivery. This dominant theme encompassed three sub-themes: Engagment, Team Cohesion and Other Agencies. Four related themes also emerged as key programme ingredients: Managing Expectations, Staff Characteristics, System Navigation and Organizational Factors.
Conclusions: Staff and clients strongly endorsed the team approach to building relationships and navigating a complex system of social and health services. Relational aspects to service delivery must be considered when planning for future program changes and/or refinements.
P06–07 Lessons learned from the SCORE project: Efficacy of an outreach and education initiative related to safer crack use
S. Malchy1, J. Johnson1, J. Buxton2, V. Bungay3, S. Boyd4, J. Loudfoot5
1UBC, School of Nursing, Vancouver, Canada, 2University of British Columbia, School of Population and Public Health, Vancouver, Canada, 3BC Centre for Disease Control (BCCDC), STI/HIV Prevention and Control, Vancouver, Canada, 4Centre for Addictions Research BC, Studies in Policy and Practice, University of Victoria, Canada, 5Oaktree Clinic, BC Women’s Hospital and Health Centre, Vancouver, Canada
Background: Smoking crack has been associated with HIV, HCV, and pneumonia as well as contextual factors such as poverty, homelessness, social isolation and underutilization of services.
Methods: In order to facilitate a better understanding of the health concerns and service needs of people living in the inner city who smoke crack, we held weekly “kit making circles” to assemble “safer crack kits”. 14,000 kits were distributed by peer and integrated outreach teams for one year. Two way harm reduction discussion was facilitated throughout all project activities. Research to evaluate the efficacy of the project included surveys, kit inventories, qualitative interviews and field notes.
Results: We learned that provision of unlimited safer crack use supplies should be integrated into existing harm reduction services and a variety of approaches must be employed as part of a continuum of outreach distribution. Efforts must be made to tailor strategies to the unique needs and circumstances of particular contexts and education efforts must include demonstrations on how to use paraphernalia safely.
Conclusions: In order to address gaps in knowledge about safer crack use, comprehensive educational outreach programming is required and special attention must focus on those who are most vulnerable and marginalized. Those who currently use crack must be involved in the development of programs and concerted efforts are required to provide women who use with specialized services. Based on the lessons learned from our safer crack initiative, our presentation will recommend strategies in which to address crack smoking in the urban Canadian context.
P06–08 Measuring the mental health of Arab youth: A case study from Lebanon
R. Afifi1, R. Nakkash2
1American University of Beirut, Health Education and Behavior, Beirut, Lebanon, 2American University of Beirut, Center for Research on Population and Health, Beirut, Lebanon
Background: The objective of this research was to develop and validate an Arab Youth Mental Health (AYMH) scale for use to measure change pre and post intervention. Although many mental health instruments are available, researchers rarely identify specific reasons for choice of one over the other. This scale was developed in response to our perceived need for a context and culture specific measure of youth mental health.
Method: Fourteen mental health scales were identified and rated by researchers and community members according to specific criteria. Accordingly, three scales were selected and translated into Arabic. Qualitative group discussions with children 10–14 years were then conducted for input regarding appropriateness, relevance and comprehension. A 40 item scale was then constructed and reviewed by mental health experts. This content validation reduced the scale to 28 items. The reduced scale underwent reliability and validity testing with 300 Palestinian refugee youth, and clinical validation with 150 disadvantaged Lebanese youth.
Results: The AYMH scale is the outcome of this process. It is a clinically validated 21-item scale which is locally constructed and context specific. Reliability of the scale is high. Results of construct validation indicate a strong scale. These results will be shared along with the cut off point identified by the clinical validation.
Conclusions: The process of validation was grounded in community yet met professional criteria for common mental disorders. We recommend this process of triangulation of quantitative and qualitative data; as well as community and professional feedback in the development of culturally relevant scales.
P06–09 Mental health and addiction issues and health service needs of people living with HIV/AIDS in Ontario: The Positive Spaces, Healthy Places Study
S.B. Rourke1, R. Tucker2, S. Greene3, M. Sobota4, J. Koornstra5, L. Monette6, S. Byers7, D. Guenter8, S. Hwang9, J. Dunn9, A. Ahluwalia10, J. Bacon2
1Ontario HIV Treatment Network; University of Toronto; St. Michael’s Hospital, Toronto, Canada, 2Ontario HIV Treatment Network, Toronto, Canada, 3McMaster University and Fife House, Hamilton, Canada, 4AIDS Thunder Bay, Thunder Bay, Canada, 5Bruce House, Ottawa, Canada, 6Ontario Aboriginal HIV/AIDS Strategy, Toronto, Canada, 7AIDS Niagara, Hamilton, Canada, 8McMaster University, Hamilton, Canada, 9St. Michael’s Hospital and University of Toronto, Toronto, Canada, 10Fife House, Toronto, Canada
Background: Prevalence data on depression and substance use in combination with the location, availability and access to services are critically needed in order to know where and how to address mental health and addiction issues for people living with HIV in Ontario.
Methods: 605 people living with HIV in Ontario were interviewed by peer research assistants to collect information regarding socio-demographics, social, psychological and mental health status, housing stability, health care access, experiences of discrimination, and health outcomes and health-related quality of life.
Part I: Depression exists in over 50% of people living with HIV in Ontario and rates vary geographically. Harmful alcohol use occurs in 17–42% of sample while harmful drug use occurs in 1–2 out of 4 people with HIV. Substance use rates vary geographically with higher rates in Eastern and Northern Ontario. Having 2 or more conditions (depression, alcohol and/or drug use) occurs in 20–30% of sample studied.
In Part II, we examined the access and location to mental health and addiction services: Of those with depression, only 1 out of 3 has received psychological services and 1 out of 4 psychiatric care in past 3 months (about 70% overall are not getting the help they need). Access to mental health services varies significantly across province - Eastern and Central Ontario have 50% less access than the GTA. Approximately 1–2 out of 4 people across the province report needing more access to mental health services. People from countries where HIV is Endemic have highest rate of need of mental health services.
Conclusions: Rates of mental health (depression) and addiction issues are high in populations with HIV accessed through community-based AIDS service organizations and there are significant gaps in appropriate health services across Ontario to meet the needs of these populations.
P06–10 Mental health promotion with refugee youth: Lessons learned from a pilot study
R. Nakkash1, R. Afifi2
1American University of Beirut, Center for Research on Population and Health, Beirut, Lebanon, 2American University of Beirut, Health Education and Behavior, Beirut, Lebanon
Background: This presentation discusses lessons learned from piloting a multi component year-long youth mental health intervention in a Palestinian refugee camp in Lebanon. The intervention was developed and planned, by a community coalition including researchers, civil society, and youth.
Methods: The pilot involved implementing 20% of the intervention in a different refugee camp in Beirut with a similar context and age group. The pilot sample was selected as per the plan for the definitive trial and activities were implemented in the same way. Qualitative methods and continuous research team and field group discussions were used to critically assess the various aspects of the pilot experience.
Results: Piloting the process of parent consent and child assent indicated the need to allow for child privacy when assenting. Changes for more efficient recruitment were also suggested. Coordinating with NGO’s was found critical to ensure access to the community, facilitate locating households, and avoid double scheduling of activities. Mothers indicated a need for childcare services in order to attend sessions. Reaching fathers and gaining their participation in activities was difficult. Creative strategies for engaging fathers are needed. The pilot provided rich feedback regarding length of session and cognitive level of activities for the youth intervention.
Conclusions: The process of implementation and evaluation of the definitive trial will be made easier as a result of the pilot experience. Use of qualitative methods during the pilot was critical to more fully understand the intricacies of implementation to achieve objectives and impact youth health.
P06–11 Methamphetamine initiation among HIV-positive gay and bisexual men
N. Nakamura1, S.J. Semple1, S.A. Strathdee1, T.L. Patterson1
1University of California, San Diego (UCSD), La Jolla, United States
Background: Methamphetamine is often used for sexual, social, or emotional reasons (Halkitis, Fischgrund, & Parsons, 2005; Semple, Patterson, & Grant, 2002). An understudied area is whether there are differential reasons for methamphetamine initiation (MI) based on methamphetamine use patterns. Another is the link between MI and sexual risk outcomes. This study describes reasons for MI in a sample of 340 HIV-positive men who have sex with men (MSM). We hypothesized that reasons for MI would be differentially related to binge use, injection drug use, polydrug use, unprotected sex, and number of STIs.
Methods: Data for these analyses were collected between November, 2000 and October, 2004 from baseline assessments of participants enrolled in a behavioural intervention study in San Diego, California. Eligible participants were at least 18 years of age, used methamphetamine at least twice in the past two months and at least once in the past 30 days, and had unprotected sex with at least one HIV-negative or serostatus-unknown male partner during the same period.
Results: A factor analysis was conducted on reasons for initiation, and five factors were identified: to cope, for sex, for energy, to party, and to improve self-esteem. Methamphetamine to cope accounted for more than a third of the variance in the factor analysis, which suggests that coping is an important underlying reason for MI. Regression analyses revealed differential associations between MI factors and HIV risk behaviours.
Conclusions: These findings suggest that MI among MSM is multifaceted, which has implications for intervention development.
P06–12 More than just needles: An evidence-informed approach to enhancing harm reduction supply distribution in British Columbia
J.A. Buxton1, E.C. Preston2, S. Mak2, S. Harvard2
1UBC, BC Centre for Disease Control (BCCDC), Epidemiology, Vancouver, Canada, 2BC Centre for Disease Control (BCCDC), Vancouver, Canada
Issues: The BC Harm Reduction Strategies and Services (HRSS) policy states that each health authority (HA) and their community partners will provide a full range of harm reduction (HR) services to their jurisdictions and these HR products should be available to all who need them regardless of where they live and choice of drug. Preliminary analysis revealed wide variations between and within HAs.
Description: The objective of this study is to analyze distribution of HR products by site using GIS and to investigate the range, adequacy and methods of HR product distribution using qualitative interviews. The BCCDC pharmacy database tracks HR supplies distributed to health units and community agencies. Additionally, eleven face-to-face interviews were conducted in eight mainland BC communities using an open-ended questionnaire.
Lessons learned: There is evidence in BC that HR supplies are not equally available throughout the province. There are variations within jurisdictions in how HR supplies are distributed, adequacy of current HR products, collection of used needles, alternative uses of supplies and community attitudes towards HR. GIS illustrates where availability of HR supplies may be lacking but with secondary distribution, true reach and availability of supplies cannot be determined.
Next steps: Currently, a consultant has been employed to develop a ‘best practice’ document and relevant health files to further establishment of standard training and protocols within HAs. There is a need to enhance the profile and availability of culturally appropriate HR services for Aboriginal populations. Distribution of wooden push sticks and mouthpieces is also being investigated.
P06–13 Needle exchanges are a start: Lessons from current efforts in the US
J.S. Pedersen1, W. Zhang2, S. Strathdee3, V. Lima2, R.S. Hogg1
1BC Centre for Excellence in HIV/AIDS/Simon Fraser University, Vancouver, Canada, 2BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 3University of California, San Diego (UCSD), San Diego, United States
Background: Needle Exchange Programs (NEPs) can reduce blood-borne infections among injection drug users (IDUs). We investigated the effect of number of IDUs and NEPs on the reported AIDS case rate in the US.
Methods: State-level data from 2005 and 2006 on AIDS rates, NEPs numbers, health insurance coverage, employment, and poverty rates, and median household income, and estimated numbers of IDUs from 1998, were collected from The U.S. Centers for Disease Control and Prevention, U.S. Census Bureau or published journal articles. Poisson regression was used to separately model the effect of IDUs and NEPs on the reported AIDS case rate, adjusting for potential confounders.
Results: At the state-level, NEPs were not significantly associated with the reported AIDS case rate (p=0.84). After controlling for potential confounders in the model for the number of IDUs, such as NEPs, health insurance coverage, employment, and poverty rates, and median household income, the estimated AIDS case rate increased by 0.4% (95% confidence interval: 0.1%–0.7%, p=0.04) per 1,000 increase in the number of IDUs.
Conclusions: IDUs remain an important determinant of the reported AIDS case rate in the US, and both the coverage and number of NEPs must be expanded for a better assessment of their effect on reducing HIV/AIDS transmission in this population. One limitation is the use of reported AIDS case rate, which may be an underestimate of the true population rate. Also, because it is an ecological study, the findings cannot be used to make inferences at the individual level.
P06–14 Opioid-dependent medical inpatients treated with buprenorphine
B. Chabon1, R.M. Aszalos2, C. Caraos1, M.K. Murphy3, M. Herman1
1Montefiore Medical Center/ Albert Einstein College of Medicine, Psychiatry and Behavioral Sciences, Bronx, United States, 2Saint Joseph’s Medical Center, Department of Family Practice, Yonkers, United States, 3Montefiore Medical Center/ Albert Einstein College of Medicine, Emergency Medicine, Bronx, United States
Background: Medical hospitalization of opioid-dependent patients offers an opportunity to address numerous complex medical, substance related, psychiatric and social needs. Although methadone is the mainstay of opioid assisted treatment (OAT), buprenorphine provides a new treatment option.
Objective: To describe patient characteristics and OAT outcomes among an untreated cohort of medical inpatients referred to an Addiction Psychiatry Consultation Service (APS) of an urban teaching hospital in the Bronx, New York.
Methods: Data on 502 opioid dependent patients seen by APS between 2003–2007 were abstracted via chart review and a computerized Clinical Information System (CIS). Process indicators include acceptance of buprenorphine for detoxification, withdrawal management, induction and outpatient treatment referral. Univariate and bivariate analyses used SPSS vs.11.
Results: The sample was 52% male, mean age of 46 years (sd=10.8), 60% Hispanic and 20% African American. Almost half (43%, n=215) of the opioid dependent patients were not in OAT. Abuse of non-opioid drugs was prevalent (74%) as were co-morbid HIV+ (41%) and HCV+ (30%) infections. Most patients (78%) were unemployed, 26% were uninsured, 12% were homeless and 10% left against medical advise (AMA). OAT during hospitalization was accepted by 47% (n=103) of the patients. Although more patients accepted buprenorphine than methadone (28% vs. 19%; p<0.01), buprenorphine treated patients were more likely to leave the hospital AMA (4.2% vs. 0.09%, p<0.01). Opioid dependent patients refusing any OAT had the higher rates of AMA.
Conclusions: Although buprenorphine is accepted by medical inpatients for OAT, the reasons that buprenorphine treated patients were more likely than methadone treated patients to leave the hospital AMA deserves further study. Research is needed to assess current interdiscplinary provider training about buprenorphine. Multi-site collaborative studies on the use of buprenorphine in opioid addicted medically hospitalized patients would help to expand on current clinical guidelines and optimize care.
P06–15 Substance abuse and associated factors among the fishing communities of Ggaba town centre
S. Muwonge1, H. Luyiga2, S. Namuwonge3
1Urban Youth Revival Association, kampala, Uganda, 2Uganda Change Agent Association, kampala, Uganda, 3Uganda Convetion for Development, kampala, Uganda
Background: The use of psychoactive substances has been on the rise because there is wide spread availability of licit and illicit drugs yet the laws meant to discourage or prevent use are either not enforced or not stringent enough. It is important to assess factors that influence substance abuse.
Methods: A cross sectional study was conducted using a sample of 384 respondents. Eight (8) focus group sessions and twelve (12) key informant interviews were conducted.
Results: The most common substances abused were alcohol (61%), tobacco (37%), Khat (7%) and cannabis (4%). About 53% of respondents depended on alcohol, 4.2% on Cannabis, 26.3% on tobacco while 6.5% depended on Khat. Male respondents were more likely to abuse alcohol than their female counterparts. Alcohol consumption was mainly used to reduce tension and stress while Cannabis was abused to increase strength and courage. Tobacco, on the other hand, was abused because it keeps fishermen warm while Khat kept them awake on the lake.
Conclusion: Substances are abused because they are viewed as a major coping mechanism for individuals working on the lake.
P06–16 The cost-effectiveness of heroin addiction interventions: A review
T. Hansen1, J. Hoch1
1Centre for Research on Inner City Health (CRICH), Toronto, Canada
Background: Heroin use is highly prevalent in marginalized urban areas, which may be attributed to socio-economic structures that create difficulties in individuals’ abilities to cope with their environment. Research should be directed towards finding effective interventions to treat people with heroin addiction and investigating factors predisposing people to heroin use in at risk populations such as youth. However, in many jurisdictions, an effective intervention may not be implemented without accompanying evidence of its cost-effectiveness.
Methods: A literature search was performed in PUBMED (1966-May 2008) using relevant English-language studies and the keywords ‘heroin’ and ‘cost-effective’. Relevant data on the cost-effectiveness of heroin interventions was extracted.
Results: Twenty-four studies met inclusion criteria. The majority of the articles were based on research conducted in the United States and evaluated the cost-effectiveness and efficiency of methadone maintenance treatment (MMT). Six studies showed MMT was cost-effective and appealing to heroin users who were seeking treatment. One study evaluated co-prescriptions of heroin and methadone for treating people who were treatment resistant showing a gain of 0.058 more Quality Adjusted Life Years per patient per year and a savings of $16,122 per patient per year when compared to MMT alone. Another study involved interviewing clients and staff of substance abuse programs to assess barriers to enrolling in substance abuse treatment programs. The study identified treatment accessibility as a major barrier.
Conclusions: There are not many cost-effectiveness studies of heroin addiction interventions. The evidence suggests that MMT programs should be more easily accessible and implement heroin and methadone co-prescriptions. If future research findings confirm those currently reported in the scientific medical literature, it will be easier to make the case that MMT programs should receive increased funding because these programs are cost-effective, produce better health outcomes for heroin users and result in higher benefits to society.
P06–17 The impact of the pharmacy syringe access program in Seattle, Washington
B. Appert1, E. Rugel2, B. Somerfield3
1Oregon State University, Public Health, Corvallis, United States, 2Portland State University, Public Health, Portland, United States, 3Portland State University, Urban Planning, Portland, United States
Background: This study investigated the impact of the Seattle-King County Public Health Department’s Pharmacy Syringe Access Program on crime rates in the Census tracts surrounding the 46 participating pharmacies, and also delineated demographic factors influencing pharmacy participation.
Methods: Data on 7 specific crime categories were collected from the Seattle Police Department. Publicly available U.S. Census data were utilized to create a demographic profile of each tract at the time of the Program’s inception. Using ArcGIS software, the number of participating pharmacies in each tract was calculated; maps were created to symbolize percentage change in crime rates between 2000 and 2005; and demographic data were spatially associated. Finally, Pearson correlations between the number of participating pharmacies in a tract and each of the variables of interest were calculated using SPSS.
Analysis: The number of participating pharmacies in a Census tract was not associated with an increase in overall crime rates (r=−0.162). There was a negative correlation between the number of pharmacy sites and burglary rates (r=−0.198) and a positive correlation with vice rates (r=0.256). Both the proportion of renter-occupied housing and the percentage of residents receiving public assistance income were positively associated with pharmacy participation (r=0.342 and r=0.203, respectively).
Conclusion: This study demonstrates that expanded pharmacy access programs are not associated with an overall increase in neighborhood crime rates, providing support for the diffusion of such programs as part of a comprehensive harm reduction strategy.
P06–18 The potential population impact of increasing the use of methadone on heroin-user deaths and of reducing cigarette smoking on asthma events
P. Torun1, R.F. Heller2, A. Verma1
1University of Manchester, Clinical Epidemiology and Public Health Unit, Manchester, United Kingdom, 2University of Manchester, Evidence for Population Health Unit, Manchester, United Kingdom
Background: The drug misuse and asthma are major health problems in urban settings. There are effective interventions to reduce cigarette smoking and also to treat heroin use; the potential population impact of those interventions has been investigated in the paper.
Methods: In the context of European System of Urban Health Indicators Project (EURO-URHIS), we explored the use of Population Impact Measures to support policy-making in substance misuse area using smoking and heroin use as exemplars. The two Population Impact Measures calculated here are the Number of Events Prevented in your Population (NEPP) and the Population Impact Number of Eliminating (or reducing the prevalence of) a Risk Factor (PIN-ER-t).
Results: Increasing methadone treatment uptake from its current levels to 90% would prevent 359 (95% CI: 308;415) deaths in Manchester City, 3 648 (95% CI: 3 143;4 208) in Greater London and overall 20 842 (95% CI: 17 959;23 941) in England in one year. In males 2 (95% CI:−22;28), 27 (95% CI: −296;363) and 170 (95% CI: −1 757;2186) and in females 36 (95% CI:6;70), 0 and 2 312 (95% CI: 934;3 783) fewer asthma cases would have been expected in Manchester City, Greater London and overall in England respectively, if the smoking prevalence is reduced from current levels to 20% in both sexes.
Conclusions: Population Impact Measures provide estimates of absolute risk and benefit to a total population, of potential use to policy-makers since current practice and intervention goals are taken into account.
P06–19 Treatment of HCV in injection drug users: A novel model incorporating multidisciplinary care, peer-support and directly observed therapy
E. Knight1, J. Grebely1, T. Ngai1, K. Genoway1, F. Duncan2, M. Vilijoen2, L. Gallagher1, M. Storms1, D. Elliott2, J. Raffa3, B. Conway1
1University of British Columbia, Anesthesiology, Pharmacology & Therapeutics, Vancouver, Canada, 2Vancouver Coastal Health, Pender Community Health Centre, Vancouver, Canada, 3University of Waterloo, Statistics and Actuarial Science, Waterloo, Canada
Objectives: We evaluated HCV treatment outcomes among IDUs attending a weekly peer-support group at a multidisciplinary clinic and receiving directly observed HCV therapy (DOT).
Methods: Beginning in March 2005, patients interested in receiving treatment for HCV infection were referred to a weekly peer-support group and evaluated for treatment readiness and eligibility. Utilising our existing infrastructure for addiction disease management, we incorporated a multidisciplinary model of care for the treatment of HCV infection, including directly observed therapy (DOT) for medication administration. Patients received DOT pegylated interferon alpha 2a or alpha 2b (PEG-IFN alpha-2a or alpha-2b), both in combination with self-administered ribavirin (RBV). We evaluated end of treatment (ETR) and sustained virologic response (SVR) among those having completed therapy.
Results: Overall, 57(27.9%) of 204 patients referred to the support group initiated HCV treatment (mean age 49 years, mean weight 82 kg, 86% male). Forty seven subjects received PEG-IFN alpha-2a and 10 received PEG-IFN alpha-2b, while 30 (52.6%) were genotype 1. Twenty one were receiving methadone maintenance therapy (36.8%) and 6 were co-infected with HIV (10.5%). At baseline, 12 (21.1%) were actively using illicit drugs and the median duration of drug abstinence prior to treatment was 5.5 months. The median time from entry into the support group to treatment initiation was 3.5 months. Among subjects having completed therapy (n=19, genotypes 2 or 3: n=14), ETR and SVR were 78.9% (15/19) and 63% (12/19), with 71.4% (10/14) genotype 2/3 patients achieving an SVR. This occurred despite illicit drug use during treatment in 52.6% (10/19), with 80% (8/10) using weekly or less.
Conclusion: A relatively high rate of response to treatment for HCV infection can be achieved among IDUs receiving peer-support, multidisciplinary care and DOT, despite ongoing illicit drug use during treatment.
P06–20 Women, drug use & sex work: Women’s harm reduction & community safety project, 2007
1South Riverdale Community Health Centre, Harm Reduction, Toronto, Canada
Issues: Women who are involved in sex work and use illicit drugs have unique needs that have historically been poorly addressed by health, social and harm reduction services.
Description: During 2007, South Riverdale Community Health Centre facilitated a community research project to look at the unique needs of women who are involved in sex work and use illicit drugs. Information was gathered through interviews and focus groups with this population of women, interviews with community workers and a review of relevant literature. Broadly, this research demonstrated that women who use illicit drugs and are involved in sex work:
The end result of this project was a report that shared insights about the experiences and needs of this population and described women centered recommendations for program development and social change.
Lessons learned & next steps: This project has had direct implications for the way South Riverdale Community Health Centre works with sex workers and women who use illicit drugs. The implications range from individual services and service qualities to social - political advocacy. Currently, we are implementing programming to work with this population of women, partnering with local agencies, developing strategies around safety, sexual health and harm reduction services and conducting training for local agencies.
Environmental Health and Justice in Urban Settings
P07–01 Environment and health inequalities of women in different neighbourhoods of metropolitan Lagos, Nigeria
I.I.C. Nwokoro1, B.S. Agbola2
1University of Lagos, Urban and Regional Planning, Lagos, Nigeria, 2University of Ibadan, Urban and Regional Planning, Ibadan, Nigeria
Background: Despite all the policies by the various governments in Nigeria to maintain a healthy environment, inequalities in health persist among women in Lagos. This study examines the nature of the relationship between environmental health factors and health status of women in different neighbourhoods of metropolitan Lagos.
Methods: All the 17 LGAs were selected to achieve 100% representation. 1150 questionnaires were administered to randomly selected women aged 18 years and above.Focus Group Discussions were held with women of same age bracket from different neighbourhoods. Data analysis included descriptive statistics, chi-square tests, one-way ANOVA and logistic regression.GIS was employed to show the spatial variation of health status of women across neighbourhoods.
Results: The mean of environmental diseases experienced by women varied among income neighbourhoods but while the difference in means between the low and medium income groups was highly significant F2=10–865, p<0–5, that of the medium and high income groups was not. GIS highlighted the high income neighbourhood as having women in the highest health status. The more access to pipe borne water, the lower the incidence of diarrhea(Wald=19.125, p<0.05) Also, diarrhea increased with age, irrespective of neighbourhood location. The FGDs identified stress as a major cause of ill health among women across income neighbourhood groups.
Conclusions: The study identified various neighbourhood environmental factors that affect the health of women. Improved environmental conditions are germaine to improving the health status of women in metropolitan Lagos while emphasis is placed on attending to the stressors that affect women’s health.
P07–02 Excreta, solid waste disposal and water supply in urban centres in Rakai
R. Lutwama1, M. Nankinga2, D. Ssentaba3
1Environmental Awareness Agency, Kampala, Uganda, 2Mbidde Community Development Agency, Kampala, Tuvalu, 3Sow lnternational Uganda, Kampala, Uganda
Objectives: To determine factors that affects sanitary facilities and water supply.
Methodology: A descriptive cross sectional study was conducted and a sample of 220 households were used. Forty four clusters were sampled in five urban centres within which a probability proportion to size technique was used to sample households. Simple random sampling was employed to select households under study. Ten FGD s were held two in each centre (one woman and the other for men). Elements were purposively selected. Key informant interviews were conducted among urban authorities while observation check lists were employed to assess the water sources. Water in all centres was sampled for laboratory analysis.
Results: Majority 88% of respondents used safe water sources while 12% used water from unsafe sources. 80% of the water sources were found to be grossly contaminated with a high feacal content. 90% of respondents had own latrines while 45% of those who didn’t have shared. 55% of those who didn’t have latrines used unhygienic methods like plastic bags and bushes. Factors that influenced excreta disposal included distance of the latrine from the house, culture, awareness about sanitary diseases, type of soils (that influence the digging of pits) and climatic conditions. The most common used method of solid waste disposal was open ground dumping (87%). Some respondents 61% dumped their waste near their houses in less than the recommended 10 metres.
Conclusion: Poor solid waste disposal greatly affects water sources in the district since most of the protected and unprotected sources are dilapidated.
P07–03 Explaining unanticipated success: The case of lead poisoning in Detroit
L. Thompson1, M. Sorbo1
1Wayne State University, Center for Urban Studies, Detroit, United States
Background: Detroit has the third highest incidence of lead poisoning of young children in the United States, but that problem is rapidly diminishing. From 2000 to 2007 the number of lead poisoned children in Detroit declined from 5,300 to 1,100. The reasons for the decline are far from fully understood. Without an explanation, it is uncertain whether this decline can be sustained or replicated elsewhere. This case study seeks to account for this unexpected success.
Methods: These authors have obtained enumerations of childhood lead poisoning cases and instances of service provision. We have also gathered Census and postal service data enumerating demographic processes such as population change, housing abandonment and demolition. We use these data to explore the hypothesis that the decline in lead poisoning results from services versus demographic processes such as housing abandonment.
Results: Preliminary data demonstrate that some interventions (500 abatements across 6 years) were too small to account for the decline, while at the same time it is clear that other processes, such as visits by health department employees and housing abandonment, are large enough (5,000 homes abandoned per year) to account for the change. The data tend to indicate abandonments and lead poisoning are associated.
Conclusions: Our findings are consistent with a theory that areas of housing abandonment is intensified in the areas of largest decline in lead poisoning. We speculate that these processes may be accelerated by publicity and health department visits, which, in turn, facilitate processes of parental choice.
P07–04 Factors influencing waste management in Jinja municipal council (JMC)
R. Lutwama1, F. Katongole1
1Environmental Awareness Agency, Kampala, Uganda
Objective: Establish factors that drive and facilitate waste management in JMC.
Methodology: The study focused on apartment dwellers, industrial workers, grocery vendors, restaurant attendants, local leaders and JMC officials. Data was collected from 400 respondents. Focus group discussions were held between vendors and restaurant attendants, in-depth interviews with apartment dwellers and industrial workers, key informant interviews with local leaders and JMC officials, structured observations were conducted to expose restaurant attendants and vendors to proper waste disposal junctures (bins) within their localities.
Results: JMC generates 149 tones of solid waste per day; the municipal council is only able to collect 40%-60% of the total waste generated hence leaving 59 tones uncollected. Among respondents interviewed, 60% disposed of their waste anyhow while 35% used garbage skips. 12% expressed ignorance of proper disposal channels. Findings further showed that barriers ranged from physical (distance to the skip), Biological (fatigue due to the frequency of disposal rounds), cognitive (ignorance and cultural beliefs) and socio-economic (poverty-people perceive proper waste management through private collection firms to be costly, politics/politicians compromise the work of health assistants and lastly attitude to urban authorities). Overall, disgust, comfort and safety were observed as the best motivators for proper waste management. Disgust referred to dirt, contamination and stench while comfort referred how one feels when their localities are free of garbage. Safety meant to avoid diseases induced by poor waste management.
Conclusion: Industrial wastes have greatly depleted the great source of River Nile where waters are dwindling and turning green.
P07–05 Housing conditions influencing the health of destitutes in Sabo, Ibadan
A.A. Ogun1, E.I. Enweasor2, O.O. Adetule2
1University College Hospital, Epidemiology, Medical Statistics and Environmental Health (EMSEH), Ibadan, Nigeria, 2University of Ibadan, Epidemiology, Medical Statistics and Environmental Health (EMSEH), Ibadan, Nigeria
Although studies have revealed the socio-economic situations which influence the migration of destitutes to cities in Nigeria, little is known about the housing conditions which may adversely influence their health. The study was therefore designed to identify the housing factors which could put the health of destitutes at risk while on the streets in cities.
A cross-sectional study of destitutes and non-destitutes in Sabo area of Ibadan was done. A total population of 108 beggars with equal number of non-beggars (controls) of the same age group in the same community was involved in the study. Interviewer administered questionnaires and Focus Group Discussions were employed for data collection. Data obtained was analyzed using descriptive statistics, logistic regression and Chi-Square Tests.
Majority of the beggars were living in unhealthful housing. Twenty seven percent of the beggars compared to 85.2% of the controls were living in cemented houses (P<0.05) while 9.4% of beggars compared to 0% of controls where living in wooden shelves (P<0.05) and 4.6% compared to 0% of controls were living outside (P<0.05). Out of those who were living outside, 100% reported body pains. Large proportions (36.7%) of the beggars compared to 5.6% of controls did not have functional toilets in their houses (P<0.05). Majority of newly came beggars were living outside and wooden shelves.The destitutes live under poor housing conditions which make them vulnerable to several environmental hazards which can compromise their health. It is recommended that health intervention programmes aimed at providing healthy housing be implemented for destitutes.
P07–06 Spatial data integration for global and local assessments of environmental equity in major Canadian cities
T.R. Tooke1, B. Klinkenberg2, N.C. Coops1
1University of British Columbia, Forest Resources Management, Vancouver, Canada, 2University of British Columbia, Dept. of Geography, Vancouver, Canada
This paper provides a methodology for quantifying environmental equity at global and local scales in major Canadian cities by integrating remote sensing technologies, geographic information systems, and spatial statistics. Census data is used to provide key socioeconomic indicators of environmental equity including income, education, family status, and immigrant status. These variables are related to vegetation fractions derived from moderate resolution satellite imagery, and the relationships are quantified using Pearson correlation coefficients and geographically weighted regression. Results demonstrate strong global correlations which coincide with recent studies, and local regression analyses demonstrate opportunities for predicting variable environmental inequalities within individual cities. Discussion is provided regarding the application of these methodologies for urban planning and community development initiatives for managing environmental equity at various scales.
P08–01 Health and living conditions of migrants with a precarious status in Montreal: Review of the situation & possible solutions
Z. Brabant1, M.-F. Raynault1
1University of Montreal, Montreal, Canada
Background: Migrants with a precarious migration status are an understudied population in Canada, both on the characteristics and the needs aspects. Nevertheless, there are indications that they could be particularly vulnerable due to multiple deleterious health determinants linked to their status. While international migrations are reaching never seen levels, it appears essential to better look at this crucial public health and urban health problem, in a perspective of equity. As such, the objectives of the survey were to i) draw an exploratory portrait of migrants with a precarious migration status in Montreal (a- characteristics like age, gender, origin, cause of precarious status and b - health and living conditions, and needs) and to identify possible solutions.
Semi-structured interviews and additional data collection;
Results: Like other migrants, especially newly arrived, migrants with a precarious migration status are confronted with multiple obstacles to health (language, economic...). However, their status brings additional challenges and makes their situation harmful to their health. Unhealthy accommodations, underpaid and precarious jobs, lack of access to education, isolation and lengthy separation from family members, mental health problems linked to status, and barriers to healthcare are parts of the range of detrimental health determinants associated with their status.
Conclusions: This survey shoes that, although universality and accessibility are core principles of the Canadian health system, and equity and social justice are considered eminent values of the health policies, an important number of persons are faced with health inequalities in Montreal. While some answers have been initiated in other provinces or countries, it is crucial to develop innovative, and ideally long term, solutions to this problematic situation.
P08–02 Maintaining integration or enforcing segregation - What is best? The public health implications of a camp based response to urban refugees in a time of emergency: Experiences from South Africa
J. Vearey1, L. Nunez2
1Forced Migration Studies Programme and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, 2Forced Migration Studies Programme, University of the Witwatersrand, Johannesburg, South Africa
Issues: South Africa has an urban integrative asylum policy. No refugee camps exist and individuals are encouraged to self-settle and integrate within the host population. Rights are afforded to refugees and asylum seekers, including the right to work, go to school, and access public health services. Recent xenophobic violence in urban South Africa has resulted in estimates of 100,000 displaced refugees and asylum seekers seeking safety. Currently, these individuals are located in temporary emergency shelters but the possibility of transforming these into permanent refugee camps is being considered.
Description: Displaced persons require continued access to their places of work, schools and healthcare facilities. Whilst it is essential that adequate (temporary) spaces of safety and shelter are provided to displaced persons, moving towards the establishment of longer-term (permanent) refugee camps raises critical concerns as displaced persons are moved from their communities and freedom of movement will be restricted. Research is being undertaken to assess the public health consequences of a camp-based response rather than an assisted re-integration process which would ensure access to mainstream public health services.
Lessons learned: Existing research indicates that urban refugees and asylum seekers often fall within the peripheries of health and social welfare provision. Data collection on the public health consequences resulting from the establishment of temporary and/or permanent refugee camps is currently underway.
Next steps: The research will assess the public health responses to displaced persons in urban South Africa. Research will include in situ interviews with beneficiaries, aid agencies, public health providers and government officials. In addition, the application of international humanitarian guidelines (e.g. Sphere handbook) will be assessed to determine whether healthy and appropriate places of safety are being created. The longer term public health implications resulting from a changed policy response - from urban integration to refugee camps - will be investigated.
P08–03 Migration and Morbidity pattern among urban slum community of Chandigarh Union Territory of India.
J.S. Thakur1, M. Singh1, H. Negandhi1, S. Goel1
1School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
Urban migration has become an important problem in India due to better opportunities for work, life and desire to live in cities. Six hundreds families were selected from six slums by simple random sampling to study migration and health problems among migrants by using a pre-tested questionnaire. Majorities (94.3%) of the migrants were Hindus with about two fifth (41.4%) of them, mainly females, were illiterate. Most (97.3%) of the migrants were poor, from rural areas with 80% from states of Uttar Pradesh and Bihar. Over 64% migrated between the years 1975–1995. Majority (70%) was working as wage laborers, 19% unemployed, and 5.7% self-employed. After migration, 94% lived in mud houses with poor living conditions as nuclear family. Majority (96%) had access to public water supply but only half had access to any toilet facility. About 17% were addicted to tobacco smoking, tobacco chewing or alcohol. Only quarter of the children (1–2 years) were partially immunized with 8% had no immunization. Sickness rate (any member of family sick in past one year) increased from 2.5% before migration to over 40% after migration. The most commonly reported acute morbidities were fever (25.8%), abdominal pain (12.9%), cough (17.6%) and diahorrea (6.5%), while chronic morbidities were hypertension (12.8%), anemia (6.8%), RTI/STI (6.4%) and Tuberculosis (5%). Females had higher chronic morbidity (37.4%) as compared to males (21.7%). About one third first contacted non registered practitioners. Over 78% sought medical consultation from government facility for the illness with only 10% from private sector. Migration is mainly due to poverty; social inequities from rural poor, mordity rates increased substantially after migration and needs urgent policy interventions in India.
P08–04 Migration into Nairobi: Evidence from ten-year migration histories
D. Beguy1, E. Zulu1, K. Muindi1
1African Population and Health Research Center, Nairobi, Kenya
Background: Rural-urban migration continues to play an important role in the urbanization process in many cities in sub-Saharan Africa. Nairobi, Kenya’s capital and commercial city attracts a lot of migrants who usually come from their rural homes in search of better livelihood opportunities. Once in town, a large proportion of these new urban dwellers live in poor conditions in the informal settlements on the periphery of Nairobi.
Methods: This paper seeks to describe the characteristics of migrants, their migration histories, reasons for migrating into two Nairobi slums, Korogocho and Viwandani. The paper draws on data from the migration and employment histories collected from 12,638 participants in both sites, under the Urbanization, Poverty and Health Dynamics, a research project nested in the Nairobi Urban Health Demographic Surveillance System.
Results: Findings show that Korogocho has a lower proportion (70%) of migrants (67% of females and 72% of males) compared to Viwandani with 90% (88% of females and 92% of males) of migrants. In both sites, majority of migrants come from rural Kenya (95% in Korogocho and 94% in Viwandani). While males aged 20 and above report poor job prospects as the main reason for leaving their rural homes, high proportions of females of all ages report family-related reasons. At the moment of the survey, 72% and 74% of migrants are involved in an income generating activity in Korogocho and Viwandani, respectively. In both sites, slightly above 50% of female migrants are involved in income generating activities compared to above 80% of males. Males in Viwandani are mainly working in the formal sector while in Korogocho they work in the informal sector. In both sites, females are mainly occupied in self-employed income generating activities.
Conclusion: The results are significant in informing further work investigating factors associated with migration into the slums of Nairobi.
P08–05 Psychosocial assessment of displaced young girls: Findings from a household survey in an urban setting in Lebanon
N. Choueiry1, D. Basil2
1American University of Beirut Medical Center, Beirut, Lebanon, 2Partners for Development, Beirut, Lebanon
Background: The July war 2006 in Lebanon has resulted in disruption of normal life and internal displacement of civilians living in different areas in Lebanon in general and in the south in particular. As part of a UNFPA-sponsored program in Nabatieh (Southern Lebanon), this survey estimated the prevalence of distress among displaced young girls; identified factors that increased their resilience to war and assessed their social life.
Methods: The survey consisted of conducting, in the Caza of Nabatieh between January 14 and February 13, 2007 a sample cluster household survey targeting 210 young girls aged 12–19 years. Participants were administered a checklist of symptoms of psychological distress. Descriptive statistics and bivariate associations were provided using Pearson’s chi-square tests and odds ratios were then obtained from binary logistic regression models.
Results: Psychological distress was present in 43% of the sample. The findings highlight that the the significant factors that alleviate the distress among surveyed girls were having access to internet cafes (OR=0.33; p=0.002), being able to play in a landmine free spaces/playground (OR=0.32; p=0.001) and feeling self satisfied (OR=0.17; p=0.005). At the same time young girls complained of deterioration of their social life and worsening relationships. They get frequently involved in fights and arguments (40%) and isolate themselves during leisure time (22%).
Conclusion: Collected data illustrated a disturbance of psychosocial status in the after war period in the surveyed areas and therefore implementing an intervention to address the psychosocial needs of these young girls is highly needed.
P09–01 A picture is worth a thousand words: Illustrating spatial distribution of social environment and health indicators at the local level
M. Pageau1, M. Ferland1
1Agence de la Sante et des Services Sociaux de la Capitale-Nationale, Public Health, Quebec, Canada
In order to monitor its public health objectives and to detect emerging problems, the Public Health department of the Quebec region (Capitale-Nationale) has produced an extensive Health Portrait.Its two main objectives are to provide a large range of data about determinants of health, health status and consequences of health and to make comparisons in time and space. It was conceived as a reference tool to assist the regional health officers and planners in the decision making process in regard of establishing area based targets. It served as the basis for the second Regional Report on Health.
Two documents, one presenting data and the other focusing on analysis, have been published in 2008. The first document presents in detail the data used. The system is based on 200 indicators using 60 distinct sources, each presenting data for Quebec, the 18 health regions and by Quebec region health districts. When possible, comparisons are made with other Canadian urban regions. To facilitate access to the data, the information for each indicator is presented on two contiguous pages. There is a brief description of the data, charts, tables, sources and relevant references. Technical notes and principal limitations are also included. Statistical tests are used in most cases when comparing regions. Examples of charts and maps used to illustrate spatial distribution of social environment and health indicators at the local level will be presented.
P09–02 A tale of two neighborhoods: survival among HIV-positive individuals prescribed HAART in Vancouver, British Columbia
E.F. Druyts1, B.S. Rachlis1, W. Zhang1, V.D. Lima1, E. Wood1, S.A. Strathdee2, J.S.G. Montaner1, R.S. Hogg1, E.K. Brandson1
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2University of California, San Diego, Division of International Health and Cross-Cultural Medicine, San Diego, United States
Background: Vancouver’s West End neighborhood has the city’s largest gay and bisexual community, and the Downtown Eastside neighborhood is the center of the city’s illicit drug scene. We compared the risk of death among HIV-infected individuals accessing highly active antiretroviral therapy (HAART) in these two neighborhoods.
Methods: Clinical and socioeconomic characteristics were compared between the two neighborhoods from September 1, 1997 to November 30, 2005, using contingency table statistics. Cox survival models and Kaplan-Meier methods were used to estimate the cumulative mortality rates for the two neighborhoods.
Results: A total of 533 ARV-naïve individuals initiated HAART during the study period: 287 (54%) lived in the West End and 246 (46%) lived in the Downtown Eastside. Significant differences were observed between the two neighborhoods for all socioeconomic variables. Individuals living in the Downtown Eastside were more likely to be female, have a history of injection drug use, a less HIV-experienced physician, and poor adherence to therapy. Individuals residing in the West End were more likely to have an AIDS diagnosis. A total of 96 deaths occurred in the study population, the majority among individuals in the Downtown Eastside. The risk of death was statistically significantly higher for individuals residing in the Downtown Eastside (hazard ratio [HR] 3.01; 95% confidence interval [CI] 1.73, 5.24).
Conclusions: Our results indicate that individuals living in the Downtown Eastside are three times more likely to die than those living in the West End. Our findings point to the need for services and interventions that consider the needs and challenges of the local populations they are attempting to reach. Novel health care delivery systems need to be expanded to address the important health outcome gap uncovered. This should be done in a systematic fashion to produce the evidence necessary to support future policy development in this area.
P09–03 Absence of regular gynecological follow-up in Paris metropolitan area: A mixture of both individual and neighborhood socio-economic factors
P. Chauvin1, F. Grillo2, V. Massari1, I. Parizot3, E. Cadot1
1INSERM, U707, Research Group on the Social Determinants of Health and Healthcare, Paris, France, 2Université Paris 6, UMR-S 707, Research Group on the Social Determinants of Health and Health Care, Paris, France, 3Centre Maurice Halbwachs (CNRS, EHESS, ENS), ERIS, Paris, France
Introduction: Despite a universal health insurance by the French social security system, notable social inequalities persist in France in term of healthcare access and/or utilization which are not only explained by financial barriers, especially in primary care. Women primary healthcare inequalities remain poorly investigated in France, especially in urban contexts.
Methods: Data: First wave of the SIRS cohort study in Paris metropolitan area, conducted among a representative sample of 3000 adults in 2005. Outcome: absence of regular gynaecological follow up as declared by interviewed women. Independent variables: age, socioeconomic status and immigration status, neigborhood socioeconomic status. Statistics: multilevel logistic model.
Results: In multivariate analysis, an age under 30 or over 45 years old, a low level of education, a health insurance status limited to the basic universal health coverage and living alone were associated with the absence of regular gynaecological follow-up, as well as being a foreigner or born from foreign parents. After adjustment on all these individual factors, living in the most deprived neighbourhoods of Paris metropolitan area was also associated with a 2 fold higher risk of such an absence.
Conclusion: These results suggest that - even in the context of a universal health insurance like in France - SES, migration status and neighborhood status are as many cumulative risks of insufficient gynecological follow-up. Women health promotion and gynecological health education need to be targeted to the underserved women, especially in poorest neighborhoods.
P09–04 Access to and level of information on health care and nutrition and practices among extremely poor people in urban Bangladesh
A. Azim1, G.M. Miah1, S.H. Patwary1, S. Putul1, Z.R. Chowdhury1, S.I. Rasul1, G. Stallkamp2
1Concern Worldwide Bangladesh, Dhaka, Bangladesh, 2Concern Worldwide, Dublin, Ireland
Background: Maternal and child health care and infant and young child feeding (IYCF) practices of urban extremely poor people are often suboptimal as is knowledge about these. To improve health care and nutrition services for extremely poor people it is necessary to know their current access to and level of information as well as their health care and IYCF practices.
Method: Qualitative information on access to health and nutrition information, knowledge and practices of maternal and child care as well as on IYCF was collected in selected slums of Dhaka, Chittagong and Khulna. Twenty-four focus group discussions were conducted with 179 extremely poor people, including pregnant and lactating women, mothers of children under five years of age, husbands, women-headed households and primary health care providers (PHCP).
Results: Urban extremely poor people have very limited access to electronic media and thus to health and nutrition information broadcasted there. Their main information sources for ante- and post-natal care (ANC, PNC), child care and nutrition are neighbours, relatives, friends and informal and formal PHCP. Extent and quality of the information, however, is often inadequate. Out of 136 pregnant and lactating women, four knew about the benefits of having at least three ANC check-ups and four received PNC. Mothers of children under five had limited knowledge of IYCF in general and few (12) practiced appropriate IYCF. Among husbands, predominantly the decision-makers for seeking health care, information about health care for pregnant and lactating women and IYCF knowledge was often inadequate. Among PHCP, insufficient knowledge and counselling skills on IYCF and a large workload aggravated the situation.
Conclusion: Improving knowledge and skills of PHC providers and appropriate information sharing with and among the urban slum population could address existing knowledge-practice gaps and increase information about and access to health care for urban extremely poor people.
P09–05 Assessing community health cohesion in disadvantaged neighborhoods of Port-au-Prince
G. Debrosse1, M. Kouletio2, M. Laroche3
1Concern Worldwide Haiti, Petion-Ville, Haiti, 2Concern Worldwide US, Inc., New York, United States, 3GENESIS, Port-au-Prince, Haiti
Issue: Improving community health in urban slums requires greater community participation. In Port-au-Prince, local political and community-based organizations are the primary civil society institutions.
Description: From 2005–07 Concern Worldwide and its partners FOCAS and GRET initiated community mobilization forging relationships among non-health organizations, local health institutions and residents in five disadvantaged neighborhoods in the metropolitan area. In 2007, an independent Haitian research firm, GENESIS, assessed community health capacity using key informant interviews with 100 household heads, and 50 community based organization (CBO) leaders, assessing capacity areas of planning, dialogue and negotiation, organization structure, interaction with health system, and resource mobilization.
Lessons learned: While variation across neighborhoods exists, CBOs are increasingly working together and have taken on the role of community health mobilization. Evidence of this includes neighborhood level health prioritization, planning and inter-CBO meetings. With the exception of one neighborhood where the intervention started years earlier, residents are largely unaware of these efforts with the community. Partnership opportunities have be underexploited between the health service providers and the CBOs. On another hand, facing poor living conditions, CBO members tend to develop wider expectations towards the NGO’s.
Next steps: Qualitative findings for each capacity area were tallied and a scoring system established to facilitate action planning for CBO capacity strengthening. Recommendations include greater interchange of experiences across CBO groups and neighborhoods; concerted methodologies to engage with residents beyond holding classic meetings; promote greater self-determination among CBO members while at the same time leveraging more resources for community plans to increase momentum and the need for consultation with health services and the population.
P09–06 Community asset mapping: A tool to promote population health
1University of British Columbia, Interdisciplinary Studies, Vancouver, Canada
This poster will highlight the practice of Community Asset Mapping (CAM). CAM is the discussion, collection and display of both formal and informal resources in a community. This is a valuable process both as a community building exercise and as a method for recording the spatial distribution of resources that exist in a neighbourhood/community.
The content of this poster will draw from the research and mapping work that takes place at the Human Early Learning Partnership (HELP), an interdisciplinary research organization interested in Early Child Development. HELP is involved with CAM in both a research and a community capacity. CAM plays an important role in the context of Early Child Development work. Through CAM we are able to map the locations and capacities of services together with child development outcomes. This helps communities to gain a greater understanding of where services are most needed and how to best design programs to support the families and children who require them.
In general CAM is a powerful tool that can be used to better understand the relationship between population health outcomes and access to community services and resources. Knowledge dissemination of our research findings and helping community members engage with this process are ongoing goals at HELP. The information provided on this poster is accessible to a broad audience and will encourage participants to introduce this process in their respective communities.
P09–07 Community based groups (CBGs) can induce healthy maternal and child health (MCH) practices in the households
S. Agarwal1, R. Kumar1, K. Srivastava1, P.K. Jha1, V. Sethi1
1Urban Health Resource Centre, New Delhi, India
Background: Sub-optimal hygiene, maternal care, delivery care and child care behaviours in slum households have a cumulative adverse effect on lives of mothers and children. These behaviours are reinforced through informal social processes in the neighbourhood. Eighty slum CBGs have been able to bring positive changes in household MCH behaviours in 1.5 lakh slum population of Indore city in India.
Methods: The strategy aimed at positively influencing household MCH behaviours through informed CBGs. These CBGs started as a nucleus of early adopters. They showcased benefits of positive healthy behaviours especially those pertaining to MCH. They promoted these positive behaviours through scheduled home visits and monthly mothers meetings during critical junctures of pregnancy, neonatal period and infancy. Simple behaviour change communication technologies like flip charts, pictorial posters, context responsive job aids and experience sharing of positive and negative experiences were used for stimulating thinking for the need for change and propelling positive healthy behaviour adoption. Informal meetings during day to day social transactions also served as contact points for information sharing. Activities like Anaprasanna (traditional Indian ritual of initiating cereal food to infants at 6 months) and healthy mother-baby competitions increased MCH consciousness at home and community level.
Results: The intervention evaluation (post 3 years) shows significant positive change in household behaviours. Initiation of breast feeding within two hours of birth increased from 21% to 44% and exclusive breast feeding (0–3 months) increased form 23% to 46%.
Conclusion: Facilitating CBGs of early adopters have potential to effectively improve healthy household behaviour adoption and increase community’s capacity to improve their own health.
P09–08 Community characteristics, individual attributes and health perception among older Canadians
W. Omariba1, B. Corbett2
1Statistics Canada, Health Information & Research Division, Ottawa, Canada, 2Statistics Canada, Research Data Centres Program, University of Western Ontario, London, Canada
This study links aggregate data from the 2001 census to individual data from a combined data set of the Canadian Community Health Survey cycles 1.1, 2.1, and 3.1 to examine health perceptions among older Canadians. The sample comprises 167,768 individuals living in 3,393 neighbourhoods. The study has two main objectives: First, the study seeks to analyse the determinants of health perception to provide an indication of the determinants of healthy aging. Second, the study incorporates both individual- and neighbourhood-level factors to ascertain the relative effect of compositional (individual) and contextual (place) characteristics on self-ratings of health and to quantify between-neighbourhoods variation in self-perceived health. Although differences by neighbourhoods in self-perceived health among the older population could be due to the concentration of individuals of similar socio-economic and demographic characteristics in a certain areas, neighbourhood contexts could also affect health through available resources such as health services, the extent of social or economic inequality, and level of social cohesion. In particular, the focus on between-neighbourhoods variation and contextual factors opens up the potential to identify factors that influence health at the population level and which could be a focus of policy actions. There is modest, yet significant between-neighbourhoods variation in self-perceived health; and most of this variation is accounted for more by individual factors relative to contextual factors. The results are discussed in the context of policy implications of focusing on population-level influences of health versus individual level factors.
P09–09 Defining a neighborhood in a developing country
N.Z. Janjua1, R. Iqbal1
1Aga Khan University, Community Health Sciences, Karachi, Pakistan
Background: Defining a neighborhood a complex problem and the definitions vary from place to place even in developed countries. There is scare literature from developing countries on this issue. We conducted focus groups to come up with a definition of neighborhoods for use in our local context in Karachi, Pakistan.
Methods: We have conducted focus groups discussion with the public health professionals to seek their opinion/thoughts on what they consider a neighborhood. We listed the emerging themes and organized them in order of their frequency and emphasis.
Results: During our discussions, several themes emerged including “people living closer to each other in terms of space”. Another theme was “sharing common community resources such as mosques, local area-shops such as milk and yogurt shops”. A third although some what debatable theme was “people sharing schools and clinics”, however, many commented that clinics and schools may not be a good sharing resource as children are sent to near or far schools due to other preferences, but mosque is a major resource that provides a better sense of sharing and social interaction. Catchments of the collective resources for women such as tailor shop, beauty saloons “Women Places” was another theme. Neighborhoods defined by shared resource use may not be restricted to the administrative/political/geographical boundaries set by the local authorities.
Conclusion: Many themes emerged in our discussions but the recurrent and major emphasis was on people living in an area going to the same mosque or going to same place for purchasing daily use food items such as milk, yogurt and bread. Our work suggests that in a developing Muslim context, neighborhood could be defined by the peripheries/catchment area of a Mosque or other common use place in the area.
P09–10 Diabetes control in relation to area-level sociodemographic factors in one urban Canadian center
N. Pinto1, J. Polsky2, R.H. Glazier3, N. Kennie2
1University of Toronto, Toronto, Canada, 2St. Michael’s Hospital, Family and Community Medicine, Toronto, Canada, 3Institute for Clinical Evaluative Sciences, Toronto, Canada
Background: Socioeconomically disadvantaged groups experience high rates of adverse health outcomes, including increased risk of acute complications of diabetes. We investigated whether sociodemographic factors are related to diabetes control among patients at an inner-city academic family medicine centre.
Methods: Records of type 2 diabetes patients with at least two clinical visits in 2004–2005 were identified using physician billing claims and linked to laboratory markers of diabetes control including glycosylated haemoglobin (HbA1c), blood pressure (BP) and lipid profile. Residential postal codes were used to derive area-level sociodemographic factors from the 2001 census.
Results: A sample of 161 randomly selected records of patients with type 2 diabetes aged 40 and older was reviewed. 56% were males, and the mean age was 63 years. Compared to the city of Toronto, our study population resided in neighbourhoods that were poorer (16.7 vs. 27.6% below Statistics Canada’s low-income cut-off), and had more recent immigrants (8.9 vs.11.7%). Over half (59%) of all patients met the HbA1c targets (median HbA1c 6.7%), and less than half met targets for BP (46.6%), low-density lipoprotein (49%) and total cholesterol/high density lipoprotein ratio (TC/HDL) (43.8%). Patients in all sociodemographic groups fared similarly on nearly all laboratory parameters. The TC/HDL ratio was the only parameter that varied across sociodemographic factors, with patients residing in high-immigration and low-income areas more likely to achieve good control (Rate Ratio (RR) = 1.37, 95% Confidence Interval (CI): 1.01–1.84 and RR=1.47, 95% CI: 1.07–2.01, respectively). Approximately 10% of patients met all current guideline targets.
Conclusion: Although sociodemographic factors were not consistently related to diabetes control in this inner-city population, few patients had optimal diabetes control. With just over half of all patients meeting the HbA1c target, clinical practice has much ground to cover toward meeting current guidelines.
P09–11 Individual and contextual characteristics associated to the functional limitation in Belo Horizonte, MG, 2002–2003 - A multilevel analysis
A.A.L. Friche1, M.N. Abreu Silva1, C.C. Cesar1, V.C. Passos1, D.C. Malta2, V.C. Figueiredo2, C. Noronha2, W.T. Caiaffa1
1Federal University of Minas Gerais, Belo Horizonte Urban Health Observatory, Belo Horizonte, Brazil, 2Ministério da Saúde, SVS, Brasilia, Brazil
Background: This study aimed to evaluate the relationship between neighborhood, household and individual characteristics with functional limitation for habitual activities (FLHA).
Methods: 2.253 Individuals (>15yo) living in Belo Horizonte, Brazil, from a multicenter household survey carried out by Brazilian National Cancer Institute (2003) reported functional status for habitual activities. The presence of reported FLHA was analyzed according to the following variables: gender, age and individual self perception of health (individual level variables); socioeconomic characteristics such as total income, family’s head age and schooling (household level variables); and neighborhood characteristics using Health Vulnerability Index created by the City Health Department to classify the census tracts in 4 risk category - low, moderate, high and very high (contextual level variables). Multivariate multilevel analysis was performed by STATA software.
Results: Among 2,492 interviewed, 278 (12.3%) reported FLHA; 54.4% were women, and 37.9+16.7yo. In the final multilevel model the following variables were associated to FLHA (P<0.01): male gender (OR=0.5), age in years (OR=1.1), bad self perception of health (OR=5.2) at the individual level; at the contextual level, living in high (OR=2.7) and very high risk census tracts (OR=2.6).
Conclusions: Functional limitation among urban Brazilians has been changing not only throughout the life, as they have been influenced by factors related to the conditions of life. Being a women and living in a high and very high risk area of health vulnerability were the ones most related to the habitual activities limitations. The results point out the necessity of specific interventions directing the most vulnerable population.
P09–12 Neighbourhood stressors, perceived neighbourhood quality, and child mental health in New York City
1St. Michael’s Hospital, Centre for Research on Inner City Health, Toronto, Canada
Background: Systematic Social Observations (SSO), a technique in which trained observers rate neighbourhoods in terms of social and physical conditions (e.g., condition of buildings, residents’ behaviours), is currently becoming a popular method for measuring neighbourhood attributes. Essentially, observers rate the presence of neighbourhood stressors such as people loitering, gang and drug activity but, interestingly, studies utilizing SSO typically do not examine the data through such a perspective. The purpose of this study was to explore the relationship between these neighbourhood and other stressors and child depression as well as the potentially mediating role of children’s evaluations of neighbourhood quality.
Methods: 126 young adolescents in three disadvantaged New York City neighbourhoods completed surveys on their evaluations of neighbourhood quality and child depression. The children’s parents provided information on their own mental health and parenting practices to assess stressors at home. Neighbourhood stressors on urban decay, drug/alcohol use, and loitering were measured through SSO by outside raters.
Results: Children’s evaluations of neighbourhood quality were positively related to their assessments of depression and there was an unexpected positive association between the neighbourhood drug/alcohol stressor and child depression. Moreover, the relationship between the drug/alcohol stressor and child depression was fully mediated by the children’s assessments of neighbourhood quality.
Conclusions: Findings suggest that children can serve as valuable informants about their neighbourhoods but, interestingly, these residents do not appear to perceive neighbourhood stressors related to drug and alcohol use as such. Future directions for neighbourhood and health research will be discussed.
P09–13 Operationalization of neighborhoods to study the relations between contextual factors and health
S.M. Santos1, D. Chor2, G.L. Werneck3
1Oswaldo Cruz Foundation-FIOCRUZ, Health Information Bureau, Rio de Janeiro, Brazil, 2National School of Public Health-ENSP/FIOCRUZ, Rio de Janeiro, Brazil, 3Social Medicine Institute-IMS/UERJ, Rio de Janeiro, Brazil
Several studies highlighted the importance of collective social factors for population health. One of the major challenges is an adequate definition of the spatial units of analysis which present properties potentially related to the outcomes of interest. Political and administrative divisions of urban areas are the most common used definition, although they have limitations to fully express the neighborhoods as social and spatial units.
In this study we present a proposal for setting the limits of neighborhoods in Rio de Janeiro city. Neighborhoods are constructed by means of aggregation of contiguous census tracts which are homogeneous regarding socioeconomic indicators. Neighborhoods were created using the SKATER method (TerraView software). Criteria used for socioeconomic homogeneity were based on four census tracts indicators and considering a minimum population of 5,000 people living in the neighborhood. The process took into account the geographical limits of “bairros” (a larger neighborhood political-administrative division) and natural geographic barriers.
The original 8,145 census tracts were collapsed into 794 neighborhoods, distributed along 158 “bairros”. Neighborhoods contained a mean of 10 census tracts. The neighborhoods units set up in this study are less socioeconomic heterogeneous than the “bairros” and provide a mean of diminishing the well-known statistical variability of indicators based on census tracts. The neighborhoods were able to make a distinction between different areas within “bairros”.
Although the literature on neighborhood and health is increasing, few attention has been deserved to criteria for operationalize neighborhoods. The proposed method is well-structured, available in open access software and easily reproducible, for this reason we expect new experiences to be carried out to evaluate its potential use in other settings. The method might be an important contribution in fostering studies interested on intra-urban differentials, particularly concerning contextual factors and its implications for different health outcomes.
P09–14 Urban deprived environment and depression: Contextual analysis of the SIRS cohort data, Paris metropolitan area, France, 2005
E. Cadot1, C. Roustit1, E. Renahy1, P. Chauvin1
1INSERM UMR-S 707, Paris, France
Introduction: It has long been suggested that places where people live influence their health. However, there is little consistent evidence for the relation between urban environments and depression. We investigated relation between urban poverty and depression in a population-based prospective cohort study in Paris metropolitan area. The objective was to investigate geographical differences in depression prevalence according to the neighborhood socio economic level.
Methods: The SIRS cohort study is a longitudinal health and socio epidemiological survey of a random sample of 3000 households initiated in 2005. Prevalence of depression was estimated by the MINI-Diag questionnaire in that year. The neighborhoods of residence (NR) were classified into 4 categories according to a socioeconomic typology (from the poorest to the wealthiest). We used a multilevel regression model to examine if the NR category was still associated with a higher risk of depression, after adjusting for the individual factors.
Results: About 12% of the adult population of the Paris metropolitan area were suffering from depression in 2005. As well, a significantly higher prevalence was observed in the poorest neighborhoods. In a previous analysis, we found that many individual factors were associated with a higher risk of depression: gender, family status and job status, but also certain adverse childhood events, such as sexual abuse*. After adjustment, a strong association persisted at level 2 between living in the poorest neighborhoods and depression (aOR=2.17; 95% CI: 1.54–3.13).
Conclusion: These results suggest that social contextual factors may play a role in the risk of depression, apart from individual socioeconomic factors. Among them, neighborhood characteristics other than the typology, which was used here, will be examined with the SIRS cohort study data and the same methodology, e.g., structural (population density, urban characteristics), economic (poverty, unemployment) and social (social interactions, social capital) characteristics.*cf. companion paper
Urban Health from a Global Perspective
P10–01 Attitudes to menopause and a needs assessment for menopausal clinics among women in an urban community in Southwestern Nigeria
F.M. OlaOlorun1, T.O. Lawoyin1
1University of Ibadan, Community Medicine, Ibadan, Nigeria
Background: Although the majority of women have a positive attitude toward menopause, women in low-income countries like Nigeria face many challenges due to the lack of specialized menopausal clinics. The goals of this study were to determine the attitudes of women to menopause, factors affecting these and to explore the perceived need for menopausal clinics in an urban Nigerian community.
Methods: Both quantitative and qualitative. A cross-sectional, descriptive community-based study was designed to collect quantitative data using face-to-face interviews from 1189 women aged 40–60 years in selected clusters in Ibadan, Nigeria. Purposive sampling was used to constitute 6 focus groups (FGs), each consisting of women from similar backgrounds.
Results: Response rate for quantitative survey was 92.7%. Mean age of respondents: 48.0±5.9 years. Mean age at menopause: 48.5±4.6 years. Attitudes to menopause were generally positive. Women with >5 and 1–4 deliveries were respectively 8 and 7 times more likely than those with no previous deliveries to have a positive attitude (95% CI: 1.4–48.9; 1.1–37.3 respectively). Similarly, women who did not exercise regularly were less likely than those who did to have a positive attitude (95% CI: 0.46–0.98). All but one of the 49 participants in the FGs expressed the need for special clinics for menopausal women to provide healthcare and information on menopausal issues.
Conclusions: In the Nigerian context, a woman with children has a more positive attitude to menopause. Women in this study felt a strong need for menopausal clinics in order to experience optimal health during this period of their lives.
P10–02 Could urbanization impact the blood supply?
C.D. Oliveira1, F.A. Proietti2, A.B.F. Carneiro-Proietti1
1Hemominas Foundation, Belo Horizonte, Brazil, 2Federal University of Minas Gerais, Belo Horizonte, Brazil
The growing of the big cities could affect the public health, including the blood transfusion system. The prevalence and emergence of infectious diseases have increased and some of these diseases are transmitted by blood (AIDS, hepatitis). The urbanization also affects the needs of blood because more medical treatment and more blood products are required. Besides this, blood donor’s lifestyle and behavior are changing. Consequently, understanding the causes of deferral of donor candidates can be a way to improve donor recruitment campaigns. In MG State, Brazil, Hemominas Foundation collects, analyzes and distributes over 90% of the blood components. Blood is collected in 19 fixed units located in cities grouped,in this study, according the number of inhabitants: (1) < 100,000; (2) 100,000 to < 500,000; (3) 500,000 to < 2,000,000 and (4) ≥ 2,000,000. Data from 335,109 blood donors candidates we analyzed. Most of them were men (62.98 to 67.09%) and younger than 40 years (74.51% to 78.66%) in all groups. The percentage of approved donors were 78.91% and 65.78% in the group of cities <100,000 inhabitants and cities >2,000,000. Of the collected blood bags, 2.63% (group 1); 2.16% (group 2); 3.27% (group 3) and 2, 84% (group 4) were discarded due to reactive laboratory tests. In group 4, 2.42% of blood candidates gave up donation before completing the process, but only 0.28% in the group 1. Comparing the clinical deferrals in the four groups, 15.35% were deferred in the group 1; 18.81% in the group 2; 20.15% in the group 3 and 27.06% in group 4. Donors from the larges cities are younger; they had a higher clinical deferral rate and interrupted the donation process more frequently. These results suggest that urbanization may influence the motivation to donate and the modern lifestyle could affect the eligible donors pool.
P10–03 Environmental and health impact of household solid waste handling and disposal methods in African urban cities: Case of Ibadan metropolis
A.T. Idowu1, I.Y. Kosiru1
1Action Network, Ibadan, Nigeria
Background: The recent rapid growth of urban cities in Africa has resulted in increased consumption of resources to meet growing demands of urban populations. This resulted in increased generation of large amount of waste the existing waste management infrastructure cannot handle adequately. Most Residents, particularly of Ibadan, Nigeria resort to indiscriminate burning and burying, dumping into surface drains and water bodies. These practices pose major environmental and health threats through pollution and breeding of pathogenic organisms. Study intends to educate urban residents on the public health risks associated with indiscriminate waste disposal and stimulate policy makers to improve existing waste management system.
Methods: Study involved interviews with 960 female heads of household randomly selected within the study area of Ibadan. Target population are female household heads since women were responsible for upkeep of household environments. A detailed structured questionnaire was used to collect information on household solid waste storage and disposal practices as it relates to pest infestation, incidences of respiratory health symptoms and incidences of diarrhea among household members.
Results: solid waste was usually disposed of close to the home. Home waste storage was associated with presence of houseflies in the kitchen. Majority of respondents that reported always seeing flies in the toilet also reported presence of flies in kitchen during food cooking. Fly infestation in the kitchen is significantly associated with incidences of diarrhea. Solid waste burning was linked with incidence of respiratory health symptoms among both adults and children.
Conclusion: Study demonstrated the problems of household solid waste disposal practices and associated environment and health problems. Indiscriminate disposal is a common strategy to deal with waste as a result of inadequate infrastructure. Deteriorating environment quality is a major cause of high incidences of infectious and parasitic diseases. These problems obstruct the possibility of sustainable urban health.
P10–04 Examining the social parameters of health of the urban poor and linkages to primary health care programs: A case study from Ghana
S.M. Igras1, L. Palmer2, A. Kolb3
1Georgetown University, Institute for Reproductive Health, Washington, United States, 2The Urban Institute, Washington, United States, 3Urban Health Advisor, U.S. Agency for International Development, Washington, United States
Governments and the international health community alike are ill-prepared and equipped to tackle the emerging challenge presented by steady urban growth. The need to address health inequities of the urban poor is growing significantly and the consequences of ineffective responses are beginning to be seen. In countries such as Ghana, for example, which saw sustained reductions in national under five infant mortality rates in the last two decades and national government dedication to community-based primary health care, improvements have stagnated, possibly due to ill-health among the growing population of urban poor children. This presentation illustrates the complexities of health programming in the urban slum setting through a case study of a Ghanaian pilot health project operating in greater Accra. Urban health issues are explained by a myriad of factors outside of traditional epidemiology, such as the built environment, social inequalities, and poor governance. We conclude by proposing a primary health care approach to urban health poor programming that is multi-faceted and not disease-specific and based upon three program pillars of service delivery, community competency, and pro-poor policies linked to good governance.
P10–05 Luxurious living, green living, and healthy living: Comparative analysis of the Lullioshe hypothesis
1Simon Fraser University, Burnaby, Canada
In low- and middle-income countries, public health can be seriously threatened by urban development processes as massive demand and lack of financial resources (of possibly both developers and consumers) are major decision-making factors that often override considerations for both environmentally-friendly and healthy development. Particularly, environmental degradation by rapid development and subsequent environmental carcinogenesis pose significant amount of threat as rising chronic illness rates are already known to accompany the transition into a developed country. In search for a solution, this work explores the health capacity of the Lullioshe model (Hu, 2005), a green-architecture development model to minimize this environmental degradation for a first step in improving public health. In looking beyond environmental health, a comparative overview of varying scales of planning from land-use to room-arrangement is carried out to gauge the net health outcomes; the analysis reveals a new combination of induced health benefits and risks, including highly-marketable health promotion opportunities that may serve as suitable solutions in various situations. Results show that the central concepts of minimizing ecological footprint and marketing environmentally-sustainable living as luxurious living transfer as two distinct advantages: firstly, as minimizing the ecological footprint both protects the environment and involves resource minimization, the subsequent capital-cost reduction allows the model to be economically competitive and thus, feasible in low- and middle-income countries. Secondly, the need to rely on health education of developers and consumers is minimized through synergistic marketing of healthy choices along with environmentally-sustainable lifestyles. Conclusively, the dual-function of the Lullioshe as an environmentally-sustainable model and a healthy development model provides new diversity that will contribute to solving the complex issue of health and global urban development.
P10–06 Medical travel: A challenge for urban primary health care systems
F. Grenier1, J. Kumaresan2
1WHO Centre for Health Development, Kobe, Japan, 2Center for Health Development WHO (WKC), Kobe, Japan
Health care, one of the most rapidly growing sectors in the world economy, has not escaped the phenomenon of globalization and has become an increasingly tradable commodity. This liberalization of trade in health-related services has been supported in the last 15 years by several legal instruments, including the General Agreement on Trade in Services (GATS). While GATS provides a framework that could ultimately improve health in cities, in the absence of sound social policies, it may also deepen health inequities to the disadvantage of the urban poor. The rising popularity, particularly in developed countries, of accessing health care services abroad -most commonly in developing countries- can be seen as a potential opportunity and risk for health. While providing an attractive source of income, the liberalization of trade in medical services can alter national health systems. This literature review analyzes the status of medical travel worldwide and discuss its most important effects on urban health services. It provides a better understanding of the further research needed to shed light on the long-term consequences for urban primary health care systems. It is necessary to move toward a more equitable distribution of the potential economic benefits of trade openness through robust social policies.
P10–07 Non-communicable disease and tuberculosis burden in an urban cohort of 1,18,772 subjects in Kerala, India
S.K. T1, L.K. B2, S.S. T3, R. Peto4
1Sree Gokulam Medical College and Research Foundation, Gastroenterology, Venjaramoodu, India, 2Population Health and Research Institute, Trivandrum, India, 3CERTC, Trivandrum, India, 4CTSU, Oxford, United Kingdom
Background: Burden and risk factors for chronic diseases among tobacco users in Urban Trivandrum, India is not clear and hence the study.
Methods: Population-based, cross- sectional, house-to-house survey in Corporation of Trivandrum during 2002–2005. Baseline chronic morbidity was recorded using standard criteria. Blood pressure, height and weight, waist circumference and peak flow rate were measured among 118772 adult males aged 25 and above. Of tobacco in any form and alcohol abuse were noted. Odds Ratio with 95% confidence intervals were computed for the risk factors with prevalent cases and the controls.
Results: 48.8% were ever smokers and 35.1% were current smokers. Smoking was more in the age group 40–69 years (54%) and in the young (25–29 Years), it was 32%. Odds ratio (95% CI) for ever smoking in coronary artery diseases OR 1.85 (1.74–1.97); Tuberculosis: 3.09(2.71–3.53); stroke 1.82 (1.6–2.08); chronic bronchitis 2.36 (2.03–2.17); peptic ulcer disease 1.86 (1.7–2.1). 10.2% of non-smokers and 10.9% smokers had diabetes.22.8% of the non-smokers and 26% of the smokers had stage 1 and 2 hypertension (JNC VII). Smoking was an independent risk factor in the multivariate analysis.
Conclusions: High burden of chronic morbidity in the urban community in Kerala and the association with smoking calls for multi level interventions.
P10–08 Safe needles save lives: Improving the knowledge and practice of injection safety amongst student nurses of the University of Benin Teaching Hospital
1University of Benin, Community Health, Benin, Nigeria
Background: The World Health Organization estimates that at least 50% of the developing world’s injections are unsafe and pose serious health risks to the recipient, health workers and the public. Nigeria has been identified as a country with poor injection practices among health care workers and patients. This study aimed at improving the knowledge and practice of injection safety amongst student nurses of the University of Benin Teaching Hospital, Edo State, Nigeria.
Methodology: This quasi-experimental study was conducted between the 24th of January and the 8th of June, 2007 amongst 106 student nurses of the University of Benin Teaching Hospital using 115 students of the State School of Nursing as controls. A total population was used for the study. Every nursing student who had spent one year in the school was recruited for the study. Information was obtained from the respondents using a self-administered questionnaire and an observational checklist. The WHO/AFRO/JSI Inc. Facilitators Guide for Injection Safety was used as the manual for training intervention.
Results: There was a marked increase in the overall knowledge of injection safety amongst subjects from a baseline knowledge of 42% to 82% following intervention and this difference was found to be statistically significant (p=0.0000). There was a slight increase in knowledge of injection safety amongst controls from a baseline of 45% to 47% but this increase was not statistically significant.
Conclusion: The poor knowledge and practice of injection safety implies a need for it’s inclusion in the curriculum of Nursing Schools in Nigeria.
P10–09 Socioeconomic position and self rated health during pregnancy in urban Pakistani women
N.Z. Janjua1, B. Mahmood2, N. Sathiakumar3
1Aga Khan University, Community Health Sciences, Karachi, Pakistan, 2RTI International, Durham, United States, 3School of Public Health, Unversity of Alabama at Birmingham, Epidemiology, Birmingham, United States
Objectives: To assess the relationship between socioeconomic position and self rated health (SRH) during pregnancy among urban Pakistani women.
Methods: We conducted a cross-sectional study including 540 pregnant women presenting for delivery at obstetric units of two tertiary care hospitals in Karachi. We constructed a linear index constructed using coefficients from principle component analysis of household assets and utilities for assessment of socioeconomic position. SRH was measured using a single item on a scale of poor to excellent. We created a dichotomous variable of poor SRH by merging fair and poor. We performed logistic regression analysis to evaluate the association of socioeconomic position and self rated health.
Results: There was an inverse dose response relationship between wealth index tertiles and poor SRH after adjusting for poor nutritional status and feeling of depression. Women in lower tertile of wealth index were more likely to report poor SRH in comparison to those in upper tertile (AdjORs: 2.23, 95%CI: 1.30–3.83). Women in the middle tertile were also more likely to report poor SRH (AdjORs: 1.70, 95% CI: 1.03–2.81). Women with poor nutritional status as measured by biceps skin fold thickness and those with extreme feeling of depression were also more likely to report poor SRH.
Conclusion: Socioeconomic position is strongly associated with self rated health of women during pregnancy. Since poor SRH is related to adverse health outcomes, our results further the findings that investment in the poverty elevation programs will promote health of women.
P10–10 The built environment as a tool for global health in the face of climate change: Discussion of the new sanctuary approach
1Simon Fraser University, Burnaby, Canada
The built environment serves to modify our relationship and exposure to nature in making our world more habitable. In the face of climate change, which is, in actual fact, a grander issue of natural-environment change, our built environment needs to change accordingly. This work discusses the built environment as a potential tool for global health in the face of climate change. Firstly, it identifies the invisible populations in developing areas as ideal candidates for improved health through built environment change. Through examining the economic feasibility and overall effectiveness, a new way of establishing sanctuaries is proposed as the direction in which the built environment should change for these vulnerable populations. This work explains the benefits of two concepts: firstly, establishing sanctuaries prior to the initiation of disaster, and secondly, restructuring of communities through drawing populations into these sanctuaries as long-term dwellings. In addition, the challenges of this new sanctuary approach are discussed, and a reordered relationship between health organizations, corporations, and human rights organizations is proposed as a potential solution. When the overall cost-effectiveness of the new sanctuary approach is compared to that of our traditional ways for disaster response, it appears to be that the benefits of the new approach can arise solely from reorganizing existing systems without additional funding. Conclusively, the work proposes the new sanctuary approach as a working alternative to our ways of fighting for global health and human rights.
P10–11 The impact of compliance with international environmental law on urban health, using world cities as case studies
1Seton Hall University, Sidney, United States
Background: This research seeks to demonstrate the potential impact of participation in international environmental law on the individual’s health. By establishing an international norm of compliance with environmental law, states will cumulatively improve the overall health of the population. Because populations in general are concentrated in urban areas, this study will also concentrate on urban populations.
Methods: To measure the impact of the environmental laws being examined, raw data pertaining to urban health will be gathered from time periods before and after such laws were implemented. The difference in statistics will then be compared to control cities in which no such laws have been adopted. Concentration will be given to clean air and water laws as these issues are relevant in every environment but can be complicated by dense populations.
Results: The bulk of research is to be completed in July and August of 2008 (in conjunction with the SURF Fellowship at Seton Hall University). The hypothesis, however, predicts that cities which have committed themselves to existing international environmental laws will have healthier populations, for example having far lower rates of respiratory ailments.
Conclusions: Naturally, conclusions are unable to be reached at this time, but if the hypothesis is correct, even more value will be realized in regards to international environmental concern, and likely more awareness and activism.
P10–12 Urban health in developing countries: progress and prospects - Reflecting on interface challenges of international and national policy and realities of working on the ground
1MRC, HIV Health and Development, Johannesburg, South Africa
Using Johannesburg and South Africa as a case study, the paper brings together policy reflections on the new international urban health developments emerging from the Urban Health Knowledge Network of the WHO’s Social Determinants of Health Commission and the reality of growing urban health inequities found in cities in the south, using Johannesburg as a case study. Urban health progress and prospects are very important issues for reflection given the rapid urbanization of low income people, especially in developing countries. A review of the literature, policy analysis and secondary data are used to highlight the underlying factors impacting on the progress in achieving urban health of the poor. MDG comparisons between regions and the Johannesburg case study highlight the inequities regionally and at an intra-urban scale. In considering the prospects for urban health in the south, the paper concludes with clear pointers. Addressing poverty will have major positive impacts on urban health. In a context of high infant mortality rates, unless basic services are provided to all, many of the health related MDGs will remain a dream, especially in Africa. In addition, special efforts need to be made for access to health services, especially ante natal treatment to prevent mother to child transmission of HIV and the roll out of ART to vulnerable urban populations. Further, integrated participatory approaches to urban health often remain an ideal glittering, shimmer on the horizon. Despite the 30 years since adoption, the Alma Ata Declaration is a key policy document. The recommitment to the primary health care approach, along with greater equity is necessary for achieving the goal of “Health for All”, especially for the urban poor.
P10–13 Waste recycling for urban agriculture in Kampala, Uganda: Mapping community health hazards
1University of Toronto, Public Health Sciences, Toronto, Canada
An urban majority in Sub-Saharan Africa is expected by 2030. Kampala, Uganda is one of the Sub-Saharan’s fastest growing cities, has a population of 1.2 million, growing at a rate of 5.6% annually. Kampala is also well known for it’s innovation in urban agriculture, where 40% of the city’s food requirements are internally produced. People in urban slum environments also face environmental burdens caused by a lack of sanitation and vulnerability to flooding. The links between the recycling of wastes, urban agriculture, and food security in Kampala are well researched, yet the knowledge, perceptions, and spatial distribution of human health hazards associated with these activities are less understood.
Data is being collected through semi-structured interviews, photographs, and participatory mapping activities with residents who do not have access to sanitation, and are involved in waste recycling and urban agriculture. Qualitative and spatial data is being mapped digitally using Participatory Geographic Information Systems techniques and software including the use of mobile Geographic Positioning Systems (GPS).
This project is currently in the stage of data collection and analysis. Preliminary results show there are opportunities to improve agricultural production and reduce environmental burdens through waste recycling, but that the hazards are not equitably distributed. This new data is being combined with prior studies of flooding vulnerability, and the economic impacts of health effects related to waste exposures in the project area, to uncover any correlations between socio-economic status, spatial location and health impacts related to wastes or urban agriculture.
This project will be completed in August, 2008 and results will be disseminated to Kampala City Council, and NGOs involved in urban agriculture policy development, where several new ordinances were recently enacted.
Urban Physical Environment and Health
P11–01 A municipal-public health partnership project to develop a municipal walkability strategy in Edmonton, Alberta, Canada
M.S. Carlson1, I.S. Hosler2
1Alberta Health Services - Capital Health, Population Health & Research, Edmonton, Canada, 2City of Edmonton, Community Services (Walkable Edmonton), Edmonton, Canada
Health systems everywhere are currently struggling with the burden of 21st century public health problems-most notably chronic disease and injury-while urban centers world-wide wrestle with the complex challenges to maintaining quality of life and sustainability posed by our car-culture and sprawl. Using ‘walking/walkability’ as the entry point for connecting our respective City and public health agendas, this presentation outlines the rewarding and vexing process of developing a comprehensive, integrated and coordinated municipal walkability strategy in a large, western-Canadian winter city.
Building on a number of current planning, transportation, bicycle and cycling strategies, and community programs, the Walkability Strategy will provide a high level framework for linking and coordinating activities across city departments and with external stakeholders, and is slated for completion by October 2008. The presentation will highlight key points from the stakeholder focus groups, environmental scan, public involvement plan, special activities designed for local design and youth groups, links to related University research and the synthesis of walkability solutions.
The final report will contain a 3–5 year work plan including quantifying anticipated levels of resources required for implementation, key responsibilities and potential funding sources. Framing walkability as an element of the City’s core business and emphasizing a strategic vs. operational approach are central characteristics of the companion Strategic Communications plan, and the project overall. Nonetheless, receiving Council approval of the Strategy will depend, in part, on our success in communicating the right information to the right people at the right time. Lessons learned about moving a comprehensive initiative through levels of decision-making will also be shared.
P11–02 A summary of what is known about the cost-effectiveness of interventions for homeless populations. Are healthcare interventions for homeless populations cost-effective?
J.M. Lee1, D.J. Hoch1
1Centre for Research on Inner City Health (CRICH), Toronto, Canada
Background: Economic evidence, in addition to clinical evidence, often informs decisions about whether to provide healthcare interventions for homeless populations. However, studies about the cost-effectiveness of programs and treatments serving homeless populations are limited in number. Our study presents the results of a systematic search of available research providing economic evidence that innovative initiatives can assist homeless individuals in a cost-effective manner.
Methods: We developed a search strategy to locate information about cost-effectiveness analyses of interventions for homeless populations. A search of the PUBMED database was conducted using key terms “homeless*” and “cost-effective*” to obtain results and categorized them onto the following groups:
Results: Of the forty abstracts retrieved from the search, half described cost-effectiveness outcomes related to improved access to healthcare and services. These described how improved case management, tracking and observation, access to assertive community treatment, continuity of care, and housing supports delivered improved access to care and treatment improved outcomes. Cost-effectiveness was noted in relation to improved healthcare and service methods in half of the studies. These included savings related to modified direct drug abuse treatments methods, vaccinations, pregnancy prevention and modified therapeutic treatments for mentally ill chemical abusers. Of the remaining abstracts, 20 were unrelated to the search term “cost-effective.” Studies in this category employed a qualitative approach and reported a need for cost-effective solutions to some of the following issues: TB management, drug addiction, housing, programs to support the mentally ill, primary care, spiritual care, urban healthcare and factors leading to homelessness.
Conclusions: To better inform policy decisions, more research needs to be conducted to build the evidence base about cost-effective programs and initiatives to support homeless populations.
P11–03 A surveillance system to detect heat-related illness in a Canadian urban centre
K.L. Bassil1, D.C. Cole2, E. Pacheco3, P. Gozdyra4
1Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada, 2University of Toronto, Department of Public Health Sciences, Toronto, Canada, 3Toronto Public Health, Toronto, Canada, 4St. Michael’s Hospital, Centre for Research on Inner City Health, Toronto, Canada
Background: The adverse effect of heat on health in urban communities is of major concern. There is a need to develop a surveillance system that will indicate the incidence and distribution of heat-related illness in Canadian cities so that public health policies and interventions may be appropriately developed and targeted. Our research group pilot tested such a system using 911 medical dispatch data during the summer of 2007 in Toronto, Ontario.
Methods: Daily call information for all heat-related and aggregate counts of all emergency calls were sent to the researchers from Toronto Emergency Medical Services. The proportion of heat-related calls to all emergency calls was calculated per day and processed through an aberration detection algorithm, EARS. Public health colleagues were informed of aberrations and comparisons made with alerts generated by Toronto’s current synoptic warning system. The temporal pattern of 911 calls was compared with daily temperature measures. Spatial methods were applied to create maps of locations of calls.
Results: The temporal pattern of 911 heat-related calls was similar to temperature. There were some peaks in 911 calls that were not associated with a heat alert declared by the Toronto synoptic system. While there was not sufficient data from one study summer to examine the geospatial pattern of calls, this was possible using retrospective data from previous summers illustrating clear geospatial heterogeneity between neighbourhoods.
Conclusions: 911 calls are a useful additional data source that should be considered to support decisions around declaring heat alerts and provide new geospatial information to assist with intervention targeting for heat-related illness.
P11–04 Access to health care for homeless people with hepatitis C in Toronto, Canada
K. Mason1, E. Khandor1
1Street Health, Toronto, Canada
Background: Homeless people experience higher rates of Hepatitis C (HCV) than the general population and often experience difficulties obtaining health care, yet few studies have examined HCV-positive homeless people’s access to care. The objective of this study was to examine health and health care access among homeless adults in Toronto, Ontario who reported having HCV.
Methods: A representative random sample of 368 homeless adults in Toronto were interviewed about their health and health care access. Study findings are based on the 83 participants (23% of all homeless people interviewed) who reported having HCV.
Results: Homeless people with HCV reported higher levels of chronic pain (61%), life stress (47%) and low energy (72%), than other homeless people. HCV respondents report significantly higher rates of cirrhosis (27%), Hepatitis B (13%), latent Tuberculosis (17%) and attempted suicide in the past year (23%). Injection drug use was reported by 48% and use of crack cocaine was reported by 77%.A key indicator of health care access, 26% of homeless people with HCV reported no usual source of health care. Within the last year, 40% reported being refused health services and 61% reported experiencing discrimination by a health care provider.
Conclusions: Findings indicated that homeless people with HCV have much poorer health than other homeless people and face many barriers to accessing health care. High rates of substance use and discrimination by health care providers on the basis of drug use among people with HCV in our sample indicate a need for harm reduction models of health care. This type of model exists in Toronto and has successfully enabled HCV-positive homeless and substance using individuals to access treatment through holistic, supportive and accessible care.
P11–05 Can urban areas close to sugarcane production be healthy?
1University of São Paulo, Environmental Health, São Paulo, Brazil
Background: Brazil produces 42% of world sugarcane and the state of São Paulo 60% of Brazilian production, mainly for biofuel. Most of it is burned before manual harvest. A law scheduled the end of all burning for 2031. Meanwhile, many cities located in sugarcane areas are affected by pollutants delivered by fires in harvesting season.
Methods: Research in the city of Espírito Santo do Turvo, São Paulo, measured air pollution caused by sugarcane burning, and analyzed respiratory health of children 11 to 13 years old. Measurements of PM10, TSP, and NO2 were done during harvest period, in 2004 and 2005, at a public school patio and questionnaires to evaluate respiratory symptoms were applied to the school children. The municipality has predominantly sugarcane plantations and an alcohol processing plant close to urban area. Results of questionnaires were compared to those obtained in Juquitiba, located in watershed protection area at the metropolitan São Paulo.
Results: Air pollution levels were bellow Brazilian standards. However, results indicated higher prevalence in 22 of 28 symptoms or respiratory diseases in children living in sugarcane production municipality with statistical significance (P=0,04). Confounding factors as income of family and smoking habit of parents were controlled.
Conclusion: There are indications that pollution from sugarcane harvesting processes in use represents a respiratory health risk factor for children, even when bellow standards. More studies are needed to evaluate those effects in special in this moment of great expansion of sugar cane plantations in the country.Research funded by CNPq (Brazilian Research Council).
P11–06 Could exposition to outdoor air particulate matter pollution level serve for environmental indicator of health assessment?
J. Haluszka1, P. Konarski2, M. Scibor3, B. Balcerzak3, K. Kaczorek2, M. Cwil2, J. Radomska2, I. Iwanejko2, E. Marewicz4
1Institute of Public Health, CM, Jagiellonian University, Health and Environment, Krakow, Poland, 2Industrial Institute of Electronics, Warsaw, Poland, 3Institute of Public Health, CM, Jagiellonian University, Krakow, Poland, 4Faculty of Biochemistry Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
Background: Widespread belief of harmful health effects due to exposition to high level of airborne particles (PM) is based on the observation from disastrous accidental events and is reported in several epidemiological studies. For the other hand is not easy to prove any direct causal relationship and too little is known about its specific patomechanism. The WHO/Europe program, Environment and Health Information System (EHIS) is recommending to use the level of PM as one of environmental health risk indicators.
The main objective of our study was to find a method allowing to evidence what is the real rate and characteristic of absorption of PM into the town people airways in order to support public health and environmental policies.
Methods: The PM from the urban air in Krakow city was collected and compared with the material retrieved from the healthy volunteers sputum. Nanotechnological procedure to analyze PM included several mass spectrometry methods. Distribution of size of solid particles identified in phagocytes drawn out of the sputum was evaluated in order to compare with the ambient air pollution features.
Results: Among 20 principal elements all are in higher concentration in the urban environment than in the rural site, especially Pb, Cr - 20 times, As, Sr - 10 times higher. Phagocytic cells mostly present coarse particles in contrast to proportions in the urban air.
P11–07 Creating a relevant research method to healthcare design with action research, morphological method and evidence based design
T. Hason1, M. Thompson1, J. Holmer1
1IBI Group, Healthcare, Toronto, Canada
Issues: Healthcare facility design approaches challenges with differing methods based on the experience and education of the designer. IBI GROUP addresses the self-imposed argument that applying a common methodology when designing healthcare facilities will achieve better design outcomes and will be a better fit to meet the challenges that are unique to urban health environments.
Description: Evidence Based Design (EBD) applies research to influence healthcare facility design. EBD shares three common elements with Action Research (AR): planning, action, and reflecting. IBI hypothesizes that AR, using the Morphological Method (MM), which is an efficient way to explore solutions to non-quantified problems and can produce successful healthcare facilities. AR has not been directly connected to the EBD process until now. Used concurrently, AR and EBD create healthcare facilities that successfully integrate within urban communities and better meet the needs of users. Toronto General Hospital retained IBI to provide options for improving their public atrium. To incorporate the MM, IBI’s multi-disciplinary professionals gathered to launch an icebreaker and inspire discussion of public spaces. The group composed a list of attributes that describe preferred public spaces. Grouping these attributes into common conceptual themes, a moderator then drew “forced connections” between attributes. The groups then divided into teams and using raw materials created mock-ups of the resulting concepts.
Lessons learned: Every environment is the physical consequence of an operational strategy. EBD can be accomplished using AR principles with an attribute-oriented approach to the design of healthcare facilities, most notably in urban neighbourhoods.
Next steps: IBI will create a mandate taken from this process that can be utilized by junior and senior designers, planners and engineers. This will include ethnographic methods, observation, interviews, in-house focus groups and mock-ups.
P11–08 Designing cities for cycling
M. Winters1, K. Teschke1
1University of British Columbia, Healthcare and Epidemiology, Vancouver, Canada
Background: Cycling is a sustainable transportation option with health benefits over the car in terms of air pollution, fitness, obesity and chronic disease. Yet cycling rates in Canadian cities are low compared to certain European cities (2% modal share, versus 15–30%), indicating a great potential for change in travel behaviors. The “Cycling in Cities” opinion survey sought to understand the needs of current and potential cyclists, to target interventions to increase cycling.
Methods: We conducted a population-based survey of 1,402 adults in Metro Vancouver using a web or mail questionnaire. This elicited opinions on 73 factors that might influence cycling behavior, and current use and preference for 16 route types.
Results: The built environment was central to decisions to travel by bicycle. Factors related to route engineering and the physical, safety, and social environment had the strongest influence. The top 3 motivators were: routes away from traffic noise/pollution, bicycle paths separated from traffic for the entire distance, and with beautiful scenery. The top 3 deterrents were: routes with ice or snow, with a lot of car, bus and truck traffic, or with glass or debris. In terms of cycling infrastructure, paved off-street cycle paths were most favored. However, the most used route types were residential streets or major streets with parked cars. This disparity between preference and actual use likely lies in limited availability of preferred route types.
Conclusions: These results highlight specific infrastructure that encourages cycling, and can guide future policy to increase active transportation through city design.
P11–09 Don’t let the bed bugs bite: A community guide to living with bed bugs
S.I. Krieger1, J.L. Talbot1
1BC Persons with AIDS Society, Advocacy, Vancouver, Canada
Issue: An infestation of bed bugs can have a serious adverse effect on health. Public Health officials maintain a level of concern due to the possibility of secondary infections and weakening of the immune system. The Health department of Vancouver, Canada reported cases of bed bugs increased 600 percent from 2003 to 2005.
Description: The Advocacy Program of British Columbia Persons with HIV/AIDS Society created a fact sheet called “Are you living with Bed Bugs.” It was designed to give PLWHAS basic facts, low cost treatment and prevention tips, with a particular focus on low cost, easily accessible and applicable effective remedies.
Lessoned learned: It is challenging getting all information needed to affect PLWHA’s in an accessible and usable format. Posting the guide on the World Wide Web is empowering only to PLWHA’s with computers. We learned that easy to read fact sheets are necessary to fill the communication gap between computer user and non-computer users. This guide is a great source of self-empowerment to all PLWHA’s. This resource also teaches the use of inexpensive and non-toxic practices to prevent or control bed bugs.
Recommendation: Look at how other health authorities can use the fact sheet to create their own regional information sheets. Create an easy to read guide in several languages that will provide self-care treatment and prevention facts on bed bugs.
P11–10 Environmental control best practices: Guidelines to reduce tuberculosis transmission in homeless shelters and drop-in centres
J. Houston1, E. Rea1, B. Yaffe1, A. Longair2, N. Day1
1City of Toronto, Toronto Public Health, Toronto, Canada, 2City of Toronto, Shelter, Support & Housing Adminstration, Toronto, Canada
Toronto Public Health worked with an expert panel and community stakeholders to develop environmental control best practice guidelines and an implementation guide to reduce Tuberculosis transmission in Toronto homeless shelters and drop-in centres. These guidelines cover ventilation, ultraviolet light, and HEPA strategies, and are the first to be developed in Canada. Medical and engineering experts developed draft guidelines and then an engineering firm used them to assess nine shelters and one drop-in centre to determine (1) the extent of changes that would be required in the facility to meet the draft guidelines and (2) changes to the draft guidelines to improve them. Toronto Public Health also developed an implementation guide to assist shelter and drop-in centre operators in assessing their site and making adjustments to reduce TB transmission. This presentation will review the key recommendations in the guidelines, provide a summary of the results of the site assessments conducted by the engineers, discuss the benefits and challenges of the process used to develop the guidelines and highlight key findings for practice in other jurisdictions.
P11–11 Evaluating the effectiveness of knowledge translation of land use planning terms and processes to health professionals
L. Drasic1, T. Cheadle1, J. Mccarney2
1Provincial Health Services Authority, Population and Public Health, Vancouver, Canada, 2Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
Professional workshops and conferences are the chosen method of continuing education for public health professionals. Many stakeholders are interested in the outcomes of public health professional continuing education. A training module, “Introduction to Land Use Planning for Health Professionals” was developed by PHSA to introduce health professionals to land use planning terms and processes that significantly affect the built environment and to highlight opportunities for professional involvement. The purpose of this study was to measure the effectiveness of knowledge translation of the training module.
The study was conducted during a one day pilot of the training module with 19 public health professionals in British Columbia using quantitative and qualitative questionnaire methods through a post-workshop participant questionnaire.
The majority of participants gave the workshop high ratings in all measures. 58% of the participants reported it was a useful learning experience and 63% would recommend this workshop to a colleague. The majority reported a change in knowledge; a smaller number reported a change in skills and confidence. Emerging themes from responses included; participants were unsure of their role in this work and where it fit within the health authority mandate, and reported needing support to venture into this new role. Participants also provided suggestions on the format and content of the training module.
The workshop was effective at translating knowledge about health and the built environment and land use planning, but less effective at improving participant’s skills and confidence to work in this area. Successful knowledge translation requires relevant content, an effective delivery process and engaged participants. Embedding knowledge translation into practice requires on-the-ground support for staff to acquire skills, strategies and confidence in a new role. The learning’s from this evaluation can assist health authorities to successfully plan for and deliver future training in land use planning to health professionals.
P11–12 Getting into the kitchen: Housing, kitchen access, and nutrition of women in Vancouver’s downtown eastside
N. Formigoni1, N. Lauster2, C. Rideout3
1University of Toronto, Public Health, Toronto, Canada, 2Univerisity of British Columbia, Vancouver, Canada, 3University of Manitoba, Winnipeg, Canada
Background: Studies suggest links between housing situation and nutrition, but have not explored access to kitchens as a mediating variable.
Methods: Using a combination of qualitative and quantitative data, we investigate the relationship between housing location, kitchen access, and nutrition for women living in or using the services of Vancouver’s Downtown Eastside neighbourhood. Our lead author performed over 30 interviews with women at a prominent service provider in the DTES, followed by nutritional assessments.
Results: We find evidence that while most women currently had access to kitchen facilities, access was often limited, or had been limited in the past, with deleterious results for nutrition. We discuss these results, and we also consider the effects of sample bias on data.
Conclusions: Granting study limitations, we suggest that this preliminary research provides evidence for an important mechanism linking housing situation to health that extends beyond previous research in the area.
P11–13 Hot weather and air pollution - A global problem
M. Shum1, T. Kosatsky1
1BC Centre for Disease Control, National Collaborating Centre for Environmental Health, Vancouver, Canada
Air pollution and climate change are two of the most widespread global environmental threats. Oftentimes, hot weather and high concentrations of air pollutants occur together, particularly in urban environments. Both factors are recognized to be associated with a number of different health effects, but the effect of simultaneous exposure has not been well-studied. As opposed to air pollution studies that adjust for temperature, research studies on weather rarely adjust for air pollutants. Of those few weather studies where adjustment is made for air pollutants, the health effects from heat are less than without adjustment. The few studies that review the joint effects of air pollutants and temperature seem to indicate an additive effect and a super-additive effect for high concentrations of ozone and high temperature. Intervention strategies can include warning systems to encourage individuals to seek out shelter with central air-conditioning and education of building managers to reduce fresh air intake levels during episodes of poor air quality. With ever-increasing episodes of heat waves across the globe, understanding the interaction between heat and air pollutants becomes extremely important
P11–14 Moving right along: Transportation, public health and social equity
1Alberta Health Services - Capital Health, Population Health and Research, Edmonton, Canada
The impacts of built environment design on public health are increasingly being recognized by researchers and practitioners in both public health and planning fields. In this presentation, the health implications of urban transportation network design - which emphasizes automobile transportation - will be analyzed from two perspectives -impact on physical health (e.g., chronic disease, injury) and impact on social equity.
There are three interconnected components to this discussion. The first part examines connections between transportation and public health, building on existing evidence demonstrating linkages between automobile dependent transportation planning and rates of chronic disease and injury. The second section explores questions of transportation and social equity, examining the way(s) current transportation planning privileges some groups, and marginalizes others - most notably, children, some seniors, those with low socio-economic status, and others with limited access to automobile transportation. This paper concludes with a brief analysis of the benefits of including a public health perspective in municipal transportation planning processes and lessons learned from the experience of strategically advocating for health-promoting urban design.
P11–15 The problems of poor physical planning on the health of urban residents in Akure, Nigeria
1Ondo State Ministry of Lands, Housing and Environment, Planning, Research and Statistics, Akure, Nigeria
This paper examines akure physical environment and its various implications on the Health of residents. The paper also identifies the various problems that have aided the decline in quality of akure urbanscape which is characterized by lack of basic infrastructural amenities, low quality housing, high occupancy ratio, inaccessible neighbourhood, poor ventilation, poor sanitation, contravention of lands and building regulations. The study confirmed that the poor physical planning situation in akure has serious adverse effects on the heath of its residents. Strategies for improving the built environment for healthy and sustainable living are variously suggested. In conclusion, it was suggested that it is imperative to check and prevent further physical deterioration giving room for harmonious living and sustainable development in akure metropolis.
Urban Social Environment and Health
P12–01 Air pollution and BTEX: A case study in Quito, Ecuador
R.E. Harari1, M. Fierro2, R. Brillante2, A. Barbieri2
1IFA.Corporation for Production Development and Work Environment, Research, Quito, Ecuador, 2Universita degli Studi di Bologna, Servizio di Medicina del Lavoro, di Prevenzione e Protezione e di Fisica Sanitaria, Bologna, Italy
Background: In Quito, Ecuador, traffic is considered as the main source of air pollution. Environmental compounds commonly monitored are NO2, SO2, O3, and Particulate Matter but few information has been collected for VOC’s, especially Benzene, Toluene, Ethyl Benzene and Xylene (BTEX) that by now is not monitored by the air monitoring network.
Methods: Air monitoring was realized for BTEX in 5 areas known to have high traffic in Quito. The monitoring was realized during 12 hours and during 14 days with different samplers (Radiello and Drager respectively). Also in inhabitants of these areas urine samples were collected to determine metabolites of these compounds to assess individual exposure. All the samples were analyzed in the Department of Medicina del Lavoro of the Bologna University, Italy and in Drager Safety AG & Co. KGaA, in Germany.
Results: Results showed the environmental presence of BTEX in all the areas but especially in areas with high traffic of public transportation where concentrations were higher than 20 ug/m3 for Benzene, Toluene and Xylene. For Ethylbenzene Concentrations were around 10 ug/m3.In the urine samples of inhabitants of these areas the presence of metabolites of BTEX in urine was found. Results in the reference area were lower.
Conclusions: Public transportation is a big problem in Quito and also could be the cause of environmental exposures in population and in informal workers that work in the streets of this areas.
P12–02 Asking health professionals about workplace and patient safety
S. Baculea1, P.C. Radu2
1National School for Public Health and Health Services Management, Health Services Analysis, Bucharest, Romania, 2National School for Public Health and Health Services Management, Teaching, Bucharest, Romania
Background: The working environment in healthcare facilities and organizational culture are major determinants of patient safety. This study is aimed to get some perspective on the organizational culture in Romanian hospitals.
Method: A survey was conducted in 12 hospitals from different districts, based on a questionnaire; the target group were senior and junior medical and non-medical staff. The questionnaire was aimed to realize a screening of the problem, to get some specific views of respondents from their work experience, and eventually to get suggestions on how to improve patient safety. Same questionnaire has been previously applied in four other countries: Australia, Singapore, Sweden and Norway. Overall views of hospital professionals from Romania were compared to those from the other countries. Also, views per professional categories were compared.
Results: Answers from 100 respondents from Romania indicate that patient safety is a major concern of hospital professionals, and it should be improved. No major differences in the organizational culture exist between countries in regard to patient safety. However, differences among professional categories have been noticed, for example nurses are more aware than doctors on the need to take action for improving patient safety.
P12–03 Assessment to find the causes for discontinuation and treatment limiting adverse drug reactions among HIV infected patients
1Kathmandu Medical College Teaching Hospital, Medicine and Research, Kathmandu, Nepal
Background: There are various factors that affect the treatment regimen of the HIV infected patient. There are cases of discontinuation and treatment limiting adverse drug reactions (TLADR) among the patients. The aim of this study is to find out the causes for discontinuation and treatment limiting adverse drug reactions among patients starting their first protease inhibitor (PI).
Methods: 200 HIV infected patients were involved in the study. Data on patients starting a PI regimen (ritonavir, saquinavir and indinavir) were observed and these documents were used to reason out the discontinuation and TLADR. Risk factors for discontinuation of the initial PI and TLADR were assessed.
Results: A total of 23 discontinued the initial PI therapy within less than 1and half years. TLADR was the most common reason for discontinuation. The incidence of TLADR was: 7.5 (indinavir), 59.0 (ritonavir),18.7 (saquinavir) per 100 person within a years of follow-up. It was found that body weight and type of PI initiated were risk factors for treatment discontinuation and TLADR. The risk of developing TLADR increased by 18% per 6kg lower body weight when starting the PI regimen. It was observed that ritonavir was associated with higher risk of TLADR than other PI regimens.
Conclusions: Because of adverse drug reactions, most patients stopped the treatment with the initial PI. Low body weight and initiation of ritonavir relative to other PIs were associated with an increased risk of TLADRs.
P12–04 Burden of life style risk factors in a transition society in Kerala, India
L.K. B1, S.K. T2, S.S. T3, R. Peto4
1Population Health and Research Institute, Trivandrum, India, 2Sree Gokulam Medical College and Research Foundation and Population Health and Research Institute, Gastroenterology, Venjaramoodu, India, 3CERTC, Trivandrum, India, 4CTSU, Oxford, United Kingdom
Background: Very little data on the burden of life style risk factors in an urban society in Kerala, S India.
Methods: Design: Population-based, cross- sectional study in the Corporation of Trivandrum during 2000–2002. Data were collected from 1,18,772 permanent resident adult males aged 25 and above. Using a structured questionnaire, trained social investigators collected data on the habits (smoking; smokeless tobacco; alcohol consumption), body mass index and household possessions, education, occupation.
Results: 48.8% were ever smokers and 35.1% were current smokers. Smoking was more in the age group 40–69 years (54%) and in the young (25–29 Years), it was 32%. Current use of smokeless tobacco was 12.8% and ever use was 16.7%. 42.2% consumed alcohol in any form. Tobacco habits were associated with low levels of schooling (p 0.00001) and the prevalence rate of smoking was 65% in the illiterate; 68.8% in the primary (1–5 Years of schooling); 63% in the secondary (6–9 Years of schooling); 47% in the matriculate and 35% in the educated group (11 years or more of schooling). 37% did not have any habits; 25% had at least one habit and 28% had 2 habits and 8.4% had all the three. There was inverse relation with income, type of housing and possessions. Quit rates of Tobacco among the various age groups were: 25 to 29 Years: 3.7%; 30 to 44 Years: 7.8%; 45–59 Years 16.4%; 60 and above 26.9%. 26% in the young (25–43 Years), 28% in the middle age (44 to 59) and 20% in the elderly (60 and above) had a BMI of greater than 25.
Conclusions: High prevalence of tobacco use, alcohol abuse and higher BMI in the urban Trivandrum is different from other states in India and needs behavioral interventions.
P12–05 Development and pilot test of project DiSH - A novel HIV risk reduction intervention targeted to African-American MSM
S. Bonner1, B. Powell2, P. Metralexis3, J.J. Chin4, J.E. Egan1, B. Koblin5
1The New York Academy of Medicine, Center for Urban Epidemiologic Studies, New York, United States, 2Gay Men of African Descent (GMAD), New York, United States, 3The Educational Alliance, New York, United States, 4Hunter College, Department of Urban Affairs and Planning, New York, United States, 5The New York Blood Center, Laboratory of Infectious Disease Prevention, New York, United States
Background: It is estimated that half of all African-American men who have sex with men (MSM) living in major US cities are already infected with HIV. The multiple stigmas experienced by these men contribute to their greater risk through fractured identities and dislocation from communities.
Methods: This five session intervention, designed as an opportunity to engage African-American MSM in deconstructing sex and food choices while developing skills to create a new social environment, integrates sexual risk reduction exercises with the cooking and sharing of a meal. Sessions include “The Healthy Me Meal” and “The Intimate Meal.” A pilot and focus group was conducted with nine participants. The group included both HIV+ and negative men of a range of ages (20–50 years), sexual identities, and cooking experience. There was 100% attendance across the 5 sessions and the focus group.
Results: In the post-intervention focus group, participants clearly articulated analogies between healthy eating and healthy sex and reported increased sense of connection to other African-American MSM, confidence in their ability to grow social and sexual support networks, and increased sense of community responsibility. Many participants also reported changes in dietary and sexual behavior. The efficacy of the intervention will be assessed in an upcoming RCT with 300 men.
Conclusion: This intervention presents a creative new modality for addressing stigma and sexual risk that affect HIV transmission among African-American MSM.
P12–06 Exploring the roles of urban municipal governments in addressing population health inequities: A census of opinions of politicians and senior-level staff
1Simon Fraser University, Geography, Burnaby, Canada
Background: Despite an outpouring of literature on health inequities (HI) in the past 30 years, very little of this academic activity has translated into policy action to alleviate HI in Canada. Many challenges to knowledge translation have been articulated, but the roles of urban municipalities in addressing HI remain unclear.
Objective: To census municipal politicians and senior-level employees across the Metro Vancouver region to assess their perceptions of the roles and responsibilities of urban municipalities in addressing local HI.
Methods: A postal survey was administered to 637 politicians and senior-level employees of 17 Metro Vancouver member municipalities. The survey assessed participants’ attitudes towards the social determinants of health (SDOH); their perceptions of municipalities’ roles, relative to other sectors, in addressing HI; their views on levers for, and constraints on, municipal HI policy; and their awareness of existing municipal policies that address HI.
Results: The overall response rate was 54% (345/637). The majority of respondents were high-income, university-educated, middle-aged males. Maintaining a healthy lifestyle was viewed as the most influential SDOH. Provincial governments were deemed the most responsible sector for addressing HI. Parks & recreation facilities were considered the most influential policy levers, while insufficient federal and provincial funding were deemed the biggest constraints on municipal HI policy. Parks & Recreation were viewed as bearing the greatest responsibility within municipal governments, while affordable housing and fitness programs were the most commonly identified municipal HI policies.
Conclusions: Respondents offered fairly traditional views regarding the SDOH, approaches to reduce HI, and level of municipal responsibility relative to higher levels of government. Greater efforts could be made by researchers to engage with municipal policy actors on the HI literature to ensure the complexity of the SDOH and the broad scope of HI policy is understood by these actors.
P12–07 Falling short: Factors associated with HIV testing among Canada’s Aboriginal population
C.W. McInnes1, E.F. Druyts1, K.A. Fernandes1, K. Clement2, M. Gilbert3, V.D. Lima1, J.S.G. Montaner1, R.S. Hogg1, A. Palmer1
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2Healing our Spirit, British Columbia Aboriginal HIV/AIDS Society, Vancouver, Canada, 3BC Centre for Disease Control, Vancouver, Canada
Background: HIV testing is a fundamental component of both treatment and prevention efforts for the disease. Given the high rate of HIV incidence among Aboriginals, identifying testing barriers among Aboriginals remains an important public health initiative.
Methods: Data were drawn from the Aboriginal Peoples Survey (APS) Public Use File (2001) which represents a weighed sample of 522,621 Canadian Aboriginals. Bivariate analysis and logistic regression were used to identify variables that were associated with individuals having received an HIV test.
Results: Variables that were associated with having received an HIV test in multivariate analysis included female gender (Odds Ratio [OR] 1.59; 95% CI 1.47, 1.71), being over the age of 24 (OR 1.31; 95% CI 1.19, 1.45), living in urban communities (OR 1.38; 95% CI 1.19, 1.45), having completed grades 10–13 (OR 1.22; 95% CI 1.12, 1.34), an income greater than $10,000 (OR 1.31; 95% CI 1.20, 1.43), contact with a family doctor (OR 1.53; 95% CI 1.41, 1.66) or a traditional healer (OR 1.70; 95% CI 1.46, 1.97), having self-rated health below “excellent/very good” (OR 1.35; 95% CI 1.24, 1.48), drinking (OR 1.16; 95% CI 1.05, 1.28), and smoking (OR 1.21; 95% CI 1.07, 1.37).
Conclusions: The results of this study demonstrate that Aboriginals with less education, lower incomes, and reduced access to care were less likely to have received an HIV test. Additionally, males, non-smokers, and younger Aboriginals were also less likely to get tested. Service planners should consider these factors in future HIV testing strategies for Aboriginals.
P12–08 Ffactor influencing the use and non-use of seatbelt among professional drivers in University of Ibadan, Nigeria
C.R. Onyema1, O.O. Oladepo1
1University of Ibadan, Health Promotion and Education, Ibadan, Nigeria
Introduction: Road traffic accidents (RTAs) are a major cause of death and disability in Nigeria. The use and non use of seatbelt is one of the technologies put in place to reduce the impact of RTAs on drivers. However, little is known about the factors that influence its use. This study was therefore designed to determine the factors that influence the use and non use of seatbelt among professional drivers employed by the University of Ibadan.
Methodology: A cross sectional study was employed, using a self administered semi-structured questionnaire. Out of 228 questionnaires administered, 202 were recovered. The questionnaire explored drivers’ demographic characteristics, knowledge on seatbelt, attitude to seatbelt use and factors which influence their compliance with seatbelt use. In addition, a key informant interview guide was used to collect qualitative information. The quantitative data collected were analyzed using descriptive statistics and Chi square.
Results: All the drivers were males, More than half (56.4%) had primary Education. All the respondents had heard about seatbelt and their overall mean knowledge score relating to seatbelt was 1.3±0.7 out of 2points. Respondents with tertiary education knew more about seatbelt use (1.4±0.5) than those in secondary (1.2±0.6) and primary education (1.3±0.5). The overall attitude score relating to seatbelt use by the respondent was 66.3%.More than half of the respondents (51.2%) feel comfortable with seatbelt, (44.8%) uncomfortable, while (4.0%) feel caged up.Only (38.6%) used seatbelt always, while (61.4%) used seatbelt occasionally. Occasional use of seatbelt was mainly when the law enforcement agents are on the check (60.5%).
Conclusions: Overall seatbelt use were low (38.4%) in spite of the existence of the law mandating the use of seatbelt by drivers. Better enforcement of law on seatbelt and enlightenment, training by the institution authority is necessary to upgrade their knowledge.
P12–09 Intake of nutrition supplements amongst people exercising in gyms
J.L. Goston1, W.T. Caiaffa2, I. Correia1
1Federal University of Minas Gerais - Belo Horizonte, Belo Horizonte, Brazil, 2Federal University of Minas Gerais - Belo Horizonte, Epidemiology, Belo Horizonte, Brazil
Background: Exercise has become more popular amongst the general population and the intake of nutritional supplements has been widely increased, with people using these products for different purposes not well defined. Therefore, it was the objective of the present study to assess the prevalence and the factors associated with dietary supplement usage amongst exercisers in different gyms in the city of Belo Horizonte, Brazil.
Methods: Cross sectional study enrolling randomly selected individuals in 50 gyms located in different regions of the city.
Results: 1,102 subjects of both genders and all social classes were assessed. It was found that 36.8% (n=405) of the people used supplements. The highest intake was amongst men (63.5%). Five products were mostly consumed and they were those rich in proteins and amino acids (58%), isotonic drinks (32%), rich in carbohydrates (23%), natural/phytotherapy (20%) and multivitamins/mineral supplements (19%). 43.5% of cases used two or more products simultaneously. Many participants (55%) reported consuming nutritional supplements without any specialized professional guidance, usually based on self-prescription or recommendation of either friends or salespeople and some (14.1%) used supplements as advised by physical trainers, who are not qualified to make such recommendations. Interestingly, 74% of the gyms had working dietitian on staff. Choices and reasons for using supplements varied with age and gender of the participants. The oldest (> 45 y) consumed mostly multivitamins and herbal supplements. They took supplements to prevent future illness while the youngest <30y consumed protein supplements more frequently with the intention to build up muscle mass.
Conclusion: Our results suggest that supplements are widely taken and are often prescribed by those not qualified to do so. Therefore, increased efforts should be undertaken to educate the general population on the subject, mainly in gyms or sports areas.
P12–10 Internet use by clients in an urban provincial STI clinic
G. Ogilvie1, D. Taylor1, M. Gilbert1, H.-J. Kim1
1BC Centre for Disease Control (BCCDC), STI/HIV Prevention and Control, Vancouver, Canada
Background: The internet is understood to be an increasingly important venue for individuals to find sexual partners. Reports of such work have focused on internet use among men who have sex with men (MSM). In this study, we examined the use of internet for seeking sexual partners by women.
Methods: Between August 2005 and April 2008, all women seen at the BCCDC Provincial STI Clinic were asked about their use of the internet to find sexual partners. Bivariate comparisons were performed between internet users and non-users in terms of age, gender, participation in the sex trade, injection drug use, sexual orientation and history of STIs using Chi square analysis for categorical variables and Student’s t-test for continuous variables. Logistic regression analysis was conducted to determine factors associated with seeking partners on the internet.
Results: Of the 11,319 encounters with women during this time period, 834 (7.4%) used the internet to seek sexual partners. Among those who disclosed which websites they used (574), LAVALIFE (207) and PLENTYOFFISH.COM(108) were the most commonly reported sites. Women who were seen at the Provincial STI clinic compared to those seen in outreach settings were significantly more likely to report use of the internet to see partners (AOR 4.5;95%CI 3.8,5.3). Women who were sex trade workers (AOR 0.1; 0.02, 0.9), who had current Chlamydia infections (AOR 0.6; 0.4, 0.8) and who used injection drugs (AOR 0.4; 0.2, 0.6) were significantly less likely to report use of the internet to find sexual partners on the internet.
Conclusions: Women use the internet to seek sexual partners, and thus, is a venue for education and information for women who present for screening for STIs. For some women, such as sex trade workers, and injection drug users, the internet may not be the most effective tool for communication.
P12–11 Making sense: Communicating neighbourhood indicators data on health and social environment to local communities
M. Ferland1, M. Pageau1
1Agence de la Sante et des Services Sociaux de la Capitale-Nationale, Public Health, Quebec, Canada
In order to monitor its public health objectives and to detect emerging problems, the Public Health department of the Quebec region (Capitale-Nationale) has produced a extensive Health Portrait. Its two main objectives are to provide a large range of data about determinants of health, health status and consequences of health and to make comparisons in time and space. It was conceived as a reference tool to assist the regional health officers and planners in the decision making process in regard of establishing area based targets. It served as the basis for the second Regional Report on Health.
Two documents, one presenting data and the other focusing on analysis, have been published in 2008. The second document summarizes the main results in sixteen sections covering the determinants of health (social, economic and physical environments, lifestyles, behaviors and risk factors, organization of health care) the main health problems (chronic and infectious diseases, morbidity, mortality, disability) and different life cycles and populations (gender differences, perinatal and maternal health, youth, workers, seniors). It is based mainly on the 200 indicators described in the first document. When possible, comparisons are made with other Canadian urban regions. Special attention was given to present neighborhood indicators in a format accessible to a non specialized audience. Different formats used to summarize the data will be presented including a foldable poster inserted in each document showing district disparities for 50 indicators.
P12–12 Mapping dignity: The cartography of dignity in the city
N. Jacobson1, V. Oliver2
1University of Toronto, Toronto, Canada, 2York University, Toronto, Canada
Every interaction among city dwellers has the potential to be a dignity encounter in which dignity may be either promoted or injured. How do the physical and social environments of urban geography figure in the urbanite’s experience of dignity?
In the health and human rights approach, dignity has been theorized as a social determinant of health, a mechanism that explains health disparities linked to factors like economic inequality and social exclusion. This poster draws on interviews with members of marginalized groups living in Toronto, Canada and with health and social services providers who work in Toronto to map the social processes of dignity encounters. These encounters are embedded in a complex web of conditions related to social order, settings, actors, and relationships. Our aim is to illustrate the ways in which urban dignity encounters, and therefore urban health, are related to the places and spaces that urban residents navigate every day.
P12–13 Promoting HIV/AIDS and sexual reproductive health rights (SRHR) in Kalisizo town council
E. Mbidde1, S.M. Mbidde2, R. Lule3, S. Nelson4
1Rakai Community Development Trust (RACDET), Kampala, Uganda, 2Rural-Urban Change Initiative, Kampala, Uganda, 3Rakai Rural Change Agency, Kyotera, Uganda, 4Millennium Development Consult, Kampala, Uganda
Issues: Mainstreaming HIV/AIDS and SRHR in the existing organizational Mechanisms as well as reviewing HIV/AIDS program, policy strategy and implementation.
Objectives: To enhance a supportive environment among staff in dealing with HIV/AIDS and SRHR at the work place. To build capacity and promote a right based approach to implementation of program activities among stakeholders and their networks.
Project description: HIV/AIDS is increasingly affecting productivity and sustainability of employment. As a result the project has developed an internal HIV/AIDS policy aiming at promoting and protecting the health and rights of her employees by creating and supporting the creation of a safe and friendly environment for all staff affected or infected by HIV/AIDS.The project focuses on strengthening partners, interventions and their networks to initiate and implement community based interventions for HIV/AIDS prevention Care and Support, long-term coping and impact mitigation for improved reproductive health
Lesson learned:HIV/AIDS programs at the workplace should include;
Next steps: HIV/AIDS programs at the workplace must aim to strengthen the institutional capacities of partner CBO’s and their networks, strengthen policy and advocacy campaigns both at national and regional levels and strengthen the sharing experiences, knowledge and skills among partner.
P12–14 Reasons for and consequences of choosing informal over formal health care providers by extremely poor people in urban Bangladesh
A. Azim1, G.M. Miah1, S.H. Patwary1, S. Putul1, Z.R. Chowdhury1, S.I. Rasul1, G. Stallkamp2
1Concern Worldwide Bangladesh, Dhaka, Bangladesh, 2Concern Worldwide, Dublin, Ireland
Background. For extremely poor people living in urban slums of Bangladesh, informal health care providers (IHCP), including pharmacists and quacks, are usually the first entry point for seeking health care/ treatment. To improve health care provision in urban slums, it is important to understand why extremely poor people choose a certain provider. Method. Qualitative information on health care seeking behavior was collected in selected slums of Dhaka, Chittagong and Khulna. Twenty focus group discussions (FGDs) were conducted with 158 extremely poor people. In each city, an in-depth interview on knowledge and practices was carried out with the most popular IHCP identified during FGDs. Results. Most of the urban extremely poor people choose IHCP due to their proximity to the community. There is good rapport between the IHCP and the community and the latter do not need to pay any consultation fee. This is especially important when screening for available fee/ cost exemption schemes did not identify eligible extremely poor people. IHCPs sell medicines at lower prices due to lower drug quality and cheaper procurement; and they allow people to buy them on credit. IHCPs have longer service opening hours (late evening) than formal primary health care (FPHC) providers (early afternoon). However, IHCP sometimes prescribe inappropriate medicines or inadequate doses due to lack of formal training. Furthermore, there is a misconception in the population that FPHC is available to mothers and children only. Conclusion. Choosing IHCPs provides financial advantages to people with extremely limited financial capacity. Such choice may, however, increase the risk of irrational drugs use and misuse of limited financial resources. Moreover, the FPHC system may not be accessed by the male population when actually needed. Developing capacity of IHCPs and establishing effective referral systems with existing FPHC providers will improve health care delivery to extremely poor urban people.
P12–15 Social support and depression: Results from the SIRS cohort study, Paris area, 2005–2007
C. Roustit1, E. Cadot1, H. Wynne1, P. Chauvin1
1INSERM, UMR-S 707, Research Group on the Social Determinants of Health and Healthcare; UPMC Univ Paris 06, UMR-S 707, Paris, France
Background: Social support reflects a transactional process between the individual and his/her social environment, which, in turn, can influence his/her mental state. The aim of this study was to investigate the predictive effect of a lack of social support on the risk of depression occurring in the general population.
Methods: Data: the Health, Inequalities and Social Ruptures cohort study (SIRS), a longitudinal study initiated in 2005. Sample: a representative random sample of households (n=3023 adults) in the Paris metropolitan area; second wave of data collection in 2007 (n=2082; lost cases: 31%). Outcome: self-reported depression. Independent variable: familial and extrafamilial support recorded as a dichotomized variable. Covariates: parent-child relationships in childhood, parental psychopathologies, adverse life events in childhood, and current socioeconomic status. Analysis: weighted logistic regression analysis.
Results: In 2005, the prevalence rate of depression in the Paris metropolitan area was 11.7%. In 2007, 202 new cases of depression were recorded in the second wave of data collection. After adjusting for current socioeconomic status, the risk of depression was found to be higher in individuals who had been exposed to domestic violence in childhood and/or who had had poor parent-child relationships. When these adverse childhood experiences and the sociodemographic factors were included in the models, a lack of social support in 2005 increased the risk of depression in 2007 threefold.
Conclusion: Our prospective investigation supports the association between a lack of social support and the occurrence of depression. However, a lack of social support may only be a presymptom of depression at the clinical level. To conclude, with regard to causal factors, further multilevel analyses are needed to argue for the importance of strengthening the social network as a means of preventing depression.
P12–16 Social support buffers the negative effects of HIV-related stigma on health-related quality of life in the OHTN cohort study
S. Rueda1, T. Bekele1, K. Gibson2, J. Cairney3, S. Rubenstein1, P. Millson2, B. Adam1, R. Rosenes4, C. Logie2, S.B. Rourke1
1Ontario HIV Treatment Network, Toronto, Canada, 2University of Toronto, Toronto, Canada, 3McMaster University, Hamilton, Canada, 4Canadian Treatment Action Council, Toronto, Canada
Background: Stigma continues to act as a significant stressor in the lives of PHAs. The objectives of this study are:
Methods: A total of 290 PHAs provided baseline data in the context of the OHTN Cohort Study (OCS), an ongoing observational study examining the clinical and sociobehavioural determinants of health in HIV/AIDS. We collected data on demographic status (age, gender, country of birth, ethnicity, education, sexual orientation, employment status), HIV disease markers (time since diagnosis, HIV-related stigma), psychosocial resources (social support, mastery) and HRQOL (SF-36). We performed regression analyses to evaluate the effects of stigma on both the Physical and the Mental Component Summary of the SF-36 (PCS and MCS respectively). We controlled for potential confounders and computed interaction terms to examine whether an external (social support) and an internal psychosocial resource (mastery) moderate the relationship between stigma and HRQOL.
Results: The first model showed that stigma has an independent effect on both HRQOL summary scores after controlling for potential confounders [PCS (β=−.16, 95%CI −.3 to −.04) and MCS (β=−.45, 95%CI −.56 to −.34)]. Subsequent models showed that social support and mastery diminished the strenght of the association between stigma and HRQOL. However, an examination of the interaction terms showed that only social support buffers the negative effect of stigma on the physical health component of quality of life.
Conclusions: HIV-related stigma has detrimental effects on health-related quality of life and these negative effects were attenuated by the presence of social support. These findings lend partial support to the notion that social and personal resources can be mobilized to ameliorate or contain the negative effects of stigma.
P12–17 Socio-cultural determinants of hepatitis B screening-behavior in the Turkish-Dutch population in the Netherlands
Y.J.J. van der Veen1, H.A.C.M. Voeten2, O. de Zwart2, J.P. Mackenbach1, J.H. Richardus1
1Erasmus MC, University Medical Centre Rotterdam, Dept. of Public Health, Rotterdam, Netherlands, 2Municipal Public Health Services, Infectious Disease Control, Rotterdam, Netherlands
Chronic Hepatitis B virus infections (HBV) are an important problem in the Turkish-Dutch community. To prevent further transmission and to detect individuals eligible for treatment, screening for HBV should be promoted through cultural sensitive public health interventions in this population. In order to develop these interventions, we need to have insight in how socio-cultural and behavioral determinants are related with the intention to be screened for HBV.
We conducted a postal survey amongst first and second generation migrants in the age group 16–40 years. We tested an hypothesized model, which described the plausible associations of socio-cultural and behavioral determinants with the intention to be screened for HBV. Statistical analysis included ordinal regression and mediation analysis.
The response rate was 30.2% (n=355). Univariate ordinal regression showed that a positive intention towards screening was associated with higher age (p=.02), Dutch language orientation (p=.04), more positive attitude (p=.005), higher self efficacy (p=.002), a lower chance locus of control score (p=.04), higher perceived social influence (p=.02) and social support (p=.003), higher level of ethnic identity (p=.02), higher satisfaction regarding the quality of Dutch health care [satisfaction] (p=.04), and weaker perception of a link between HBV screening and sexuality [sexuality] (p=.04). Multivariate analysis adjusted for gender, age, and language orientation, produced a base model of ethnic identity (OR=1.6 (1.13–2.14)), satisfaction (OR=1.2 (1.01–1.45)) and sexuality (OR=0.8 (0.64–0.98). Mediation analysis showed that the effect of sexuality was partly mediated by attitude and self-efficacy, and that satisfaction with the Dutch health care was partly mediated by self-efficacy. Ethnic identity was directly associated with the intention to screening.
We identified socio-cultural determinants related to the intention to HBV screening, and how these are mediated by behavioral determinants. Based on this knowledge we will develop a culturally tailored intervention aimed at promoting HBV screening in this particular population.
P12–18 The social construction of homelessness - Whose fault? What solutions?
J. Frankish1, D. Grey1, G. Moulton1
1University of British Columbia, Centre for Population Health Promotion Research, Vancouver, Canada
Our focus was health disparities in homeless persons in Vancouver. We need understanding of knowledge, attitudes, beliefs and values of individuals/groups who are affected by, or engaged with, the ‘problem’ of homelessness. We gathered innovative data around ‘public perceptions’ of homelessness. We shared these perspectives with stakeholders. Our study focussed on
Our approach included the adoption of a participatory research approach and creation of a community advisory council. Our methods involved an updated literature review. In parallel, we did a review of coverage of homelessness in Vancouver print media since Expo 86. We also did semi-structured interviews of service providers, health professionals and policy and decision makers. Our results provide important insight into the role of media in shaping urban health issues such as homeless. We will present data on the portrayal of causes/solutions to homelessness and discuss their implications for policy and practice.
P12–19 The social production of healthy public space
A. Kane Speer1, M. Zangeneh2, A. Jabbar2, H. Gibson-Wood2, B. Ross1, J. Dunn3
1Centre for Urban Health Initiatives, University of Toronto, Toronto, Canada, 2Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Canada, 3Centre for Research on Inner City Health, St. Michael’s Hospital, and University of Toronto, Departments of Geography and Public Health Sciences, Toronto, Canada
Background: This study investigates the relationship between access to public gathering spaces and self-reported health with community social characteristics (sense of community, collective efficacy, etc.) as the intervening variables. This study was undertaken to investigate the relationship between access to public space and self-rated health status, specifically those aspects of public space which foster place attachment and may address urban health concerns in multicultural communities.
Methods: A survey of randomly selected households was conducted across four low-income Toronto neighbourhoods, which were selected to represent diverse built environment types and different distances from the central business district. A sample of 785 people participated in the study, representing a 77.8% response rate. Although the survey focused on a broad range of health-related issues, the current study highlights variables related to social support, social capital, sense of belonging, community gathering/ green spaces and self-rated health status.
Results: The analysis consisted of non-parametric tests of significance, which found significant associations between access and satisfaction with public gathering spaces and community social characteristics but not with green space satisfaction. Furthermore, neighbourhood satisfaction and collective efficacy were significantly associated with self-reported health and mental health status while sense of community was significantly associated with reported mental health and incidence of chronic conditions.
Conclusions: Many urban planning initiatives fail to integrate public health concerns into resource allocation. While this study is limited in size and scope, it offers a valuable framework from which planners and policymakers can sustainably address urban health concerns through the physical, mental and social dimensions of public space.
P12–20 Urban poverty and health challenges in rapidly growing cities in developing countries: Reflections from the perspective of the most vulnerable living in informal settlements in Johannesburg, South Africa
S. Mporetji1, E. Thomas2, J. Vearey3
1MRC/PEPFAR Intern, HIV, Health and Development, Johannesburg, South Africa, 2MRC/ WITS University Public Health, HIV Health and Development, Johannesburg, South Africa, 3WITS University, Forced Migration, Johannesburg, South Africa
Issues: Johannesburg, is characterised by population growth exceeding the rate of economic growth due to natural increase and urban migration. Despite the rich mineral wealth, the city is characterised by nearly a fifth of the population living in informal housing, high unemployment and increasing levels of inequity. On their own, these factors are already a challenge for local government committed constitutionally to addressing development needs. In addition, these factors are acknowledged drivers of the rapid increase in HIV prevalence in the City, found to be highest in informal housing areas, especially in young women.
Description: Using the provision of basic services as an entry point, the study assessed the views of people living in informal settlements, arguably the most vulnerable urban residents regarding their perceptions of the links between the quality of health related services and their health outcomes. The community voices are contrasted with a primary-health-focussed assessment of the city’s development interventions over a two year period. Despite the pro-poor city-wide policy, intervention strategies in the study informal settlements could be described as having failed on a number of counts.
Lessons learned: Although “developmental in policy commitment”, the services provided by the city failed on a number of counts to be “developmental”. For example, the lack of participatory approaches of line functions providing basic services, the absence of inter department co-ordination on the ground, limited access of the community to primary health clinics, inadequate waste removal and overall a failure to consider the impact of HIV on community needs. In contrast, community voices highlighted concerns about inappropriate development interventions, especially for AIDS-sick community members.
Next steps: Drawing from the findings, a set of guidelines for health promoting urban development in informal settlements have been prepared for piloting and hopefully adoption by the city council.