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2.  Perceived Parent Financial Burden and Asthma Outcomes in Low-Income, Urban Children 
The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child’s asthma and related associations with their children’s asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child’s condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. Eight hundred thirty-five parents were interviewed by telephone regarding their child’s asthma management. Associations between demographic and clinical factors and perception of financial burden were examined using bivariate analysis. Multivariate regression analyses were used to examine associations between perceptions of financial burden and asthma outcomes, including emergency department visits, hospitalizations, and missed school days. Perceived financial burden was evident in 10 % (n = 79) of parents. Female heads of household (χ2(3) = 7.41; p < 0.05), those at the lowest income levels (χ2(3) = 12.14; p < 0.01), and those whose child’s asthma was poorly controlled (χ2(2) = 49.42; p < 0.001) were most likely to perceive financial burden. In models controlling for level of asthma control, income, and having a usual source of asthma care, parents who perceived financial burden were more likely to have children who had at least one emergency department visit (OR = 1.95; 95 % CI = 1.15 to 3.29), hospitalization (OR = 3.99; 95 % CI = 2.03 to 7.82), or missed school days due to asthma (OR = 3.26; 95 % CI = 1.60 to 6.67) in the previous year. Our results supported our hypotheses. Among low-income parents of children with asthma, the majority do not perceive financial burden to obtaining care. However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a usual source of asthma care. Mothers and grandmothers heading families and those caring for children with uncontrolled asthma were most likely to report burden. These findings have implications for clinical practice in that health care providers may be able to take simple actions to determine patients’ financial-related perceptions, correct misconceptions, and help patients consider their full range of options to manage their child’s asthma.
doi:10.1007/s11524-012-9774-7
PMCID: PMC3675711  PMID: 23179603
Childhood asthma; Low income; Urban children; Outcomes; Barriers to care; Asthma
3.  The Urban Health Transition Hypothesis: Empirical Evidence of an Avian Influenza Kuznets Curve in Vietnam? 
The literature on development has focused on the concept of transition in understanding the emergent challenges facing poor but rapidly developing countries. Scholars have focused extensively on the health and urban transitions associated with this change and, in particular, its use for understanding emerging infectious diseases. However, few have developed explicit empirical measures to quantify the extent to which a transitions focus is useful for theory, policy, and practice. Using open source data on avian influenza in 2004 and 2005 and the Vietnam Census of Population and Housing, this paper introduces the Kuznets curve as a tool for empirically estimating transition and disease. Findings suggest that the Kuznets curve is a viable tool for empirically assessing the role of transitional dynamics in the emergence of new infectious diseases.
doi:10.1007/s11524-012-9719-1
PMCID: PMC3675712  PMID: 22798150
Avian influenza; Vietnam; Emerging infectious disease; Urban transition; Health transition
4.  Mass Transit Ridership and Self-Reported Hearing Health in an Urban Population 
Information on prevalence and risk factors associated with self-reported hearing health among mass transit riders is extremely limited, even though evidence suggests mass transit may be a source of excessive exposure to noise. Data on mass transit ridership were collected from 756 study participants using a self-administered questionnaire. Hearing health was measured using two symptom items (tinnitus and temporary audiometric threshold shift), two subjective measures (self-rated hearing and hearing ability), and two medical-related questions (hearing testing and physician-diagnosed hearing loss). In logistic regression analyses that controlled for possible confounders, including demographic variables, occupational noise exposure, nonoccupational noise exposure (including MP3 player use) and use of hearing protection, frequent and lengthy mass transit (all forms) ridership (1,100 min or more per week vs. 350 min or less per week) was the strongest predictor of temporary threshold shift symptoms. Noise abatement strategies, such as engineering controls, and the promotion of hearing protection use should be encouraged to reduce the risk of adverse impacts on the hearing health of mass transit users.
doi:10.1007/s11524-012-9734-2
PMCID: PMC3675713  PMID: 22711170
Noise; Mass transit; Urban ridership; Hearing protection; Hearing health
5.  Multi-level Factors Associated with Pregnancy among Urban Adolescent Women Seeking Psychological Services 
The purpose of this study was to examine the prevalence of pregnancy as well as multi-level factors (i.e., individual, family, and environment) associated with history of pregnancy among a sample of urban adolescent women seeking psychological services. Data were collected from a total of 264 sexually active, 13–18-year-old, adolescent women who participated in a larger HIV prevention study. Adolescents and one participating parent completed an audio computer-assisted self-interviewing survey. A total of 17.4 % of participants reported a history of pregnancy. A multivariable logistic regression model suggests that after controlling for empirically derived sociodemographic and behavioral covariates, absence of father in the home, family support and cohesion, and neighborhood risk were positively related to pregnancy. This study is among the first to examine multi-level factors associated with pregnancy among adolescent women diagnosed with psychological disorders. Consideration of such factors is crucial both in terms of clinical practice and in the design of pregnancy prevention programs. Collaboration between physicians and mental health providers working with adolescent women is crucial and represents an ideal opportunity to promote parental involvement and access to supportive community resources, including pregnancy prevention programs for this vulnerable population of adolescents.
doi:10.1007/s11524-012-9768-5
PMCID: PMC3675714  PMID: 23054473
Adolescent pregnancy; Psychological disorders; Family dynamics; Neighborhood environment
6.  Adherence to Chronic Disease Medications among New York City Medicaid Participants 
Medication adherence is critical for cardiovascular disease prevention and control. Local health departments are well positioned to address adherence issues, however relevant baseline data and a mechanism for monitoring impact of interventions are lacking. We performed a retrospective analysis using New York State Medicaid claims from 2008 to 2009 to describe rates and predictors of adherence among New York City Medicaid participants with dyslipidemia, diabetes, or hypertension. Adherence was measured using the medication possession ratio, and multivariable logistic regression was used to assess factors related to adherence. Medication regimen adherence was 63%. Greater adherence was observed in those who were older, male, and taking medications from ≥3 drug classes. Compared with whites, blacks and Hispanics were less likely to be adherent (adjusted odds ratio [OR]=0.67, 95% confidence interval [CI]: 0.65–0.70 and adjusted OR=0.76, 95% CI: 0.73–0.78, respectively), while Asians were as likely. Medication adherence was inadequate and racial disparities were identified in NYC Medicaid participants on stable medication regimens for chronic disease. This study demonstrates a claims-based model that may be used by local health departments to monitor and evaluate efforts to improve adherence and reduce disparities.
doi:10.1007/s11524-012-9724-4
PMCID: PMC3675715  PMID: 22722919
Medication adherence; Health disparities; Cardiovascular prevention; Public health
7.  The Concrete Jungle: City Stress and Substance Abuse among Young Adult African American Men 
Substance use is prevalent among African American men living in urban communities. The impact of substance use on the social, psychological, and physical health of African American men has important public health implications for families, communities, and society. Given the adverse consequences of alcohol and drug abuse within communities of color, this study evaluated the relationship between city stress, alcohol consumption, and drug use among African American men. Eighty heterosexual, African American men, 18 to 29 years old, completed psychosocial risk assessments that assessed substance use and city stress. Multiple logistic regression analyses, controlling for age, indicated that participants reporting high levels of urban stress, relative to low levels of urban stress, were more likely to report a history of marijuana use (AOR = 5.19, p = .05), history of ecstasy and/or GHB use (AOR = 3.34, p = .04), having family/friends expressing strong concerns about their illicit drug use (AOR = 4.06, p = .02), and being unable to remember what happened the night before due to drinking (AOR = 4.98, p = .01). African American men living within the confines of a stressful urban environment are at increased risk for exposure to and utilization of illicit substances. Culturally competent public health interventions for substance use/abuse should address psychological factors, such as stress and neighborhood violence.
doi:10.1007/s11524-012-9716-4
PMCID: PMC3675716  PMID: 22739803
City stress; Neighborhood; Substance use; African American; Men
8.  Experiences of Racial Discrimination and Relation to Sexual Risk for HIV among a Sample of Urban Black and African American Men 
This study aimed to examine racial discrimination and relation to sexual risk for HIV among a sample of urban Black and African American men. Participants of this cross-sectional study were Black and African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban clinical sites in the northeast. Multivariate logistic regression models were used to analyze the relation of reported racial discrimination to the following: (1) sex trade involvement, (2) recent unprotected sex, and (3) reporting a number of sex partners in the past 12 months greater than the sample average. The majority of the sample (96 %) reported racial discrimination. In adjusted analyses, men reporting high levels of discrimination were significantly more likely to report recent sex trade involvement (buying and/or selling) (adjusted odds ratio (AOR) range = 1.7–2.3), having recent unprotected vaginal sex with a female partner (AOR = 1.4, 95 % confidence interval (CI), 1.1–2.0), and reporting more than four sex partners in the past year (AOR = 1.4, 95 % CI, 1.1–1.9). Findings highlight the link between experiences of racial discrimination and men's sexual risk for HIV.
doi:10.1007/s11524-012-9690-x
PMCID: PMC3675717  PMID: 22674464
Racial discrimination; STD/HIV
9.  Assessing the Psychometric and Ecometric Properties of Neighborhood Scales in Developing Countries: Saúde em Beagá Study, Belo Horizonte, Brazil, 2008–2009 
Although specific measurement instruments are necessary to better understand the relationship between features of neighborhoods and health, very few studies have developed instruments to measure neighborhood features in developing countries. The objective of the study was to develop valid and reliable measures of neighborhood context useful in a Latin American urban context, assess their psychometric and ecometric properties, and examine individual and neighborhood-level predictors of these measures. We analyzed data from a multistage household survey (2008–2009) conducted in Belo Horizonte City by the Observatory for Urban Health. One adult in each household was selected to answer a questionnaire that included scales to measure neighborhood domains. Census tracts were used to proxy neighborhoods. Internal consistency was evaluated by Cronbach’s alpha, and multilevel models were used to estimate ecometric properties and to estimate associations of neighborhood measures with socioeconomic indicators. The final sample comprised 4048 survey respondents representing 149 census tracts. We assessed ten neighborhood environment dimensions: public services, aesthetic quality, walking environment, safety, violence, social cohesion, neighborhood participation, neighborhood physical disorder, neighborhood social disorder, and neighborhood problems. Cronbach’s alpha coefficients ranged from 0.53 to 0.83; intraneighborhood correlations ranged from 0.02 to 0.53, and neighborhood reliability varied from 0.76 to 0.99. Most scales were associated with individual and neighborhood socioeconomic predictors. Questionnaires can be used to reliably measure neighborhood contexts in developing countries.
doi:10.1007/s11524-012-9737-z
PMCID: PMC3675718  PMID: 22692842
Epidemiologic methods; Psychometrics; Residence characteristics; Data collection; Self-report; Environment design; Censuses
10.  Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico 
Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over the counter without a prescription, but police practices are often at odds with the law. FSW-IDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48 %. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR] = 2.54, 95 % confidence interval [CI] = 1.11–5.80), reporting sexual abuse by police (aOR = 12.76, 95 % CI = 6.58–24.72), engaging in groin injection (aOR = 1.84, 95 % CI = 1.15–2.93), injecting in public (aOR = 1.64; 95 % CI = 1.14–2.36), and obtaining syringes from pharmacies (aOR = 1.54; 95 % CI = 1.06–2.23). Higher education level was negatively associated with syringe confiscation (aOR = 0.92, 95 % CI = 0.87–0.98) as was frequent injection with clients within the last month (aOR = 0.64, 95 % CI = 0.44–0.94). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.
doi:10.1007/s11524-012-9741-3
PMCID: PMC3675719  PMID: 22806453
Injection drug use; Sex work; Police; HIV risk factors; Risk environment
11.  Neighborhood Socioeconomic Status in Relation to Preterm Birth in a U.S. Cohort of Black Women 
This study examines the association between neighborhood socioeconomic status (SES) and preterm birth among U.S. Black women. A composite variable for neighborhood SES, derived from 7 U.S. Census Bureau indicators, was assessed in relation to self-reported preterm birth (505 spontaneous and 452 medically indicated) among 6,390 women in the Black Women’s Health Study who delivered singleton births during 1995–2003. The odds ratio (OR) for preterm birth, comparing the lowest (most deprived) to the highest (least deprived) quartiles of neighborhood SES, was 0.98 (95 % CI, 0.80, 1.20) after adjustment for individual-level characteristics. Low neighborhood SES was not associated with spontaneous or medically indicated preterm birth overall or within strata of maternal age, education, or geographic region. The only significant finding was higher odds of medically indicated preterm birth associated with low neighborhood SES among unmarried women. Low neighborhood SES was not materially associated with preterm birth in this study of U.S. Black women.
doi:10.1007/s11524-012-9739-x
PMCID: PMC3675720  PMID: 22752302
African Americans; Premature birth; Residence characteristics; Social class
12.  Comparison of Two Indices of Availability of Fruits/Vegetable and Fast Food Outlets 
Studies of food environment often examine single dimensions of areas that may not account for complexity of exposure to all food sources. With respect to the deprivation amplification hypothesis, particular needs are to assess whether relative or absolute measures of the food environment are related to characteristics of social environment. The objective of this study was to compare absolute availability (AA) of fast food outlets (FFO) and stores selling fresh fruits and vegetables (FVS) with the relative availability (RA) of the same food sources in relation to area-level poverty and ethnic diversity in 248 selected census tracts (CT) in Montreal, Canada. AA of FFO and FVS were expressed as areal densities of food sources within CTs. RA indices were calculated as the proportion of FVSs relative to total food stores and the proportion of FFOs relative to all restaurants within CTs, respectively. Whereas the AA of FFO was positively associated with area-level poverty and ethnic diversity, the RA of FFO was inversely associated with area-level poverty and not associated with ethnic diversity. Both measures of FVS were positively associated with area-level poverty and ethnic diversity. These findings do not support a model of deprivation amplification. Furthermore, results of FFO suggest that the alternate measure of RA can complement information based on AA indicators of the food environment, with potential utility in predicting eating practices.
doi:10.1007/s11524-012-9722-6
PMCID: PMC3675721  PMID: 22736278
Food environment; Neighborhood; Geographical information system; Accessibility
13.  Low-Frequency Heroin Injection among Out-of-Treatment, Street-Recruited Injection Drug Users 
In this paper, we explore the understudied phenomenon of “low-frequency” heroin injection in a sample of street-recruited heroin injectors not in drug treatment. We conducted a cross-sectional study of 2,410 active injection drug users (IDUs) recruited in San Francisco, California from 2000 to 2005. We compare the sociodemographic characteristics and injection risk behaviors of low-frequency heroin injectors (low-FHI; one to 10 self-reported heroin injections in the past 30 days) to high-frequency heroin injectors (high-FHI; 30 or more self-reported heroin injections in the past 30 days). Fifteen percent of the sample met criteria for low-FHI. African American race, men who have sex with men (MSM) behavior, and injection and noninjection methamphetamine use were independently associated with low-FHI. Compared to high-FHI, low-FHI were less likely to report syringe sharing and nonfatal heroin overdose. A small but significant proportion of heroin injectors inject heroin 10 or less times per month. Additional research is needed to qualitatively examine low-frequency heroin injection and its relationship to drug use trajectories.
doi:10.1007/s11524-012-9720-8
PMCID: PMC3675722  PMID: 22689300
Low-frequency heroin injection; Heroin; Drug injection; Out-of-treatment drug users
14.  Pharmacy Syringe Purchase Test of Nonprescription Syringe Sales in San Francisco and Los Angeles in 2010 
The two main legal sources of clean needles for illicit injection drug users (IDUs) in California are syringe exchange programs (SEPs) and nonprescription syringe sales (NPSS) at pharmacies. In 2004, California became one of the last states to allow NPSS. To evaluate the implementation of NPSS and the California Disease Prevention Demonstration Project (DPDP), we conducted syringe purchase tests in San Francisco (SF) and Los Angeles (LA) between March and July of 2010. Large differences in implementation were observed in the two cities. In LA, less than one-quarter of the enrolled pharmacies sold syringes to our research assistant (RA), and none sold a single syringe. The rate of successful purchase in LA is the lowest reported in any syringe purchase test. In both sites, there was notable variation among the gauge size available, and price and quantity of syringes required for a purchase. None of the DPDP pharmacies in LA or SF provided the requisite health information. The findings suggest that more outreach needs to be conducted with pharmacists and pharmacy staff. The pharmacies' failure to disseminate the educational materials may result in missed opportunities to provide needed harm reduction information to IDUs. The varied prices and required quantities may serve as a barrier to syringe access among IDUs. Future research needs to examine reasons why pharmacies do not provide the mandated information, whether the omission of disposal options is indicative of pharmacies' reluctance to serve as disposal sites, and if the dual opt-in approach of NPSS/DPDP is a barrier to pharmacy enrollment.
doi:10.1007/s11524-012-9713-7
PMCID: PMC3675724  PMID: 22718357
Nonprescription syringe sales; IDU; SB1159; California; Pharmacy; Policy
15.  Revitalizing Communities Together 
Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.
doi:10.1007/s11524-012-9733-3
PMCID: PMC3675725  PMID: 22711169
City planning; Educational status; Public health; Social change; Urban health
16.  Characteristics of Federally Licensed Firearms Retailers and Retail Establishments in the United States: Initial Findings from the Firearms Licensee Survey 
Firearms have widely supported legitimate purposes but are also frequently used in violent crimes. Owners and senior executives of federally licensed firearms dealers and pawnbrokers are a potentially valuable source of information on retail commerce in firearms, links between legal and illegal commerce, and policies designed to prevent the firearms they sell from being used in crimes. To our knowledge, there has been no prior effort to gather such information. In 2011, we conducted the Firearms Licensee Survey on a probability sample of 1,601 licensed dealers and pawnbrokers in the United States believed to sell 50 or more firearms per year. This article presents details of the design and execution of the survey and describes the characteristics of the respondents and their business establishments. The survey was conducted by mail, using methods developed by Dillman and others. Our response rate was 36.9 % (591 respondents), similar to that for other establishment surveys using similar methods. Respondents had a median age of 54; 89 % were male, 97.6 % were White, and 98.1 % were non-Hispanic. Those who held licenses under their own names had been licensed for a median of 18 years. A large majority of 96.3 % agreed that “private ownership of guns is essential for a free society”; just over half (54.9 %) believed that “it is too easy for criminals to get guns in this country.” A match between the job and a personal interest in the shooting sports was the highest-ranking reason for working as a firearms retailer; the highest-ranking concerns were that “there are too many ‘gun control’ regulations” and that “the government might confiscate my guns.” Most respondents (64.3 %) were gun dealers, with significant variation by region. Residential dealers accounted for 25.6 % of all dealers in the Midwest. Median annual sales volume was 200 firearms for both dealers and pawnbrokers. Dealers appeared more likely than pawnbrokers to specialize; they were more likely to rank in the highest or lowest quartile on sales of handguns, inexpensive handguns, and tactical rifles. Sales of inexpensive handguns and sales to women were more common among pawnbrokers. Internet sales were reported by 28.3 % of respondents and sales at gun shows by 14.3 %. A median of 1 % of sales were denied after purchasers failed background checks; firearm trace requests equaled <1 % of annual sales. Trace frequency was directly associated with the percentage of firearm sales involving handguns, inexpensive handguns, and sales to women. Frequency of denied sales was strongly and directly associated with frequency of trace requests (p < 0.0001). These results are based on self-report but are consistent with those from studies using objective data.
doi:10.1007/s11524-012-9754-y
PMCID: PMC3579296  PMID: 22936108
Firearms; Crime; Violence; Firearms policy; Federal firearms licensees
17.  Association of Residential Segregation and Disability: A Multilevel Study Using Iranian Census Data 
The association of racial segregation and health outcomes has been reviewed recently in the literature, but the health effect of other contexts of segregation with respect to residential environment has not as yet been fully reviewed. Besides, most of the literature on segregation has been performed in Western countries. Here, we undertake a multilevel analysis of residential segregation of socioeconomic and demographic factors and disability rate in an Eastern developing country in order to elucidate the effects of this aspect of segregation on disability rate. The latest Iranian national census in 2006 was used to measure segregation indices and perform the analysis. Information theory index and its ordinal form were applied to measure evenness dimension of segregation of categorical and ordinal variables, respectively. Segregation of contextual and structural characteristics of residential environment, which are important determinants of socioeconomic status in Iran, had different relations with disability rate. Provinces which were segregated by type of occupation of residents, sex, and ownership of a motorcycle had a lower individual disability rate, while age segregation and house ownership had a positive effect on the rate of individual disability in the province. The findings also showed that almost all the aforementioned segregation indices had the same effect on the rate of family disability. The unique contribution of this study is that it considers how segregation with respect to aspects of social characteristics other than race affects health outcomes. Further studies in this regard may reveal new insights into health outcome inequalities.
doi:10.1007/s11524-012-9705-7
PMCID: PMC3579297  PMID: 22684426
Residential segregation; Disability; Information theory segregation index; Multilevel modeling
18.  Effects of Baltimore’s Safe Streets Program on Gun Violence: A Replication of Chicago’s CeaseFire Program 
Chicago’s CeaseFire program is an evidence-based public health approach to preventing gun violence. Baltimore is one of many US cities attempting to replicate the program. We compared changes in the number of homicide and nonfatal shooting incidents per month in four intervention neighborhoods with changes in high-crime comparison areas (police posts) without the intervention, while controlling for several measures of police activity and baseline levels of homicide and nonfatal shootings. In South Baltimore there were large program-related reductions in homicide and nonfatal shooting incidents. Among three East Baltimore program sites, the program was associated with a reduction of homicides in one area, a reduction in nonfatal shootings in another area, and a simultaneous increase in homicides and decrease in nonfatal shootings in another area. In some instances, program effects extended to neighborhoods bordering the intervention areas. Program-related reductions in homicides appear to be linked with conflict mediations conducted by program outreach workers.
doi:10.1007/s11524-012-9731-5
PMCID: PMC3579298  PMID: 22696175
Violence prevention; Community intervention; Firearm violence
20.  Differing HIV Risks and Prevention Needs among Men and Women Injection Drug Users (IDU) in the District of Columbia 
Washington, DC has among the highest HIV/AIDS rates in the US. Gender differences among injection drug users (IDUs) may be associated with adoption of prevention opportunities including needle exchange programs, HIV testing, psychosocial support, and prevention programming. National HIV Behavioral Surveillance data on current IDUs aged ≥18 were collected from 8/09 to 11/09 via respondent-driven sampling in Washington, DC. HIV status was assessed using oral OraQuick with Western Blot confirmation. Weighted estimates were derived using RDSAT. Stata was used to characterize the sample and differences between male and female IDU, using uni-, bi-, and multivariable methods. Factors associated with HIV risk differed between men and women. Men were more likely than women to have had a history of incarceration (86.6 % vs. 66.8 %, p < 0.01). Women were more likely than men to have depressive symptoms (73.9 % vs. 47.4 %, p < 0.01), to have been physically or emotionally abused (66.1 % vs. 16.1 %, p < 0.0001), to report childhood sexual abuse (42.7 % vs. 4.7 %, p < 0.0001), and pressured or forced to have sex (62.8 % vs. 4.0 %, p < 0.0001); each of these differences was significant in the multivariable analysis. Despite a decreasing HIV/AIDS epidemic among IDU, there remain significant gender differences with women experiencing multiple threats to psychosocial health, which may in turn affect HIV testing, access, care, and drug use. Diverging needs by gender are critical to consider when implementing HIV prevention strategies.
doi:10.1007/s11524-012-9687-5
PMCID: PMC3579300  PMID: 22692841
HIV/AIDS; Behavioral surveillance; Gender; IDU; HIV/AIDS prevention
21.  Reconsidering the Effects of Poverty and Social Support on Health: A 5-Year Longitudinal Test of the Stress-Buffering Hypothesis 
Prior research in the general population has found that social support can buffer the adverse effects of stressors on health. However, both stressors and social support may be qualitatively different for those living in urban poverty. We examined the effects of social support and poverty-specific stressors on self-rated health. We used data from the Welfare Client Longitudinal Survey (WCLS), a 5-year longitudinal study of 718 public aid recipients. We measured received social support and “net social support,” defined as the difference between support received and that given to others. We used restricted cubic splines to model the stress-buffering effects of social support on self-rated health as a function of stressful life events and neighborhood disorder. Increased exposure to stressors was associated with poorer self-rated health. Evidence of stress buffering was confined to those with the heaviest exposure to stressors, and its effects decreased across increasing levels of social support. Analyses using net social support had generally more modest effects than those using received social support. Social support does not buffer the effects of stressors on health uniformly for individuals living in conditions of urban poverty. Researchers and policymakers should be cautious in overestimating the beneficial effects that social support may have on health for marginalized populations.
doi:10.1007/s11524-012-9757-8
PMCID: PMC3579301  PMID: 22948789
Social support; Stressors; Self-rated health; Social environment; Urban poverty
22.  Financial Distress and Depressive Symptoms among African American Women: Identifying Financial Priorities and Needs and why it Matters for Mental Health 
Prior research found that financial hardship or distress is one of the most important underlying factors for depression/depressive symptoms, yet factors that contribute to financial distress remain unexplored or unaddressed. Given this, the goals of the present study were (1) to examine the relationship between perceived financial distress and depressive symptoms, and (2) to identify financial priorities and needs that may contribute to financial distress. Surveys from 111 African American women, ages 18–44, who reside in Allegheny County, PA, were used to gather demographic information and measures of depressive symptoms and financial distress/financial well-being. Correlation and regression analyses revealed that perceived financial distress was significantly associated with levels of depressive symptoms. To assess financial priorities and needs, responses to two open-ended questions were analyzed and coded for common themes: “Imagine you won a $10,000 prize in a local lottery. What would you do with this money?” and “What kinds of programs or other help would be beneficial to you during times of financial difficulties?” The highest five priorities identified by the participants were paying bills and debt, saving, purchasing a home or making home repairs, and/or helping others. The participant’s perceived needs during times of financial difficulty included tangible assistance and/or financial education. The findings from this study can be used to create new and/or enhance existing programs, services, and/or interventions that focus on the identified financial priorities and needs. Collaborative efforts among professionals in different disciplines are also needed, as ways to manage and alleviate financial distress should be considered and discussed when addressing the mental health of African American women.
doi:10.1007/s11524-012-9755-x
PMCID: PMC3579302  PMID: 22930003
African American women; Depression; Depressive symptoms; Risk factors for depression; Perceived financial distress; Financial strain; Economic strain; Financial priorities; Financial needs
23.  Walking for Recreation and Perceptions of the Neighborhood Environment in Older Chinese Urban Dwellers 
Engagement in walking for recreation can contribute to healthy aging. Although there is growing evidence that the neighborhood environment can influence walking for recreation, the amount of such evidence in relation to older adults is scarce and limited to Western low-density urban locations. Asian urban environments are typified by distinctive environmental and cultural characteristics that may yield different patterns to those observed in Western countries. Therefore, the main aim of this study was to examine associations of perceived environmental attributes with overall and within-neighborhood walking for recreation in Chinese elders (65+ years) residing in Hong Kong, an ultradense Asian metropolis. A sample of 484 elders was recruited from 32 neighborhoods stratified by socio-economic status and walkability (dwelling and intersection densities). Validated questionnaires measuring perceived neighborhood environment and weekly minutes of overall and within-neighborhood walking for recreation were interviewer administered. Results showed that the level of recreational walking was twice to four times higher than that reported in Western adults and elders. While overall walking for recreation showed a general lack of associations with perceived environmental attributes, within-neighborhood recreational walking was positively related with proximity of recreational facilities, infrastructure for walking, indoor places for walking, and presence of bridge/overpasses connecting to services. Age and educational attainment moderated the associations with several perceived environmental attributes with older and less-educated participants showing stronger associations. Traditional cultural views on the benefits of physical activity and the high accessibility of facilities and pedestrian infrastructure of Hong Kong may explain the high levels of walking. Although specific neighborhood attributes, or their perception, may influence recreational walking within the neighborhood, the compactness and public transport affordability of ultradense metropolises such as Hong Kong may make it easy for elders to compensate for the lack of favorable neighborhood attributes by walking outside the neighborhood.
doi:10.1007/s11524-012-9704-8
PMCID: PMC3579303  PMID: 22678651
Walking for recreation; Older adults; Perceived environment; Moderators
24.  Early Life Predictors of Adult Depression in a Community Cohort of Urban African Americans 
Depression among African Americans residing in urban communities is a complex, major public health problem; however, few studies identify early life risk factors for depression among urban African American men and women. To better inform prevention programming, this study uses data from the Woodlawn Study, a well-defined community cohort of urban African Americans followed from age 6 to 42 years, to determine depression prevalence through midlife and identify childhood and adolescent risk factors for adult depression separately by gender. Results indicate that lifetime depression rates do not differ significantly by gender (16.2 % of men, 18.8 % of women) in contrast to findings of a higher prevalence for women in national studies. Furthermore, rates of depression in this urban African American population are higher than those found in national samples of African Americans and more comparable to the higher rates found nationally among Whites. Regarding early predictors, for both men and women, family conflict in adolescence is a risk factor for adult depression in multivariate regression models. For women, vulnerability to depression has roots in early life, specifically, low maternal aspirations for school attainment. Females displaying more aggressive and delinquent behavior and those growing up in a female-headed household and a household with low maternal education have elevated rates of depression. Males growing up in persistent poverty, those engaging in greater delinquent behavior, and those with low parental supervision in adolescence also have elevated rates of depression. Effective prevention programming for urban African Americans must consider both individual characteristics and the family dynamic.
doi:10.1007/s11524-012-9707-5
PMCID: PMC3579304  PMID: 22689296
African Americans; Depression; Gender differences; Life course; Longitudinal data; Risk factors
25.  2012 Reviewers 
doi:10.1007/s11524-013-9788-9
PMCID: PMC3579305

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