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4.  Mismatch between Perceived and Objectively Measured Land Use Mix and Street Connectivity: Associations with Neighborhood Walking 
Studies on the mismatch between objective and perceived measures of walkability and walking provide insights into targeting interventions. These studies focused on those living in more walkable environments, but perceiving them as less walkable. However, it is equally important to understand how the other mismatch (living in less walkable areas, but perceiving them as walkable) is related to walking. This study examined how the mismatch between perceived and objective walkability measures (i.e., living in less walkable areas, but perceiving them as walkable, and living in more walkable areas, but perceiving them as less walkable) was associated with walking. Baseline data from adult participants (n = 1466) of the RESIDential Environment Project (Perth, Australia in 2004-06) collected self-report neighborhood walking for recreation and transport in a usual week and participants’ perceptions of street connectivity and land use mix in their neighborhood. The exposure was the mismatch between objective and perceived measures of these. Multilevel logistic regression examined associations of walking with the mismatch between perceived and objective walkability measures. Perceiving high walkable attributes as low walkable was associated with lower levels of walking, while perceiving a low walkable attribute as walkable was associated with higher levels of walking. Walking interventions must create more pedestrian-friendly environments as well as target residents’ perceptions.
PMCID: PMC4411311  PMID: 25539783
Walkability; Built environment; Walking; Street connectivity; Land use mix; Perceptions; Urban design
5.  Homies with Aspirations and Positive Peer Network Ties: Associations with Reduced Frequent Substance Use among Gang-Affiliated Latino Youth 
In marginalized urban neighborhoods across the USA, Latino youth are disproportionately represented among the growing number of youth gangs. Substance use among gang-involved youth poses both immediate and long-term health risks and can threaten educational engagement, future socioeconomic stability, and desistance. Conventional assessments of gang-affiliated youth and their peer network overlook the possibility that positive peer ties may exist and can foster health promoting behavior norms. Drawing on a positive deviance framework, in this study, we examine the relationship between positive peer network characteristics tied to post-secondary educational aspirations and frequent alcohol and marijuana use among Latino, gang-affiliated youth from a neighborhood in San Francisco. Using generalized estimating equations regression models across 72 peer network clusters (162 youth), we found that having close friends who plan to go to a 4-year college was associated with a lower odds of frequent marijuana and alcohol use (OR 0.27, p = 0.02; OR 0.29, p = 0.14, respectively) and that this association persisted when adjusting for risk characteristics (OR 0.19, p < 0.01; OR 0.25, p = 0.12). Public health can advance gang intervention efforts by identifying protective and risk factors associated with non-criminal health outcomes to inform participatory research approaches and asset-based interventions that contribute to building healthy communities.
PMCID: PMC4411312  PMID: 25649980
Latino youth; Gangs; Social networks; Substance use; Positive deviance
6.  Do Relationships Between Environmental Attributes and Recreational Walking Vary According to Area-Level Socioeconomic Status? 
Residents of areas with lower socioeconomic status (SES) are known to be less physically active during leisure time. Neighborhood walkability has been shown to be related to recreational walking equally in low and high SES areas. This cross-sectional study tested whether associations of specific environmental attributes, measured objectively and subjectively, with walking for recreation were moderated by area-level SES. The data of the North West Adelaide Health Study collected in 2007 (n = 1500, mean age 57) were used. Self-reported walking frequency was the outcome of the study. Environmental exposure measures included objectively measured walkability components (residential density, intersection density, land use mix, and net retail area ratio) and perceived attributes (access to destinations, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety). Participants’ suburbs were categorized into low and high SES areas using an indicator of socioeconomic disadvantage. Low SES areas had lower scores in residential density, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety. Recreational walking was associated with residential density, access to destinations, esthetics, traffic/barriers, and crime safety. Effect modification was observed for two attributes (out of nine): residential density was associated with walking only in low SES areas, while walking infrastructure was associated with walking only in high SES areas. The associations of neighborhood environmental attributes with recreational walking were largely consistent across SES groups. However, low SES areas were disadvantaged in most perceived environmental attributes related to recreational walking. Improving such attributes in low SES neighborhoods may help close socioeconomic disparities in leisure time physical activity.
PMCID: PMC4411313  PMID: 25604935
Physical activity; Neighborhood environment; Walkability; Inequality; Effect modification
7.  Assessing the Geographic Coverage and Spatial Clustering of Illicit Drug Users Recruited through Respondent-Driven Sampling in New York City 
We assess the geographic coverage and spatial clustering of drug users recruited through respondent-driven sampling (RDS) and discuss the potential for biased RDS prevalence estimates. Illicit drug users aged 18–40 were recruited through RDS (N = 401) and targeted street outreach (TSO) (N = 210) in New York City. Using the Google Maps API™, we calculated travel distances and times using public transportation between each participant’s recruitment location and the study office and between RDS recruiter–recruit pairs. We used K function analysis to evaluate and compare spatial clustering of (1) RDS vs. TSO respondents and (2) RDS seeds vs. RDS peer recruits. All participant recruitment locations clustered around the study office; however, RDS participants were significantly more likely to be recruited within walking distance of the study office than TSO participants. The TSO sample was also less spatially clustered than the RDS sample, which likely reflects (1) the van’s ability to increase the sample’s geographic heterogeneity and (2) that more TSO than RDS participants were enrolled on the van. Among RDS participants, individuals recruited spatially proximal peers, geographic coverage did not increase as recruitment waves progressed, and peer recruits were not less spatially clustered than seeds. Using a mobile van to recruit participants had a greater impact on the geographic coverage and spatial dependence of the TSO than the RDS sample. Future studies should consider and evaluate the impact of the recruitment approach on the geographic/spatial representativeness of the sample and how spatial biases, including the preferential recruitment of proximal peers, could impact the precision and accuracy of estimates.
PMCID: PMC4411314  PMID: 25694223
Spatial analysis; Respondent-driven sampling; Targeted sampling; Geographic coverage; Spatial clustering; Illicit drug users
8.  Home Exposure to Secondhand Smoke among People Living in Multiunit Housing and Single Family Housing: a Study of California Adults, 2003–2012 
Public health education efforts continue to encourage people to adopt voluntary smoking bans at home; nonetheless, the home remains a place where many people are exposed to secondhand smoke (SHS). Little is known about how SHS exposure in the home differs between adults residing in multiunit housing (MUH) and those residing in single family housing (SFH). This study (1) compared the socio-demographic characteristics, chronic disease conditions, and smoking status of adults living in MUH with those living in SFH, (2) assessed the correlates of living in MUH for adults, and (3) evaluated the association of residency in MUH and SFH with the odds of being exposed to SHS at home using population-based survey data of California adults. Smoking prevalence was significantly higher among MUH residents than SFH residents. The adjusted odds of exposure to SHS at home were 32 % higher for MUH smokers than SFH smokers but were not significantly different for non-smokers. This study presents evidence that there are significant socio-demographic differences between MUH residents and SFH residents and that MUH smokers have higher rates of exposure to SHS at home than SFH smokers after adjusting for other covariates. To reduce home exposure to SHS among MUH residents, it is important to adopt tobacco control policies that are aimed at reducing SHS exposure in and around MUH and at reducing cigarette smoking among current smokers in MUH.
PMCID: PMC4411315  PMID: 25466438
Smoking status; Secondhand smoke exposure at home; Multiunit housing; Single family housing
9.  Provider’s and User’s Perspective about Immunization Coverage among Migratory and Non-migratory Population in Slums and Construction Sites of Chandigarh 
Strengthening routine immunization is a corner stone for countries to achieve the United Nations Millennium Development Goal 4 (MDG 4) which aims to reduce under-five mortality by two-thirds and MDG 5 improving maternal health compared to 1990 estimates by 2015. The poor urban newborns are more vulnerable to many health and nutrition problems compared to the non-poor urban counterparts. Therefore there is a need to strengthen health system to cater the needs of urban poor. Standardized WHO30*7 cluster sampling for slums and convenience sampling for construction sites. In depth interviews were conducted for user’s as well as provider’s perspective about immunization coverage. Two hundred ten children and 210 mothers were enrolled in slums and 100 were sampled from construction sites. The slum workers are considered as non-migratory groups whereas construction site workers are considered as migratory population. Among children, 23 % were fully immunized, 73 % were partially immunized and 3 % were unimmunized in non-migratory population whereas 3 % were fully immunized, 91 % were partially immunized and 6 % were unimmunized in migratory population. Among mothers, 43 and 39 % were fully immunized, 13 and 15 % partially immunized and 43 and 46 % were unimmunized in non-migratory and migratory population, respectively. The various reasons attributed for low coverage are (a) dissatisfaction of the users with the service delivery and procedural delays (bureaucracy), (b) lack of faith in health workers, (c) insistence upon ID/vaccination card/aadhar card by the health worker before vaccinating child and (d) ignorance of the need of immunization by the people and migration of the population.
PMCID: PMC4411318  PMID: 25690459
Immunization; Aadhar card; Migration
10.  Residential Mobility and Trajectories of Adiposity among Adolescents in Urban and Non-urban Neighborhoods 
Using data from the 1994–2008 National Longitudinal Study of Adult Health (Add Health), this research examines the relationship between residential mobility and weight gain over time among urban and non-urban young adults. It is theorized that changes in residence act as a barrier to achieving an active lifestyle, which would increase an individual’s body mass index (BMI) over time. Relying on linear mixed-effects growth curve models, the results indicate that mobility is protective against weight gain over time after controlling for sociodemographic characteristics. For young adults who are residentially stable in urban neighborhoods, increases in physical activity are associated with a linear decline in BMI. In non-urban areas where respondents are residentially mobile, body weight does not fluctuate as sedentary behavior increases. However, in those areas, weight increases as sedentary behavior increases for those who did not move. Overall, the results suggest that the effect of mobility on weight gain is partially due to the kind of health behaviors that one engages in as well as whether or not one lives in an urban area. Policies geared toward relocating residents (such as Moving to Opportunity), and neighborhood processes that can lead individuals to change residences (such as foreclosures or gentrification) may have adverse health effects depending on whether they are occurring in urban or non-urban areas.
PMCID: PMC4411319  PMID: 25801487
Active lifestyle; Body mass index; Mobility; Neighborhoods; Obesity; Sedentary behavior
11.  Examining the Spatial Distribution of Law Enforcement Encounters among People Who Inject Drugs after Implementation of Mexico’s Drug Policy Reform 
In 2009, Mexico decriminalized the possession of small amounts of illicit drugs for personal use in order to refocus law enforcement resources on drug dealers and traffickers. This study examines the spatial distribution of law enforcement encounters reported by people who inject drugs (PWID) in Tijuana, Mexico to identify concentrated areas of policing activity after implementation of the new drug policy. Mapping the physical location of law enforcement encounters provided by PWID (n = 461) recruited through targeted sampling, we identified hotspots of extra-judicial encounters (e.g., physical/sexual abuse, syringe confiscation, and money extortion by law enforcement) and routine authorized encounters (e.g., being arrested or stopped but not arrested) using point density maps and the Getis-Ord Gi* statistic calculated at the neighborhood-level. Approximately half of the participants encountered law enforcement more than once in a calendar year and nearly one third of these encounters did not result in arrest but involved harassment or abuse by law enforcement. Statistically significant hotspots of law enforcement encounters were identified in a limited number of neighborhoods located in areas with known drug markets. At the local-level, law enforcement activities continue to target drug users despite a national drug policy that emphasizes drug treatment diversion rather than punitive enforcement. There is a need for law enforcement training and improved monitoring of policing tactics to better align policing with public health goals.
PMCID: PMC4411320  PMID: 25300503
Injection drug use; Law enforcement; Spatial; Hotspot analysis
12.  An Active City Approach for Urban Development 
With an increasing percentage of the global population living in cities and the concurrent decrease in physical activity in daily life, public health issues for urban development have arisen. This study responds to that trend by presenting an approach to measure city-wide physical activity levels. Comparing of city indices for active sports and the active transportation shows differences between subject cities and activity level of age groups in sports as well as walking and cycling. Therefore, our study lends itself to implications for urban development towards creating a healthier city.
PMCID: PMC4411321  PMID: 25547044
Sport development; Urban development; Healthy city; Active city
13.  Correlates of Smoke-Free Housing Policies and Interest in Implementing Policies among Multiunit Housing Owners in New York City 
Secondhand smoke exposure is a concern in multiunit housing, where smoke can migrate between apartments. In 2012, the New York City (NYC) Department of Health and Mental Hygiene conducted a cross-sectional mail and phone survey among a random sample of low-income and market-rate multiunit housing owners and managers in NYC. The study compared experiences and attitudes regarding smoke-free policies between owners/managers (owners) with and without low-income units. Logistic regression analysis was used to assess the correlates of smoke-free residential unit rules and interest in adopting new smoke-free rules. Perceived benefits and challenges of implementing smoke-free rules were also examined. Overall, one-third of owners prohibited smoking in individual units. Among owners, nearly one-third owned or managed buildings with designated certified low-income units. Owners with low-income units were less likely than those without to have a smoke-free unit policy (26 vs. 36 %, p < 0.01) or be aware that owners can legally adopt smoke-free building policies (60 vs. 70 %, p < 0.01). In the final model, owners who believed that owners could legally adopt smoke-free policies were more likely to have a smoke-free unit policy, while current smokers and owners of larger buildings were less likely to have a policy. Nearly three quarters of owners without smoke-free units were interested in prohibiting smoking in all of their building/units (73 %). Among owners, correlates of interest in prohibiting smoking included awareness that secondhand smoke is a health issue and knowledge of their legal rights to prohibit smoking in their buildings. Current smokers were less likely to be interested in future smoke-free policies. Educational programs promoting awareness of owners’ legal right to adopt smoke-free policies in residential buildings may improve the availability of smoke-free multiunit housing.
PMCID: PMC4411322  PMID: 25670210
Secondhand smoke; Housing; Urban; Disparities
14.  Hepatitis C Surveillance among Youth and Young Adults in New York City, 2009–2013 
Increases in prescription opioid misuse, injection drug use, and hepatitis C infections have been reported among youth and young adults in the USA, particularly in rural and suburban areas. To better understand these trends in New York City and to characterize demographics and risk factors among a population who, by virtue of their age, are more likely to be recently infected with hepatitis C, we analyzed routine hepatitis C surveillance data from 2009 to 2013 and investigated a sample of persons 30 and younger newly reported with hepatitis C in 2013. Between 2009 and 2013, 4811 persons 30 and younger were newly reported to the New York City Department of Health and Mental Hygiene with hepatitis C. There were high rates of hepatitis C among persons 30 and younger in several neighborhoods that did not have high rates of hepatitis C among older people. Among 402 hepatitis C cases 30 and younger investigated in 2013, the largest proportion (44 %) were white, non-Hispanic, and the most commonly reported risk factor for hepatitis C was injection drug use, mostly heroin. Hepatitis C prevention and harm reduction efforts in NYC focused on young people should target these populations, and surveillance for hepatitis C among young people should be a priority in urban as well as rural and suburban settings.
PMCID: PMC4411323  PMID: 25450518
Hepatitis C; Surveillance; Youth; Young adults; Adolescents; Public health
15.  The Impact of a Temporary Recurrent Street Closure on Physical Activity in New York City 
At least 70 US cities have now introduced ciclovías—large-scale street closures to promote physical activity—joining numerous other cities worldwide that have implemented ciclovías in efforts to improve population health. We assessed the impact of Summer Streets, a New York City program in which 6.9 contiguous miles of urban streets were closed to traffic and opened for walking, cycling, and group activities, such as dancing and yoga, on population physical activity levels. Screen line counts were used to estimate attendance, and a street intercept survey was conducted to assess demographic characteristics of participants, baseline adherence to physical activity recommendations, and type and duration of physical activity at Summer Streets. In addition, a traffic study was used to determine if there were vehicular traffic delays as a result of the program. About 50,000 people participated in Summer Streets; among participating New Yorkers, bicyclists averaged 6.7 miles, runners 4.3 miles, and walkers 3.6 miles, equivalent to 72–86 min of moderate physical activity. Among New Yorkers attending Summer Streets, 24 % reported that they did not routinely engage in moderate- or vigorous-intensity physical activity. These non-routine exercisers engaged in the equivalent of 26–68 min of moderate-intensity physical activity at Summer Streets. Summer Streets served as an enticement for New Yorkers, including those who did not ordinarily meet physical activity recommendations, to engage in physical activity. There were no significant vehicular traffic delays during the program.
PMCID: PMC4411324  PMID: 25575672
Active design; Ciclovía; Active transportation; Physical activity; Built environment; Street closure; Open streets; Summer streets
16.  Comparison of Risk-Based Hepatitis C Screening and the True Seroprevalence in an Urban Prison System 
Hepatitis C virus (HCV) is the most common blood-borne infection in the USA, though seroprevalence is elevated in certain high-risk groups such as inmates. Correctional facility screening protocols vary from universal testing to opt-in risk-based testing. This project assessed the success of a risk-based HCV screening strategy in the Philadelphia Prison System (PPS) by comparing results from current testing practices during 2011–2012 (Risk-Based Screening Group) to a September 2012 blinded seroprevalence study (Philadelphia Department of Public Health (PDPH) Study Cohort). PPS processed 51,562 inmates in 2011–2012; 2,727 were identified as high-risk and screened for HCV, of whom 57 % tested HCV antibody positive. Twelve percent (n = 154) of the 1,289 inmates in the PDPH Study Cohort were anti-HCV positive. Inmates ≥30 years of age had higher rates of seropositivity in both groups. Since only 5.3 % of the prison population was included in the Risk-Based Screening Group, an additional 4,877 HCV-positive inmates are projected to have not been identified in 2011–2012. Gaps in case identification exist when risk-based testing is utilized by PPS. A more comprehensive screening model such as opt-out universal testing should be considered to identify HCV-positive inmates. Identification of these individuals is an important opportunity to aid underserved high-risk populations and to provide medical care and secondary prevention.
PMCID: PMC4411325  PMID: 25795212
Hepatitis C virus; Correctional health; Testing strategies
17.  Tackling the Urban Health Divide Though Enabling Intersectoral Action on Malnutrition in Chile and Kenya 
As momentum grows for a sustainable urbanisation goal in the post-2015 development agenda, this paper reports on an action research study that sought to tackle the urban health divide by enabling intersectoral action on social determinants at the local level. The study was located in the cities of Mombasa in Kenya and Valparaíso in Chile, and the impact of the intervention on child nutrition was evaluated using a controlled design. The findings showed that an action research process using the social educational process known as PLA could effectively build the capacity of multisectoral teams to take coordinated action which in turn built the capacity of communities to sustain them. The impact on child nutrition was inconclusive and needed to be interpreted within the context of economic collapse in the intervention area. Four factors were found to have been crucial for creating the enabling environment for effective intersectoral action (i) supportive government policy (ii) broad participation and capacity building (iii) involving policy makers as advisors and establishing the credibility of the research and (iii) strengthening community action. If lessons learned from this study can be adapted and applied in other contexts then they could have a significant economic and societal impact on health and nutrition equity in informal urban settlements.
PMCID: PMC4411326  PMID: 25758598
Urban health divide; Child malnutrition; Social determinants; Participation; Informal settlements; Kenya; Chile
18.  Increases in Lifestyle Activities as a Result of Experience Corps® Participation 
Experience Corps® (EC) was designed to simultaneously increase cognitive, social, and physical activity through high-intensity volunteerism in elementary school classrooms. It is, therefore, highly likely that EC participation may alter pre-existing patterns of lifestyle activity. This study examined the impact of “real-world” volunteer engagement on the frequency of participation in various lifestyle activities over a 2-year period. Specifically, we examined intervention-related changes on reported activity levels at 12 and 24 months post-baseline using Intention-to-Treat (ITT) and Complier Average Causal Effect (CACE) analyses, which account for the amount of program exposure. ITT analyses indicated that, compared to the control group, EC participants reported modest increases (approximately half a day/month) in overall activity level, especially in intellectual and physical activities 12 months post-baseline. Increases in activity were not found at the 24-month assessment. CACE models revealed similar findings for overall activity as well as for intellectual and physical activities at 12 months. Additionally, CACE findings suggested modest increases in social activity at 12 months and in intellectual and passive activities at 24 months post-baseline. This community-based, health promotion intervention has the potential to impact lifestyle activity, which may lead to long-term increases in activity and to other positive cognitive, physical, and psychosocial health outcomes.
PMCID: PMC4338117  PMID: 25378282
Lifestyle; Engagement; Activities; Older adults; Volunteers
19.  Objective Measures of the Built Environment and Physical Activity in Children: From Walkability to Moveability 
Features of the built environment that may influence physical activity (PA) levels are commonly captured using a so-called walkability index. Since such indices typically describe opportunities for walking in everyday life of adults, they might not be applicable to assess urban opportunities for PA in children. Particularly, the spatial availability of recreational facilities may have an impact on PA in children and should be additionally considered. We linked individual data of 400 2- to 9-year-old children recruited in the European IDEFICS study to geographic data of one German study region, based on individual network-dependent neighborhoods. Environmental features of the walkability concept and the availability of recreational facilities, i.e. playgrounds, green spaces, and parks, were measured. Relevant features were combined to a moveability index that should capture urban opportunities for PA in children. A gamma log-regression model was used to model linear and non-linear effects of individual variables on accelerometer-based moderate-to-vigorous physical activity (MVPA) stratified by pre-school children (<6 years) and school children (≥6 years). Single environmental features and the resulting indices were separately included into the model to investigate the effect of each variable on MVPA. In school children, commonly used features such as residential density \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.5\cdot {10}^{-4},p=0.02\right) $$\end{document}β^=0.5⋅10−4,p=0.02, intersection density \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.003,p=0.04\right) $$\end{document}β^=0.003,p=0.04, and public transit density \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.037,p=0.01\right) $$\end{document}β^=0.037,p=0.01 showed a positive effect on MVPA, while land use mix revealed a negative effect on MVPA \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=-0.173,p=0.13\right) $$\end{document}β^=−0.173,p=0.13. In particular, playground density \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.048,p=0.01\right) $$\end{document}β^=0.048,p=0.01 and density of public open spaces, i.e., playgrounds and parks combined \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.040,p=0.01\right) $$\end{document}β^=0.040,p=0.01, showed positive effects on MVPA. However, availability of green spaces showed no effect on MVPA. Different moveability indices were constructed based on the walkability index accounting for the negative impact of land use mix. Moveability indices showed also strong effects on MVPA in school children for both components, expanded by playground density \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.014,p=0.008\right) $$\end{document}β^=0.014,p=0.008 or by public open space density \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \left(\widehat{\beta}=0.014,p=0.007\right) $$\end{document}β^=0.014,p=0.007, but no effects of urban measures and moveability indices were found in pre-school children. The final moveability indices capture relevant opportunities for PA in school children. Particularly, availability of public open spaces seems to be a strong predictor of MVPA. Future studies involving children should consider quantitative assessment of public recreational facilities in larger cities or urban sprawls in order to investigate the influence of the moveability on childhood PA in a broader sample.
PMCID: PMC4338118  PMID: 25380722
Accelerometry; Built environment; Children; IDEFICS study; Moderate-to-vigorous physical activity; Walkability
20.  Correlates of HIV Testing among African American and Latino Church Congregants: The Role of HIV Stigmatizing Attitudes and Discussions about HIV 
Faith-based organizations can be key settings in which to reach African Americans and Latinos for HIV prevention, but little is known regarding factors that predict congregants’ HIV testing behaviors. We examined the extent to which sociodemographic factors, HIV-related cues to action (e.g., knowing someone who is HIV-positive), and the social climate surrounding HIV (stigma toward a hypothetical HIV-positive congregant, HIV-related discussions at church about abstinence, condoms, and testing) were associated with willingness to be tested in church and with ever having been tested among 1211 African American and Latino congregants. Multivariate analyses indicated that congregants were more open to church-based testing if they were younger and had discussed condoms at church. They were less open if they expressed stigmatizing attitudes toward a hypothetical congregant. Foreign-born Latinos with low English proficiency were more willing to be tested at church than were African Americans. Congregants were more likely to have ever been tested if they were younger, African American, female, or married; if they knew someone who was HIV-positive; and if they had discussed testing and condoms at church. They were less likely if they had discussed abstinence. Open dialogue around HIV may activate congregants to be more receptive to church-based prevention.
PMCID: PMC4338119  PMID: 25537729
African American/Black; Faith-based organizations; HIV/AIDS; HIV testing; Latino/Hispanic
21.  Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health, Substance Use, and HIV 
Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems—binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse—comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.
PMCID: PMC4338120  PMID: 25476958
Healthcare utilization; Transition; Transgender women; HIV; Substance use; Mental health
22.  Relationship Characteristics Differ Based on Use of Substances with Sex among an Urban Internet Sample of HIV-Discordant and HIV-Positive Male Couples 
Previous research with men who have sex with men (MSM) has found that substance use with sex is strongly associated with HIV acquisition and poor adherence to HIV treatments. Although some studies have assessed male couples’ use of substances with unprotected anal sex, little is known on whether differences in their relationship dynamics are associated with their usage. Current HIV prevention initiatives underscore the importance of studying male couples’ relationship dynamics. Using dyadic data from 28 HIV-positive and 58 HIV-discordant male couples, this analysis sought to: (1) describe, by substance type, whether neither, one, or both partners in the couple used a particular substance with sex within their relationship or outside of the relationship, respectively, and (2) assess, by substance type, whether relationship characteristic differences existed between these three groups of couples with respect to substance use with sex within and outside the relationship. Data from 86 dyads came from a cross-sectional, Internet study. Multivariate multinomial regression models were employed to achieve the aims. Except for alcohol, most did not use substances with sex. Within the relationship, those who used with sex varied by substance type; outside the relationship, most couples had only one partner who used with sex regardless of substance type. Several relationship characteristic differences were noted between the groups of couples. Within the relationship, marijuana and erectile dysfunction medication (EDM) use with sex was associated with having less tangible resources; for outside the relationship, these were associated with perceiving to have greater quality of alternatives. In general, amyl nitrates and party drug use with sex were associated with viewing the main partner as being less dependable for trustworthiness. Marijuana and party drug use with sex within the relationship and EDM use with sex outside the relationship were negatively associated with being able to communicate constructively. Mixed results were noted for relationship satisfaction. Additional research is urgently needed for prevention and promotion of healthy relationships for male couples who use substances with sex.
PMCID: PMC4338121  PMID: 25559366
Substance use with sex; Male couples; Concordant HIV-positive relationships; HIV-discordant relationships; Relationship dynamics
23.  Breast Cancer Treatment among African American Women in North St. Louis, Missouri 
Similar to disparities seen at the national and state levels, African American women in St. Louis, Missouri have higher breast cancer mortality rates than their Caucasian counterparts. We examined breast cancer treatment (regimens and timing) in a sample of African American breast cancer patients diagnosed between 2000 and 2008 while residing in a North St. Louis cluster (eight zip codes) of late stage at diagnosis. Data were obtained from medical record extractions of women participating in a mixed-method study of breast cancer treatment experiences. The median time between diagnosis and initiation of treatment was 27 days; 12.2 % of the women had treatment delay over 60 days. These findings suggest that treatment delay and regimens are unlikely contributors to excess mortality rates for African American women diagnosed in early stages. Conflicting research findings on treatment delay may result from the inconsistent definitions of treatment delay and variations among study populations. Breast cancer treatment delay may reduce breast cancer survival; additional research is needed to better understand the points at which delays are most likely to occur and develop policies, programs, and interventions to address disparities in treatment delay. There may also be differences in treatment-related survivorship quality of life; approximately 54 % of the women in this sample treated with mastectomies received breast reconstruction surgery. Despite the high reconstruction rates, most women did not receive definitive completion. African American women have higher reconstruction complication rates than Caucasian women; these data provide additional evidence to suggest a disparity in breast reconstruction outcomes by race.
PMCID: PMC4338122  PMID: 24912599
St. Louis; Breast cancer; African American women; Treatment delay; Breast reconstruction
24.  A Child’s View: Social and Physical Environmental Features Differentially Predict Parent and Child Perceived Neighborhood Safety 
Parent and child perceived neighborhood safety predicts child health outcomes such as sleep quality, asthma, physical activity, and psychological distress. Although previous studies identify environmental predictors of parent perceived safety, little is known about predictors of child perceived safety. This study aims to identify the social and physical environmental neighborhood features that predict child and parent perceived neighborhood safety and, simultaneously, to assess the association between child and parent perceptions. Data were from the QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort, an ongoing study of Caucasian children (aged 8–10 years) with a parental history of obesity, and their biological parents from Québec, Canada. Measures of social and physical neighborhood features were collected using a spatial data infrastructure and in-person audits. Structural equation modeling was used to test direct and indirect associations between neighborhood features, child and parent perceived safety. Results suggest that among children (N = 494), trees and lighting were positively associated with perceived neighborhood safety, whereas a high proportion of visible minorities was associated with poorer perceived safety. Parents’ perceptions of safety were more strongly tied to indicators of disorder and a lack of community involvement, and to traffic. Child perceived safety was partly explained by parent perceived safety, suggesting moderate concordance between perceptions. Although associated with each other, parent and child perceived safety seemed to be determined by distinct environmental features. Though this study focused on determinants of child and parent perceived safety, future research investigating the impact of neighborhood safety on child health should consider both child and parent perspectives.
PMCID: PMC4338123  PMID: 25450517
Québec; Socioecological model; Neighborhood; Safety; Parent; Child
25.  Estimating the Number of Men Who Have Sex with Men by Race/Ethnicity at the County Level in Texas 
This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs.
PMCID: PMC4338124  PMID: 25347955
MSM; Texas; Men who have sex with men; HIV surveillance; Population estimates

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