Search

Objectives. We examined the prevalence and correlates of human papillomavirus (HPV) vaccine initiation among adolescents in low-income, urban areas. Methods. The study consisted of electronic health record data on HPV vaccination for 3180 adolescents (aged 10-20 years) at a multisite community health center in 2011. Results. Only 27% initiated the HPV vaccine. The adjusted odds ratio (AOR) of HPV vaccination was lower among older adolescents (AOR = 0.552; 95% confidence interval [CI] = 0.424, 0.718) and those seen by nonpediatric health care providers (HCPs; AOR = 0.311; 95% CI = 0.222, 0.435), and higher among non-English speakers (AOR = 1.409; 95% CI = 1.134, 1.751) and those seen at 2 site locations (AOR = 1.890; 95% CI = 1.547, 2.311). Insurance status was significant only among female and Hispanic adolescents. Language was not a predictor among Hispanic adolescents. Across all analyses, the interaction of age and HCP specialty was associated with HPV vaccination. Dramatically lower HPV vaccination rates were found among older adolescents seen by nonpediatric HCPs (3%-5%) than among other adolescents (23%-45%). Conclusions. Improving HPV vaccination initiation in low-income urban areas is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations. [ABSTRACT FROM AUTHOR]

Objectives. We examined relationships between parenting status and multiple forms of violence perpetration among young adults in high-poverty environments. Methods. We analyzed data obtained from a survey of 990 young adults in New York City. Respondents reported on violence they had perpetrated toward themselves, intimate partners, and others. Associations between parenting and violence were examined in logistic regressions, controlling for sociodemographics. Results. Fewer young men (33.0%) than young women (48.6%) reported that they were raising children. Among young men, parenting was associated with violence toward themselves (odds ratio [OR]=1.8; 95% confidence interval [CI]=1.03, 3.16) but not with violence toward partners or others. Among young women, violence perpetration did not differ by parenting status. Correlations among forms of violence were higher among young women than among young men, especially among mothers. Community violence was associated with violence toward others for both genders. For young men, community violence was associated with violence toward partners. Conclusions. Parenting did not reduce inner-city young adults' perpetration of violence. Among fathers, parenting may be, along with unemployment, a risk for violence toward self. Understanding patterns of violence can inform interventions that support young adults, including those who are parenting, in creating nonviolent homes and communities. [ABSTRACT FROM AUTHOR]

Objectives. We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma. Methods. Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were randomly assigned into 2 groups (immediate and delayed intervention) in a crossover study. Each group participated in the active phase (intervention) and the inactive phase. Outcomes included asthma symptoms, albuterol use, emergency department visits, hospitalizations, and trigger reduction. Results. A total of 264 primarily Black (94%) children were enrolled. The mean number of emergency visits decreased by 30% and inpatient visits decreased by 53% (P<.001) after the intervention. Reductions were seen in pests, presence of carpets in bedrooms, and dust. Nighttime wheezing was significantly reduced after the intervention in both groups (P<.001). Conclusions. Lay health educators effectively reduced asthma triggers and increased caregiver asthma knowledge, which resulted in reduced emergency department visits, hospitalizations, and asthma symptoms. The relationships formed between the caregivers and the lay health educators appeared to positively impact asthma outcomes in this disadvantaged population. (Am J Public Health. 2009;99:S657-S665. doi:10.2105/AJPH.2009.165423) [ABSTRACT FROM AUTHOR]

Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities. (Am J Public Health. 2009; 99:1603-1611. doi:10.2105/AJPH.2008.150136) [ABSTRACT FROM AUTHOR]

This article presents the results of a pilot study on the effect of providing a safe play space on the physical activity levels of U.S. inner-city schoolchildren. There is increasing evidence that physical and social environments influence levels of physical activity. It is vital for inner-city children to have a sense of safety in order to make use of outdoor settings. The study opened a play yard and provided attendants to ensure safety. Over two years, the number of children and their physical activity levels were studied. The study found the number of children who were physically active was 84 percent higher in the play space neighborhood than in the control neighborhood.

Conclusions. These differences between MSM who live in gay ghettos and those who live elsewhere have clear implications for HIV prevention efforts and health care planning. (Am J Public Health. 2001;91:980-983) [ABSTRACT FROM AUTHOR]

Factors affecting the extent to which individuals aged 65 and over living in inner-city households received health care for three chronic conditions (high blood pressure, heart trouble, arthritis) are examined. These factors are age, sex, living arrangements, and the presence of more than one chronic condition. Indicators of receiving care are having seen a health care provider within the previous six months and being on medication for the condition. A more detailed scrutiny of care received for high blood pressure is undertaken as well. This analysis is part of a larger study investigating health care of groups within East Baltimore who utilize different systems of care, focusing on a hospital outpatient department and a new HMO. Data were obtained from 1455 household interviews among three sample populations: enrollees in an HMO, public housing project residents, and the general community. The findings indicate that high proportions of the elderly who report having these conditions also report receiving care for them. For people with high blood pressure, the majority are receiving care and being given self-care instructions, and high proportions report compliance with instructions. [ABSTRACT FROM AUTHOR]

Objectives. This study assessed hypertension control among high-risk African Americans. Methods. We interviewed 583 African Americans aged 18 years and older residing in 438 randomly selected inner-city households. Results. Forty-two percent of the respondents were hypertensive, Blood pressure was uncontrolled in 74% of hypertensive persons, although 64% of hypertensive persons reported having seen a physician within the previous 3 months. Hypertension control was associated with female gender and higher socioeconomic strata but not with public versus private sources of medical care. Conclusions. Hypertension control is inadequate in this population, although health care services are used frequently. Hypertension control efforts should focus on the effectiveness of health care delivery. [ABSTRACT FROM AUTHOR]

Objectives. Drug use is commonly depicted and treated as an individual problem. This study describes the extent of drug use, human immunodeficiency virus (HIV) infection, and acquired immunodeficiency syndrome (AIDS) among drug users' sexual partners and family and household members in order to broaden considerations of risk. Methods. Social network charts and structured interviews were administered to 126 women (predominantly African American and Latino) enrolled in methadone treatment. The charts elicited the prevalence of drug use and HIV infection among subjects' family and household members. Results. Drug use and HIV/AIDS permeated subjects' sexual, familial, and household relationships. More than half of the women who resided with a sexual partner reported that their partners currently used drugs. Almost one third of the subjects' siblings were drug users. Of the 715 total siblings (all subjects plus their siblings), 69 (9.7%) were known to be HIV positive or to have an AIDS diagnosis. Conclusions. The sexual, familial, and household expressions of drug use underscore the notion that drug use and attendant risks, including but not limited to HIV infection, might be usefully viewed and treated as an inter- and intracommunity problem rather than as an exclusively individual one. [ABSTRACT FROM AUTHOR]

This paper deals with the critical dental and medical manpower shortage in the ghettos, some underlying causes, how blacks might be recruited, and what support is needed from government and the health professions for this purpose. [ABSTRACT FROM AUTHOR]

The article discusses the study that aims to assess the medical costs of treating drug abuse at inner-city hospitals in the U.S. Also prompting the study is the insufficiency of population-based data describing the medical complications of drug abuse both in national and community level. The study used the charts of all inpatients discharged from Harlem Hospital Center in November 1976 by reviewing the history of drug addicts. Researchers found out that the average length of stay for drug abusers was 16.7 days compared to 9.5 days for all discharged patients that month. Other resource utilization measures were also above those of the general population.

The article presents the editor's views on a study on violence against women, initiated by Grisso and colleagues and published in this issue. The researchers lament that much health research on violence has focused solely on men. Thus, they present a population-based study of injury morbidity among women in inner-city African American community in Philadelphia, Pennsylvania. The researchers emphasize the role that violence towards women plays in determining injury incidence. The study contributes to the literature on the epidemiology and prevention on violence towards women.

Perinatal illicit drug use was determined by anonymously testing the urine of 1111 inner-city parturient's. Fourteen percent tested positive, 11.5% for cocaine. As determined by self-report or by positive test results, 17% used drugs. Twenty-eight percent of low birthweights and 20% of premature births in this group were attributable to drug use. Risk of prematurity was reduced by a factor of 2 to 3 with adequate prenatal care. These data suggest an enormous potential for improving perinatal health. [ABSTRACT FROM AUTHOR]

An experimental program to train urban ghetto residents as environmental extension agents in their own communities is described. [ABSTRACT FROM AUTHOR]

The article reports that severe lead poisoning was diagnosed among children living in inner cities of the United States. Through the combined efforts of public health agencies, regulations on quantities of lead permitted in paint as well as dedicated actions of individual physicians and parents, there has been a substantial decline in the prevalence of pediatric lead encephalopathy.

Abstract: Age-specific death rates for pedestrian-car accidents among the populations living in four contiguous areas of a large city one being the downtown area and the others gradually more removed from it were compared. The rates are highest downtown and decrease progressively in the outlying areas, the absolute differences between areas being largest above age 65. These data suggest that pedestrian accident prevention efforts should lake into account the specific needs of the elderly living in the inner city. [ABSTRACT FROM AUTHOR]

The article investigates the father's influence on the intellectual level of Black ghetto children in the U.S. National interest has shifted on black ghetto children, especially upon their educational achievement and relationships between that achievement and family background on one hand and new educational programs on the other. Particular efforts have been made to identify a constellation of family variables that may account for a documented gap between the level of intellectual skills shown by these children and the level shown by white, middle class children of the same age.

The article investigates the perceptions of health problems and solutions among inner city residents and health decision-makers in the U.S. In this study, the researchers conducted interviews in a north central model cities area with sixteen members of a Health Task Force and twenty-five professional health decision-makers in an attempt to determine whether perceptions of health problems and solutions are consistent in these groupings. Task Force members referred to problems with emergency services as the most significant problem facing residents. In elaborating, many respondents suggested that residents utilize the hospital emergency room much as middle class individuals use private physicians.