Search

We examined whether the interplay between community disadvantage and a conduct disorder polygenic risk score (CD PRS) was associated with sexual health outcomes among urban women. Participants (N = 511; 75.5% African American) were originally recruited to participate in a school-based intervention and were followed into adulthood. Community disadvantage was calculated using census data when participants were in first grade. At age 20, blood or saliva samples were collected and participants reported on their condom use, sexual partners, and sexually transmitted infections. A CD PRS was created based on a genome-wide association study conducted by Dick et al. [2010]. Higher levels of community disadvantage was associated with greater sexually transmitted infections among women with a higher CD PRS. Implications of the study findings are discussed.

Extant research has typically examined neighborhood characteristics in isolation using variable-centered approaches; however, there is reason to believe that perceptions of the neighborhood environment influence each other, requiring the use of person-centered approaches to study these relationships. The present study sought to determine profiles of youth that differ in their perceptions of their neighborhoods and objective neighborhood characteristics, and whether these profiles are associated with youth coping. Participants were low-income, African American youth (N = 733; 51.0% female, M age = 18.76 years, SD = 1.71) from a metropolitan city who were originally recruited for the Youth Opportunity program in Baltimore, Maryland. A latent profile analysis was conducted which included self-reported neighborhood social cohesion, collective efficacy, disorder, violence, and disadvantage derived from census data. Coping behaviors, specifically positive cognitive restructuring, problem-focused coping, distraction strategies, and avoidant behaviors were assessed via self-reported questionnaires. Four neighborhood profiles were identified: highest disorder (20.0%); highest violence/highest disadvantage (5.2%); high violence (26.6%); and highest cohesion/lowest disorder (48.2%). Individuals in the highest violence/highest disadvantage profile reported higher positive cognitive restructuring and problem-focused coping than the other profiles. These findings warrant an investigation into the individual assets and contextual resources that may contribute to more positive coping behaviors among youth in more violent and disadvantaged neighborhoods, which has the potential to improve resilient outcomes among youth in similar at-risk settings.

Background In emerging adulthood when many youth are maturing out of marijuana use, Blacks continue to have high rates of use and disorder. Theory suggests that factors tied to neighborhood disadvantage may partially explain this phenomenon but research is limited. Objectives This study examines the influence of neighborhood physical and social disorder on transitions in marijuana use during emerging adulthood in a low-income urban sample. Methods 379 primarily Black young adults residing in low-income neighborhoods in Baltimore City were followed-up annually from ages 18 to 21. Neighborhood environment was evaluated using a valid and reliable field-rater assessment of the residential block. Longitudinal latent class and latent transition analyses were performed. Results Fit indices supported three-classes of marijuana use: no use, infrequent use and frequent use. Between ages 18 and 21, young adults tended to transition toward lower levels of use. However, neighborhood physical disorder was associated with transitioning to increased marijuana use (no use to frequent use; AOR = 2.712; p = .023) while positive neighborhood social activity was associated with a decreased risk (AOR = 0.002; p = .013). Neighborhood social activity was also associated with decreases in use (frequent to infrequent use; AOR = 2.342; p = .020). Conclusions/Importance: These findings demonstrate that physical disorder within the context of a low-income urban neighborhood adversely impacts marijuana use. However, even in the presence of physical disorder, interventions that foster collective efficacy among residents through positive social activity may prevent initiation and progression of marijuana use.

Few studies have considered the potential role of the built environment in increasing adolescent substance use. The current study explored the relationship between alcohol outlets, a potential malleable component of the neighborhood environment, and adolescent behavioral outcomes. Specifically, we investigated the relationship between alcohol outlet density, perceived alcohol, tobacco, and other drugs (ATOD) availability, perception of substance use as a problem at the school, and self-reported ATOD use. Data come from Maryland Safe and Supportive Schools (MDS3) Initiative, a statewide project focused on measuring and improving school climate. The sample includes 25,308 adolescents from 58 high schools (Grades 9–12) across 12 counties. Multilevel path models indicated a positive relationship between the count of alcohol outlets and perceived availability of ATOD among girls but not boys. Perceived availability was associated with increased ATOD use at both individual and school levels as well as other students’ ATOD use. Findings provide support for the potential role of the built environment in adolescent risk for substance use, particularly among girls.

Studies have shown that communities with higher concentrations of low-income racial and ethnic minorities correlate with a greater presence of tobacco outlets. Community-level income has consistently been among the strongest predictors of tobacco outlet density. This study analyzes two Maryland geopolitical areas with similar racial concentrations yet differing income levels in an attempt to disentangle the race-income relationship with tobacco outlet density.In this cross-sectional examination of tobacco outlet and census tract-level sociodemographic data, Baltimore City, Maryland, and Prince George's County, Maryland, were geocoded to determine tobacco outlet density.Tobacco outlet density was defined as the mean number of tobacco outlets per 1000 persons per census tract. Comparisons of tobacco outlet density and sociodemographic variables were analysed via two-sample t-tests, and the direct effect of sociodemographic variables on tobacco outlet density for each area was analysed via spatial lag regressions.Prince George's County, the area with the higher income level ($77,190 vs $43,571), has a significantly lower tobacco outlet density than Baltimore City (P 0.001). Prince George's County has a 67.5% Black population and an average of 3.94 tobacco outlets per 1000 persons per tract. By contrast, Baltimore City has a 65.3% Black population and an average of 7.95 tobacco outlets per 1000 persons per tract. Spatial lag regression model results indicate an inverse relationship between income and tobacco outlet density in Baltimore City and Prince George's County (β = -0.03, P 0.01β = -0.01, P = 0.02, respectively), and a significant interaction term indicating a greater magnitude in the relationship between income and tobacco outlet density in Baltimore City (β = -0.05, P 0.01).Results suggest that higher socio-economic status, even in primarily underrepresented racial and ethnic geopolitical areas, is linked to lower tobacco outlet density.

Substance use can occur as a result of coping with stress. Within the school context, youth are exposed to stressors related to school achievement and peer-relationships. Protective factors, such as spirituality, may moderate adolescents' engagement in substance use.The current study investigated the role of spirituality in the association between stress and substance use, in an effort to test the hypothesis that spirituality moderates the association between stress and substance use.This study used data from youth in grades 6-8 attending 40 parochial private schools. A total of 5,217 students participated in the web-based survey administered in Spring 2013. Multilevel structural equation models were used to examine the association between stress, spirituality, and substance use, while accounting for the nested nature of the data (i.e., students within schools).Higher stress was significantly associated with increased alcohol, tobacco, and other drug use among youth (b =.306, p.001). In addition, lower spiritual beliefs were associated with greater substance use (b =.349, p.001). Spiritual beliefs did not moderate the relationship between stress and substance use.Implications for increasing students' adaptive coping when confronted with school-related stressors and the role of school climate are discussed.

This research examined whether publicly funded drug treatment centers (DTCs) were associated with violent crime in excess of the violence happening around other commercial businesses.Violent crime data and locations of community entities were geocoded and mapped. DTCs and other retail outlets were matched based on a Neighborhood Disadvantage score at the census tract level. Street network buffers ranging from 100 to 1,400 feet were placed around each location. Negative binomial regression models were used to estimate the relationship between the count of violent crimes and the distance from each business type.Compared with the mean count of violent crime around drug treatment centers, the mean count of violent crime (M = 2.87) was significantly higher around liquor stores (M = 3.98; t test; p.01) and corner stores (M = 3.78; t test; p.01), and there was no statistically significant difference between the count around convenience stores (M = 2.65; t test; p = .32). In the adjusted negative binomial regression models, there was a negative and significant relationship between the count of violent crime and the distance from drug treatment centers (β = -.069, p.01), liquor stores (β = -.081, p.01), corner stores (β = -.116, p.01), and convenience stores (β = -.154, p.01).Violent crime associated with drug treatment centers is similar to that associated with liquor stores and is less frequent than that associated with convenience stores and corner stores.

Tobacco outlet exposure is a correlate of tobacco use with potential differences by gender that warrant attention. The aim of this study is to explore the moderating role of gender in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults 21 to 24 years old. This cross-sectional study (n = 283) used geospatial methods to determine the number of tobacco outlets within walking distance (i.e., a quarter mile) of participants' homes and distance to the nearest outlet. Logistic regression models were used to test interactions between gender and tobacco outlet exposure (i.e., density and proximity). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets). Neither density nor proximity was associated with past month tobacco use in the pooled models. However, gender modified the relationship between TO outlet density and tobacco use, and this relationship was significant only among women (OR = 1.02; p < 0.01; adjusted OR = 1.01; p < 0.05). This study underscores the importance of reducing tobacco outlet density in residential neighborhoods, especially TO outlets, as well as highlights potential gender differences in the relationship between tobacco outlet density and tobacco use.

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

The oversaturation of alcohol outlets can have disastrous public health consequences. The goal of this study was to evaluate the potential impact of new zoning legislation, TransForm Baltimore on locations of alcohol outlets. More specifically, the study sought to determine the effect of the new zoning code on the potential re-distribution of alcohol outlets and also provide empirical support for the need to actively monitor redistribution of outlets to avoid further inequitable oversaturation in disadvantaged neighborhoods. METHODS: Data on off-premise alcohol outlets (e.g. packaged goods stores) were obtained from the Board of Liquor License Commissioners for Baltimore City. The alcohol outlets were geocoded and assigned to zoning parcels. Churches and schools were also geocoded. The alcohol outlets were also assigned to Census tracts to calculate socioeconomic statuses. RESULTS: 172 of the 263 off-premise packaged goods stores (PGS) were in violation of the new zoning law. TransForm will reduce the land parcels available to alcohol outlets by 27.2%. Areas containing non-conforming PGS were more likely to have a higher percentage of Black residents, single parent families, unemployment, household poverty, and vacancy compared to Baltimore City averages and areas without non-conforming PGS. CONCLUSIONS: Planning enforcement efforts need to accompany related laws to prevent/reduce overconcentration of PGS in disadvantaged neighborhoods.

There is limited research on e-cigarette availability despite increased use. E-cigarette availability within Baltimore alcohol outlets was analyzed for disparities among residential neighborhoods. Data were obtained via field surveys of alcohol outlets, and then spatially merged with sociodemographic data; 18.8% of alcohol outlets had any e-cigarette availability. Regression models showed greater odds ratios for e-cigarette availability when cigarettes, cigars, or hookah paraphernalia were sold, and lower odds ratios when alcohol outlets had an on-site consumption license. Outlets with e-cigarette availability were in predominantly lower-income, nonwhite neighborhoods. It is important to assess exposure of another potentially damaging substance among perpetually disadvantaged populations.

BACKGROUND Alcohol outlet density has been associated with increased pedestrian injury risk. It is unclear whether this is because alcohol outlets are located in dense retail areas with heavy pedestrian traffic or whether alcohol outlets contribute a unique neighborhood risk. We aimed to compare the pedestrian injury rate around alcohol outlets to the rate around other, similar retail outlets that do not sell alcohol. METHODS A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury emergency medical services (EMS) records from January 1, 2014 to April 15, 2015 (n = 848); locations of alcohol outlets licensed for off-premise (n = 726) and on-premise consumption (n = 531); and corner (n = 398) and convenience stores (n = 192) that do not sell alcohol. Negative binomial regression was used to determine the relationship between retail outlet count and pedestrian injuries, controlling for key confounding variables. Spatial autocorrelation was also assessed and variable selection adjusted accordingly. RESULTS Each additional off-premise alcohol outlet was associated with a 12.3% increase in the rate of neighborhood pedestrian injury when controlling for convenience and corner stores and other confounders (incidence rate ratio [IRR] = 1.123, 95% confidence interval [CI] = 1.065, 1.184, p

Nationally, 80% of pedestrian fatalities occur in urban environments, yet the distribution of injuries across urban areas is not uniform. Identifying street-level risk factors for pedestrian injury is essential for urban planning and improvement projects, as well as targeted injury prevention efforts. However, creating and maintaining a comprehensive database of a city’s traffic safety infrastructure can be cumbersome and costly. The purpose of this study was to create and validate a neighborhood environmental observational assessment tool to capture evidence-based pedestrian safety infrastructure using Google Street View (GSV)—The Inventory for Pedestrian Safety Infrastructure (IPSI). We collected measures in-person at 172 liquor stores in Baltimore City from June to August 2015 to assess the tool’s reliability; we then collected IPSI measures at the same 172 locations using GSV from February to March 2016 to assess IPSI reliability using GSV. The majority of items had good or excellent levels of inter-rater reliability (ICC ≥ 0.8), with intersection features showing the highest agreement across raters. Two scales were also developed using exploratory factor analysis, and both showed strong internal consistency (Cronbach’s alpha ≥ 0.6). The IPSI provides a valid, economically efficient tool for assessing pedestrian safety infrastructure that can be employed for a variety of research and urban planning needs. It can also be used for in-person or GSV observation. Reliable and valid measurement of pedestrian safety infrastructure is essential to effectively prevent future pedestrian injuries. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11524-017-0226-2) contains supplementary material, which is available to authorized users.

The present study examined the influence of neighborhood factors on transitions in marijuana involvement during adolescence in a sample of primarily low-income, urban Black youth.556 Black adolescents were interviewed annually beginning in first grade as part of a longitudinal study. Latent class analysis (LCA) was used to examine stages of marijuana involvement from 6th to 9th grades. The influence of neighborhood disorder, drug activity, violent crime, safety and disadvantage on transitions in marijuana involvement was tested using latent transition analysis (LTA).There was evidence for three stages of involvement: no involvement, offered, and use and problems. Involvement increased steadily during adolescence with a slightly greater risk to transition from offers to use between 6th and 7th grades. Neighborhood disorder (AOR=1.04, CI=1.00, 1.08), drug activity (AOR=1.12, CI=1.02, 1.22) and disadvantage (AOR=1.44, CI=1.10, 1.92) were associated with the transition from marijuana offers to use and problems. Neighborhood disorder (AOR=1.07, CI=1.02, 1.11), drug activity (AOR=1.19, CI=1.10, 1.29) and violent crime (AOR=1.17, CI=1.03, 1.32) were associated with transitioning rapidly from no involvement to use and problems.Understanding how neighborhoods could be organized and provided with supports to discourage marijuana use and promote non-drug using behaviors should be an important goal of any prevention program in low-income, urban Black neighborhoods. Enhancing citizen participation and mobilization to address the social processes of neighborhood disorder has the potential to reduce marijuana involvement in these neighborhoods.

School safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents' risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools.

Adolescents are exposed to various stressors that may increase the risk for substance use. Due to the detrimental, and potentially long-lasting, effects related to substance use, it is necessary to explore more optimal coping strategies. This study explored the association between substance use and stress among male and female high school students in relation to spirituality as a moderator. To examine these relationships, the study used cross-sectional data collected from 27,874 high school students (Male = 50.7%, Female = 49.3%) across 58 high schools in Maryland that included an ethnically diverse sample (49% Caucasian, 30% African American) with an average age of 16 years old. Bivariate results showed differences in substance use, stress, and spirituality between male and female students. Higher rates of substance use were generally found among male students compared to female students; rates tended to be higher among female students for stress and spirituality compared to their male counterparts. Multilevel analyses indicated a positive association between stress and substance use among male and female students after adjusting for demographic and school-level factors. Both male and female students who reported turning to spiritual beliefs when experiencing problems were less likely to use substances. However, the interaction between stress and spirituality was significant for males only. These findings suggest that stress may increase the propensity for substance use and that spirituality might be a viable coping mechanism useful for helping high school students adapt to stressful circumstances and situations.

African American male high school students have the highest rates of marijuana use among all racial, ethnic, and gender groups, yet there is limited research examining contextual factors salient to the African American community. The purpose of this study was to examine how neighborhood environment measured in 8th grade is related to longitudinal transitions in marijuana use during high school (9th to 12th grades) in a sample of urban African Americans. Four hundred and fifty-two African American children were interviewed annually beginning in 1st grade as part of a longitudinal field study in Baltimore city. Latent transition analysis indicated early in high school posed the greatest risk for initiation and progression of marijuana use. Community violence exposure was associated with an increased likelihood of transitioning from no marijuana use to infrequent use (adjusted odds ratios (AOR) = 2.40, p

Violent crime such as homicide causes significant excess morbidity and mortality in US urban areas. A health impact assessment (HIA) identified zoning policy related to alcohol outlets as one way to decrease violent crime. The objectives were to determine the relationship between alcohol outlets including off-premise alcohol outlets and violent crime in one urban area to provide local public health evidence to inform a zoning code rewrite. An ecologic analysis of census tracts in Baltimore City was conducted from 2011 to 2012. The data included violent crimes (n = 51,942) from 2006 to 2010, licensed alcohol outlets establishments (n = 1,327) from 2005 to 2006, and data on neighborhood disadvantage, percent minority, percent occupancy, and drug arrests from 2005 to 2009. Negative binomial regression models were used to determine the relationship between the counts of alcohol outlets and violent crimes controlling for other factors. Spatial correlation was assessed and regression inference adjusted accordingly. Each one-unit increase in the number of alcohol outlets was associated with a 2.2 % increase in the count of violent crimes adjusting for neighborhood disadvantage, percent minority, percent occupancy, drug arrests, and spatial dependence (IRR = 1.022, 95 % CI = 1.015, 1.028). Off-premise alcohol outlets were significantly associated with violent crime in the adjusted model (IRR = 1.048, 95 % CI = 1.035, 1.061). Generating Baltimore-specific estimates of the relationship between alcohol outlets and violent crime has been central to supporting the incorporation of alcohol outlet policies in the zoning code rewrite being conducted in Baltimore City.

This investigation examined the association between alcohol outlets and substance use during young adulthood in Baltimore, MD. Geospatial methods were used to determine the number of outlets within walking distance of the participant's home and distance to nearest outlet. Logistic regression models found that distance to the nearest alcohol outlet was associated with past year marijuana use after adjusting for community disadvantage and sociodemographic characteristics (OR = 0.77, p = .03); specifically, as distance to the nearest outlet increased the likelihood of marijuana use decreased. Findings suggest that distance to the nearest alcohol outlet was a better predictor of marijuana use than the density of alcohol outlets.

This study examined the association between the count of alcohol outlets around children's homes and opportunities to use alcohol, tobacco, and other drugs (ATOD) during pre-adolescence. Data were collected in 2007 from 394 Baltimore City children aged 8-13 (86% African American). Participants' residential address and alcohol outlet data were geocoded with quarter mile (i.e., walking distance) buffers placed around each participant's home to determine the number of outlets within walking distance. The unadjusted logistic regression models revealed that each unit increase in the number of alcohol outlets was associated with a 14% increase in the likelihood of children seeing people selling drugs (OR=1.14, p=.04) and a 15% increase in the likelihood of seeing people smoking marijuana (OR=1.15, p

Purpose. Child and adolescent obesity is increasingly prevalent and predisposes risk for poor physical and psychosocial health. Physical and social factors in the environment, such as neighborhood disorder, may be associated with childhood obesity. This study examines the association between living in a disordered neighborhood and being overweight among a sample of urban schoolchildren. Design. Baseline interview data, including height, weight, and hip circumference, were obtained from 313 elementary school–aged participants in a community-based epidemiologic study. Setting. The setting was Baltimore, Maryland, a large metropolitan city. Subjects. Subjects were elementary school students ages 8 to 12 years. Measures. To assess neighborhood characteristics, independent evaluators conducted objective environmental assessments using the Neighborhood Inventory for Environmental Typology instrument on the block faces (defined as one side of a city block between two intersections) where the children resided. Analysis. Logistic regression models with generalized estimating equations were used to examine the association between neighborhood disorder and children being overweight. Results. Neighborhood disorder showed a trend toward a statistically significant association with being overweight during childhood (odds ratio [OR], 1.03; confidence interval [CI], .99–1.07; p = .07) in the unadjusted model. Gender was significantly associated with being overweight, with female gender increasing the odds of being overweight by 50% in the sample (OR, 1.50; CI, 1.18–1.92; p < .01). After controlling for race, age, and comparative time spent on a sport, multivariable analyses revealed that gender (adjusted odds ratio [AOR], 2.42; CI, 1.63–3.59; p < .01) and neighborhood disorder (AOR, 1.09; CI, 1.03–1.15; p < .01) were associated with being overweight. Further, an examination of interactions revealed girls (AOR, 2.40; CI, 1.65–3.49; p < .01) were more likely to be overweight compared with boys (AOR, 2.20; CI, 1.57–3.11; p < .01) living in neighborhoods with the same level of neighborhood disorder. Conclusion. Results suggest neighborhood hazards warrant additional consideration for their potential as obesogenic elements affecting gender-based disparities in weight among urban schoolchildren. Future studies in this area should include longitudinal examinations.

In the U.S., cigar use doubled from 5.0 to 10.6 billion cigars consumed annually between 1997 and 2007, driven in large part by increased sales of cigarette-sized "little cigars" and narrow, mid-sized "cigarillos." The present study examined prevalence of cigarillo use as well as attitudes, knowledge and behaviors related to cigarillo use among a sample of predominantly urban African American young adults 18-24 not in school and not employed. Survey data were collected from 131 young adults attending education and job training centers in Baltimore, Maryland and from 78 young adults attending education, job training, or recreational programs in Washington, D.C. In Baltimore, 22% of young adults had smoked a cigarillo in the past 30 days, compared with nearly 63% in D.C. Both populations were heavily exposed to cigarillo advertising and marketing. Cigarillo use in this urban young adult population is a growing public health problem and undermines the progress made in decreasing cigarette use.

This research investigated the relationship between alcohol outlet density (AOD) and life expectancy, as mediated by community violence and community disadvantage. We used linear regression models to assess bivariate and multivariate relationships. There was a negative bivariate association between liquor store density and average life expectancy (β = -7.3370, p < 0.001). This relationship was partially attenuated when controlling for community disadvantage and fully attenuated when controlling for community violence. Bars/taverns (i.e., on-premise) were not associated with average life expectancy (β = -0.589, p = 0.220). Liquor store density is associated with higher levels of community disadvantage and higher rates of violence, both of which are associated with lower life expectancies. Future research, potential intervention, and current related policies are discussed.

African American young adults ages 18-25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18-25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues-selected on the basis of youth reports of popular venues-were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.

The Problem : The prevalence of injection drug use (IDU) and incidence of human immunodeficiency virus (HIV) remain high in Baltimore, where IDU is a primary HIV risk factor. Substance use disorders and HIV are related syndemically—their causes and consequences interact synergistically. Baltimore is increasingly considering the syndemic relationship of substance use disorders, IDU, and HIV in making decisions about drug treatment funding and location. Purpose of Article : Our goal was to empirically identify the optimal location of new drug treatment programs through the development and application of a novel, practical tool. Key Points : Syndemic triangles were constructed to measure and visualize unmet need for drug treatment services. These data were used to determine priority zones for new treatment centers. Conclusions : The application of this tool helped inform strategies for locating drug treatment services in Baltimore, and its successful use suggests its potential value in other metropolitan areas.

Among youth 15 to 24years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth's attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43% of the attitudes assessed in the intervention community post-intervention compared to 13% of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = -0.522, p

Management of daily stress can be greatly improved by delivering sensor-triggered just-in-time interventions (JITIs) on mobile devices. The success of such JITIs critically depends on being able to mine the time series of noisy sensor data to find the most opportune moments. In this paper, we propose a time series pattern mining method to detect significant stress episodes in a time series of discontinuous and rapidly varying stress data. We apply our model to 4 weeks of physiological, GPS, and activity data collected from 38 users in their natural environment to discover patterns of stress in real-life. We find that the duration of a prior stress episode predicts the duration of the next stress episode and stress in mornings and evenings is lower than during the day. We then analyze the relationship between stress and objectively rated disorder in the surrounding neighborhood and develop a model to predict stressful episodes.

Background: With patterns of initiation of tobacco and marijuana changing, there is increasing evidence that marijuana use may serve as an antecedent to tobacco use among adolescents. However, studies have not fully characterized the prevalence of these patterns among vulnerable youth and have rarely examined the factors that predict the sequencing of onset of tobacco and marijuana use. Methods: Utilizing longitudinal data from a sample of urban youth followed from age 6 to age 18, the authors identify the sequencing of initiation of tobacco and marijuana and test whether race and 5 neighborhood factors (i.e., perceived disorder, drug activity, drug access, exposure to violence, and exposure to violent victimization) predict onset sequencing. Results: Various sequencing patterns were observed, with 12.4% of the sample initiating marijuana use before tobacco use was initiated. In adjusted logistic regression models, black youth were 2.66 times as likely as whites to initiate marijuana before tobacco compared with initiating tobacco before marijuana ( P = .032). Youth with greater exposure to violent victimization were 3.89 times as likely to initiate marijuana first than initiate tobacco first ( P = .002). Other neighborhood factors were not statistically significantly associated with sequencing. Conclusions: Black youth and youth with greater exposure to victimization had an increased risk of initiating marijuana before tobacco, which suggests that this pattern may be rooted in specific risk factors. Substance use prevention efforts should consider taking into account that marijuana use may put certain youth at risk of initiating tobacco. Future research needs to monitor sequencing, as well as risk factors for and consequences of the various patterns, particularly since marijuana use and the mixing of tobacco and marijuana use are gaining acceptability in general populations.

Gun violence remains a pressing public health concern, especially in high-risk urban environments. Community-level violence intervention efforts are being mounted in cities across the United States to prevent and reduce the most severe forms of violence. There is growing evidence to suggest the effectiveness of the Safe Streets Program/ Cure Violence as a community-based intervention to reduce homicides and shootings. The mechanism underlying the reductions in community violence is theorized to be linked with changes in attitudes toward violence as well as shifts in social norms related to violence and retaliation, but there are few tools to assess these domains. This preliminary investigation sought to establish the metric properties of the Survey on Attitudes About Guns and Shootings (SAGAS) with the goal of providing an empirical measure of attitudes and community-level norms. Males aged 18 to 24 were surveyed using the SAGAS in two high-violence communities in Baltimore, Maryland, using street intercept methodology. We found acceptable reliability and validity metrics for the SAGAS. Reliability and validity of the SAGAS were assessed using internal consistency and a latent class analysis with violent behavior outcomes. The internal consistency of the total scale was in the extensive range (α = .70-.79) and the internal consistency of the factors was in the exemplary range (α ≥ .80). In addition, latent classes of attitudes were predictive of being arrested or being shot. Future studies will examine if rates of violence decrease in neighborhoods targeted by the Safe Streets Program and the mediating role of attitudes toward gun violence using the SAGAS.

Cigarette sales have declined in the United States over the past decade; however, small cigar sales have been rapidly increasing. In most urban areas, small cigars are inexpensive and are sold as singles without health warnings.This paper describes a community- academic-practice partnership's (CAPP) efforts to decrease small cigar use in young adults living in Baltimore, Maryland, through legislative strategies.Survey data among young adults not in school indicated that 20% of individuals reported current small cigar use, often in combination with cigarettes. The community- academic partnership engaged the community in discussion about small cigar use in the fall of 2007. In collaboration with partners, bills were submitted to the legislative bodies for the city and state to impose minimum packaging requirements on small cigars.Collaborative partnerships between community-based organizations, public health agencies, and academic institutions can lead to policy initiatives with the potential to improve public health.

While there are a growing number of observational instruments to assess the built and social dimensions of the neighborhood environment, there are few reliable and validated instruments; there are no instruments that assess the neighborhood environment during nighttime hours, a potential peak period of health and safety risk. The purpose of this investigation is to establish the metric properties of Neighborhood Inventory for Environmental Typology (NIfETy) Instrument nighttime ratings. Reliability of the scale was measured by internal consistency reliability and test re-test correlation. Validity was evaluated through correlation with the daytime NIfETy rating and regression models with local violent crime data. The nighttime items had good internal consistency (α = .81-82) for the total scale and acceptable internal consistency for a seven-item nighttime disorder scale (α = .66-.71). Future investigations will examine the nighttime NIfETy and its association with specific risk behaviors to evaluate changes in neighborhood environment.

This study examines gender differences in the association between environment and internalizing problems in a sample of predominately African American schoolchildren. Internalizing problems was assessed using the Youth Self Report. Violence and alcohol and other drug (AOD) exposure subscales were created using observational assessments of neighborhood blocks. Logistic regression models were used to assess the relationship between neighborhood environment and internalizing problems. For each AOD item present on the block the odds of internalizing problems among girls increased by 17% (OR = 1.17, CI: 1.01, 1.35, P = 0.039). The relationship was not significant among boys. Violence exposure did not predict internalizing problems in boys or girls. These preliminary findings suggest that primary school-aged girls' emotional well-being is more negatively impacted by deleterious environments. Future investigations will examine the relationship between deleterious neighborhood environments and internalizing problems as the children age into adolescence. Language: en

Risk factors for marijuana use in older adolescents and young adults have focused primarily on family environment and peer affiliation. A growing body of work has examined the relationship between environmental context and young adult substance use. This study builds on previous research linking neighborhood environment to young adult marijuana use by exploring two distinct features of neighborhoods, namely the physical (e.g., broken windows) and social environment (e.g., adults watching youth). Data were obtained from a longitudinal sample of 398 predominately African American young adults living in an urban environment. The data also included observational measures of physical and social order and disorder collected on the young adult’s residential block. Exploratory structural equation modeling (ESEM) was utilized to test hypothesized relationships between these two features of the neighborhood environment and past year young adult marijuana use. A two-factor model of neighborhood environment with good fit indices was selected (CFI = 0.97, RMSEA = 0.037). There was a positive and significant direct effect from neighborhood physical disorder to marijuana use (0.219, p

The practice of selling single cigarettes (loosies) through an informal economy is prevalent in urban, low socioeconomic (low SES) communities. Although US state and federal laws make this practice illegal, it may be occurring more frequently with the recent increase in taxes on cigarettes. This investigation provides information concerning the illegal practice of selling single cigarettes to better understand this behavior and to inform intervention programs and policymakers. A total of 488 African American young adults were recruited and surveyed at two education and employment training programs in Baltimore City from 2005 to 2008. Fifty-one percent of the sample reported smoking cigarettes in the past month; only 3.7 % of the sample were former smokers. Approximately 65 % of respondents reported seeing single cigarettes sold daily on the street. Multivariate logistic regression modeling found that respondents who reported seeing single cigarettes sold on the street several times a week were more than two times as likely to be current smokers compared to participants who reported that they never or infrequently saw single cigarettes being sold, after controlling for demographics (OR = 2.16; p = 0.034). Tax increases have led to an overall reduction in cigarette smoking. However, smoking rates in urban, low SES communities and among young adults remain high. Attention and resources are needed to address the environmental, normative, and behavioral conditions influencing tobacco use and the disparities it causes. Addressing these factors would help reduce future health care costs and save lives.

In the US, past month tobacco use is higher among young adults aged 18-25 years than among any other age group. Neighborhood disorder may be a malleable environmental determinant of tobacco use among young adults; its correlation with tobacco use is understudied. The purpose of this study is to examine whether perceived and objectively measured neighborhood factors are associated with tobacco use among young adults in Baltimore City.This cross-sectional study of predominately African American young adults (n=359) used logistic regression models via generalized estimating equations (GEE) to estimate the association of perceived and objective neighborhood disorder with past month tobacco use, adjusting for race, age, sex, income, and other substance use. Two measures of perceived neighborhood environment - neighborhood drug involvement, and neighborhood social cohesion - were derived from the Neighborhood Environment Scale (NES). Objective neighborhood disorder was measured via trained field raters using the Neighborhood Inventory for Environmental Typology (NIfETy) instrument.Sex modified the relationship between perceived neighborhood drug involvement and past month tobacco use, and the association was significant among women only (aOR=1.49; 95% CI=1.19-1.88). Perceptions of neighborhood social cohesion (aOR=0.97; 95% CI=0.83-1.13), and objective neighborhood disorder (aOR=1.17; 95% CI=0.98-1.38) were not significantly associated with past month tobacco use.Understanding the correlation between perceived and objective neighborhood disorder, and their independent association with tobacco use can potentially lead to environmentally based interventions aimed at reducing tobacco use among young adults who live in urban environments.

Despite the national push encouraging children to walk to school, little work has been done to examine what hazards children encounter on the route to school. This study examined the association between the presence of alcohol outlets on children’s route to school and perceived safety on the route to school as well as exposure to alcohol, tobacco, and other drugs (ATOD). Data come from a community-based epidemiological study of 394 urban elementary school students. Participants’ residential address, school location, and alcohol outlet data were geocoded and the route to school was mapped. The route to school layer and the geocoded alcohol outlet data were joined to determine the number of alcohol outlets children pass on the route to school. Logistic regression models estimated the association between the presence of alcohol outlets on the route to school, alcohol and drug exposure, and self-reported safety. Children with an alcohol outlet on the route to school were more likely to be offered ATOD (OR = 2.20, p = 0.02) as well as be exposed to drug selling (OR = 1.72, p = 0.02) and seeing people using drugs (OR = 1.93, p = 0.02). After adjusting for individual-level variables, the relationship between presence of alcohol outlets and being offered ATOD and seeing people using drugs remained significant. However, after adjusting for individual-level control variables and a proxy for the larger neighborhood context, the association between the presence of alcohol outlets and exposure to ATOD was no longer significant. As national campaigns are encouraging children to walk to school, it is essential to consider what children are exposed to on the route to school.

Disordered neighborhood environments are associated with crime, drug use, and poor health outcomes. However, research utilizing objective instruments to characterize the neighborhood environment is lacking.This investigation examines the relationship between objective measures of neighborhood disorder and juvenile drug arrests (JDAs) in an urban locale.The neighborhood disorder scale was developed using indicators from the Neighborhood Inventory for Environmental Typology (NIfETy) instrument; a valid and reliable tool that assesses physical and social disorder. Data on 3146 JDAs from 2006 were obtained from the police department.Negative binomial regression models revealed a significant association between neighborhood disorder and the count of JDAs in the neighborhood (β == .34, p.001). The relationship between neighborhood disorder and JDAs remained significant after adjusting for percent African-Americans in the neighborhood (β == .24, p.001).This preliminary investigation identified a positive and statistically significant relationship between an objective measure of neighborhood disorder and JDAs. Future investigations should examine strategies to reduce drug-related crime by addressing the larger neighborhood and social context in which drug involvement and crime occurs.

This investigation examined the relationship between living in disordered neighborhoods during childhood and anxiety 1 year later. Objective measures of neighborhood environment and individual data from a study of mental health in suburban children were utilized. Linear regression models were used to assess relationships between neighborhood hazard and anxiety. Childhood neighborhood disorder was inversely associated with generalized anxiety (β = 0.037, p

Purpose/Methods To investigate the relationship between childhood neighborhood environment and risk-taking propensity in adolescence by using an objective environmental measure and a laboratory-based risk-taking propensity measure. Results Childhood neighborhood disorder predicted risk-taking propensity on a behavioral measure during early adolescence ( β = 1.8, p Conclusion Early toxic environments affect laboratory-based behavioral manifestations of risk.

This study examines the growth of neighborhood disorder and subsequent marijuana use among urban adolescents transitioning into young adulthood.Data are derived from a longitudinal sample of 434 predominately African American 12th graders followed-up at 2 years after high school. The data are rich in repeated measures documenting substance use and misuse and neighborhood characteristics. Growth mixture modeling was used to examine how neighborhood disorder trajectories, measured through the presence of abandoned buildings on the blocks where participants reside, influence subsequent drug use beginning in late adolescence and into young adulthood.A four-class solution characterizing neighborhood growth was selected as the final model and included rapidly improving, slightly improving, always-good, and deteriorating neighborhoods. Young adults living in neighborhoods that had been deteriorating over time were 30% more likely to use marijuana 2 years after high school than adolescents living in always-good neighborhoods (odds ratio = 1.30, p = .034). There was no relationship between living in a neighborhood that was improving and marijuana use.This study identified a salient and malleable neighborhood characteristic, abandoned housing, which predicted elevated risk for young-adult marijuana use. This research supports environmental strategies that target abandoned buildings as a means to improve health and health behaviors for community residents, particularly young-adult substance use.

Community and school violence continue to be a major public health problem, especially among urban children and adolescents. Little research has focused on the effect of school safety and neighborhood violence on academic performance. This study examines the effect of the school and neighborhood climate on academic achievement among a population of 3(rd)-5(th) grade students in an urban public school system. Community and school safety were assessed using the School Climate Survey, an annual city-wide assessment of student's perception of school and community safety. Community violence was measured using the Neighborhood Inventory for Environmental Typology, an objective observational assessment of neighborhood characteristics. Academic achievement was measured using the Maryland State Assessment (MSA), a standardized exam given to all Maryland 3(rd)-8(th) graders. School Climate Data and MSA data were aggregated by school and grade. Objective assessments of neighborhood environment and students' self-reported school and neighborhood safety were both strongly associated with academic performance. Increasing neighborhood violence was associated with statistically significant decreases from 4.2%-8.7% in math and reading achievement; increasing perceived safety was associated with significant increases in achievement from 16%-22%. These preliminary findings highlight the adverse impact of perceived safety and community violence exposure on primary school children's academic performance.

Objectives: Establish metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy). Method: A total of 919 residential block faces were assessed by paired raters using the NIfETy. Reliability was evaluated via interrater and internal consistency reliability; validity by comparing NIfETy data with youth self-reported violence, alcohol, and other drug exposure and crime statistics. Results: Validity and reliability metrics were moderate to exemplary for the total scale and subscales. NIfETy data correlated strongly with crime data and youth self-reported exposure. Conclusions: The NIfETy is valid and reliable. Future investigations will explore its use in other urban centers and association to other health outcomes.

disciplines. This was particularly timely, given that the substance abuse regulatory agency in NY instituted Ambulatory Patient Groups as their payment methodology. Results: The research found that for: (1) Quality, preimplementation annual medical assessments and annual, 30-day and 90-day multidiscipline assessments were timely for 83% and 70%, 72%, and 42% of cases, respectively. Post-implementation, timeliness was 97% and 96%, 87%, and 70% respectively, all highly statistically significant improvements. Hepatitis C viral load was appropriately performed in 85% of cases pre-implementation and 81% post-implementation; a non-significant difference; (2) Satisfaction, there was no change for patients and a non-significant upward trendpost-implementation for staff; (3) Productivity, there was a decline post-implementation; reaching statistical significance for counselors; and (4) Financial Performance, there was no significant change. The ability to generate monthly reports covering Quality (opiate and cocaine-free status for >80% of patients; HIV viral load suppression; HgbA1c

had≥one positive urine drug tests for cocaine. Receipt of BZD prescription was associated with an increased hazard of having≥ two early opioid refills, adjusted hazard ratio (HR) =1.54 (95% CI, 1.09–2.18); but was not associated with increased odds for a positive cocaine test, adjusted odds ratio =1.07 (95% CI, 0.55–2.23). Conclusions: Among primary care patients receiving chronic opioid therapy, BZD prescription was associated with≥ two early opioid refills but not with cocaine use. Because alternative therapies exist for the primary indications for BZD prescription, further research should better elucidate the risks and benefits of prescribing BZDs to patients receiving chronic opioid therapy. Financial support: R01DA034252-01, R25DA033211.