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The aim of this study was to describe the spatial distribution of cervical cancer mortality in the Autonomous City of Buenos Aires during the period 1999-2003 and its relationship to the socioeconomic conditions of the population, as well as to compare the distribution during this period with that of the triennium 2004-2006. This ecological study used electoral districts as the unit of analysis. The selected socioeconomic indicators were educational deficit, lack of health insurance and the Material Deprivation of Households Index (Índice de Privación Material de Hogares), taken from the National Population and Housing Census (Censo Nacional de Población, Hogares y Viviendas) of 2001. The stratification of the city into areas according to these conditions and the analysis of standardized mortality ratios showed an increased risk of dying from cervical cancer associated with worse socioeconomic conditions. The stratification and death risks demonstrated a clear spatial pattern, with the south of the city presenting the highest death risks, and the northern and central areas presenting the lowest risks.

Evidence suggests that 20 mph zones are an effective intervention to reduce casualties from road traffic crashes in urban areas. This analysis compares the costs of construction of the 20 mph zone intervention in high and low casualty areas in London to the value of casualties avoided over 5 and 10 year time horizons. Probabilistic sensitivity analyses were conducted to quantify uncertainty in the results associated with model parameters. Results indicate a net present value (NPV) of £18 947 (90% credible limits -£75 252 to £82 021 2005 prices) after 5 years and £67 306 (£-29 157 to £137 890) after 10 years when 20 mph zones are implemented in areas with one or more casualty per kilometre of road. Simulations from our model suggest that the 'threshold of casualties' where NPVs become positive using a 10 year time horizon is 0.7 casualties per kilometre.

Leptospirosis is a serious public health concern in the Philippines, not only because of its increasing incidence rate, but also because of its significant health and economic impacts. Despite its relatively high seroprevalence, knowledge on the economic burden of disease, particularly on the value that the society places on disease prevention remains limited. Obtaining such information is important within the context of public health policy. This study was conducted in Metro Manila to determine the economic burden of leptospirosis, by asking respondents about their willingness to contribute to labor (WTCL) for the prevention of leptospirosis. The respondents pledged an average labor contribution of 10.66 h/month. The average WTCL corresponded to a monetary value of US$4.01 per month when valued using the opportunity cost of labor (leisure rate of time). From the monetized labor contribution, the total economic value of preventing leptospirosis was estimated at US$124.97 million per annum, which represents 1.13% of Metro Manila's gross domestic product (GDP). Estimates from a Tobit regression model identified the respondents' knowledge regarding leptospirosis, the susceptibility of their homes to flooding, and the proximity of their homes to sewers as significant factors to consider when developing resource contribution programs for leptospirosis prevention. More efforts need to be made in developing community level preventive programs, and in improving public's knowledge and awareness about leptospirosis.

Objective: To analyse trends in socio-economic inequalities in mortality due to all injuries, as well as, suicide and motor vehicle injuries, in men in the census tracts of 26 Spanish cities for the periods 1996-2001 and 2002-2007., Methods: Ecological study of trends based on two periods (1996-2001 and 2002-2007). The study population consisted of male residents in each city during the period 1996-2007. We fitted a hierarchical Bayesian model which takes into account the spatial structure of the data in order to obtain relative risks (RRs), and their 95% credible intervals (CIs), between mortality and a socio-economic deprivation index, in each period., Results: In most of the cities, mortality due to total injuries presents the same geographical pattern as the deprivation index in the two periods. Moreover, inequalities remained stable. In contrast, socio-economic inequalities in mortality due to motor vehicle injuries tended to diminish in the second period in the majority of the cities, particularly Castellón (first period: RR(1)=2.56; 95%CI: 1.19-4.84; second period: RR(2)=1.06; 95%CI: 0.45-2.12), whereas in the case of suicides, the inequalities remain stable but are only significant in large cities., Conclusion: This study has demonstrated that socio-economic inequalities in mortality due to all injuries in small areas of 26 Spanish cities remain stable over time. These results highlight the importance of intra-urban inequalities in mortality due to injuries and their evolution over time., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Urbanization is often cited as a main cause of increasing BMIs in low- and middle-income countries (LMICs), and urban residents in LMICs tend to have higher BMIs than do rural residents. However, urban-rural differences may be driven by differences in socioeconomic status (SES)., Objective: Using nationally representative data collected at 2 time points in 38 LMICs, we assessed the association between urban residence and BMI before and after adjustment for measures of individual- and household-level SES., Design: We conducted a cross-sectional analysis of nationally representative samples of 678,471 nonpregnant women aged 15-49 y, with 225,312 women in the earlier round of surveys conducted between 1991 and 2004 and 453,159 women in the later round conducted between 1998 and 2010. We used linear and ordered multinomial analysis with a country fixed effect to obtain a pooled estimate and a country-stratified analysis., Results: We found that mean BMI (kg/m²) in less-developed countries was generally higher within urban areas (excess BMI associated with urban residence before wealth index adjustment: 1.55; 95% CI: 1.52, 1.57). However, the urban association was attenuated after SES was accounted for (association after adjustment: 0.44; 95% CI: 0.41, 0.47). Individual- and household-level SES measures were independently and positively associated with BMI., Conclusion: The association between urban residence and obesity in LMICs is driven largely by higher individual- and community-level SES in urban areas, which suggests that urban residence alone may not cause increased body weight in developing countries.

Background: Children under five bear the largest cholera burden. We therefore sought to identify modifiable risk factors among Bangladeshi children., Methodology/principal Findings: We used multivariate Poisson regression to assess risk factors for severe cholera among diarrheal patients presenting at hospitals in Matlab (rural) and Dhaka (urban), Bangladesh. Risk increased with age. Compared to those under one, rural and urban four-year-olds had adjusted risk ratios (aRR) of 4.17 (95% confidence interval (CI) 2.43-7.15) and 6.32 (95% CI: 4.63-8.63), respectively. Breastfeeding halved the risk in both rural (aRR = 0.49, 95% CI: 0.35-0.67) and urban (aRR = 0.51, 95% CI: 0.41-0.62) settings. Rural children's risk decreased with maternal education (P-trend: <0.001) and increased among those with a family member with diarrhea in the past week (aRR = 1.61, 95% CI: 1.22-2.14) and those with prior vitamin A supplementation (aRR = 1.65, 95% CI: 1.12-2.43). Urban children whose mothers daily (aRR = 0.41, 95% CI: 0.21-0.79) or occasionally (aRR = 0.55, 95% CI: 0.36-0.84) read a newspaper experienced reduced risk. Urban children from households with incomes between 34-84 USD/month had a 30% increased risk compared to those from households with incomes >84 USD/month., Conclusion/significance: Increasing age, lower socioeconomic status, and lack of breastfeeding are key correlates of increased risk for cholera hospitalization among those under five in rural and urban Bangladesh. In addition, having a family member with diarrhea in the past week was associated with increased risk among rural children. Continued attention should be directed to the promotion of breastfeeding. Further research is needed to elucidate the relationship between maternal education and cholera risk. Renewed research regarding the use of chemoprophylaxis among family members of cholera cases may be warranted in rural endemic settings.

In Camden, New Jersey--as in many urban areas--health care costs are concentrated in a disproportionately small number of patients. These "super-utilizers" typically have multiple chronic conditions combined with social barriers that make it hard to access and coordinate the care they need to manage these conditions and stay healthy. Launched in 2002, the Camden Coalition of Healthcare Providers strives to reform the quality, capacity, and accessibility of the health care system for the city's vulnerable populations.

Background: The extent to which the poor health profile of Glasgow, the city with the highest mortality rates in the UK, can be explained solely by socio-economic factors is unclear. This paper additionally considers behavioural and biological factors as explanations of excess risk., Methods: Scottish Health Survey data for 2008-09 were analysed using logistic regression models to compare the odds of physical and mental health outcomes, as well as adverse health behaviours, for residents of the Greater Glasgow and Clyde (GGC) conurbation compared with the rest of Scotland., Results: After adjustment for age and sex, significant differences were observed among Glasgow residents for most mental and physical health outcomes, but not for most adverse health behaviours. Adjustment for area and individual-level socio-economic characteristics explained the differences for all outcomes except anxiety, psychological ill-health, heart attack and men being overweight. After additional adjustment for behavioural and biological characteristics, significantly higher odds of anxiety and heart attack remained for residents of the Glasgow area., Conclusions: Adjusting for area- and individual-level socio-economic conditions explained the excess risk associated with residents of GGC for most (16 out of 18) outcomes; however, significant excess risks for two outcomes remained: anxiety and heart attack. Additional explanations are, therefore, required.

Low-income populations, minorities, and children living in inner cities have high rates of asthma. Recent studies have emphasized the role of psychosocial stress in development of asthma. Residence in unsafe neighborhoods is one potential source of increased stress. The study objective was to examine the association between parental perception of neighborhood safety and asthma diagnosis among inner city, minority children. Cross-sectional data from a community-based study of 6-8-year-old New York City children were used. Asthma was defined as parental report of physician-diagnosed asthma and at least one asthma-related symptom. Parental perceptions of neighborhood safety were assessed with a questionnaire. Associations between perceived neighborhood safety and asthma were examined using chi-squared tests. Multivariate logistic regression analyses were then performed. Five hundred four children were included with 79% female, 26.5% non-Hispanic Black, and 73.5% Hispanic. Asthma was present in 23.8% of children. There was an inverse association between feeling safe walking in the neighborhood and asthma with 45.7% of parents of asthmatic children reporting they felt safe compared to 60.9% of parents of non-asthmatic children (p = 0.006). Fewer parents of asthmatic children than of non-asthmatic children reported that their neighborhood was safe from crime (21.7% versus 33.9%, p = 0.018). In multivariate analyses adjusting for race/ethnicity, age, gender, socioeconomic status, number of smokers in the home and breastfeeding history, parents reporting feeling unsafe walking in the neighborhood were more likely to have a child diagnosed with asthma (OR = 1.89, 95%CI 1.13-3.14). Psychosocial stressors such as living in unsafe neighborhoods may be associated with asthma diagnosis in urban ethnic minority children. Addressing the increased asthma burden in certain communities may require interventions to decrease urban stressors.

Background: Cost savings from the use of generic drugs versus brand-name drugs are well known. Both private and public prescription drug plans encourage the use of generic drugs through a variety of mechanisms. The magnitude of cost savings for a given generic drug is dependent on the degree to which the generic market is competitive. Should the competitive structure become compromised, higher prices and reduced cost savings may result. An alleged conspiracy between Mylan Laboratories and its active-ingredient suppliers in 1997 was associated with an increase in seller concentration in the generic lorazepam market. The Federal Trade Commission (FTC) alleged that Mylan raised costs to consumers by $120 million because of price increases for generic lorazepam from March through December 1998 and for generic clorazepate from January through December 1998. In November 2002, a settlement with Mylan was approved by the FTC, and a federal district court required Mylan to pay $147 million, including $28.2 million to state agencies including Medicaid., Objectives: To (a) describe the seller concentration in the national Medicaid generic lorazepam market over a 19-year period from January 1991 through December 2009, (b) estimate the excess payments for generic lorazepam by Medicaid between 1998 and 2009, and (c) investigate potentially increased utilization and prices of 2 substitute pharmaceuticals: branded lorazepam (Ativan) and generic alprazolam (another widely used intermediate-acting benzodiazepine)., Methods: Using Medicaid State Drug Utilization Data from the Centers for Medicare Medicaid Services, we calculated the 4-firm concentration ratio (CR₄) and the Herfindahl-Hirschman Index (HHI) for the Medicaid generic lorazepam market, along with pre-rebate reimbursement for pharmacy claims, number of claims (utilization), and average pre-rebate reimbursement per claim (average "price") for generic lorazepam, from 1991 through 2009. Medicaid's excess payments were estimated under 2 different assumptions regarding what the average generic lorazepam price would have been in the absence of the alleged conspiracy. To find counterfactual prices, the average per-claim reimbursement for lorazepam for the 4 quarters prior to the alleged conspiracy, $6.80, was inflated using (a) the quarterly change in the average per-claim reimbursement for generic alprazolam and (b) the Consumer Price Index (CPI) for all urban consumers, all goods. Potential impact of the alleged conspiracy on the branded lorazepam and generic alprazolam markets was investigated., Results: The average pre-rebate reimbursements per claim for generic lorazepam were $10.25, $23.12, and $8.48 in 1991, 1998, and 2009, respectively. For the same 3 years, CR₄ = 52.80, 76.02, and 86.74, while HHI = 905.71, 2,166.25, and 2,233.36. Medicaid's excess payments from 1998-2009 were estimated at approximately $625-$657 million. The data also suggest the possibility of small impacts on the utilization of branded lorazepam and the price of generic alprazolam., Conclusions: Prior to the alleged conspiracy in 1997, average pre-rebate reimbursement per claim for generic lorazepam was declining, while seller concentration was rising. After a jump in average payment per claim in the years immediately following the alleged conspiracy, prices have gradually returned to their pre-1998 levels. However, the generic lorazepam market was more concentrated in 2009 than prior to the alleged conspiracy., (Copyright © 2012, Academy of Managed Care Pharmacy. All rights reserved.)

There is a growing debate on whether agricultural land in urban fringes should be maintained or converted to other uses. While 'pro-ruralists' believe agricultural land conversion can threaten food security and cause rural-urban migration, 'pro-urbanists' find it a necessary change for transition from a primitive agricultural-based community to an advanced industrial-based society which has the capacity to create mass productions. New-Ruralists follow an agricultural-based development approach that promotes small-medium farming and acknowledges rural lifestyle while New-Urbanists give a priority to large industrial-based sectors and encourage urban lifestyle. Given the unlike concerns of different societies, the paper concludes that the approaches might have different priorities in the less developed, developing, and developed world., (Copyright © 2012 Society of Chemical Industry.)

Background: The food group intake patterns of low income Hispanic and African American preschool children are not well documented. The aim of this study was to perform a food group intake analysis of low income minority preschool children and evaluate how macronutrient and micronutrient intake compares to Dietary Reference Intakes (DRI)., Methods: A cross sectional study design using three-day food diaries analyzed by dietary analysis software (Nutrient Database System for Research) was used. Children were recruited from well-child clinics at Children's Healthcare of Atlanta at Hughes Spalding and North Dekalb Grady Satellite Clinic, Atlanta, GA. Low-income, African American and Hispanic preschool age children (n = 291) were enrolled. A total of 105 completed and returned the 3-day food diaries. Chi-squared tests were used to assess demographic variables. The mean percentage of intake per day of specific food groups and sub-groups were obtained (servings of given food group/total daily servings). Food intake data and proportion of children meeting DRIs for macro- and micronutrients were stratified by race/ethnicity, nutritional status, and caloric intake, and were compared using t-tests. Regression models controlling for age, BMI and sex were obtained to assess the effect of total caloric intake upon the proportional intake of each studied food group., Results: The mean age of African American children was 2.24 ± 1.07 years and Hispanic children 2.84 ± 1.12 years. African Americans consumed more kcal/kg/day than Hispanics (124.7 ± 51 vs. 96.9 ± 33, p < 0.05). Hispanics consumed more fruits (22.0 ± 10.7% vs. 14.7 ± 13.7%, p < 0.05), while African Americans consumed more grains (25.7 ± 7.8% vs. 18.1 ± 6.4%, p < 0.05), meats (20.7 ± 9.0% vs. 15.4 ± 6.1%, p < 0.05), fats (9.8 ± 5.4% vs. 7.0 ± 5.8%, p < 0.05), sweet drinks (58.7 ± 17.1% vs. 41.3 ± 14.8%, p < 0.05) and low-fat dairy products (39.5 ± 19.3% vs. 28.9 ± 12.6%, p < 0.05). Among Hispanics, the proportional intake of fruits, fats and grains varied by total caloric intake, while no difference by total caloric intake was found for the dietary patterns of African Americans. Micronutrient intake also differed significantly between African American and Hispanic children., Conclusions: Food group intake patterns among low-income children differ by ethnic group. There is a need for more research to guide program design and target nutritional interventions for this population.

Background: New maize varieties have been biofortified with provitamin A, mainly a-carotene, which renders the grain yellow or orange. Unfortunately, many African consumers prefer white maize. The maize consumption patterns in Africa are, however, not known., Objective: To determine which maize products African consumers prefer to purchase and which maize preparations they prefer to eat., Methods: A survey of 600 consumers was conducted in Nairobi, Kenya, at three types of maize outlets: posho mills (small hammer mills), kiosks, and supermarkets., Results: Clients of posho mills had lower incomes and less education than those of kiosks and supermarkets. The preferred maize product of the posho-mill clients was artisanal maize meal; the preferred product of the others was industrial maize meal. Maize is the preferred staple for lunch and dinner, eaten as a stiff porridge (ugali), followed by boiled maize and beans (githeri), regardless of socioeconomic background. For breakfast, only half the consumers prefer maize, mostly as a soft porridge (uji). This proportion is higher in low-income groups. Consumers show a strong preference for white maize over yellow, mostly for its organoleptic characteristics, and show less interest in biofortified maize., Conclusions: Maize is the major food staple in Nairobi, mostly eaten in a few distinct preparations. For biofortified yellow maize to be accepted, a strong public awareness campaign to inform consumers is needed, based on a sensory evaluation and the mass media, in particular on radio in the local language.

This study aimed to document whether food insecurity was associated with beliefs and attitudes towards exclusive breastfeeding (EBF) among urban Kenyan women. We conducted structured interviews with 75 human immunodeficiency virus (HIV)-affected and 75 HIV-status unknown, low-income women who were either pregnant or with a child ≤24 months and residing in Nakuru, Kenya to generate categorical and open-ended responses on knowledge, attitudes and beliefs towards EBF and food insecurity. We facilitated six focus group discussions (FGD) with HIV-affected and HIV-status unknown mothers (n = 50 women) to assess barriers and facilitators to EBF. Of 148 women with complete interview data, 77% were moderately or severely food insecure (FIS). Women in FIS households had significantly greater odds of believing that breast milk would be insufficient for 6 months [odds ratio (OR), 2.6; 95% confidence interval (95% CI), 1.0, 6.8], that women who EBF for 6 months would experience health or social problems (OR, 2.7; 95% CI, 1.0, 7.3), that women need adequate food to support EBF for 6 months (OR, 2.6; 95% CI, 1.0, 6.7) and that they themselves would be unable to follow a counsellor's advice to EBF for 6 months (OR, 3.2; 95% CI, 1.3, 8.3). Qualitative analysis of interview and FGD transcripts indicated that the maternal experience of hunger contributes to perceived milk insufficiency, anxiety about infant hunger and a perception that access to adequate food is necessary for successful breastfeeding. The lived experience of food insecurity among a sample of low-income, commonly FIS, urban Kenyan women reduces their capacity to implement at least one key recommended infant feeding practices, that of EBF for 6 months., (© 2010 Blackwell Publishing Ltd.)

Background: The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city., Methods: The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program., Results: Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance., Conclusions: The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Objective: To determine the social cost and burden of depression in the city of Sabadell (Barcelona, Spain) in 2007 and 2008., Method: The social cost of depression was calculated using the prevalence approach, based on information obtained in the development of the European Project Against Depression (EAAD). The results referred to the cost of public resources used, and the sources came from the appropriate official registers., Results: The direct public cost of depression in the city of Sabadell was € 9,155,620 in 2007 and € 9,304,706 in 2008. The relative weight of primary care visits and the use of drugs accounted for more than 85% of direct costs. In the section of indirect costs, the cost of permanent work disability could not be obtained. Indirect costs amounted to € 9,720,225 in 2007 and € 9,763,541 in 2008. In both years, the highest weight corresponded to temporary work disability reaching € 8,561,962 and € 7,333,181, respectively., Conclusions: Depression has a substantial economic impact on the health system because it is associated with high direct public costs. However, the lack of knowledge of the cost associated with permanent work disability is a major limitation, as this cost category represents the highest percentage for this disorder., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

The purpose of this investigation was to study a social portrait in 15-17-year-old girls studying at secondary specialized educational establishments and the characteristics of their families. The urban girls have better living conditions than the rural ones. The income of the families of first- and second-year students from other towns was significantly more frequently lower (63.9 and 57.5%, respectively) versus that of the urban students (14.7 and 20.8%). The urban students had more conflicts with their parents (66.1% versus 52.6%). There are also differences in the professional and educational level of their parents. The parents living in the rural areas had a lower education level and more frequently belong to a class of workers and, accordingly, had more often occupational harms and heavy working conditions than the urban dwellers. The spread of bad habits in the families of urban and rural inhabitants is rather high. Nearly one-third of the students of Moscow and other towns experienced emotional violence by the members of their families.

Monitoring food consumption and its determinants over time is essential for defining and implementing health promotion strategies, but surveillance is scarce in Africa. The present study aimed to describe fruit and vegetable consumption in Mozambique according to socio-demographic characteristics and place of residence (urban/rural). A national representative sample (n 3323) of subjects aged 25-64 years was evaluated in 2005 following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance, which included an assessment of usual fruit and vegetable consumption (frequency and quantity). Crude prevalence and age-, education- and family income-adjusted prevalence ratios (PR) with 95 % CI were computed. Less than 5 % of the subjects reported an intake of five or more daily servings of fruits/vegetables. Both fruits and vegetables were more often consumed by women and in rural settings. In urban areas, the prevalence of fruit intake ( ≥ 2 servings/d) increased with education ( ≥ 6 years v. < 1 year: women, adjusted PR = 3·11, 95 % CI 1·27, 7·58; men, adjusted PR = 3·63, 95 % CI 1·22, 10·81), but not with income. Conversely, vegetable consumption ( ≥ 2 servings/d) was less frequent in more educated urban men ( ≥ 6 years v. < 1 year: adjusted PR = 0·30, 95 % CI 0·10, 0·94) and more affluent rural women ( ≥ $801 US dollars (USD) v. $0-64: adjusted PR = 0·32, 95 % CI 0·13, 0·81). The very low intake of these foods in this setting supports the need for fruit and vegetable promotion programmes that target the whole population, despite the different socio-demographic determinants of fruit and vegetable intake.

Objective: Develop the Index of Nutritional Purchasing Power Parity (Nut3-CiO) as an instrument to compare the caloric costs of a healthy versus an unhealthy diet between regions or cities in a country over time., Methods: Indices of caloric prices were constructed and the "law of one price" was used to derive the Nut3-CiO index. Caloric inflation rates were obtained using basic descriptive statistics. The Nut3-CiO was applied in the major cities of Mexico during the period from January 1996 to December 2010., Results: The statistical behavior of the Nut3-CiO revealed that, in Mexican cities, products for a typical diet are less expensive than products for a healthy diet. The findings showed a cyclical behavior to the index, a high correlation between inflation for the typical diet and inflation for the market basket, and a high persistence of prices., Conclusions: The Nut3-CiO index makes it possible to periodically compare the price differential of two types of diets-typical and healthy-between cities in a single country. This instrument could help health authorities identify the cities where it is easier or more difficult for consumers to access a typical or healthy diet in terms of cost. Furthermore, it makes it possible to estimate the percentage adjustment necessary in each city to attain levels of nutritional purchasing power parity.

This article presents an analysis of social sustainability in comparative theoretical context and as a challenge to the post-political interpretation of sustainability in policy practice at the urban and regional scales. Metro Vancouver provides a case study for improving our understanding of the meaning of social sustainability as a framework for social policy in that it is among the handful of cities around the world currently working to define and enact social sustainability in governance terms. Results of this participant research provide evidence that some cities are politically engaging alternative development pathways using the concept of social sustainability. For sustainable development to retain its promise as an alternative policy framework for cities, social sustainability must be at the forefront.

Background: Along with economic improvement, China is experiencing increasing rates of non-communicable disease and a rise in alcohol consumption. While a modest intake of red wine has been shown to be health enhancing, the pathophysiology associated with excessive alcohol consumption is being increasingly recognized. The purpose of this study is to demonstrate the health consequences of alcohol consumption among middle-aged urban Chinese people., Methods: This cross-sectional study included 793 subjects aged 44, 48 or 52 years, from urban community health centres and a local hospital, who participated in a survey, anthropometrics and blood chemistry. Multiple logistic regression analysis was used to obtain adjusted odds ratios (OR) between alcohol intake and medical history of diabetes and hypertension, metabolic syndrome and its five component variables., Results: Metabolic syndrome (MetS) was detected in 53.5% and 42.8% of men and women, respectively, (p < .05), and regular alcohol consumption was found among 72.5% and 12.4% of men and women (p < .00). A weak association was found between consuming alcohol ≥ 2 times a week (or having quit) and MetS (OR = 1.7, 1.0, 2.9) and elevated blood pressure (OR = 1.8, 1.0, 3.1)., Conclusion: Alcohol consumption is an under-appreciated risk factor found in association with increased rates of metabolic syndrome and associated non-communicable diseases among urban residents in China.

The present study tested the relationships between macro-level violence and birthweight in structurally disadvantaged communities in the District of Columbia. The study hypothesized that both rates of violence and violence "uncertainty" (the latter was operationalized as within-census tract residual change scores in violence), should be inversely associated with birthweight among all live singleton births in DC from 2000 to 2002. Using mixed models, the study found that (1) patterns of violence and violence uncertainty were significantly associated with birthweight among mothers residing in structurally disadvantaged communities, and (2) these findings held for Black and Hispanic, but not white, mothers. The study argues that urban ecological researchers should begin to consider not just how rates (or levels) of violence influence health and other social outcomes in communities, but also the effects of violence uncertainty as a source of unpredictable risk and territorial disruption., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Evidence indicates that people who reside in non-urban areas have a higher use of complementary and alternative medicine (CAM) than people who reside in urban areas. However, there is sparse research on the reasons for such differences. This paper investigates the reasons for geographical differences in CAM use by comparing CAM users from four geographical areas (major cities, inner regional, outer region, rural/remote) across a range of health status, healthcare satisfaction, neighbourhood and community factors., Methods: A cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Women's Health (ALSWH) conducted in 2009., Results: The average total cost of consultations with CAM practitioners was $416 per annum and was highest for women in the major cities, declining with increasing distance from capital cities/remoteness (p < 0.001). The average total cost of self-prescribed CAM was $349 per annum, but this did not significantly differ across geographical areas. The increased use of CAM in rural and remote areas appears to be influenced by poorer access to conventional medical care (p < 0.05) and a greater sense of community (p < 0.05) amongst these rural and remote residents. In contrast to the findings of previous research this study found that health status was not associated with the differences in CAM use between urban and non-urban areas., Conclusion: It appears that a number of factors influence the different levels of CAM use across the urban/non-urban divide. Further research is needed to help tease out and understand these factors. Such research will help support health care policy and practice with regards to this topic.

The main objective of the study has been to identify trajectories of health seeking behaviour of the urban poor, particularly their use of the private health sector, with the aim to identify strategies to improve quality of health care for this burgeoning population. This article presents findings from a slum settlement in Delhi where ethnographic sub-studies were carried out over two years among private health providers and selected households alongside a survey of household expenditure patterns. The primary research tools were in-depth interviews with practitioners and key informants as well as observations of clinical interactions. Illness narratives and case studies were documented over two years. The software package q.s.r. Nvivo was used for coding and content analysis. It was found that almost 90% of the respondents exclusively depend on local unlicensed and unregistered practitioners for basic primary health care. Long distances, time-consuming procedures, rude behaviour and, in many cases, bribes that had to be paid to staff in the hospitals were cited as major deterrents to utilising government facilities. Despite the public health consequences of inappropriate treatment protocols and misuse of drugs by these untrained private providers, in the absence of a structured urban primary health care system in the country, they seem to be the only alternative for the burgeoning urban poor in vast metros such as Delhi.

In the San Francisco Bay Area, where residential rent is among the highest in the United States, an analysis of data from several sources demonstrates that high rent cannot be accounted for by higher quality, higher operating costs, or higher construction costs. At least one-third of the total rent paid is land rent. Despite increases in real incomes, very-low-income tenants in the Bay Area today have less income remaining after payment of rent than tenants did in 1960. High land rent is a long-term feature of the Bay Area rental market that results mostly from its geography, the density of its urban centers, and a strong economy, rather than from regulatory barriers to new multifamily construction. Deregulation is not a sufficient response to the effects of land rent on low-income tenants. Government should subsidize non-profit housing organizations, particularly land trusts that remove residential land from the market. Taxes on land rent would be a particularly appropriate funding source.