Journal of Urban Health (J URBAN HEALTH)

Publications in this journal

• Article: Addressing the Social and Environmental Determinants of Urban Health Equity: Evidence for Action and a Research Agenda

  Sharon Friel, Marco Akerman, Trevor Hancock, Jacob Kumaresan, Michael Marmot, Thomas Melin, David Vlahov, GRNUHE members
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  ABSTRACT: Urban living is the new reality for the majority of the world’s population. Urban change is taking place in a context of other global challenges—economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban–rural divide) and within cities (the rich–poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central policy goals for urban management. KeywordsUrban health–Health inequity–Climate change–Social inclusion–Urban planning and design–Governance
  Journal of Urban Health 04/2012; 88(5):860-874.
• Article: Regional varation in drug purchase opportunity among youths in the United States, 1996–1997

  Kirk E. James, Frenando A. Wagner, James C. Anthony
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  ABSTRACT: This study was designed to examine geographic variation in illegal drug purchase opportunity among young people living in the United States; there was a subfocus on age, sex, and urban/rural residence. Data from the 1996–1997 National Household Surveys on Drug Abuse were analyzed; the nationally representative sample of community residents included 21,531 participants aged 12–24 years old. Respondents were asked if someone had approached them to sell them an illegal drug during the past 30 days. To protect responsents’ confidentiality, there is no fine-grained geographical coding of data in the National Household Surveys on Drug Abuse public use data files, but mine geographical divisional indicators are provided (i.e., West Norht Central, New England, etc.). Results indicated males were an estimated 1.8 times more likely than females to have had a recent illicit drug purchase opportunity, and urban residents were 1.5 times more likely than rural residents to have had a recent drug purchase opportunity. As for geographic divisions, the Pacific division surpassed all other divisions: Its residents were 1.5 times more likely to have recent drug purchase opportunities tha the West North Central division (used bere as a reference category). After controlling statistically for age, sex, and urban/rural residence, fresidence in four divisions was foun to be associated with greater likelihood of an illicit drug purchase opportunity. The observed patterns of drug purchase opportunity add new features to our understanding of illicit drug involvement across the United States. KeywordsAdolescence-Adult-Neighborhood-Street Drugs-Substance-Related Disorders-Urban-Rural
  Journal of Urban Health 04/2012; 79(1):104-112.
• Article: Partnering with communities to improve health: The New York City turning point experience

  Eve R. Cagan, Tamara Hubinsky, Andrew Goodman, Deborah Deitcher, Neal L. Cohen
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  ABSTRACT: Concurrent with the New York City Department of Health’s reorganization efforts, the Robert Wood Johnson and W.K. Kellogg Foundations launched Turning Point, a national initiative designed to strengthen the nation’s public health system. The Turning Point initiative has emphasized broad-based partnership building and planning as key prerequisites for improving public health practice. In response to the foundations’ request for proposals, the department formed a New York City Public Health Partnership, which in turn applied for and was granted a Turning Point planning grant. This funding allowed New York City Turning Point to initiate a public health planning process, part o f which involved convening forums in each of the five boroughs. With over 1,100 community participants, these forums provided both a starting point for establishing public health priorities and an interactive setting for sharing health and demographic data. Included among the issues that emerged as priorities were: access to care, environmental health, mental health, housing, asthma, education, and dietary issues. Building on the forum outcomes, the New York City Public Health Partnership developed a public health system improvement plan. The goals delineated in this plan are: (1) to create and support public health partnerships at the community, borough, and citywide levels; (2) to identify community health concerns and develop strategies responsive to these concerns; and (3) to develop policies to support and sustain a community health approach to improve health status. This article also discusses possible roles for local health departments in promoting a community health approach to address public health concerns.
  Journal of Urban Health 04/2012; 78(1):176-180.
• Article: Women’s Perceptions of Their Community’s Social Norms Towards Assisting Women Who Have Experienced Intimate Partner Violence

  Karen Ann McDonnell, Jessica G. Burke, Andrea C. Gielen, Patricia O’Campo, Meghan Weidl
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  ABSTRACT: The role of social norms has played an often unrecognized role in the perception of and action to assist low-income urban women who are in violent relationships. Two forms of social norms will be assessed, including descriptive norms—what people typically do to assist women in a violent relationship—and injunctive norms—defined as what people should do to assist women. This study will present our initial findings into the development of measures to assess women’s perception of their community’s social norms toward assisting women who have experienced intimate partner violence (IPV) and how these norms are related to women’s perception of the community, reasons for community assistance toward women experiencing IPV, and women’s own experience of IPV. Systematic measurement development processes were applied to reliably and validly develop the social norms measures. A three-phase approach was used to develop eight paired items measuring descriptive and injunctive norms. A total of 176 low-income urban women were interviewed and the scale responses were compared to length of time at the residence, perceptions of their neighborhood, perceived reasons for community involvement and non-involvement in assisting women experiencing IPV, and IPV experienced as an adult. The two developed social norms scales were found to have high internal consistency alpha coefficients of 0.84 for descriptive norms and 0.93 for injunctive norms. Paired t tests were statistically significant, denoting higher injunctive than descriptive social norms. Lowered descriptive norms were found among younger women, women who reported that they did not think their neighborhood was a good place to live, women who had ever experienced intimate partner violence as an adult, and perceived lower reasons for neighbor involvement and higher reasons for neighbor non-involvement toward assisting women experiencing IPV. Higher levels of injunctive social norms were statistically associated with living in a good place and increased perceived reasons for neighbor involvement toward assisting women experiencing IPV. Significant differences between descriptive and injunctive norms suggest that women, especially those who are currently experiencing IPV, would prefer greater support from community neighbors than they are currently providing. The descriptive and injunctive social norms scales demonstrated a high level of internal reliability and significantly associated with other influencing factors thought to be associated with social norms. Overall, the performance of the injunctive and descriptive norms scales support their use as a tool to investigate social norms toward neighbors taking action to assist women experiencing IPV. KeywordsSocial norms–Intimate partner violence–Urban–Women
  Journal of Urban Health 04/2012; 88(2):240-253.
• Article: Neighborhood Effects and Intimate Partner and Sexual Violence: Latest Results

  Victoria Frye, Patricia O’Campo
  Journal of Urban Health 04/2012; 88(2):187-190.
• Article: Factors associated with liver biopsy performance in HCV-HIV coinfected injecting drug users with HCV viremia: Results from a five-year longitudinal assessment

  Dominique Rey, Maria-Patrizia Carrieri, Bruno Spire, Sandrine Loubière, Pierre Dellamonica, Hervé Gallais, Gilles-Patrice Cassuto, Jean-Albert Gastaut, Yolande Obadia, the MANIF Study Group
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  ABSTRACT: The last international consensus conference about hepatitis C virus (HCV) treatment emphasized the importance of treatment for persons coinfected with HCV and human immunodeficiency virus (HIV). As liver biopsy precedes treatment, we aimed to identify factors associated with the performance of liver biopsy among HIV-HCV coinfected drug users during a 5-year follow-up to study their access to HCV treatment. Of the 296 patients followed in the HIV hospital departments of Nice and Marseilles and with retrievable records about HCV diagnosis and care, 166 were eligible for analysis having had detectable HCV RNA at least once during the study period. Overall, 45.2% of patients underwent liver biopsy during follow-up. Using proportional hazard models, predictors of having had a liver biopsy were high social support, complete abstinence from drug injection, and lack of immunosuppression as well as male gender, no history of multiple incarcerations, more recent onset of drug use, and an increase of liver enzyme levels. These results suggest that specific efforts should be devoted to HIV-HCV coinfected drug users to assist with stabilizing these patients to optimize their access to HCV care whenever possible.
  Journal of Urban Health 04/2012; 81(1):48-57.
• Article: Urban homelessness and poverty during economic prosperity and welfare reform: Changes in self-reported comorbidities, insurance, and sources for usual care, 1995–1997

  Thomas P. O’Toole, Jeanette L. Gibbon, Deborah Seltzer, Barbara H. Hanusa, Michael J. Fine
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  ABSTRACT: Little is known of how homeless and other urban poor populations have fared during the robust economy and within structural changes in health care delivery and entitlement programs of the 1990s. This is important in determining the need for population-specific services during a vigorous economy with low unemployment and increasing Medicaid managed-care penetration. This study compared health insurance status and availability of a source for usual medical care, psychiatric and substance abuse comorbidities, and perceived causes of homelessness in homeless adults surveyed in 1995 and 1997. Cross-sectional, community-based surveys were conducted in 1995 and 1997 at sites frequented by urban homeless adults residing in Pittsburgh, Pennsylvania. Self-reported medical, mental health, and substance abuse comorbidities, health insurance, and source for usual care were measured. Compared to the 388 individuals surveyed in 1995, the 267 homeless adults surveyed in 1997 had more medical comorbidity (56.6% vs. 30.2%, P<.001) and mental health comorbidity (44.9% vs. 36.9%, P=.04) and required more chronic medication (52.1% vs. 30.3%, P<.001). More respondents in 1997 than 1995 reported having no health insurance (41.4% vs. 29.4%, P<.001). While there was no difference in the overall proportion reporting a source for usual care (78.3% in 1997 vs. 80.2% in 1995, P=.55), fewer persons reported use of the emergency department and more persons reported using a shelter-based clinic for usual care in 1997 compared with 1995. These findings suggest more need for medical care among homeless and urban poor persons in 1997 compared with 1995 and support the continued need for outreach and support services despite a vigorous economy. KeywordsHealth Access-Homeless-Medicaid Managed Care-Welfare Reform
  Journal of Urban Health 04/2012; 79(2):200-210.
• Article: Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992–1998

  Keith M. Sabin, Robert L. Frey, Rosemarie Horsley, Stacie M. Greby
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  ABSTRACT: Inmate contact with the correctional health care system provides public health professionals an opportunity to offer HIV screening to a population that might prove difficult to reach otherwise. We report on publicly funded human immunodeficiency virus (HIV) voluntary counseling, testing, and referral (VCTR) services provided to incarcerated persons in the United States. Incarcerated persons seeking VCTR services received pretest counseling and gave a blood specimen for HIV antibody testing. Specimens were considered positive if the enzyme immunoassays were repeatedly reactive and the Western blot or immunofluorescent assay was reactive. Demographics, HIV risk information, and laboratory test results were collected from each test episode. Additional counseling sessions provided more data. From 1992 to 1998, there were 527,937 records available from correctional facilities from 48 project areas; 484,277 records included a test result and 459,155 (87.0%) tests came with complete data. Overall, 3.4% (16,797) of all tests were reactive for HIV antibodies. Of reactive tests accompanied by self-reports of previous HIV test results (15,888), previous test results were 44% positive, 23% negative, 6% inconclusive or unspecified, and 27% no previous test. This indicates that 56% of positive tests were newly identified. During the study period, the number of tests per year increased three-fold. Testing increased among all racial/ethnic groups and both sexes. The largest increase was for heterosexuals who reported no other risk, followed by persons with a sex partner at risk. Overall, the greatest number of tests was reported for injection drug users (IDUs) (128,262), followed by men who have sex with men (MSM) (19,928); however, episodes for MSM doubled during the study, while for IDUs, they increased 74%. The absolute number of HIV-positive (HIV+) tests increased 50%; however, the percentage of all tests that were HIV+ decreased nearly 50% due to the increased number of tests performed. HIV+ tests fell 50% among blacks (7.6% to 3.7%), Hispanics (6.7% to 2.5%), and males (5.1% to 2.5%); 33% among females (4.5% to 3.1%); 95% among IDUs (8.6% to 4.4%); and 64% among MSM (19.3% to 11.8%). Among HIV+ episodes, those for IDUs dropped from 61.5% to 36.6%, while episodes for heterosexuals with no reported risk factor increased from 4.3% to 18.2%. The use of VCTR services by incarcerated persons rose steadily from 1992 to 1998, and 56% of HIV+ tests were newly identified. High numbers of tests that recorded risk behaviors for
  Journal of Urban Health 04/2012; 78(2):241-255.
• Article: Trends in the AIDS epidemic among New York City’s injection drug users: Localized or citywide?

  Russell Rockwell, Sherry Deren, Marjorie F. Goldstein, Samuel R. Friedman, Don C. Des Jarlais
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  ABSTRACT: The New York City injection drug user acquired immunodeficiency syndrome (IDU AIDS)epidemic accounts for almost one quarter of AIDS cases in IDUs in the United States. Recent studies have reported declines in seroprevalence and risk behaviors among IDUs in New York City during the 1990s. These trends, however, are based on studies primarily conducted in the city’s central borough of Manhattan. This article analyzes data from all five boroughs of New York City to examine trends over phases of the epidemic and to determine the level of prevention services available; an exploratory qualitative study was also conducted to assess access to prevention services and injection practices in areas in the “outer boroughs”. Findings indicated that (1)borough differences in services and behaviors existed from early in the epidemic; (2)services have been concentrated in Manhattan; and (3)declines in seroprevalence were greatest among Manhattan-recruited IDUs. Enhancing access to services for IDUs in the boroughs outside Manhattan may be needed to continue the positive trends in all areas of New York City.
  Journal of Urban Health 04/2012; 79(1):136-146.
• Article: Bioethics in the urban context

  Alan R. Fleischman, Betty Wolder Levin, Sharon Abele Meekin
  Journal of Urban Health 04/2012; 78(1):2-6.
• Article: Mixed Method Approaches to Understanding Cancer-Related Dietary Risk Reduction among Public Housing Residents

  Ann C. Klassen, Katherine Clegg Smith, Maureen M. Black, Laura E. Caulfield
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  ABSTRACT: Improving diet is one important pathway for addressing cancer disparities. We conducted mixed-method analyses of 468 24-h dietary recalls from 156 African–American women residents of Washington DC public housing to better understand dietary patterns. Recalls were rated for five cancer-related preventive characteristics (adequate fruits/vegetables, moderate fat, moderate calories, no alcohol, and adequate Healthy Eating Index score), combined as a scale. Bivariate and multivariate analyses identified psychosocial and dietary characteristics associated with scale scores. Qualitative analyses of dietary records identified contextual aspects of food patterns within and across score groups. Sixty-one percent of respondents met zero or one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either three (6%), four (4%), or all five (<1%) goals; five fruit and vegetable servings were least common (15%). The underlying scalar structure of responses suggests that fruit and vegetable consumption is seldom achieved in this population without other scale components. Poorer scores were associated with younger age, depressive symptoms, stressful life events, smoking, and food-purchasing practices. Qualitative analyses identified eight themes related to differences between dietary patterns. Findings reinforce the value of nonreductionist approaches to cancer-related nutrition intervention.
  Journal of Urban Health 04/2012; 86(4):624-640.
• Article: Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

  Kathleen Falster, John M. Kaldor, Lisa Maher, on behalf of the collaboration of Australian Needle and Syringe Programs
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  ABSTRACT: High hepatitis C virus (HCV) prevalence has been documented among many injecting drug user (IDU) populations worldwide; however, there is limited published data on trends in incidence of infection in these epidemics over time. To address this, we used a novel method of analyzing data collected via repeat, cross-sectional sero-surveys by injection initiation cohorts to investigate trends in HCV seropositivity among a population of needle and syringe program (NSP) attendees in Australia between 1995 and 2004, and thereby infer annual incidence trends. Injection initiation cohorts were defined by their time of entry into the IDU population. We also investigated the associations between HCV antibody seroprevalence and risk factor data, and trends in risk factor data over the decade. Approximately 20,000 NSP attendees participated in the study over the 10-year period. Within each injection initiation cohort, we found an increase in HCV prevalence over time, with prevalence appearing to reach saturation around 90%. There was little indication that the slopes of increase had changed with more recent initiation cohorts. While duration of injecting was most strongly associated with HCV seropositivity in this study, we also found that self-reported history of needle and syringe sharing and imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting, with the exception of IDUs who have 15 or more years injecting experience. In this group, recent risk behavior had no relationship to prevalence. In summary, our findings suggest a persistent HCV epidemic despite significant harm reduction efforts in Australia since the mid-1980s, with HIV incidence effectively constant in successive initiation cohorts.
  Journal of Urban Health 04/2012; 86(1):106-118.
• Article: The New York cancer project: Rationale, organization, design, and baseline characteristics

  Maria K. Mitchell, Peter K. Gregersen, Stephen Johnson, Ramon Parsons, David Vlahov for the New York Cancer Project
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  ABSTRACT: Cancer is the second leading cause of death in New York City, with nearly 15,000 deaths each year. The urban setting of New York City provides ready access to large and diverse populations for whom racial/ethnic disparities in cancer risk and outcomes can be examined. A new cohort study was undertaken with several aims: (1) to provide a database and biorepository for studies of cancer etiology and pathogenesis, including host genetics; (2) to differentiate risk factors that contribute to racial/ethnic disparities in cancer risk, prevention, control, incidence, mortality, and survival; (3) to provide timely data on cancer risk and preventive behaviors that can be used to mobilize and then evaluate public health programs. Scientists from multiple institutions contributed to protocol design and implementation. Study instruments included demographics, personal and family history of cancer, risk and prevention efforts. End points include linkage with registries and medical record reviews. Using venue-based sampling with quotas, 18,187 adults aged 30 years or older were recruited over a year to undergo a baseline questionnaire, venipuncture, and contact information. The sample was 39% male, 37% older than 50 years, 58% white, 20% African American, 18% Hispanic, and 9% Asian. In terms of family history of cancer, 21% reported mother, 21% reported father, and 5.9% reported both parents with cancer; 8.5% reported any sibling with cancer. At baseline, 1,231 participants reported prior cancer. Showing the feasibility of constructing a cohort based in New York City, plans proceed for additional recruitment and analyses on the salient questions about cancer.
  Journal of Urban Health 04/2012; 81(2):301-310.
• Article: Does HIV status make a difference in the experience of lifetime abuse? descriptions of lifetime abuse and its context among low-income urban women

  Karen A. McDonnell, Andrea Carlson Gielen, Patricia O’Campo
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  ABSTRACT: Women living in poor urban communities are doubly disadvantaged with regard to increased risk for two major public health crises in the United States today—HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and violence. This study moves beyond the comparison of rates of lifetime abuse among women to incorporate contextual information of the abusive situation and experiences of HIV-positive women and a sample of sociodemographically similar HIV-negative women. A total of 611 women, 310 of whom were diagnosed as HIV positive, provided interviews integrating quantitative data and qualitative text on their lifetime experience of abuse. Quantitative results yielded few statistically significant differences between the lifetime experiences of violence between HIV-positive women and their HIV-negative counterparts. Of the women, 62% reported intimate partner violence, and 38% reported experiencing nonpartner abuse as an adult. A majority of the abused women reported that their alcohol or drug use or their partner’s alcohol or drug use was associated with the abuse experienced. Significant differences were found between HIV-positive women and HIV-negative women in the pattern of abuse experience as a child, the frequency of abuse as an adult, and the involvement of women’s drinking before or during a violent episode. Qualitative excerpts from the interviews were found to differ thematically and were integrated with the quantitative data to provide a more comprehensive understanding of the women’s contextual situation in understanding interpersonal violence experienced by both HIV-positive and HIV-negative women.
  Journal of Urban Health 04/2012; 80(3):494-509.
• Article: A brief sexual barrier intervention for women living with AIDS: Acceptability, use, and ethnicity

  Deborah L. Jones, Stephen M. Weiss, Robert Malow, Mary Ishii, Jessy Devieux, Heidi Stanley, Andrea Cassells, Jonathan N. Tobin, Elizabeth Brondolo, Arthur LaPerriere, Jonell Efantis-Potter, Mary Jo O'Sullivan, Neil Schneiderman
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  ABSTRACT: Interventions aimed at reducing sexual transmission of human immunodeficiency virus/sexually transmitted diseases (HIV/STDs) have focused primarily on male condom use among seronegative men and women. However, female-controlled sexual barriers (female condoms and vaginal microbicides) offer women living with acquired immunodeficiency syndrome (AIDS) alternative methods to protect themselves and others from disease transmission. A pilot behavioral intervention was conducted to increase sexual barrier use and enhance and assess factors related to acceptability. Participants (N=178) were drawn from the Stress Management and Relaxation Training with Expressive Supportive Therapy (SMART/EST) Women's Project, a multisite phase III clinical trial for women living with AIDS (Miami, FL; New York City, NY; Newark, NJ). Intervention participants (n=89) were matched for age and ethnicity with control condition participants (n=89). Women were African American (52%), Haitian (15%), Hispanic (19%), Caucasian (10%), and other ethnicities (4%). The intervention condition received barrier products (male and female condoms and spermicides based on nonoxynol-9 in the form of vaginal gel, film, and suppositories) during three sessions held over 3 months. Data on barrier use and acceptability were analyzed at baseline and 3 and 9 months postintervention. Use of N-9 spermicides on a trial basis increased significantly by 3 months in the intervention conditions (22%–51%, P<.05). Cultural differences in acceptability were greatest between Haitian women and women in other ethnic groups. Exposure to this pilot behavioral intervention was associated with increased acceptability and use of chemical barriers without decreased use of male condoms. KeywordsAcceptability-Ethnicity-HIV/AIDS-Sexual barriers-Women
  Journal of Urban Health 04/2012; 78(4):593-604.
• Article: Balancing the risks: Vector control and pesticide use in response to emerging illness

  Audrey Thier
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  ABSTRACT: The competing public health concerns of vector-borne disease and vector control strategies, particularly pesticide use, are inherently subjective and difficult to balance. Disease response decisions must frequently be made in the absence of data or clear criteria. The factors to be weighed include the vector control measures versus those posed by the disease itself; short-term versus long-term disease management goals, specifically with regard to the issue of pesticide resistance; the need to distinguish among diseases of differing severity in making response choices; and the issue of pesticide efficacy. New York City's experience with West Nile virus has illustrated each of these issues. A framework for assessing the appropriate response to West Nile virus can serve to guide our response to likely new pathogens.
  Journal of Urban Health 04/2012; 78(2):372-381.
• Article: The challenges of emerging illness in urban environments: An overview

  Michael McCally, Anjali Garg, Christopher Oleskey
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  ABSTRACT: The New York City West Nile outbreak is an important case study for examining several medical and public health issues raised by the specter of emerging illnesses in urban areas. Five specific issues are addressed in this issue of theJournal of Urban Health: ecosystem health, vector (e.g., mosquito) control, risk communication, public health infrastructure, and parallels between this outbreak and bioterrorism.
  Journal of Urban Health 04/2012; 78(2):350-358.
• Article: Urban Young Women’s Experiences of Discrimination and Community Violence and Intimate Partner Violence

  Ann Stueve, Lydia O’Donnell
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  ABSTRACT: This paper examines the interrelationships between urban young adult women’s experiences of discrimination and community violence and their reports of involvement in intimate partner violence (IPV). We explore whether such experiences are independent risk factors for IPV victimization and perpetration, even when accounting for aggressive behaviors and related risk taking, including drinking and sexual initiation, during early adolescence. We use data from the Reach for Health study, in which a sample of 550 urban African American and Latina women was followed from recruitment in economically distressed middle schools into young adulthood, over approximately 7years. At the last wave, respondents were 19–20years old; 28% were raising children. More than 40% reported experiencing at least one form of racial/ethnic discrimination sometimes or often over the past year. About 75% heard guns being shot, saw someone being arrested, or witnessed drug deals within this time period; 66% had seen someone beaten up, 26% had seen someone get killed, and 40% knew someone who was killed. Concurrent reports of lifetime IPV were also high: about a third reported being a victim of physical violence; a similar proportion reported perpetration. Results of multivariate regression analyses indicate that discrimination is significantly associated with physical and emotional IPV victimization and perpetration, controlling for socio-demographic characteristics, including ethnic identity formation, and early adolescent risk behaviors. Community violence is correlated with victimization, but the relationship remains significant only for emotional IPV victimization once early behaviors are controlled. Implications for violence prevention are discussed, including the importance of addressing community health, as well as individual patterns of behavior, associated with multiple forms of violence victimization and perpetration.
  Journal of Urban Health 04/2012; 85(3):386-401.
• Article: The acceptability of reuse of the female condom among urban South African women

  Audrey E. Pettifor, Mags E. Beksinska, Helen V. Rees, Nokuzola Mqoqi, Kim E. Dickson-Tettell
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  ABSTRACT: This study assessed whether reuse of the female condom was acceptable among two groups of women in central Johannesburg, South Africa, who were taking part in two separate studies of female condom reuse. The first group consisted of women (aged 17 to 43years) attending a family planning/sexually transmitted infections (STIs) clinic who were participating in a cross-sectional survey of the acceptability of female condoms reuse (n=100). The second group included women (aged 18–40 years) at high risk for STI (80% self-declared sex workers) who were taking part in an ongoing cohort study to investigate the safety of reuse of the female condom through a structural integrity and microbial retention study (n=50). Among women participating in the acceptability study, 83% said that they would be willing to reuse the female condom, and 91% thought the idea of reuse, of the female condom was acceptable. All women taking part in the safety of reuse study and who reused the female condom up to seven time (n=49) reported that the steps involved in reusing the device were easy to perform and acceptable. All 49 women said they would reuse the female condom at least once, while 45% said they would use it a maximum of seven or eight times. From the results of the interviews with both study groups, it can be concluded that, among women in a South African urban environment who have used a male and/or female condom, the concept of reuse of the female condom is acceptable and thought to be a good idea. KeywordsAcceptability-Female condom-Reuse-South Africa
  Journal of Urban Health 04/2012; 78(4):647-657.
• Article: Substance abuse and high-risk needle-related behaviors among homeless youth in minneapolis: Implications for prevention

  Alan R. Lifson, Linda L. Halcón
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  ABSTRACT: Homeless and runaway youth face a variety of health, risks, including those related to substance abuse and use of unsterile needles. During 1998–1999, we recruited 201 Minneapolis homeless youths aged 15–22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or “couch hopping.” There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization. KeywordsAdolescence-Hepatitis B virus-Hepatitis C virus-Human immunodeficiency virus-Substance use
  Journal of Urban Health 04/2012; 78(4):690-698.