Journal of urban health : bulletin of the New York Academy of Medicine
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Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. ⋯ We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.
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There is increasing recognition that the nutrition transition sweeping the world's cities is multifaceted. Urban food and nutrition systems are beginning to share similar features, including an increase in dietary diversity, a convergence toward "Western-style" diets rich in fat and refined carbohydrate and within-country bifurcation of food supplies and dietary conventions. Unequal access to the available dietary diversity, calories, and gastronomically satisfying eating experience leads to nutritional inequalities and diet-related health inequities in rich and poor cities alike. ⋯ Finding common solutions to under- and overnutrition is required, the first step of which is poverty eradication through creating livelihood strategies. In many cities, thousands of positions of paid employment could be created through the establishment of sustainable and self-sufficient local food systems, including urban agriculture and food processing initiatives, food distribution centers, healthy food market services, and urban planning that provides for multiple modes of transport to food outlets. Greater engagement with the food supply may dispel many of the food anxieties affluent consumers are experiencing.
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In the fall of 2004, the FDA and British authorities suspended the license of one of only two manufacturers that provided the US supply of inactivated influenza vaccine. With a 50% reduction in supply, a severe vaccine shortage resulted. This situation necessitated the development of priority groups for vaccination including those > or =65 years, when ordinarily, influenza vaccine is recommended for those > or =50 years old. ⋯ A significantly larger proportion of patients 50-64 years of age were unvaccinated due to the shortage (73%) compared to those who were vaccinated during both seasons (36%, P < 0.001), but there were no racial disparities in vaccination rates. Compared with patients who were vaccinated during both seasons, those who were unvaccinated due to the shortage were more frequently employed, self-reported their health positively, saw their physician less frequently, rated the US government's response to the shortage as "terrible," and blamed the US government for the shortage. Vaccination during the influenza vaccine shortage appears to have followed preferential vaccination of the CDC-established priority group (> or =65 years) and did not result in racial disparities in inner-city health centers.
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This paper critically reviews the extent in which social capital can be a resource to promote health equity in urban contexts. It analyzes the concept of social capital and reviews evidence to link social capital to health outcomes and health equity, drawing on evidence from epidemiological studies and descriptive case studies from both developed and developing countries. The findings show that in certain environments social capital can be a key factor influencing health outcomes of technical interventions. ⋯ The link between social capital and health is shown to operate through different pathways at different societal levels, but initiatives to strengthen social capital for health need to be part of a broader, holistic, social development process that also addresses upstream structural determinants of health. A clearer understanding is also needed of the complexity and dynamics of the social processes involved and their contribution to health equity and better health. The paper concludes with recommendations for policy and programming and identifies ten key elements needed to build social capital.
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Since 2002, clinicians have been encouraged to offer chronic hepatitis C virus (HCV) treatment to patients with injection drug use histories. We conducted 69 baseline and 35 follow-up interviews between September 2002 and November 2004 with HCV patients who were treatment-naïve and receiving regular medical care at an HIV or methadone clinic in New York City at baseline. ⋯ Reasons for failure to be reinterviewed were loss to follow-up at the original site of care (30), death (6), and refusal to be reinterviewed (2). Whereas offers of HCV treatment may be increasing, there is a need to improve continuity of care, patient-provider communication, and patient education regarding HCV treatment options for treatment rates to improve.