Journal of urban health : bulletin of the New York Academy of Medicine
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To improve population health, one must put emphasis on reducing health inequities and enhancing health protection and disease prevention, and early diagnosis and treatment of diseases by tackling the determinants of health at the downstream, midstream, and upstream levels. There is strong theoretical and empirical evidence for the association between strong national primary care systems and improved health indicators. The setting approach to promote health such as healthy schools, healthy cities also aims to address the determinants of health and build the capacity of individuals, families, and communities to create strong human and social capitals. ⋯ This synergistic effect would help to strengthen human and social capital development. The model can then combine the efforts of upstream, midstream, and downstream approaches to improve population health and reduce health inequity. Otherwise, health would easily be jeopardized as a result of rapid urbanization.
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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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An analysis of trends in hospital use and capacity by ownership status and community poverty levels for large urban and suburban areas was undertaken to examine changes that may have important implications for the future of the hospital safety net in large metropolitan areas. Using data on general acute care hospitals located in the 100 largest cities and their suburbs for the years 1996, 1999, and 2002, we examined a number of measures of use and capacity, including staffed beds, admissions, outpatient and emergency department visits, trauma centers, and positron emission tomography scanners. Over the 6-year period, the number of for-profit, nonprofit, and public hospitals declined in both cities and suburbs, with public hospitals showing the largest percentage of decreases. ⋯ However, the results demonstrate for the first time, a highly disproportionate share of hospital resources and use among suburbs with a low poverty rate compared to suburbs with a high poverty rate. High poverty communities represented the greatest proportion of suburban population in 2000 but had the smallest proportion of hospital use and specialty care capacity, whereas the opposite was true of low poverty suburbs. The results raise questions about the effects of the expanding role of private hospitals as safety net providers, and have implications for poor residents in high poverty suburban areas, and for urban safety net hospitals that care for poor suburban residents in surrounding communities.
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Both developed and less developed countries are becoming increasingly urbanized. The earlier industrialized countries have developed more infrastructure to support the building of healthy housing, in neighborhoods that are strongly linked to municipal and global health initiatives, but to some degree housing and neighborhood issues vary only in degree between the developing and developed worlds. Overall, a billion people, a third of people living in urban areas, live in slums, where environmental determinants lead to disease. ⋯ Examples are given of successful local community initiatives that have been set up under national strategies in Tanzania and by Indian women's collectives that are globally linked and have helped develop housing and sanitation improvements. The unit costs for such interventions are within the reach of all the key stakeholders. Global commitment is the only missing link.
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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.