Journal of urban health : bulletin of the New York Academy of Medicine
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External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. ⋯ The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders.
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Research shows that young men who have sex with men (YMSM) engage in higher rates of health risk behaviors and experience higher rates of negative health outcomes than their peers. The purpose of this study is to determine if the effects of adversity on HIV risk are mediated by syndemics (co-occurring health problems). Participants were 470 ethnically diverse YMSM ages 18 to 24 recruited between 2005 and 2006 and surveyed every 6 months for 24 months. ⋯ Syndemics mediated the effects of adversity on CS in all models. Adverse events impact HIV risk taking among YMSM through syndemics. These findings suggest that prevention programs aimed at reducing adversity may reduce both the synergistic effect of multiple psychosocial health problems and HIV risk taking.
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Known associations between the built environment and health outcomes have accelerated research examining racial/ethnic and income disparities in access to parks and other community features that support physical activity. Currently, it cannot be concluded that park characteristics are equal in quantity or condition across areas of disparate race/ethnicity and income composition. This study examined natural and built park characteristics across areas of different race/ethnicity and income composition to identify potential disparities. ⋯ Sitting and resting features in non-minority areas were found to be cleaner than those in minority areas. Results showed some evidence of disparities in park characteristics. Findings can inform park policy and design as well as renovations and maintenance procedures, particularly in specific areas where existing disparities were identified.
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Hurricane Sandy led to the closing of many major New York City public hospitals including their substance abuse clinics and methadone programs, and the displacement or relocation of thousands of opioid-dependent patients from treatment. The disaster provided a natural experiment that revealed the relative strengths and weaknesses of methadone treatment in comparison to physician office-based buprenorphine treatment for opioid dependence, two modalities of opioid maintenance with markedly different regulatory requirements and institutional procedures. To assess these two modalities of treatment under emergency conditions, semi-structured interviews about barriers to and facilitators of continuity of care for methadone and buprenorphine patients were conducted with 50 providers of opioid maintenance treatment. ⋯ Buprenorphine treatment presented fewer regulatory barriers, but buprenorphine providers had little to no cross-coverage options compared to methadone providers, who could refer to alternate methadone programs. The findings point to the need for well-defined emergency procedures with flexibility around regulations, the need for a central registry with patient dose information, as well as stronger professional networks and cross-coverage procedures. These interventions would improve day-to-day services for opioid-maintained patients as well as services under emergency conditions.
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Illicit drug use not only causes acute and chronic adverse health outcomes but also results in a significant burden to health care providers. The objective of this study is to examine the relationship between cocaine prices and purity with emergency department (ED) visits for the Chicago-Naperville-Joliet metropolitan area. Our primary outcome was number of cocaine-related ED visits per quarter provided by the Drug Abuse Warning Network. ⋯ ARIMA regression results suggest that cocaine-related ED visits were not significantly associated with powder or crack cocaine prices; however, a decrease in powder cocaine purity was associated with 2,081 fewer ED visits overall from 2007 to 2010. The cocaine trade continues to be a major public health and law enforcement threat to large metropolitan cities like Chicago. Regular monitoring of cocaine purity levels may provide early warning of impending changes in cocaine-related ED visits for law enforcement and health care providers.