Journal of urban health : bulletin of the New York Academy of Medicine
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HIV is a public health crisis that disproportionately affects Black and Latino men. To understand this crisis, syndemic theory, which takes into account multiple interrelated epidemics, should be used. ⋯ In New York City, Black and Latino men experience a syndemic of HIV/AIDS, substance abuse, trauma, incarceration, and poverty; however, current research has yet to fully identify the mechanisms of resilience that may reduce the negative impact of a syndemic or explore the potential adaptive functions of individual-level risk behaviors. To understand HIV risk as part of a syndemic and address HIV prevention in Black and Latino men, we propose the following: (1) the use of complex systems analysis, ethnography, and other mixed-methods approaches to observe changes in relations among social conditions and disease; (2) multidisciplinary and inter-institution collaboration; and (3) involvement of public health practitioners and researchers from diverse and underrepresented backgrounds.
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While studies have consistently shown that in the USA, non-Hispanic Blacks (Blacks) have higher diabetes prevalence, complication and death rates than non-Hispanic Whites (Whites), there are no studies that compare disparities in diabetes mortality across the largest US cities. This study presents and compares Black/White age-adjusted diabetes mortality rate ratios (RRs), calculated using national death files and census data, for the 50 most populous US cities. Relationships between city-level diabetes mortality RRs and 12 ecological variables were explored using bivariate correlation analyses. ⋯ Adjusting for Black/White poverty and segregation explained 72.6 % of the disparity. This study emphasizes the role that inequalities in social and economic determinants, rather than for example poverty on its own, play in Black/White diabetes mortality disparities. It also highlights how the magnitude of the disparity and the factors that influence it can vary greatly across cities, underscoring the importance of using local data to identify context specific barriers and develop effective interventions to eliminate health disparities.
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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.
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Comparative Study
Utilization of mental health services by minority urban adults: psychosocial predictors.
Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. ⋯ Psychiatric disorders had a cross-sectional association with mental health services utilization (β = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.
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Urban contexts introduce unique challenges that must be addressed to ensure that areas of high population density can function when disasters occur. The ability to generate useful data to guide decision-making is critical in this context. Widespread adoption of electronic health record (EHR) systems in recent years has created electronic data sources and networks that may play an important role in public health surveillance efforts, including in post-disaster situations. ⋯ Hurricane Sandy was the first disaster situation where PCIP was asked to assess public health impact, generating information that could contribute to aid and recovery efforts. This experience allowed us to explore the strengths and weaknesses of ambulatory EHR data in post-disaster settings. Data from ambulatory EHR networks can augment existing surveillance streams by providing sentinel population snapshots on clinically available indicators in near real time.