Journal of urban health : bulletin of the New York Academy of Medicine
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The geography of recreational open space might be inequitable in terms of minority neighborhood racial/ethnic composition and neighborhood poverty, perhaps due in part to residential segregation. This study evaluated the association between minority neighborhood racial/ethnic composition, neighborhood poverty, and recreational open space in Boston, Massachusetts (US). Across Boston census tracts, we computed percent non-Hispanic Black, percent Hispanic, and percent families in poverty as well as recreational open space density. ⋯ In bivariate and multivariate OLS models, percent non-Hispanic Black in a census tract and predominantly Black census tracts were associated with decreased density of recreational open space (p value < 0.001). Consistent with several previous studies in other geographic locales, we found that Black neighborhoods in Boston were less likely to have recreational open spaces, indicating the need for policy interventions promoting equitable access. Such interventions may contribute to reductions and disparities in obesity.
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Diversion of prescription opioids is a widespread problem in the USA. While "doctor shopping" and pill brokering are well-described types of medication diversion, we sought to understand the social dynamic of diversion of prescription opioids and identify other diversion methods. Using qualitative data collected as part of a 12-week Rapid Assessment and Response study of prescription opioid overdose and abuse (the RARx Study) conducted in three communities in two New England states, we reviewed and thematically coded 195 interviews. ⋯ Motivations for partnering indicated doing so out of fear of violence, for financial benefit, or in exchange for transportation or other services. Partnering for prescription opioids exhibited a range of power differentials, from collaboration to coercion, and tended to involve vulnerable populations such as the elderly, disabled, or destitute. Increased awareness among health providers of the ease of access and diversion of prescription opioids is needed to promote patient safety and prevent interpersonal violence.
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African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. ⋯ Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.
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Substance use can be a barrier to stable housing for homeless persons with mental disorders. We examined DSM-IV symptoms among homeless adults (N = 497), comparing those who reported daily substance use (DSU) with non-daily substance users. Multivariable linear regression modeling was used to test the independent association between DSU and symptoms using the Colorado Symptom Index total score. ⋯ We observed a higher prevalence of DSU in our sample than has been previously reported in a Housing First intervention. DSU was also independently associated with more DSM-IV symptomatology. We have an opportunity to observe this cohort longitudinally and examine if there are changes in substance use based on treatment assignment and commensurate changes in housing stability, community integration, health status, and quality of life.
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Increasingly, African American churches have been called upon to assist in efforts to address HIV/AIDS in underserved communities. African Americans churches may be well-positioned to provide HIV education, screening, and support services, particularly if they are equipped with church-appropriate, easy-to-deliver HIV tools that can be implemented through the naturalistic church environment. To inform the development of a church-based HIV tool kit, we examined church capacity with African American church leaders (N = 124 participants; n = 58 churches represented by senior pastors). ⋯ Regarding church capacity, most of their representative churches held three regular services each week, facilitated various inreach and community outreach ministries, and had paid staff and computers. Also, many of their churches facilitated HIV/AIDS education/prevention and adolescent sex education activities. Guided by church capacity findings, an ecological framework, and a CBPR approach, we describe the resulting church-based HIV Tool Kit that "fits" naturalistically within a multilevel church infrastructure, builds upon churches' HIV-related experience, and equips faith leaders to efficiently promote HIV services with the communities they serve.