Journal of urban health : bulletin of the New York Academy of Medicine
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The cumulative epidemiologic literature indicates that many injecting drug users (IDUs) initiate injection as a mode of drug administration during late adolescence or early adulthood. Recent studies have shown that IDUs are often exposed to viral infections relatively early in the course of injection, highlighting the importance of understanding this initiation process for both epidemiology and prevention. ⋯ Similarly, we know little about the ways that YMSM and other high-risk youth understand risk, the kinds of exchanges and relationships in which they participate in the context of initiating sexual activity, or how drug use is operant in these exchanges and early sexual experiences. In this article, we explore key dimensions of the early initiation of injection and sexual risk, and discuss how a social network approach might be instrumental in understanding the social course of drug injection and sexual activities among youth and young adult populations.
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The built environment has direct and indirect effects on mental health. High-rise housing is inimical to the psychological well-being of women with young children. Poor-quality housing appears to increase psychological distress, but methodological issues make it difficult to draw clear conclusions. ⋯ Even more challenging is the task of developing underlying models of how the built environment can affect mental health. It is also likely that some individuals may be more vulnerable to mental health impacts of the built environment. Because exposure to poor environmental conditions is not randomly distributed and tends to concentrate among the poor and ethnic minorities, we also need to focus more attention on the health implications of multiple environmental risk exposure.
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A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. ⋯ An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P <.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions.
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Individual behavior and social contexts are critical determinants of health. We surveyed commissioners or their designees in 22 departments of health serving US cities of at least 500,000 people to examine their use of scientific approaches to influence individual behavior and social contexts. ⋯ Behavioral and social sciences were employed most frequently in the areas of HIV/AIDS and maternal and child health and in the service of changing individual behavior rather than larger contexts, although across departments many health problems and approaches were involved. Commissioners generally found the approaches valuable, but articulated barriers to more widespread adoption.