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Black and Latino homeless youth are at high risk of HIV, and yet no HIV prevention interventions have been specifically designed for these groups. Given the success of parent–child intervention programs for housed Black and Latino youth, this study examined parental relationships that could be leveraged for future HIV prevention efforts targeting minority homeless youth, specifically the associations among presence of parents in social networks, parental influence, and parental support. A convenience sample of Black, Latino, and White homeless youth (N?=?754) was recruited from three drop-in centers in Los Angeles. Participants completed a computerized, self-administered questionnaire and an interviewer-led personal social network interview. Multivariate logistic regression models assessed the association between parental relationships and sexual risk behaviors. Forty-five percent (n?=?338) of youth identified a parent in their network. Having at least one parent in their network was significantly associated with decreased odds of using a condom for Black and White youth. Black youth were almost four times more likely to report being tested for HIV if they spoke to their parents about sex, whereas Latino youth were 91 % less likely to report being tested for HIV if they talked with their parents about sex. Black youth who identified a parent as a positive influence (i.e., promoting condom use or discouraging multiple partners) were almost four times more likely to have used a condom during their last sexual encounter. Parent–child HIV prevention interventions targeting homeless youth would benefit from culturally tailored adaptations.  相似文献   

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The association between social support and mental health across immigrant groups were examined in this study. A population-based sample was extracted from a 2009/10 Canadian community health survey. Self-reported mood or anxiety disorders and a standardized social support scale were used as outcome and explanatory variables. The association between these variables was measured using logistic regression controlling for sex, age, marital status, education, self-rated health and perceived stress. Stratified analyses were performed to test if the strength of association differed by immigrant status. In comparison with individuals who had moderate levels of social support, individuals with low social support had higher odds of reporting mental disorders and this association appeared strongest among recent immigrants. Using the same comparison group, individuals with high social support had lower odds of reporting mental disorders and this association appeared stronger among long-term immigrants. Findings were discussed within the context of immigration stress and acculturation strategies.  相似文献   

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BACKGROUND: The first Youth Risk Behaviour Survey in South Africa was carried out to establish the prevalence of key health risk behaviours among high school students. Though physical inactivity is a commonly reported contributory factor to chronic diseases of lifestyle in South Africa, there is no reliable national database on the participation of children and adolescents in physical activity. METHODS: This cross-sectional national prevalence study among students attending government schools in the nine provinces in South Africa utilized a two-stage cluster sample design. Statistical analysis allowed for clustered sampling, and data collected through self-administered questionnaire were weighted to reflect the underlying student population. RESULTS: Data of 10,699 participants were analyzed. More than one third (37.5%) of the students engaged in insufficient physical activity. By population group, a significantly lower proportion of white students (29.4%) than black (37.5%) and coloured students (45.6%) engaged in insufficient physical activity. Among those who abstained from participation, 25.9% were unwilling to participate, with significantly fewer white (26.8%) and black (25.1%) students feeling unsafe in their surroundings compared with coloured students (35.3%). Significantly fewer white students (5.6%) had no access to facilities compared to black students (17.0%). White students and students in higher grades reported lower rates of physical education classes at school. INTERPRETATION: Though the promotion of physical activity and healthy lifestyle is a national priority in South Africa, the survey indicates the need to pay attention to an appreciable proportion of high school students who do not participate sufficiently in physical activity.  相似文献   

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Using 2009 National Health Interview Survey data, we examined how social-status factors, variables describing health services, and health-related behaviors explained self-rated health among Black adults and among White adults. We wanted to evaluate whether self-rated health’s relationships with these three sets of variables were conditional on race. Our results overall indicated that social-status, health-care-services, and health-behaviors variables are important to the explanation of both groups’ self-rated health. But in this study, when all social-status, health-care-services, and health-behaviors variables were controlled, Black respondents’ self-reported health did not differ, on average, from White respondents’. Such a finding firmly suggests that the three sets of variables partially explain disparities in the groups’ self-reported health. In the end, our results showed racial health disparities to be partially explained by racial differences in distribution of health resources and health behaviors.  相似文献   

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We used adolescent simulated clients to evaluate whether HIV testing services in clinics participating in an adolescent-friendly initiative in Cape Town were superior to regular clinic services. We found improved accessibility to HIV testing, but no impact on adolescent’s experience of negative attitudes from health workers and confidentiality breaches.  相似文献   

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Current arrangements for financing and delivering behavioral health services to U.S. working-age adults with severe and persistent mental disorders (SPMD) have major inadequacies in funding for and access to critical elements of a recovery-oriented, comprehensive, and coordinated package of community-based treatment and rehabilitation services. This study presents results from a nation-wide 2-year randomized trial, involving 2,238 SSDI beneficiaries with SPMD, of a comprehensive intervention including evidence-based treatment and employment services. Estimates of impacts of the MHTS service intervention package, from a variety of regression specifications, showed clearly significant treatment group reductions in four outcomes (hospital stays and days, ER visits for mental health problems, and psychiatric crisis visits); these estimates suggest annual inpatient hospital treatment cost savings in excess of approximately $900 to 1,400. Negative estimated MHTS effects on three other utilization outcomes (hospital stays and days for mental health problems, overall ER visits) generally did not achieve statistical significance. Possible study implications for cost offsets from further expansions/replications of the MHTS intervention model are considered within the context of health reform.  相似文献   

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Much of the literature suggests that the availability of certain protective factors can help to buffer the adverse effects of negative life events such as parental loss and the negative experiences surrounding placement in orphanages. Following on from this perspective, the present study explores the influence of perceived social support, self-efficacy and resilience on the stress experience (as measured by the symptoms of depression and anxiety) of 200 children in Accra, Ghana. The sample comprised 100 orphans placed in orphanages and 100 non-orphans – all aged between seven and 17 years. The children completed the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Multidimensional Scale of Perceived Social Support, the General Self-efficacy Scale and the 14-item Resilience Scale. The results revealed that orphans had significantly stronger perceptions of social support from friends than non-orphans, whereas non-orphans had significantly stronger perceptions of support from families than orphans. However, both the orphans and non-orphans reported high levels of self-efficacy and resilience. Regression analyses also revealed that self-efficacy emerged as a significant positive predictor of resilience for the orphaned children, whereas self-efficacy and perceived social support emerged as significant positive predictors of resilience for the non-orphans. Implications of the findings are discussed.  相似文献   

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Background  

Obesity is a well recognized risk factor for various chronic diseases such as cardiovascular diseases, hypertension, and type 2 diabetes mellitus. The aim of this study was to shed light on the patterns of overweight and obesity in sub-Saharan Africa, with special interest in differences between the urban poor and the urban non-poor. The specific goals were to describe trends in overweight and obesity among urban women; and examine how these trends vary by education and household wealth.  相似文献   

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Traditional medicine (TM) and biomedicine represent parallel health systems in many developing countries; the latter dominating in public policies, while the former still retain considerable influence among the general public. This study investigates how mental health care professionals responsible for mental health care implementation comprehend and relate to the intersection between TM and biomedicine in the cases of Rwanda and the Eastern Cape Province, South Africa. The material is based on semi-structured interviews with mental health care stakeholders in Eastern Cape, South Africa and Rwanda. The findings confirm an impact of TM in the treatment of mental health issues in Rwanda and South Africa due to TM being more accessible than biomedical medicine, widespread traditional perceptions of mental illness in society, and the lack of knowledge of biomedical treatments. Furthermore, the respondents identified three strategies to manage the impact of TM; improved accessibility of biomedical facilities, outreach education about mental illness, and, in the Eastern Cape case, collaboration between traditional healers and biomedicine. The study points to the necessity to take TM into consideration as an important component of health systems and policies in the Global south.  相似文献   

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Abused women seek help from medicine services extensively. Qualitative interviews were conducted with 12 married Arab-Israeli abused women about their relationships with social workers in community health clinics. Analysis reveals that women’s evaluation of the impact of encounters with social workers is bipolar. On one pole are the difficulties and stressors derived from the cultural limitations that are placed on their ability to bring changes. On the other pole are the benefits—awareness in coping with repressive social powers and empowerment as competent choosers. The discussion elaborates the conflicts and paradoxes inherent in the nature of the interventions with abused women in a collectivistic culture.  相似文献   

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Objectives: To assess the impact of outreach, mental health, and case management services on retention in primary care of HIV+ and at-risk youth and young adult clients of the Boston HAPPENS program, a comprehensive adolescent HIV prevention and care network of agencies. Methods: Providers at 8 urban sites used standard data forms at each visit to collect background and service receipt information on at-risk clients aged 12–24 years. Data were aggregated across all visits for each client to create summary variables for the number of times each client received each type of service. The retention measure was the number of days between a client's first and last visits during the 4-year data collection period. Kaplan–Meier survival curve and Cox proportional hazards regression analyses were used to assess the association between receipt of the support services of interest and the retention measure. Results: The median retention times were 21 days for male clients (range, 0–1406, N = 512), and 26 days for female clients (range, 0–1577, N = 914). Among males, 45% were retained beyond a month, 24% beyond a year, and 10% beyond 2 years. Similar proportions of females were retained beyond a month and a year, but more females were retained beyond 2 years (15%). After adjusting for other covariates, both male and female clients had significantly longer retention times if they received q2 outreach contacts, or case management at q3 visits. Among males, receipt of mental health counseling at q2 visits also increased retention times. Conclusions: These findings suggest that provision of outreach, mental health, and case management services can improve retention in care of at-risk youth and young adults.  相似文献   

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Unique to Africa, a means-tested non-contributory pension is available to South Africans. In 2006, women over 60 and men over 65 were pension-eligible. To explore the effect of the pension for health and wellbeing indicators of rural South African men and women, we analyze data from the WHO-INDEPTH Study of Global Ageing and Adult Health Survey, carried out in the Agincourt sub-district by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in 2006. Because pension receipt was not measured directly, our findings represent intent-to-treat (ITT) rather than treatment-on-the-treated (TOT) effects using age as an indicator for intent-to-treat. Overall, women report poorer wellbeing compared to men. However, women have a "honeymoon" period at ages 60-64, the first years of pension-eligibility, in which they report lower levels of worry and sadness, and higher overall happiness, life satisfaction, and quality of life as compared to younger and older women. For men, in contrast, reports of wellbeing worsen in the pre-pension years, followed by a similar but not as prominent pattern of favorable reports in the five years following pension-eligibility, and a decline in the next five-year period. Thus, while pensions continue to enhance financial wellbeing, our results suggest that their effect on social wellbeing may be gendered and transitory. Further research is needed to improve understanding of these dynamics.  相似文献   

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In scientific societies, as in other social fields, women's participation in decision making is lower than that of men. We describe the situation in SESPAS (Spanish Society of Public Health and Health Services Administration) where, despite representing a 40% of its members, very few women have been in positions in which decisions are taken or in those of professional recognition. The process of change implemented during recent years and some of the effects of the actions taken are presented. Making the existing inequalities known has generated debate and interest in the intervention. A gender and public health working group was set up. In the last two years more women have been promoted to more senior positions in SESPAS.  相似文献   

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Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.  相似文献   

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