Untangling the associations among distrust, race, and neighborhood social environment: a social disorganization perspective

Over the past decade, interest in exploring how health care system distrust is associated with individual health outcomes and behaviors has grown substantially, and the racial difference in distrust has been well documented, with African Americans demonstrating higher distrust than whites. However, relatively little is known about whether the individual-level determinants of distrust differ by various dimensions of distrust, and even less is understood regarding whether the race-distrust association could be moderated by the neighborhood social environment. This study used a dual-dimensional distrust scale (values and competence distrust), and applied social disorganization theory to address these gaps. We combined the 2008 Philadelphia Health Management Corporation's household survey (N = 3746 adult respondents, 51% of which are of African American race) with neighborhood-level data (N = 45 neighborhoods) maintained by the 2000 U.S. Census and the Philadelphia Police Department. Using multilevel modeling, we found that first, after controlling for individual- and neighborhood-level covariates, African American residents have greater values distrust than whites, but no racial difference was found in competence distrust; second, competence distrust is more likely to be determined by personal health status and access to health care services than is values distrust; and third, ceteris paribus, the association between race and values distrust was weakened by the increasing level of neighborhood stability. These results not only indicate that different aspects of distrust may be determined via different mechanisms, but also suggest that establishing a stable neighborhood may ameliorate the level of distrust in the health care system among African Americans. As distrust has been identified as a barrier to medical research, the insight provided by this study can be applied to develop a health care system that is trusted, which will, in turn, improve population health.     

Outdoor play among children in relation to neighborhood characteristics: a cross-sectional neighborhood observation study

ABSTRACT: BACKGROUND: Although environmental characteristics as perceived by parents are known to be related to children's outdoor play behavior, less is known about the relation between independently measured neighborhood characteristics and outdoor play among children. The purpose of this study was to identify quantitative as well as qualitative neighborhood characteristics related to outdoor play by means of neighborhood observations. METHODS: Questionnaires including questions on outdoor play behavior of the child were distributed among 3,651 parents of primary school children (aged 4--12 years). Furthermore, neighborhood observations were conducted in 33 Dutch neighborhoods to map neighborhood characteristics such as buildings, formal outdoor play facilities, public space, street pattern, traffic safety, social neighborhood characteristics, and general impression. Data of the questionnaires and the neighborhood observations were coupled via postal code of the respondents. Multilevel GEE analyses were performed to quantify the correlation between outdoor play and independently measured neighborhood characteristics. RESULTS: Parental education was negatively associated with outdoor play among children. Neither the presence nor the overall quality of formal outdoor play facilities were (positively) related to outdoor play among children in this study. Rather, informal play areas such as the presence of sidewalks were related to children's outdoor play. Also, traffic safety was an important characteristic associated with outdoor play. CONCLUSIONS: This study showed that, apart from individual factors such as parental education level, certain modifiable characteristics in the neighborhood environment (as measured by neighborhood observations) were associated with outdoor play among boys and girls of different age groups in The Netherlands. Local policy makers from different sectors can use these research findings in creating more activity-friendly neighborhoods for children.     

Correlates of physical,psychological, and social frailty among formerly incarcerated,homeless women

Frailty is a deficit accumulation in physical, psychological and social domains. Correlates of frailty were explored among formerly incarcerated, homeless women (N?=?130, M_age = 38.9). Significant correlates of physical frailty were age, years homeless, prior violence, witnessing less violence, drug dependence, PTSD symptoms and tangible support. Significant correlates of psychological frailty were age, years homeless, witnessed violence, jail time, divorced less, drug use/dependence, prison time, methamphetamine use, and bodily pain. Significant correlates of social frailty were drug use, emotional regulation, and daily alcohol use. Reentry interventions are needed for formerly incarcerated, homeless women who experience physical, psychological and social frailty.     

Individual, neighborhood, and state-level predictors of smoking among US Black women: a multilevel analysis

Baseline data from the Black Women's Health Study (BWHS) were analyzed to assess the relation of smoking to individual, neighborhood, and state socioeconomic characteristics. Data on smoking status and individual socioeconomic characteristics were obtained via a self-administered postal questionnaire at entry. Neighborhood characteristics of 41,726 never and current smokers were obtained by linking participants' addresses with census tract data from the 1990 US Census. In a multilevel logistic regression model, higher neighborhood poverty was associated with increased smoking prevalence after adjusting for age, education, marital status, and occupation at the individual level, and percent high school graduate, percent college graduate, and percentage Black at the neighborhood level. Relative to women residing in neighborhoods with less than 5% of the residents below the poverty line, the odds ratio was 1.1 (95% confidence interval: 1.0-1.2) for women in neighborhoods with 5-9.9% of the residents below the poverty line, 1.3 (1.2-1.4) for women in neighborhoods with 10-19.9% of the residents below the poverty line, and 1.6 (1.5-1.8) for women in neighborhoods with 20% or more of the residents below poverty. State of residence was also significantly associated with prevalence of current smoking. These results suggest that contextual factors (at both the neighborhood and state level) play a role in Black women's smoking behaviors over and above individual characteristics.     

Elevated HIV risk behaviour among recently incarcerated injection drug users in a Canadian setting: a longitudinal analysis

Background  

While incarceration has consistently been associated with a higher risk of HIV infection for individuals who use injection drugs (IDU), the effect of incarceration on the post-release risk environment remains poorly described. We sought to assess the impact of incarceration on risk factors for HIV infection after release from prison in a sample of active IDU in Vancouver, Canada.     

Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use

Background

Take-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia.

Methods

The sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison.

Results

Most participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03–4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32–4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14–5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73–11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18–0.77) was associated with decreased odds of willingness to participate in a prison THN training.

Conclusion

Our findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period.

     

Association between neighborhood socioeconomic status and screen time among pre-school children: a cross-sectional study

Background  

Sedentary behavior is considered a separate construct from physical activity and engaging in sedentary behaviors results in health effects independent of physical activity levels. A major source of sedentary behavior in children is time spent viewing TV or movies, playing video games, and using computers. To date no study has examined the impact of neighborhood socioeconomic status (SES) on pre-school children's screen time behavior.     

Experience of intimate partner violence among women and men attending general practices in Dublin, Ireland: a cross-sectional survey

This cross-sectional study examined women's and men's reported experience of intimate partner violence in general practice in the greater Dublin region. A high prevalence of reported experience of controlling behaviour and violent incidents was found. Although the reported prevalence of both was higher in men, women were more likely to have reported fear of a partner and a severe level of violence. CONCLUSION: The findings demonstrate that intimate partner violence is a major problem among the men and women surveyed.     

Measuring the neighborhood environment: associations with young girls' energy intake and expenditure in a cross-sectional study

Background  

Neighborhood environments affect children's health outcomes. Observational methods used to assess neighborhoods can be categorized as indirect, intermediate, or direct. Direct methods, involving in-person audits of the neighborhoods conducted by trained observers, are recognized as an accurate representation of current neighborhood conditions. The authors investigated the associations of various neighborhood characteristics with young girls' diet and physical activity.     

Linking social capital and self-rated health: a multilevel analysis of 11,175 men and women in Sweden

This multilevel study included 11,175 participants interviewed 2000-2002 in Sweden. The association between neighbourhood linking social capital (voting in national elections) and self-rated health was analysed. Individuals living in neighbourhoods with the lowest levels of linking social capital exhibited a significantly higher risk of poor health than individuals living in neighbourhoods with the highest levels of linking social capital, after adjustment for individual characteristics, including individual voting. The neighbourhood variance indicated significant differences in self-rated health between neighbourhoods. Both individuals and neighbourhoods need to be targeted in order to enhance people's health in neighbourhoods with low linking social capital.     

Perceptions about the local neighborhood and walking and cycling among children

BACKGROUND: This study examined associations between perceptions of the local neighborhood and walking and cycling among children. METHODS: Children aged 5-6 years (n=291) and 10-12 years (n=919) were recruited from 19 Australian primary schools. Parents reported their child's usual walking or cycling to local destinations and their perceptions of their neighborhood. Ten- to twelve-year-olds were asked their perceptions of traffic, strangers, road safety and sporting venues, and their perceptions of their parent's views on these issues. RESULTS: Five- to six-year-old boys whose parents believed there was heavy traffic in their area were 2.8 times more likely (95%CI=1.1-6.8), and 5- to 6-year-old girls whose parents owned more than one car were 70% less likely (95%CI=0.1-0.8), and whose parents believed that public transport was limited in their area were 60% less likely (95%CI=0.2-0.9) than other children to walk or cycle at least three times per week. Parental belief that there were no lights or crossings was associated with walking or cycling among 10- to 12-year-old boys (OR=0.4, 95%CI=0.2-0.7). Among older girls, parent's belief that their child needed to cross several roads to reach play areas (OR=0.4, 95%CI=0.2-0.8) and that there is limited public transport in their area (OR=0.7, 95%CI=0.4-0.97), and child's belief that there were no parks or sports grounds near home (OR=0.5, 95%CI=0.3-0.8) were associated with a lower likelihood of walking or cycling. CONCLUSION: Perceptions of the local neighborhood may influence children's physical activity.     

Income disparities in perceived neighborhood built and social environment attributes

The present study explored whether perceived neighborhood environmental attributes associated with physical activity differ by neighborhood income. Adults aged 20–65 years (n=2199; 48% female; mean age=45 years; 26% ethnic minority) were recruited from 32 neighborhoods from the Seattle, WA and Baltimore, MD regions that varied in objectively measured walkability and neighborhood income. Perceived built and social environment variables were assessed with the Neighborhood Environment Walkability Scale. There were neighborhood income disparities on 10 of 15 variables. Residents from high-income neighborhoods reported more favorable esthetics, pedestrian/biking facilities, safety from traffic, safety from crime, and access to recreation facilities than residents of low-income areas (all p's <0.001). Low-income neighborhoods may lack amenities and safety attributes that can facilitate high levels of physical activity for both transportation and recreation purposes.     

天津市居民吸烟现况及吸烟者尼古丁依赖状况

目的了解天津市居民吸烟现况及现在吸烟者尼古丁依赖状况,为制定控烟政策及相应干预措施提供参考依据。方法采用多阶段随机抽样方法抽取天津市城区的成年居民1 993人,对其吸烟情况、尼古丁依赖状况等方面进行调查。结果天津市居民现在吸烟率为26.2%,男性现在吸烟率为46.0%,女性现在吸烟率为5.0%,差异有统计学意义(χ2=494.02,P<0.01);青年人现在吸烟率(19.0%)低于中年人(39.5%)和老年人(39.0%);文化程度越低吸烟率越高,小学及以下居民的现在吸烟率高达41.0%,大专及以上居民仅为17.7%;现在吸烟者尼古丁依赖评测量表(FTND)平均得分为(3.92±2.72)分,中年吸烟者尼古丁依赖严重,平均得分为(4.41±2.86)分;文化程度低、开始吸烟年龄小、家庭或工作场所对吸烟没有限制、吸烟频率高的吸烟者,尼古丁依赖程度较严重(P<0.01)。结论天津市居民吸烟现况及尼古丁依赖状况不容乐观;采用FTND定量分析现吸烟者的尼古丁依赖程度,有助于进一步采取针对性措施进行健康干预。     

AIDS education and incarcerated women: a neglected opportunity

Attitudes and perceptions about health, AIDS, and the need for AIDS education were explored among inmates in a women's prison in the southeastern U.S. Forty short-term inmates participated in a series of focus group interviews. A separate sample of sixteen women completed a 103-item questionnaire. Focus group participants expressed concern about AIDS within prison, sexual activity between inmates, and the institution's policy of housing seropositive women with the general inmate population. Close to half (44%) of the survey respondents believe that they were likely to be exposed to HIV in prison; most (81%) felt that AIDS education programs should discuss female homosexual activity, and nearly all respondents (94%) felt that inmates should be given an HIV antibody test upon entering prison. The study's findings confirm the need for tailoring AIDS education and prevention activities for incarcerated women.