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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Available urban health metrics focus primarily on large area rankings. Less has been done to develop an index that provides information about level of health and health disparities for small geographic areas. Adopting a method used by the Human Development Index, we standardized indicators for small area units on a (0, 1) interval and combined them using their geometric mean to form an Urban Health Index (UHI). ⋯ A map of Atlanta census tracts exposed a swath of high disparity. UHI rankings, ratio, and slope were resistant to alteration in composition and to non-extreme weighting schemes. This empirical evaluation was limited to a single realization, but suggests that a flexible tool, whose method rather than content is standardized, may be of use for local evaluation, for decision making, and for area comparison.
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Physical victimization has been linked to high-risk sexual partnerships in women. Although illicit drug-using heterosexual men are at high-risk of physical victimization, the association between violence and high-risk partners in heterosexual men has received little attention in the published literature. We examined the association between experience of severe physical victimization and acquisition of a high-risk sexual partner (i.e., a partner who injected drugs or participated in transactional sex) 1 year later among illicit drug-using men in New York City (2006-2009) using secondary cross-sectional data. ⋯ Log-binomial logistic regression with generalized estimating equation (GEE) methods was used to account for repeated measures for up to four time points. After adjustment for important covariates, participants that experienced physical victimization were significantly more likely to have acquired a high-risk sexual partner 1 year later (relative risk (RR), 3.73; 95 % confidence interval (CI), 1.55-8.97). Our study challenges gender-based stereotypes surrounding physical victimization and provides support for multidisciplinary programs that address both violence and HIV risk among illicit drug-using heterosexual men.
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The Healthy Cities project started in 1998 in Korea. Around the world, public health and healthy cities are becoming bigger and bigger priorities. ⋯ Korea follows a bottom-up approach for the development of Healthy City policies and has implemented plans accordingly. Korea has created a unique program through Healthy Cities; it has developed a Healthy City act, indicators for evaluating the program, a health impact assessment program, an award system, and a domestic networking system.