Contrasting children and women's health and the determinants of health in a small-sized city.
(41/201)
Contrasts that exist in urban infrastructure and accessibility of public health and social services between suburban and urban districts of mega-cities have been well defined. There has been less research in small-sized cities (population under 500,000). This cross-sectional study was done on 1,728 ever-married reproductive-aged women living in Manisa, Turkey, in the year 2000. The probability proportion to size cluster sampling approach was used in the sample selection. Data were collected for women and 7,016 inhabitants of the interviewed households. The data were collected from the women by face to face interviews. Suburban areas (illegally occupied public land called "Gecekondu" dwellings) in Manisa differ from other urban regions (legal settlements of the city) on socioeconomic factors including household occupancy, adult literacy, social class, rates of religious marriages, unemployment, health insurance coverage, migration, cultural segregation, and social status of women. Some traditional practices were also highly prevalent in gecekondu families, where poverty is more common. Although gross fertility rate (GFR), total fertility rate (TFR), and percent decrease of the TFR were higher for gecekondu women than urban women, total wanted fertility rate (TWFR) was lower. In urban neighborhoods, prevalence of contraceptive use was higher, and the infant and child mortality rates were lower; however, when rates were adjusted for mother's age, education and number of births, the differences turned out to be nonsignificant. Women living in urban areas receive better antenatal care, child immunization services, and professional health delivery assistance and services in a health facility; these services are very scarce in gecekondu districts. Health status of gecekondu populations can be improved by social and economic support and by making health services more available and accessible, especially maternity and child health services. (+info)
Blood pressure patterns in rural, semi-urban and urban children in the Ashanti region of Ghana, West Africa.
(42/201)
BACKGROUND: High blood pressure, once rare, is rapidly becoming a major public health burden in sub-Saharan/Africa. It is unclear whether this is reflected in children. The main purpose of this study was to assess blood pressure patterns among rural, semi-urban, and urban children and to determine the association of blood pressure with locality and body mass index (BMI) in this sub-Saharan Africa setting. METHODS: We conducted a cross-sectional survey among school children aged 8-16 years in the Ashanti region of Ghana (West-Africa). There were 1277 children in the study (616 boys and 661 females). Of these 214 were from rural, 296 from semi-urban and 767 from urban settings. RESULTS: Blood pressure increased with increasing age in rural, semi-urban and urban areas, and in both boys and girls. The rural boys had a lower systolic and diastolic blood pressure than semi-urban boys (104.7/62.3 vs. 109.2/66.5; p < 0.001) and lower systolic blood pressure than urban boys (104.7 vs. 107.6; p < 0.01). Girls had a higher blood pressure than boys (109.1/66.7 vs. 107.5/63.8; p < 0.01). With the exception of a lower diastolic blood pressure amongst rural girls, no differences were found between rural girls (107.4/64.4) and semi-urban girls (108.0/66.1) and urban girls (109.8/67.5). In multiple linear regression analysis, locality and BMI were independently associated with blood pressure in both boys and girls. CONCLUSION: These findings underscore the urgent need for public health measures to prevent increasing blood pressure and its sequelae from becoming another public health burden. More work on blood pressure in children in sub-Saharan African and other developing countries is needed to prevent high blood pressure from becoming a major burden in many of these countries. (+info)
The experience of abuse and mental health in the young Thai population A preliminary survey.
(43/201)
OBJECTIVES: The aims of this study were to examine the prevalence of child abuse exposure among Thai people in a suburban community and to describe the association of abuse experiences with common mental disorders (CMD), alcohol use disorders and substance use. METHODS: A population-based cross-sectional survey was conducted in Northern Bangkok on a representative sample of 202 young residents, aged 16-25 years. RESULTS: Thirty eight percent of the respondents reported experiencing some form of abuse during childhood, with 5.8% having been subjected to sexual penetration, 11.7% having been physically abused and 31.8% emotionally abused. A graded relationship was found between the extent of exposure to abuse during childhood and mental problems. After controlling for potential confounders, CMD remained significantly associated with emotional abuse, and alcohol use disorders remained associated with sexual abuse. Strong but non-significant trends were present for associations between CMD and sexual abuse and all forms of abuse with substance use. CONCLUSION: Child abuse experiences were common among the respondents. Childhood abuse, particularly sexual abuse, has a potentially devastating impact on adult mental health. (+info)
Patterns and correlates of substance use among affluent, suburban high school students.
(44/201)
Despite ongoing concern about substance use during adolescence, very little is known about alcohol and drug use among teens living in affluent social settings. In this longitudinal study, cluster analysis was used to characterize patterns of substance use and change in other dimensions of psychosocial adjustment within a cohort of 292 high school students (54% girls) living in an affluent, suburban community. When compared with a cluster of students reporting minimal use, clusters reporting escalating, declining, and persistently high use consistently demonstrated relatively poorer psychosocial adjustment. Moreover, other dimensions of psychosocial adjustment remained relatively stable despite changes in substance use, and there were relations involving substance use and other aspects of psychosocial adjustment that may be specific to this social setting. The findings highlight the need for preventive intervention grounded in a clear understanding of developmental process occurring within populations of affluent, suburban teens. (+info)
Fertility desires and intentions of HIV-positive patients at a suburban specialist center.
(45/201)
OBJECTIVES: To determine the extent of fertility desires and intentions of HIV-positive patients receiving care at a suburban specialist clinic and assess how these may vary by their sociodemographic and health-related factors. METHODS: Questionnaire-based interview of a consecutive sample of HIV-positive men (18-55 years) and HIV-positive women (18-45 years) who presented at the HIV clinic of the Center for Special Studies, Sagamu, Nigeria, between November and December 2004. RESULTS: 63.3% of the 147 studied participants expressed the desire for childbearing, even though 50.4% of them already had > or = 2 children. Respectively, 71.5% and 93.8% of men and women who desired children intended to have > or = 2 in the near future. Only 4.3% of those who desired children did not intend to have any. All 30 individuals who had no children intended to bear children in the future, and they constituted 32.3% of those who expressed the desire for childbearing. Multivariate logistic regression analyses of associated factors indicated that decreasing age, shorter time since diagnosis of HIV infection and nondisclosure of serostatus to current partner significantly increase the odds of desire for childbearing, while having no children and a poor most-recent CD4 count significantly increase the odds of intention to have > or = 3 children instead of 1-2. CONCLUSION: The extent of the fertility desires and intentions of these patients poses a threat to the preventive strategies against vertical and heterosexual transmission of HIV in this region. In view of their compelling desire for parenthood, it may be wise for caregivers to desist from the conventional systematic advice against pregnancy but, in addition to laying emphasis on the risks, provide adequate information on practicable reproductive options for HIV-positive individuals. (+info)
Direct observation of neighborhood attributes in an urban area of the US south: characterizing the social context of pregnancy.
(46/201)
BACKGROUND: Neighborhood characteristics have been associated with poor maternal and child health outcomes, yet conceptualization of potential mechanisms is still needed. Census data have long served as proxies for area level socioeconomic influences. Unique information captured by neighborhood inventories, mostly conducted in northern US and Canadian urban areas, has shown important aspects of the community environment that are not captured by the socioeconomic and demographic aggregated individual statistics of census data. In this paper, we describe a neighborhood data collection effort tailored to a southern urban area. METHODS: This study used data from the Pregnancy, Nutrition and Infection (PIN) prospective cohort study to describe neighborhoods where low- and moderate-income pregnant women reside. Women who participated in the PIN study and who resided in Raleigh, NC and its surrounding suburbs were included (n = 703). Neighborhood attributes captured by the inventory included litter, housing condition, road condition, and social interactions that informed theoretical constructs of physical incivility, territoriality and social spaces. US Housing and Population Census 2000 data at the block group level were also assessed to identify the unique contribution of directly observed data. We hypothesize that neighborhood environments can influence health through psychosocial mediated pathways that lead to increased stress, or through disadvantage leading to poor neighborhood resources, or by protective attributes through increased social control. RESULTS: Findings suggest that directly observed neighborhood attributes distinguished between different types of areas in which low-income pregnant non-Hispanic white and non-Hispanic black women lived. Theoretically informed scales of physical incivilities, territoriality and social spaces were constructed and found to be internally consistent. Scales were weakly associated indicating that these constructs capture distinct information about these neighborhoods. Physical incivilities, territoriality and social spaces scales were poorly explained by traditional census variables used to proxy neighborhood environment. CONCLUSION: If neighborhoods influence health through psychosocial mediated pathways then careful detailing of neighborhood attributes that contribute to stress or deterioration, beyond traditional socioeconomic status, are needed. We believe that measuring physical incivility, territoriality and social spaces as expressions of underlying issues of maintenance and social communication make important contributes to this field. (+info)
Distrust, social fragmentation and adolescents' health in the outer city: Beirut and beyond.
(47/201)
This study examined the association between place and components of social capital among adolescents living in three impoverished communities outside of Beirut, the capital city of Lebanon. We utilized a unique data set that includes a wide range of social capital items to assess the association between place, social capital and self rated health. The analyses were based on data collected by trained interviewers during the Spring of 2003 from a stratified random sample of 1294 adolescents aged 13-19 years, drawn from a sampling frame constructed from area maps and detailed household listing of the target population. Descriptive statistics and odds ratios from logistic regression models were used to assess the strength of associations between (1) the social capital items and community of residence and (2) social capital, community and self-rated health controlling for age, sex and income. Findings show that distrust and social fragmentation were generally prevalent among adolescents living in impoverished suburban communities. Even though social networks, especially the presence of family and relatives, were strong, instrumental social exchange was relatively scarce. Social capital items varied significantly by community, and the stock of social capital in one of the three communities surveyed-the Palestinian refugee camp-was quite distinctive. Findings from logistic regression models showed that social capital as measured by a simple index is strongly associated with self-rated health status, controlling for community, age, sex and income. Some implications of the findings are discussed. (+info)
Defining urban and rural areas in U.S. epidemiologic studies.
(48/201)
Among epidemiologists, there has been increasing interest in the characteristics of communities that influence health. In the United States, the rural health disparity has been a recent focus of attention and made a priority for improvement. While many standardized definitions of urban and rural exist and are used by social scientists and demographers, they are found in sources unfamiliar to health researchers and have largely not been used in public health studies. This paper briefly reviews some available definitions of urban and rural for American geographic subunits and their respective strengths and weaknesses. For example, some definitions are better suited than others for capturing access to health care services. The authors applied different definitions to breast cancer incidence rates to show how urban/rural rate ratio comparisons would vary by choice of definition and found that dichotomous definitions may fail to capture variability in very rural areas. Further study of the utility of these measures in health studies is warranted. (+info)