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1.
AIDS Behav ; 25(4): 1159-1170, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33180254

RESUMO

The adverse impact of exposure to war-related traumatic events on mental health is well documented. Few studies, however, have focused on the impact of exposure to war-related traumatic events on HIV sexual risk behavior in post-conflict countries such as Liberia. We investigated whether exposure to war-related traumatic events was linked to HIV sexual risk behavior, and identified potential mediators of this relationship, including stressful life events, problematic alcohol use, and intimate partner violence (IPV) among women and men in Liberia. Data were collected from a sample of 395 participants in Monrovia, Liberia. Results from the serial multiple mediator model did not support direct or indirect effects between war-related traumatic events and HIV sexual risk behavior among women. For men, we found both direct and indirect effects between war-related traumatic events and HIV sexual risk behavior. Findings from this research highlight the need for trauma-informed HIV prevention strategies in Liberia.


Assuntos
Infecções por HIV , Violência por Parceiro Íntimo , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Libéria/epidemiologia , Masculino , Comportamento Sexual
2.
Health Care Women Int ; 41(11-12): 1313-1334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085579

RESUMO

Spirituality has been known to have a positive correlation to resilience during disasters. This study investigated the impact of spirituality on resilience during our current pandemic. A mixed-method approach was used to analyze correlations between spirituality and resilience of women. Correlations were noted to be statistically significant with Pearson's correlation of -.450 at 0.001, CD-RISC (M = 77.94), and DSES (M = 39.74). Thematic analysis of six open-ended questions provide depth to quantitative findings supporting the positive influence of spirituality on resilience, hope, optimism, peace, and comfort suggesting that spirituality may be an important dimension as this pandemic continues to unfold across the globe.


Assuntos
COVID-19/psicologia , Resiliência Psicológica , Espiritualidade , Adaptação Psicológica , Adulto , Idoso , Feminino , Esperança , Humanos , Pessoa de Meia-Idade , SARS-CoV-2
3.
J Racial Ethn Health Disparities ; 6(6): 1157-1166, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31332688

RESUMO

African-American HIV-seropositive women are at elevated risk for depressive symptoms compared to their seropositive counterparts. Depressive symptoms have been linked to HIV/AIDS-related health predictors and outcomes such as medication and care adherence, and viral load. Project UPLIFT, a mindfulness-based cognitive therapy intervention originally designed for persons with epilepsy has been shown effective to reduce depressive and anxiety symptoms. Focus groups were conducted to assess the appropriateness and acceptability of UPLIFT for African-American HIV-seropositive women and to obtain feedback on needed modifications. The focus groups, including cisgender and transgender African-American HIV-seropositive women, revealed, while well received, modifications should include lowering the reading level of content and altering specific mindfulness-based exercises to make them relevant and acceptable to the target population. This qualitative work demonstrates UPLIFT could be a promising avenue to improve the mental health of African-American HIV-seropositive women, a group for which mindfulness interventions had not been previously considered. SIGNIFICANCE: Mindfulness-based interventions have been found effective in reducing depression, anxiety, and chronic pain. Further, it has been used for groups living with chronic illness, particularly HIV/AIDS. It has helped to improve mental and behavioral health, as well as increase CD4 count and reduce viral load for some samples of people living with HIV/AIDS. African-American women living with HIV/AIDS are especially vulnerable to poor mental and behavioral health given their experience of mental illness and hesitancy to engage mental healthcare. Though used for other groups of people living with HIV/AIDS, mindfulness-based cognitive therapy has not previously been considered for this population. This study explored the acceptability and feasibility of an MBCT intervention for this group. The data suggests that this intervention could be potentially useful in improving the mental health of this population, and includes suggestions for making the intervention culturally relevant.


Assuntos
Ansiedade/terapia , Negro ou Afro-Americano , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Infecções por HIV/psicologia , Atenção Plena/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Síndrome da Imunodeficiência Adquirida/psicologia , Adulto , Idoso , Ansiedade/psicologia , Depressão/psicologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Pessoas Transgênero , Mulheres
4.
Soc Sci Med ; 185: 81-90, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28554162

RESUMO

Theories of social causation and social influence, which posit that neighborhood and social network characteristics are distal causes of substance use, are frequently used to interpret associations among neighborhood characteristics, social network characteristics and substance use. These associations are also hypothesized to result from selection processes, in which substance use determines where people live and who they interact with. The potential for these competing selection mechanisms to co-occur has been underexplored among adults. This study utilizes path analysis to determine the paths that relate census tract characteristics (e.g., economic deprivation), social network characteristics (i.e., having ≥ 1 illicit drug-using network member) and illicit drug use, among 172 African American adults relocated from public housing in Atlanta, Georgia and followed from 2009 to 2014 (7 waves). Individual and network-level characteristics were captured using surveys. Census tract characteristics were created using administrative data. Waves 1 (pre-relocation), 2 (1st wave post-relocation), and 7 were analyzed. When controlling for individual-level sociodemographic factors, residing in census tracts with prior economic disadvantage was significantly associated with illicit drug use at wave 1; illicit drug use at wave 1 was significantly associated with living in economically-disadvantaged census tracts at wave 2; and violent crime at wave 2 was associated with illicit drug-using social network members at wave 7. Findings from this study support theories that describe social causation and neighborhood selection processes as explaining relationships of neighborhood characteristics with illicit drug use and illicit drug-using social networks. Policies that improve local economic and social conditions of neighborhoods may discourage substance use. Future studies should further identify the barriers that prevent substance users from obtaining housing in less disadvantaged neighborhoods.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Características de Residência/classificação , Condições Sociais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Negro ou Afro-Americano/etnologia , Feminino , Georgia/epidemiologia , Georgia/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Habitação Popular/estatística & dados numéricos , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/etnologia , Inquéritos e Questionários
5.
J Health Care Poor Underserved ; 28(1): 315-328, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28239005

RESUMO

INTRODUCTION: Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. METHODS: We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. RESULTS: Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). CONCLUSION: These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Meios de Transporte/estatística & dados numéricos , Adulto , Meio Ambiente , Feminino , Georgia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Sexuais , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Populações Vulneráveis
6.
Arch Sex Behav ; 46(4): 925-936, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-26927277

RESUMO

Neighborhood conditions and sexual network turnover have been associated with the acquisition of HIV and other sexually transmitted infections (STIs). However, few studies investigate the influence of neighborhood conditions on sexual network turnover. This longitudinal study used data collected across 7 visits from a predominantly substance-misusing cohort of 172 African American adults relocated from public housing in Atlanta, Georgia, to determine whether post-relocation changes in exposure to neighborhood conditions influence sexual network stability, the number of new partners joining sexual networks, and the number of partners leaving sexual networks over time. At each visit, participant and sexual network characteristics were captured via survey, and administrative data were analyzed to describe the census tracts where participants lived. Multilevel models were used to longitudinally assess the relationships of tract-level characteristics to sexual network dynamics over time. On average, participants relocated to neighborhoods that were less economically deprived and violent, and had lower alcohol outlet densities. Post-relocation reductions in exposure to alcohol outlet density were associated with fewer new partners joining sexual networks. Reduced perceived community violence was associated with more sexual partners leaving sexual networks. These associations were marginally significant. No post-relocation changes in place characteristics were significantly associated with overall sexual network stability. Neighborhood social context may influence sexual network turnover. To increase understanding of the social-ecological determinants of HIV/STIs, a new line of research should investigate the combined influence of neighborhood conditions and sexual network dynamics on HIV/STI transmission over time.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto , Feminino , Georgia/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Parceiros Sexuais
7.
Health Place ; 42: 63-68, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27685005

RESUMO

Using survey data from participants in a public housing relocation program in Atlanta, Georgia, we examine post-relocation changes in healthcare access (having a usual source of care, having an unmet need) and utilization (receiving a medical exam). Although participants moved to safer, less impoverished neighborhoods, some participants experienced improvements in access and utilization whereas others experienced declines. The supply of healthcare providers in the new neighborhood and having health insurance were associated with improvements in access for this population. Future relocation efforts may seek to assist individuals with choosing a new neighborhood that has accessible healthcare resources for low-income populations.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pobreza , Atenção Primária à Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adulto , Feminino , Georgia , Humanos , Entrevistas como Assunto , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Habitação Popular
8.
Soc Work Public Health ; 31(4): 255-63, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27092980

RESUMO

Women with disabilities experience significant disparities in accessing breast health services. Many studies have focused on barriers, but few have explored facilitators to improving breast health services. This study used a participatory-research approach involving women with physical, mobility, sensory, and developmental disabilities to explore facilitators and barriers affecting the access and quality of breast health services. Findings confirmed commonly cited barriers including attitudinal, environmental, financial, and structural issues but also identified multiple facilitators such as enhancing accessibility of breast health facilities and equipment, improving information sources, and increasing training of health professionals. Findings from this study can be used in improving breast health services among women with disabilities by targeting not only the removal of barriers but also the increase in proven facilitators.


Assuntos
Neoplasias da Mama , Pessoas com Deficiência , Acessibilidade aos Serviços de Saúde , Saúde da Mulher , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Missouri , Pesquisa Qualitativa
9.
PLoS One ; 11(3): e0150410, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26974165

RESUMO

INTRODUCTION: We analyzed relationships between place characteristics and being HIV-negative among black, Latino, and white people who inject drugs (PWID) in the US. METHODS: Data on PWID (N = 9077) were from the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance. Administrative data were analyzed to describe the 968 ZIP codes, 51 counties, and 19 metropolitan statistical areas (MSAs) where they lived. Multilevel multivariable models examined relationships between place characteristics and HIV status. Exploratory population attributable risk percents (e-PAR%s) were estimated. RESULTS: Black and Latino PWID were more likely to be HIV-negative if they lived in less economically disadvantaged counties, or in MSAs with less criminal-justice activity (i.e., lower drug-related arrest rates, lower policing/corrections expenditures). Latino PWID were more likely to be HIV-negative in MSAs with more Latino isolation, less black isolation, and less violent crime. E-PAR%s attributed 8-19% of HIV cases among black PWID and 1-15% of cases among Latino PWID to place characteristics. DISCUSSION: Evaluations of structural interventions to improve economic conditions and reduce drug-related criminal justice activity may show evidence that they protect black and Latino PWID from HIV infection.


Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Negro ou Afro-Americano , Hispânico ou Latino , Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco , Estados Unidos
10.
Sex Transm Dis ; 43(4): 222-30, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26967298

RESUMO

BACKGROUND: We investigated the implications of one structural intervention--public housing relocations--for partnership dynamics among individuals living areas with high sexually transmitted infection (STI) prevalence. High-prevalence areas fuel STI endemicity and are perpetuated by spatially assortative partnerships. METHODS: We analyzed 7 waves of data from a cohort of black adults (n = 172) relocating from 7 public housing complexes in Atlanta, Georgia. At each wave, data on whether participants' sexual partners lived in the neighborhood were gathered via survey. Participant addresses were geocoded to census tracts, and measures of tract-level STI prevalence, socioeconomic conditions, and other attributes were created for each wave. "High-prevalence tracts" were tracts in the highest quartile of STI prevalence in Georgia. Descriptive statistics and hierarchical generalized linear models examined trajectories of spatially assortative partnerships and identified predictors of assortativity among participants in high-prevalence tracts. RESULTS: All 7 tracts containing public housing complexes at baseline were high-prevalence tracts; most participants relocated to high-prevalence tracts. Spatially assortative partnerships had a U-shaped distribution: the mean percent of partners living in participants' neighborhoods at baseline was 54%; this mean declined to 28% at wave 2 and was 45% at wave 7. Participants who experienced greater postrelocation improvements in tract-level socioeconomic conditions had a lower odds of having spatially assortative partnerships (adjusted odds ratio, 1.55; 95% confidence interval [95% CI], 1.06-2.26). CONCLUSIONS: Public housing relocation initiatives may disrupt high-prevalence areas if residents experience significant postrelocation gains in tract-level socioeconomic conditions.


Assuntos
Habitação Popular , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Estudos de Coortes , Feminino , Georgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Características de Residência , Análise Espacial
11.
Drug Alcohol Depend ; 160: 30-41, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26781062

RESUMO

BACKGROUND: Few studies assess whether place characteristics are associated with social network characteristics that create vulnerability to substance use. METHODS: This longitudinal study analyzed 7 waves of data (2009-2014) from a predominantly substance-using cohort of 172 African American adults relocated from public housing complexes in Atlanta, GA, to determine whether post-relocation changes in exposure to neighborhood conditions were associated with four network characteristics related to substance use: number of social network members who used illicit drugs or alcohol in excess in the past six months ("drug/alcohol network"), drug/alcohol network stability, and turnover into and out of drug/alcohol networks. Individual- and network-level characteristics were captured via survey and administrative data were used to describe census tracts where participants lived. Multilevel models were used to assess relationships of census tract-level characteristics to network outcomes over time. RESULTS: On average, participants relocated to census tracts that had less economic disadvantage, social disorder, and renter-occupied housing. Post-relocation reductions in exposure to economic disadvantage were associated with fewer drug/alcohol network members and less turnover into drug/alcohol networks. Post-relocation improvements in exposure to multiple census tract-level social conditions and reductions in perceived community violence were associated with fewer drug/alcohol network members, less turnover into drug/alcohol networks, less drug/alcohol network stability, and more turnover out of drug/alcohol networks. CONCLUSION: Relocating to neighborhoods with less economic disadvantage and better social conditions may weaken relationships with substance-using individuals.


Assuntos
Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Condições Sociais , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Feminino , Georgia/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/economia
12.
Am J Public Health ; 106(3): 517-26, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26691126

RESUMO

OBJECTIVES: We sought to determine whether contextual factors shape injection drug use among Black adolescents and adults. METHODS: For this longitudinal study of 95 US metropolitan statistical areas (MSAs), we drew annual MSA-specific estimates of the prevalence of injection drug use (IDU) among Black adolescents and adults in 1993 through 2007 from 3 surveillance databases. We used existing administrative data to measure MSA-level socioeconomic status; criminal justice activities; expenditures on social welfare, health, and policing; and histories of Black uprisings (1960-1969) and urban renewal funding (1949-1974). We regressed Black IDU prevalence on these predictors by using hierarchical linear models. RESULTS: Black IDU prevalence was lower in MSAs with declining Black high-school dropout rates, a history of Black uprisings, higher percentages of Black residents, and, in MSAs where 1992 White income was high, higher 1992 Black income. Incarceration rates were unrelated. CONCLUSIONS: Contextual factors shape patterns of drug use among Black individuals. Structural interventions, especially those that improve Black socioeconomic security and political strength, may help reduce IDU among Black adolescents and adults.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/etnologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Direito Penal/organização & administração , Direito Penal/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Política , Prevalência , Prisões/estatística & dados numéricos , Tumultos/estatística & dados numéricos , Seguridade Social/economia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
13.
Int J Drug Policy ; 27: 43-55, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26342272

RESUMO

BACKGROUND: Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. METHODS: As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. RESULTS: Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). CONCLUSION: PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.


Assuntos
Meio Ambiente , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Coleta de Dados , Feminino , Infecções por HIV/etnologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Abuso de Substâncias por Via Intravenosa/etnologia , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos
14.
AIDS Behav ; 19(6): 1016-30, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25150728

RESUMO

Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.


Assuntos
Negro ou Afro-Americano , Habitação Popular , Características de Residência , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Meio Social , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Estudos Transversais , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Segurança , Comportamento Sexual/psicologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos , Violência/psicologia , Violência/estatística & dados numéricos , Populações Vulneráveis/etnologia , Adulto Jovem
15.
Sex Transm Dis ; 41(10): 573-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25211249

RESUMO

BACKGROUND: Cross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater postrelocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, and male/female sex ratios) would have reduced the odds of testing positive for an STI over time. METHODS: Baseline data were collected in 2009 from 172 public housing residents before relocations occurred; 3 waves of postrelocation data were collected every 9 months thereafter. Polymerase chain reaction methods were used to test participants' urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Individual-level characteristics were assessed via survey. Administrative data described the census tracts where participants lived at each wave (e.g., sex ratios, violent crime rates, and poverty rates). Hypotheses were tested using multilevel models. RESULTS: Participants experienced improvements in all tract-level conditions studied and reductions in STIs over time (baseline: 29% tested STI positive; wave 4: 16% tested positive). Analyses identified a borderline statistically significant relationship between moving to tracts with more equitable sex ratios and reduced odds of testing positive for an STI (odds ratio, 0.16; 95% confidence interval, 0.02-1.01). Changes in other neighborhood conditions were not associated with this outcome. DISCUSSION: Consonant with past research, our findings suggest that moving to areas with more equitable sex ratios reduces the risk of STI infection. Future research should study the extent to which this relationship is mediated by changes in sexual network dynamics.


Assuntos
Negro ou Afro-Americano , Pobreza/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Violência/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Chlamydia trachomatis/isolamento & purificação , Estudos Transversais , Feminino , Georgia/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Neisseria gonorrhoeae/isolamento & purificação , Razão de Chances , Prevalência , Características de Residência , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/microbiologia , Infecções Sexualmente Transmissíveis/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Trichomonas vaginalis/isolamento & purificação
16.
J Urban Health ; 91(2): 223-41, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24311024

RESUMO

USA is experiencing a paradigm shift in public housing policy: while policies used to place people who qualified for housing assistance into spatially concentrated housing complexes, they now seek to geographically disperse them, often to voucher-subsidized rental units in the private market. Programs that relocate residents from public housing complexes tend to move them to neighborhoods that are less impoverished and less violent. To date, studies have reached conflicting findings about the relationship between public housing relocations and depression among adult relocaters. The present longitudinal multilevel analysis tests the hypothesis that pre-/postrelocation improvements in local economic conditions, social disorder, and perceived community violence are associated with declines in depressive symptoms in a cohort of African-American adults; active substance misusers were oversampled. We tested this hypothesis in a cohort of 172 adults who were living in one of seven public housing complexes scheduled for relocation and demolition in Atlanta, GA; by design, 20% were dependent on substances and 50% misused substances but were not dependent. Baseline data captured prerelocation characteristics of participants; of the seven census tracts where they lived, three waves of postrelocation data were gathered approximately every 9 months thereafter. Surveys were administered at each wave to assess depressive symptoms measured using the Center for Epidemiologic Studies Depression Scale (CES-D), perceived community violence, and other individual-level covariates. Participants' home addresses were geocoded to census tracts at each wave, and administrative data sources were used to characterize tract-level economic disadvantage and social disorder. Hypotheses were tested using multilevel models. Between waves 1 and 2, participants experienced significant improvements in reported depressive symptoms and perceived community violence and in tract-level economic disadvantage and social disorder; these reductions were sustained across waves 2-4. A 1 standard deviation improvement in economic conditions was associated with a 1-unit reduction in CES-D scores; the magnitude of this relationship did not vary by baseline substance misuse or gender. Reduced perceived community violence also predicted lower CES-D scores. Our objective measure of social disorder was unrelated to depressive symptoms. We found that relocaters who experienced greater pre-/postrelocation improvements in economic conditions or in perceived community violence experienced fewer depressive symptoms. Combined with past research, these findings suggest that relocation initiatives should focus on the quality of the places to which relocaters move; future research should also identify pathways linking pre-/postrelocation changes in place characteristics to changes in mental health.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Depressão/epidemiologia , Habitação Popular , Características de Residência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Violência/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/psicologia , Estudos de Coortes , Depressão/diagnóstico , Feminino , Georgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Segurança , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos , Violência/psicologia
17.
Drug Alcohol Depend ; 133(1): 37-44, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-23850372

RESUMO

INTRODUCTION: Several cross-sectional studies have examined relationships between neighborhood characteristics and substance misuse. Using data from a sample of African-American adults relocating from U.S. public housing complexes, we examined relationships between changes in exposure to local socioeconomic conditions and substance misuse over time. We tested the hypothesis that adults who experienced greater post-relocation improvements in local economic conditions and social disorder would have a lower probability of recent substance misuse. METHODS: Data were drawn from administrative sources to describe the census tracts where participants lived before and after relocating. Data on individual-level characteristics, including binge drinking, illicit drug use, and substance dependence, were gathered via survey before and after the relocations. Multilevel models were used to test hypotheses. RESULTS: Participants (N=172) experienced improvements in tract-level economic conditions and, to a lesser degree, in social disorder after moving. A one standard-deviation improvement in tract-level economic conditions was associated with a decrease in recent binge drinking from 34% to 20% (p=0.04) and with a decline in using illicit drugs weekly or more from 37% to 16% (p=0.02). A reduction in tract-level alcohol outlet density of >3.0 outlets per square mile predicted a reduction in binge drinking from 32% to 18% at p=0.05 significance level. DISCUSSION: We observed relationships between improvements in tract-level conditions and declines in substance misuse, providing further support for the importance of the local environment in shaping substance misuse. These findings have important implications for public housing policies and future research.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Negro ou Afro-Americano/psicologia , Habitação Popular , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Economia , Feminino , Humanos , Masculino , Modelos Psicológicos , Problemas Sociais/psicologia , Estados Unidos
18.
Health Place ; 18(6): 1255-60, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23060002

RESUMO

This analysis investigates changes in spatial access to safety-net primary care in a sample of US public housing residents relocating via the HOPE VI initiative from public housing complexes to voucher-subsidized rental units; substance misusers were oversampled. We used gravity-based models to measure spatial access to care, and used mixed models to assess pre-/post-relocation changes in access. Half the sample experienced declines in spatial access of ≥ 79.83%; declines did not vary by substance misuse status. Results suggest that future public housing relocation initiatives should partner with relocaters, particularly those in poor health, to help them find housing near safety-net clinics.


Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Georgia/epidemiologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Análise Espacial
19.
Sex Transm Dis ; 39(2): 116-21, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22249300

RESUMO

BACKGROUND: High incidence and prevalence of sexually transmitted infection (STI) in blacks have been attributed to multiple factors. However, few articles have discussed spatial access to healthcare as a driver of disparities. The objective of this analysis was to evaluate the relationship between travel time to a healthcare provider and the likelihood of testing positive for 1 of 3 STIs in a sample of adults living in public housing. METHODS: One hundred and eight black adults in Atlanta, GA from November 2008 to June 2009, completed a survey that queried sexual behavior and healthcare use and had urine tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by molecular methods. Travel time was a continuous variable capturing the number of minutes it took to reach the place where participants received most of their care. Multivariate analyses tested the hypothesis that individuals reporting longer travel times would be more likely to test positive for an STI. Travel time was squared to linearize its relationship to the outcome. RESULTS: Thirty-six residents (37.5%) tested positive for ≥1 STI. A curvilinear relationship existed between travel time and STI status. When travel time was <48 minutes, a positive relationship existed between travel time and the odds of testing positive for an STI. An inverse relationship existed when travel time was ≥48 minutes. CONCLUSION: Residents of impoverished communities experience a curvilinear relationship between travel time and STI status. We discuss possible factors that might have created this curvilinear relationship, including voluntary social isolation.


Assuntos
Negro ou Afro-Americano , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Acessibilidade aos Serviços de Saúde , Habitação Popular , Comportamento Sexual/estatística & dados numéricos , Vaginite por Trichomonas/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Infecções por Chlamydia/urina , Estudos de Coortes , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Kit de Reagentes para Diagnóstico , Fatores de Tempo , Vaginite por Trichomonas/urina , Adulto Jovem
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