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PubMed2001

Witnessing violence among inner-city children of substance-abusing and non-substance-abusing women.

OBJECTIVES: To determine if children of substance-abusing mothers witness more violence than children of non-substance-abusing (control) mothers, and to determine if children who witness violence have more behavioral problems and higher stress scores than children who do not witness violence. DESIGN: Cross-sectional research design comparing exposure to violence among children of substance-abusing mothers and control mothers of low socioeconomic status. SETTING: An inner-city pediatric clinic. PARTICIPANTS: Forty substance-abusing mothers and their children, and 40 non-substance-abusing mothers and their children, examined when the children were 6 years old. MAIN OUTCOME MEASURES: Maternal report of children's exposure to violence was assessed using the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal report of children's behavior was assessed using the Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance-abusing mothers did not witness more violence than the control children (P>.05). However, 6-year-old inner-city children in the present study witnessed a high rate of violence: 43% had seen someone beaten up, 13% had seen someone threatened with a knife, and 7% had seen someone stabbed or shot. Children witnessing violence had significantly higher aggressive, delinquent, anxious/depressed, withdrawn, attention, and social problems (P<.05) on the Child Behavior Checklist, and higher stress scores (P =.05) on the Children's Response to Stress Inventory. CONCLUSIONS: More than half of the 6-year-old inner-city children in the present study witnessed some form of violence. Witnessing violence was associated with more behavioral problems and higher stress scores as assessed through maternal report. Subsequent research should examine the long-term effects of this exposure to violence among young children.

Adult↗
PubMed2002

Parental perceptions of well-child care visits in an inner-city clinic.

OBJECTIVES: To assess parental perceptions of the importance of well-child care (WCC) in an inner-city clinic and to determine what type and format of information parents would like to obtain at WCC visits. METHODS: A convenience sample of parents accompanying a child aged 12 years or younger attending an inner-city pediatric teaching clinic completed self-administered written surveys. Parents ranked the importance of WCC overall, as well as its various components, using Likert scales. Parents also responded to checklist-style questions to indicate selected topics they would like to receive more information about and the format of information they preferred (written, talking to the physician, or videotapes in the waiting room). RESULTS: A total of 239 parents completed surveys. Overall they believed WCC was important (91% responded "extremely important" or "very important"). The individual WCC components ranked most important by parents were immunizations, growth and development issues, and the opportunity to discuss behavior or other concerns. The topics of information requested most frequently were how to help their child learn healthy eating habits (55%), how to help their child do well in school (53%), and how to keep their child safe outside of their home (49%). Written information was the format most frequently preferred (65%) by parents for receiving information. CONCLUSIONS: Parents of inner-city children consider WCC important. They want to hear about child health-related issues and prefer a written format. This knowledge can guide health care providers and educators during WCC visits and while teaching.

Ambulatory Care Facilities↗
PubMed2003

Predicting adoption of home smoking restriction by inner-city black smokers.

OBJECTIVE: To identify predictors of future adoption of home smoking restriction (HSR), given that 40% of inner-city smokers report current HSR. DESIGN: Secondary analysis of data on smokers enrolled in a double-blind, placebo-controlled, randomized trial of bupropion hydrochloride for smoking cessation. SETTING: Community health center in Kansas City, Kan, from August 1, 2000, to December 31, 2001. PARTICIPANTS: Six hundred eligible black smokers, at least 18 years old, who smoked at least 10 cigarettes per day and were interested in quitting within the next 30 days. Enrollment was limited to 1 smoker per household. MAIN OUTCOME MEASURES: Adoption of HSR by 6 months by those who did not have it at baseline. Result Baseline HSR was reported by 36% of all smokers. Of 383 smokers without baseline HSR, 311 smokers had complete baseline and 6-month data. Thirty-seven percent of households without HSR at baseline had adopted HSR by 6 months. Adoption was associated with a nonsmoking adult or children in the home, progress in stage of change, and smoking cessation. Odds of adopting HSR increased with progress in stage of change (odds ratio [OR], 4.20), baseline preparatory stage of change (OR, 3.28), and having a nonsmoking partner (OR, 2.35) or children (OR, 1.75) in the home. CONCLUSIONS: A smoker's motivation to quit and the presence in the home of a nonsmoking adult or of children predict adoption of HSR by inner-city black smokers. Therefore, health professionals should motivate the smoker toward HSR and the nonsmoking partner toward advocating home smoking bans, thereby eliminating environmental tobacco smoke in the home.

Adult↗
PubMed1997

Effect of the vaccines for children program on inner-city neighborhood physicians.

OBJECTIVE: To determine the probable effect of the Vaccines for Children (VFC) program on immunization coverage. DESIGN: Preintervention and postintervention study design, with data collected before and after enrollment in the VFC program. SETTING: Twenty-three inner-city neighborhood physicians' offices in New York City. PARTICIPANTS: In 1993, 30 physicians were randomly selected from 8 neighborhoods with the highest proportions of Medicaid-eligible individuals in New York City. In 1995-1996, the 30 physicians were contacted again. Twenty-three agreed to an interview and medical record review. Within each office, the medical records of children aged 3 to 35 months, with at least 3 visits in a 3-month or longer period, were randomly selected. Medical record reviews were conducted for 173 eligible children in 1993 and 528 in 1995-1996. INTERVENTIONS: The VFC program was implemented in October 1994. The administration fee increased from $2 to $17.85; physicians received vaccines free. MAIN OUTCOME MEASURES: Up-to-date status for immunizations and lead and tuberculosis screening; percentage of visits that are missed opportunities to immunize; and percentage of visits that were well-child visits. Up-to-date status, missed opportunities to immunize, and well-child visits were compared across time using chi 2 analysis, corrected for the use of cluster sampling. RESULTS: Up-to-date status changed significantly before and alter enrollment in the VFC program (P < .05) for all immunizations and for lead and tuberculosis screening. For the diphtheria toxoid, tetanus toxoid, and pertussis vaccine, oral poliovirus vaccine, and measles, mumps, and rubella vaccine combined, coverage increased from 17.9% to 42.2%, up by 24.3 percentage points (P < .05). Missed opportunities to immunize did not change, but well-child visits increased from 15.0% to 21.6% (P < .05). Physicians generally attributed performance improvements to the VFC program and not to other competing hypotheses. CONCLUSIONS: The VFC program seems to be responsible for an increase in immunization rates among these physicians.

Child, Preschool↗
PubMed2000

Effect of a ban on carrying firearms on homicide rates in 2 Colombian cities.

CONTEXT: Homicide is a leading cause of death in Colombia, with much of the fatal interpersonal violence concentrated in the country's largest cities. Firearms are involved in as much as 80% of homicides in Colombia. OBJECTIVE: To evaluate the effect of an intermittent police-enforced ban on carrying firearms on the incidence of homicide in urban Colombia. DESIGN: Interrupted time-series study with multiple replications. SETTING: Cali, Colombia, during 1993 and 1994 and Bogotá, Colombia, from 1995 through August 1997. PARTICIPANTS: The populations of Cali and Bogotá. INTERVENTION: Carrying of firearms was banned on weekends after paydays, on holidays, and on election days. Enforcement included establishment of police checkpoints and searching of individuals during traffic stops and other routine law enforcement activity. MAIN OUTCOME MEASURE: Homicide rates during intervention days were compared with rates during similar days without the intervention; estimates were based on comparisons within the same month, day of week, and time of day. RESULTS: There were 4078 homicides in Cali during 1993 and 1994 (114.6 per 100,000 person-years). In Bogotá, 9106 homicides occurred from 1995 through August 1997 (61 per 100,000 person-years). The incidence of homicide was lower during periods when the firearm-carrying ban was in effect compared with other periods (multivariate-adjusted rate ratio, 0.86 [95% confidence interval [CI], 0.76-0.97] for Cali, and 0.87 [95% CI, 0.77-0.98] for Bogotá). CONCLUSION: An intermittent citywide ban on the carrying of firearms in 2 Colombian cities was associated with a reduction in homicide rates for both cities.

Adolescent↗
PubMed1997

Design and methods of the National Cooperative Inner-City Asthma Study.

The National Cooperative Inner-City Asthma Study (NCICAS) was established to identify and then intervene on those factors which are related to asthma morbidity among children in the inner-city. This paper describes the design and methods of the broad-based initial Phase I epidemiologic investigation. Eight research centers enrolled 1,528 children, 4 to 9 years of age, from English- or Spanish-speaking families, all of whom resided in major metropolitan inner-city areas. The protocol included an eligibility assessment and an extensive baseline visit, during which symptom data, such as wheezing, lost sleep, changes in activities of daily living, inpatient admissions, and emergency department and clinic visits were collected. A comprehensive medical history for each child was taken and adherence to the medical regimen was assessed. Access, as well as barriers, to the medical system were addressed by a series of questions including the location, availability, and consistency of treatment for asthma attacks, follow-up care, and primary care. The psychological health of the caretaker and of the child was also measured. Asthma knowledge of the child and caretaker was determined. Sensitization to allergens was assessed by skin-prick allergen testing and exposure to cigarette smoke and the home environment were assessed by questionnaire. For more than a third of the families, in-home visits were conducted with dust sample allergen collection and documentation of the home environment, such as the presence of pets and evidence of smoking, mildew, and roaches. Urine specimens were collected to measure passive smoke exposure by cotinine assays, blood samples were drawn for banking, and children age 6 to 9 years were given spirometric lung function assessment. At 3, 6 and 9 months following the baseline assessment, telephone interviews were conducted to ask about the child's symptoms, unscheduled emergency department or clinic visits, and hospitalizations. At this time, peak flow measurements with 2-week diary symptom records were collected.

Allergens↗
PubMed2001

ELF magnetic fields in a city environment.

Some epidemiological studies indicate an association between extremely low frequency electromagnetic field (ELF-EMF) exposure and cancer risks. These studies have mainly taken residential and occupational exposure into consideration. Outdoor environments are often considered as low level areas, but in this paper we show that this is not true in a city environment. We have mapped the ELF magnetic flux densities along certain stretches of sidewalk in central Göteborg City, Sweden. About 50% of the investigated street length shows flux densities of the same order of magnitude (0.2 microT and above) as those associated with increased risks of cancer in epidemiological studies. We conclude that the outdoor exposures in a city environment also should be considered in exposure assessments and risk evaluations. These elevated flux densities are probably due to stray currents. We also found strong magnetic flux densities (> 1.0 microT) close to ordinary distribution pillars, power substations, shoplifting alarms, and other electrical devices.

Electromagnetic Fields↗
PubMed1995

Occupational associations with lung cancer in two Ontario cities.

A death certificate based case-control study of lung cancer in two Ontario cities was performed to estimate the risk of lung cancer attributable to occupation in Ontario, and to estimate the proportion of occupational lung cancers receiving compensation from the Workers' Compensation Board. Occupation and industry were identified from the death certificate. A priori occupations for analysis were those whose members had received compensation for occupational cancer from the Ontario Workers' Compensation Board. Population attributable risks were computed using the relative risks observed in this study and employment data from the 1986 Census of Canada. Subjects were all men (N = 967) between the ages of 45 and 75 years resident in the cities of Hamilton and Sault Ste-Marie who died of lung cancer from 1979 to 1988. Controls (2,821) were matched on age, year of death, and city of residence. In agreement with other studies, an increased risk of lung cancer was observed for workers in the construction sector, for miners, and for truck drivers. It was estimated that only a small proportion of lung cancers attributable to occupation are compensated in Ontario. It is believed that many occupational cancers go uncompensated because of the failure to file claims, rather than because claims are rejected by Compensation Boards. Physicians are in a position to advise patients about the possibility of compensable disease and to act as advocates for them. By recognizing compensable illness, physicians have the opportunity to ease the financial burden of patients and their families. The challenge is a difficult one, but it is well worth pursuing.

Aged↗
PubMed1997

Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee.

OBJECTIVE: To evaluate a concise program of self-care education delivered by an arthritis nurse specialist as an adjunct to primary care for inner-city patients with knee osteoarthritis (OA). METHODS: An attention-controlled clinical trial; 211 inner-city patients with knee OA were assigned arbitrarily to education (E) or attention-control (AC) conditions. Group E received an individualized 30-60-minute educational intervention that emphasized nonpharmacologic management of joint pain, preservation of function by problem-solving, and practice of principles of joint protection. Brief telephone contacts 1 week and 4 weeks later monitored and reinforced new self-care activities. Group AC viewed a 20-minute standardized public education presentation on arthritis and received followup telephone calls (only to encourage continued participation in the study). Outcomes included the Health Assessment Questionnaire (HAQ) Disability and Discomfort Scales, 10-cm visual analog scales measuring knee pain at rest and while walking, and the Quality of Well-Being (QWB) scale. Assessments were made at baseline and at 4-month intervals for 1 year. RESULTS: A total of 165 subjects (78%) completed all assessments. After control for baseline status, group E had significantly lower scores for disability and resting knee pain throughout the year of postintervention followup (P < 0.05 for both). Effects were somewhat discordant. By 12 months, functional benefits had begun to wane, while the effect on resting knee pain had grown. The overall effects of education on walking knee pain, overall joint pain (by HAQ), and general health status (by QWB) were not significant. CONCLUSION: Self-care education for inner-city patients with knee OA, delivered as an adjunct to primary care, was found to result in notable preservation of function and control of resting knee pain. The magnitude of the observed effects compares well with those of more labor-intensive and time-consuming intervention models. However, more sustained preservation of function and consistent effects on pain may require prolonged, more proactive followup, either by the patient educator or by a trained clinical assistant dedicated to the task of supporting self-care by patients with knee OA.

Aged↗
PubMed1982

Serological mass survey for early detection of nasopharyngeal carcinoma in Wuzhou City, China.

A serological mass survey was carried out in Wuzhou City of the Guangxi Autonomous Region, China. Sera were collected from 12,932 persons between the ages of 40 and 59. The positive rate of VCA/IgA antibody-positive person was 5.3%, but no EA/IgA antibody was found in sera from VCA/Iga-negative persons. Thirteen and nine nasopharyngeal carcinoma (NPC) patients were detected from the VCA/Iga and EA/IgA antibody-positive persons, respectively. With the present combination method the detection rate of NPC for 12,932 persons was 100.5/100,000 and for 680 VCA/IgA antibody-positive persons it was 1,900/100,000. Thus, the rate was twice and 37 times higher, respectively, than the annual incidence rate of NPC in persons of the same age group from 1975-1978 in Wuzhou City. Of 13 NPC patients, 9 were in stage I (70%) and 4 in stage II (30%). Therefore, it is possible to reduce the mortality rate of NPC in Wuzhou City by radiotherapy of NPC patients in the early stage of the disease. The present results further suggest that EB virus is closely associated with NPC.

Adult↗
PubMed2001

Multicentered study of viral acute lower respiratory infections in children from four cities of Argentina, 1993-1994.

This study describes the first multicentered study of acute lower respiratory infection viral etiology in young children from four different geographical areas of Argentina. A total of 1,278 children under 5 years of age, hospitalized in primary care centers from Buenos Aires, Córdoba, Santa Fé and Mar del Plata cities during a 2-year period were studied (1993-1994). Nasopharyngeal aspirates were investigated for respiratory syncytial virus (RSV), adenovirus, parainfluenza, and influenza A and B viruses by indirect immunofluorescence. Out of the patients studied, 946 (74%) were under 1 year of age. Viruses were detected in 399 patients (32%). RSV was observed in 25.3% of the samples, representing 78.2% of all viral positive cases. Adenoviruses were detected in 2.5% of the cases, parainfluenza in 2.2%, influenza A in 2.1%, and influenza B in 0.2%. Compared with other viruses, the higher RSV frequency was statistically significant (P < 0.000). Most RSV cases were detected between May and September with a significant peak in July (P < 0.000). Pneumonia was observed in 46% of the patients, bronchiolitis in 41% and other entities in 13%. The case fatality rate observed during the 2 year study was 0.73%. Most of the above respiratory viruses were detected in the four cities, however, the frequency of RSV and influenza were different in the southern city.

Acute Disease↗
PubMed1997

Association between ozone and hospitalization for respiratory diseases in 16 Canadian cities.

The effects of tropospheric ozone on lung function and respiratory symptoms have been well documented at relatively high concentrations. However, previous investigations have failed to establish a clear association between tropospheric ozone and respiratory diseases severe enough to require hospitalization after controlling for climate, and with gaseous and particulate air pollution at the lower concentrations typically observed in Canada today. To determine if low levels of tropospheric ozone contribute to hospitalization for respiratory disease, air pollution data were compared to hospital admissions for 16 cities across Canada representing 12.6 million people. During the 3927-day period from April 1, 1981, to December 31, 1991, there were 720,519 admissions for which the principle diagnosis was a respiratory disease. After controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, soiling index, and dew point temperature, the daily high hour concentration of ozone recorded 1 day previous to the date of admission was positively associated with respiratory admissions in the April to December period but not in the winter months. The relative risk for a 30 ppb increase in ozone varied from 1.043 (P < 0.0001) to 1.024 (P = 0.0258) depending on the selection of covariates in the regression model and subset of cities examined. The association between ozone and respiratory hospitalizations varied among cities, with relative risks ranging from 1.000 to 1.088 after simultaneous covariate adjustment. Particulate matter and carbon monoxide were also positively associated with respiratory hospitalizations. These results suggest that ambient air pollution at the relatively low concentrations observed in this study, including tropospheric ozone, is associated with excess admissions to hospital for respiratory diseases in populations experiencing diverse climates and air pollution profiles.

Air Pollutants↗
PubMed2000

Air pollution and daily mortality in seven major cities of Korea, 1991-1997.

The relationship between ambient air pollution and daily mortality in seven major cities of Korea for the period 1991-1997 was examined. These cities account for half of the Korean population (about 22 million). The observed concentrations of sulfur dioxide (SO(2), mean=23.3 ppb), ozone (O(3), mean=23.7 ppb), and total suspended particulates (TSP, mean=77.9 microg/m(3)) during the study period were at levels below Korea's current ambient air quality standards. Generalized additive models were applied to allow for the highly flexible fitting of seasonal and long-term time trends in air pollution as well as nonlinear associations with weather variables, such as air temperature and relative humidity. In city-specific analyses, an increase of 50 ppb of SO(2) corresponded to 1-12% more deaths, given constant weather conditions. The risk of all-cause mortality was estimated to increase by 0.5-4%, with an increase in the 2-day moving average of TSP levels equal to 100 microg/m(3). In multipollutant models with pooled data, we found that the estimated risk of death by SO(2) was notably unaffected by adding the other two pollutants (TSP and O(3)) to the model and was statistically significant in various regression models. The rate ratio (RR) for SO(2) remained elevated, indicating an excess mortality of 3% 50 ppb (RR=1.03; 95% CI, 1.01-1.05). TSP's effect on mortality maintained its significance with O(3), but not with SO(2). This implies that there may be collinearity problems where TSP and SO(2) are included in the same model or that TSP may function less than SO(2) as a surrogate for fine particles in the ambient air of Korea. In conclusion, increased mortality was associated with air pollution at SO(2) levels below the current recommendation for air quality. Further research is needed to clarify the relationship between SO(2) and fine particles in Korea.

Adolescent↗
PubMed2001

Blood lead levels among children aged 1 to 5 years in Wuxi City, China.

The objective of this study was to determine mean blood lead levels and prevalence of elevated blood lead levels among 1- to 5-year-old children in Wuxi City, China. By use of a representative cross-sectional survey that included measurements of capillary blood lead, 1117 children aged 1-5 years were examined from October through December, 1997. The geometric mean blood lead level for children 1-5 years of age in Wuxi City was 8.2 microg/dL (0.40 micromol/L); 27.3% had blood lead levels >or=10 microg/dL and 1.0% had blood lead levels >or=20 microg/dL. Blood lead levels were significantly higher for males and for those living in industrial areas, particularly the Beitang, Mashan, and Xinqu districts. Residence in these districts and in the Jiaoqu industrialized district also increased the likelihood of an elevated blood lead level, with odds ratios ranging from 2.59 to 4.53. In conclusion, blood lead levels among Wuxi City children are high enough to be of concern, particularly in industrial areas. Further studies are needed to better define the extent of lead exposure among children in China. In addition, national standards for blood lead collection and measurement methods should be applied in China.

Child, Preschool↗
PubMed1975

[Microflora of the atmosphere in the city of Trujillo (Peru). III. Genera isolated during the year 1971].

There were 1762 fungi isolated from the atmosphere of Trujillo city (Peru) during the year 1971. These isolants belonged to 23 genera of fungi. The most frequently isolated were: Cladosporium, Penicillium, Fusarium, Stemphylium, Alternaria, Helminthosporium, Aspergillus and Tilachlidium. Nine genera are reported for first time from the air of the city (Tilachlidium, Cephalosporium, Mucor, Aureobasidium, Hormiscium, Trichoderma, Stachybotrys, Paecilomyces and Fisidium). Six genera may be alergenic for asthmatic patients of Trujillo city.

Air Microbiology↗
PubMed1993

Psychiatric morbidity in social workers' clients. A comparison between an inner-city area and a small town.

The rate of psychiatric disorder in a social services sample in a small town was compared to the rate in an inner-city sample. Nearly 40% of respondents in the small town had a positive General Health Questionnaire score and 37% had case status (ID greater than 5) on the Present State Examination. Most of these were cases of neurotic depression and were generally recognised as such by the social workers. The type of intervention undertaken by social workers differed in the two settings. Small-town social workers were more likely to offer advice, guidance, exploration and mobilisation of resources. The small-town social workers were more likely to have success in helping their clients with problems of social isolation and marital disharmony than were their inner-city counterparts. Mental illness problems, however, showed less improvement than in the inner-city sample, with over one-third of the small-town cases remaining unwell throughout the 12-month follow-up. Both previous psychiatric history and current depression were indicators of a poor outcome. The present findings provide further support for the argument that unless there is close collaboration between social workers, the medical profession, and health care teams, people who present their problems to social services are unlikely to have their mental health problems addressed adequately.

Adult↗
PubMed1993

Rank-size distribution and primate city characteristics in India--a temporal analysis.

"This paper is an analysis of the historical change in city size distribution in India....Rank-size distribution at national level and primate city-size distribution at regional levels are examined....The paper also examines, in the Indian context, the relation between rank-size distribution and an integrated urban system, and the normative nature of the latter as a spatial organization of human society. Finally, we have made a modest attempt to locate the research on city-size distribution...."

Asia↗
PubMed1989

The Type A city: coronary heart disease and the pace of life.

The relationship between the pace of life and coronary heart disease (CHD) was examined in a total of 36 small, medium, and large metropolitan areas across the United States. Four indicators of pace were observed: walking speed, articulation rate (talking speed), bank teller speed (work speed), and the proportion of individuals wearing watches (concern with clock time). Pace of life was strongly related to death rates from coronary heart disease both across cities and across regions of the country. This provides support, on a sociological level, for Wright's (1988) contention that time urgency is a toxic element of the Type A behavior pattern. It is proposed that individuals living in fast-paced cities may be more prone to unhealthy behaviors (e.g., cigarette smoking), which place them at a greater risk for CHD. The relationship among cities' temporal norms, Type A time urgency, and coronary heart disease is also discussed.

Anger↗