Disadvantaged Urban Communities Research Articles

SMART2D-development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden.

Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites. The trial registration number of this study is ISRCTN11913581.

Improving health literacy among older people through primary health care units in Brazil: feasibility study.

There are only a small number of reported intervention studies to improve health literacy among older populations. This paper reports on a study designed to investigate the feasibility and potential impact on health literacy and health practices of embedding an intervention programme to improve health literacy with older people through established primary health care units (PHCUs) in a disadvantaged urban community in Brazil. This investigation utilized a quasi-experimental design, with 42 participants recruited for the intervention group and comparison group. The Alfa-Health Program was offered by a nurse in a PHCU as part of the public universal health system over a period of 5 months, and was compared for its impact on a range of health literacy and self-reported health outcomes with routine health care available for older people. The intervention achieved relatively high levels of participation, and positive feedback from participants. Some improvements in vaccination rates, health literacy and reported health behaviours related to food choices and physical activity were observed. The intervention made good use of existing facilities; the content and methods were well received by the participants. However, there were some difficulties in recruitment and in retention of participants. The study has demonstrated the practical feasibility of delivering a comprehensive health education programme designed to improve health literacy in a PHCU in Brazil.

Changes in physical activity after building a greenway in a disadvantaged urban community: A natural experiment

Few studies have evaluated physical activity changes in response to active transportation investments in low-income disadvantaged communities. This quasi-experimental pre-post paired location design assessed physical activity responses to a 1.5-mile urban greenway constructed in 2013 along arterial streets in a poor, high-crime, predominantly African-American neighborhood in Philadelphia, Pennsylvania. Pre-construction (2011) and post-construction (fall 2014), systematic observations (N = 8783) and environmental audit data were collected at the greenway and a comparison area. Post-construction intercept surveys were collected at the greenway (N = 175). Secondary data sources included census 2010–2014 and crime rates. Post-construction, there were notable improvements in street and sidewalk design, however, conditions remained sub-optimal and crime remained high. Most greenway users resided in the neighborhood and were daily users. Systematic observations at the greenway found slight increases in non-walking MVPA after construction (running or bicycling rose from 4% to 9%) and MVPA that included walking-fast (rose from 16% to 18%). However, the magnitude of the increase was similar to the increase in MVPA observed at the comparison site, which suggested that intensity of physical activity did not change as a result of the greenway (p-value > 0.15 for adjusted interaction between pre-post and location). Greenways, absent comprehensive improvements to the built and social environment, may be insufficient to promote MVPA in very disadvantaged high-crime urban communities.

Engaging Disadvantaged Communities in Targeting Tobacco-Related Health Disparities and Other Health Inequities.

Tobacco-related health disparities (TRHD) (e.g., respiratory disease, cancer) have been repeatedly shown to disproportionately affect individuals living in disadvantaged communities. In our recent community-guided geospatial study, we found evidence for a previously unrecognized TRHD involving tobacco shops, which were associated with increased crime and violence in South Los Angeles: a large, disadvantaged urban community. Our findings revealed tobacco shops may directly endanger the health of community residents in South Los Angeles by negatively shaping neighborhood crime and violence. In this commentary, we explore reasons why tobacco shops may perpetuate TRHDs and other health disparities in disadvantaged communities. Using our study as a case example, we further describe how community-partnered research grounded in community-based participatory research principles may empower stakeholders in disadvantaged communities to generate positive downstream outcomes such as tobacco-related policy changes.

Impact of Small Intestine Bacterial Overgrowth on Response to a Nutritional Intervention in Bangladeshi Children from an Urban Community.

.Small intestine bacterial overgrowth (SIBO) is prevalent among children living in low-income settings, leading to impaired growth and development. The aim of this study was to assess linear and ponderal growth parameters between malnourished SIBO-positive and SIBO-negative children aged 12–18 months who prospectively underwent a nutritional intervention. A glucose hydrogen breath test to detect SIBO was performed in 194 stunted (length-for-age Z score [LAZ] < −2 standard deviations) or at-risk of stunting (LAZ score between < −1 and −2 standard deviations) children. Participants received nutritional supplementation (egg and milk) in addition to their regular family meals 6 days per week for 90 days. Small intestine bacterial overgrowth was defined as a ≥ 12-ppm rise in breath hydrogen over the patient’s baseline during the 3-hour test. Small intestine bacterial overgrowth status before intervention was forced into a multivariable linear regression model to examine its effects on anthropometric changes in response to the intervention. Sociodemographic data at enrollment was analyzed through multivariable logistic regression in an attempt to predict SIBO positivity. Overall, 14.9% (29/194) children were diagnosed with SIBO before the nutritional intervention. No statistically significant difference was observed among SIBO-positive and SIBO-negative groups in terms of their response to the nutritional intervention (SIBO-positive coefficient [95% confidence interval (CI)], P-value for ∆length-for-age Z score −0.003 [−0.14, 0.13], 0.96; ∆weight-for-age Z score −0.05 [−0.20, 0.09], 0.46; and ∆weight-for-length Z score −0.10 [−0.31, 0.10], 0.33). This study demonstrated that a noteworthy proportion of malnourished children living in a disadvantaged urban community were SIBO positive; however, it failed to reveal an association between SIBO status and response to nutritional intervention.

Protocol to develop sustainable day care for children aged 1–4 years in disadvantaged urban communities in Dhaka, Bangladesh

IntroductionLack of safe, stimulating and health-promoting environments for children under-5 hinders their physical, social and cognitive development, known as early childhood development (ECD). Improving ECD impacts on children, and can...

Empowering aspects for healthy food and physical activity habits: adolescents’ experiences of a school-based intervention in a disadvantaged urban community

ABSTRACTPurpose:This study aimed to describe adolescents’ experiences of participating in a health-promoting school-based intervention regarding food and physical activity, with a focus on empowering aspects. Method: The school was located in a urban disadvantaged community in Sweden, characterized by poorer self-reported health and lower life expectancy than the municipality average. Focus group interviews with adolescents (29 girls, 20 boys, 14–15 years) and their teachers (n = 4) were conducted two years after intervention. Data were categorized using qualitative content analysis. Results: A theme was generated, intersecting with all the categories: Gaining control over one’s health: deciding, trying, and practicing together, in new ways, using reflective tools. The adolescents appreciated influencing the components of the intervention and collaborating with peers in active learning activities such as practicing sports and preparing meals. They also reported acquiring new health information, that trying new activities was inspiring, and the use of pedometers and photo-food diaries helped them reflect on their health behaviours. The adolescents’ experiences were also echoed by their teachers. Conclusions: To facilitate empowerment and stimulate learning, health-promotion interventions targeting adolescents could enable active learning activities in groups, by using visualizing tools to facilitate self-reflection, and allowing adolescents to influence intervention activities.

Behavioral, Psychological, Gender, and Health Service Correlates to Herpes Simplex Virus Type 2 Infection among Young Adult Mexican-American Women Living in a Disadvantaged Community

ABSTRACTHerpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.

Fall-Behind Parents? The Influential Factors on Digital Parenting Self-Efficacy in Disadvantaged Communities

As the Internet penetration in the United States increases, many digital divide researchers have delved into the parent–child dynamics regarding family digital access and use. However, little attention has been paid to digital parenting in terms of monitoring, guiding, and regulating children’s digital lives, especially in the context of disadvantaged communities. As an initial step to fill the critical gaps in related literature, this study casts light on factors that affect the self-efficacy of digital parenting in disadvantaged urban communities. Using a census survey of public housing households in one of the largest public housing authorities in the United States, we found that single motherhood and home Internet access significantly accounted for low–socioeconomic status parents’ digital parenting self-efficacy. We also found that parental engagement in children’s school activities strongly affected their digital parenting self-efficacy. By contrast, we found that other sociodemographic and socioeconomic factors (i.e., gender, education, race/ethnicity), mobile Internet access, parents’ homework help, and educational expectation fail to be contributing factors.

Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma

ABSTRACTObjective: To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control. Methods: Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors. Results: Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss. Conclusion: Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk.

A Strategic Political-Culture Basis for Developing the Socioeconomic Welfare of Disadvantaged Urban Communities: General Review and Policy Framework

The goal of promoting the economy and social welfare of disadvantaged urban communities has always been at the forefront of community studies; yet, this issue has also remained consistently controversial. The resurgence of the political-culture approach in the urban subfield has shed new light on this matter, raising new insights and presenting novel conclusions. The current study summarizes the main propositions of this approach with regard to community development, and highlights its powerful impact and valuable contribution to the understanding of the construction of urban economy, particularly concerning the welfare of disadvantaged communities. This study supports the application of the political-culture approach by reviewing and discussing major studies that have specifically examined various modes of “social capital” as a moderating concept between economic logic and local political culture (e.g., trust, social cohesion and civic engagement). Analyses of such relationships illustrate the common failure inherent in universal, culturally-blind policymaking, and highlight the importance of integrating the input of political-culture knowledge into the policy-making processes. Given this theoretical base, this paper presents a more effective methodological framework for addressing policy goals, based on the redefinition of the policy problem and a reformulation of policy plans—regarding strategy, institutions, and coalition-building—in accordance with local political-culture features and specific circumstances.

Psychotic Experiences in the Context of Police Victimization: Data From the Survey of Police-Public Encounters.

Social defeat has been proposed as the common mechanism underlying several well-replicated risk factors for sub-threshold psychotic experiences (PEs) identified in epidemiological research. Victimization by the police may likewise be socially defeating among vulnerable individuals and, therefore, may be associated with elevated risk for PEs. However, no prior studies have examined the relation between police victimization and PEs. We tested the hypothesis that exposure to police victimization (ie, physical, sexual, psychological, and neglect) would be associated with increased odds for PEs in the Survey of Police-Public Encounters data (N = 1615), a general population sample of adults from 4 US cities. Respondents who reported each type of police victimization were more likely to report PEs in logistic regression analyses (all P < .01), most of which were significant even when adjusting for demographic variables, psychological distress, and self-reported crime involvement (adjusted OR range: 1.30 to 7.16). Furthermore, the prevalence of PEs increased with greater exposure to police victimization in a linear dose-response relation, OR (95% CI) = 1.44 (1.24-1.66). These findings suggest that police victimization is a clinically important and previously unreported risk factor for PEs in the urban US population. These findings support the need for community-based outreach efforts and greater police training to reduce the prevalence of this exposure, particularly in socially disadvantaged urban communities.

Prevalence, demographic variation and psychological correlates of exposure to police victimisation in four US cities.

The Survey of Police-Public Encounters study surveyed adults residing in four US cities to examine the prevalence, demographic distribution and psychological correlates of police victimisation. Participants (N = 1615) completed measures of psychological distress (K-6 scale), depression (Patient Health Questionnaire 9) and two newly constructed measures of civilian-reported police-public encounters. Both measures were developed to assess police victimisation based on the WHO domains of violence, which include physical violence (with and without a weapon, assessed separately), sexual violence (inappropriate sexual contact, including public strip searches), psychological violence (e.g., threatening, intimidating, stopping without cause, or using discriminatory slurs) and neglect (police not responding when called or responding too late). The Police Practices Inventory assesses lifetime history of exposure to positive policing and police victimisation, and the Expectations of Police Practices Scale assesses the perceived likelihood of future incidents of police victimisation. Linear regression models were used to test for associations between police-public encounters and psychological distress and depression. Psychological violence (18.6%) and police neglect (18.8%) were commonly reported in this sample and a substantial minority of respondents also reported more severe forms of violence, specifically physical (6.1%), sexual (2.8%) and physical with a weapon (3.3%). Police victimisation was more frequently reported by racial/ethnic minorities, males, transgender respondents and younger adults. Nearly all forms of victimisation (but not positive policing) were associated with psychological distress and depression in adjusted linear regression models. Victimisation by police appears to be widespread, inequitably distributed across demographic groups and psychologically impactful. These findings suggest that public health efforts to both reduce the prevalence of police violence and to alleviate its psychological impact may be needed, particularly in disadvantaged urban communities.

Intimate Partner Violence Perpetration Among Adolescent Males in Disadvantaged Neighborhoods Globally

PurposeIntimate partner violence (IPV) affects one in three women globally, with adolescent and young adult women at highest risk. Less is known about IPV perpetration. We compare the prevalence and correlates of IPV perpetration among 15- to 19-year-old adolescent males in Baltimore (United States), Johannesburg (South Africa), Delhi (India), and Shanghai (China). MethodsA cross-sectional survey was conducted in 2013 with males aged 15–19 recruited via respondent-driven sampling from disadvantaged neighborhoods in four cities: Baltimore (United States), New Delhi (India), Johannesburg (South Africa), and Shanghai (China); total n = 751 ever-partnered men. We describe the prevalence of past-year physical and sexual IPV perpetration and evaluate associations with gender norm attitudes, mental health, substance use, victimization experiences, and demographic factors. ResultsPast-year physical or sexual IPV perpetration ranged from 9% in Shanghai to 40% in Johannesburg. Factors associated with past-year perpetration across multiple sites included: binge drinking (Johannesburg adjusted odds ratio [AOR] = 2.8, Baltimore AOR = 6.7, and Shanghai AOR = 3.2), depressive symptoms (Johannesburg AOR = 2.4 and Shanghai AOR = 2.2), victimization in the home (Baltimore AOR = 2.5, Shanghai AOR = 2.7, and Johannesburg AOR = 1.7), and community violence victimization (Baltimore AOR = 7.0, Delhi AOR = 4.1, and Johannesburg AOR = 2.8). Equitable gender norm attitudes were protective against IPV perpetration in Johannesburg and Shanghai. Demographic factors (e.g., age, employment, and education) were inconsistently associated with IPV perpetration across sites. ConclusionsPast-year IPV perpetration was prevalent with differences identified across settings. Findings suggest the need to scale up evidence-based interventions targeting adolescents in disadvantaged urban communities in order to address many modifiable factors associated with IPV perpetration in this study.

Interventions to Address Reproductive Health Disparities among African-American Women in a Small Urban Community: the Communicative Construction of a “Field of Health Action”

Guided by communication infrastructure theory (CIT) and based on analyses of multiple sources of data gathered as part of a four-year intervention to address reproductive health-care disparities among African-American women in a small, disadvantaged urban community in the northeastern USA, this mixed-methods study advances understanding of challenges that such health interventions face in smaller urban settings. Findings suggest that factors in residents’ material environment and their social construction of that environment interact to produce a “field of health action,” within which health-care seeking behavior is enabled and constrained. Four factors emerged as salient: actual availability of and perceptions of access to health-care resources, transportation options, communication resources (including interpersonal, media, and organizational) that aid health-care seeking, and privacy concerns around reproductive health-care seeking. The findings are discussed with regard to their implications for future research and health communication interventions that promote reproductive health-care seeking in small urban communities.

Breaking the code of the street: extending Elijah Anderson's encryption of violent street governance to retaliation in Scotland

The ‘code of the street’ is a theoretical framework concerning violent interaction. Its enactment on the street can be seen as illustrating a hegemonic masculinity. The typical setting where the code is pervasive is in disadvantaged urban communities. Those in thrall to the code's localised retaliatory edicts are usually young working-class males. Understandably, given the code's origins in the US ghetto, it is a US criminological research tradition which has stimulated the terms of this framework. Although European scholars have pursued theorising violence by recourse to the code, Scotland has not been studied, and the qualitative study reported here aims to remedy this. Based on these data, a behavioural code is evident in Scotland sharing characteristics with Anderson's original contribution, despite differences in terms of chronology and cultural setting. The study contributes to our knowledge of the life histories and personal theorisations of young offenders whose trajectories are arguably entrapped by forms of retaliatory justice and performances of a ‘protest’ type of marginalised masculinity.

Access to Green Space in Disadvantaged Urban Communities: Evidence of Salutogenic Effects Based on Biomarker and Self-report Measures of Wellbeing

This paper describes two case studies from Scotland, UK, exploring links between access to green space, perceptions of and activities in green space, and health and quality of life. One study involved a natural experiment to study the effects of improvements to woodlands near a disadvantaged urban community, compared with a similar community without such interventions. The second study, a recent, innovative study for the Scottish Government, demonstrated use of a biomarker as a method for measuring the salutogenic effects of environmental settings such as green space, offering evidence of environment-body interactions within a real-world context of people's everyday lives.

A capacity building approach to increase sports participation in disadvantaged urban communities: a multilevel analysis.

Recent evidence showed that community capacity building is one of the key methods to reach health improvements within disadvantaged communities. Physical activity and sports participation are important means to reach health improvements. This study investigates a capacity building method which aims at increasing sports participation in the community, especially for individuals at higher risk of sports deprivation. The main aims of the present study, are the following: (1) to examine differences in sports participation between individuals living in communities implementing a sports-based capacity building program and individuals living in communities without such capacity building program and (2) to investigate if the community sports program reaches the individuals known to experience higher barriers to engage in sports. In Flanders, Belgium, five disadvantaged urban communities implementing the community capacity building program (program communities) and four without (control communities) were selected based on similarity of sociodemographic and environmental characteristics. Two hundred adults (aged 18-56 years) per community were randomly selected and visited at home to fill out a questionnaire on sociodemographics, sports participation, and the community sports program. A sample of 414 adults participated in the study. Results showed that adults from program communities reported on average 96 min/week more participation in sports than their counterparts living in control communities. Furthermore, 61.3% of the individuals of program communities indicated to engage in sports, whereas in control communities, this was only 42.4%. Respondents at higher risk of sports deprivation also engaged in significantly more sports participation in program communities than those in control communities. This difference was also noted for groups that are not related with sports deprivation. These results are promising and plead for a community capacity building approach to increase sports participation in disadvantaged communities.

Responsibilised Resilience? Reworking Neoliberal Social Policy Texts

Responsibilised Resilience? Reworking Neoliberal Social Policy Texts

Social engagement and healthy ageing in disadvantaged communities

PurposeSocial engagement is important for healthy ageing but may be challenging for residents of disadvantaged urban communities. For older residents of one such community, this project aimed to examine levels of social engagement and its link with wellbeing and community attachment.Design/methodology/approachThe project introduced activities to promote social engagement and used a survey to assess participants' wider involvement in local activities and their feelings of wellbeing and community attachment.FindingsSixty five people completed the survey: most lived alone (over 69 per cent) but had contact at least monthly with family, friends and neighbours (over 70 per cent) and made regular use of local amenities (over 79 per cent). Only 34.7 per cent were classified as “not lonely” and participants' mean health related quality of life score was lower than the national average. However, over 65 per cent of participants rated their generic quality of life as good or better and over 67 per cent had a positive sense of community attachment. Statistically significant associations were identified between a person's feelings of loneliness and generic quality of life and their level of contact with relatives, neighbours and friends and their sense of community attachment.Originality/valueResults confirm the need for strategies to promote the social engagement of older people. The link between community attachment and wellbeing also demonstrates that community wide strategies are required. The importance of maintaining the “corner shop” was evident.