Inner-city Areas Research Articles

Sleep Disturbance among Low-Income Minority Teens

Background: Sleep is particularly important for brain maturation and sleep deprivation in teens has a potent negative effect on behavior, emotion, and attention. Adolescents tend to experience more problems with sleep loss as a natural consequence of puberty, but teens from impoverished inner-city areas witness violence and experience stressors that are likely to affect sleep. Purpose: To examine sleep disturbance, violence, mood, and attitudes in very low income youth in the Mobile Youth Survey (MYS). Methodology: The MYS is a longitudinal household study of impoverished inner-city adolescents that has a strong repeat participation rate (70-80%). Data from the years 1998-2005 (N=20,716; age range = 9.75-19.25 years) were used to compare sequential surveys ie, 2-year increments). The measure of sleep disturbance captured aspects of both insomnia and nightmares and was elicited by a question about how sleep was affected “when bad things happen to a friend or a family member”. Findings: Growth curve analysis showed that reports of sleep disturbance decreased incrementally from age 10 to age 18, and that after age 10 boys had consistently lower levels of sleep disturbance than girls. Using a cross-lagged panel multivariate approach comparing reports by subject for sequential years and controlling for age and gender, sleep disturbance was associated with violent behavior (carrying, brandishing or using a gun/knife), quick-temperedness, worry, and belief in the neighborhood Street Code in the subsequent year. Conversely, worry, traumatic stress, a quick temper, a positive attitude toward the neighborhood and identification with the Street Code were each associated with sleep disruption in a subsequent year. Summary Concluding Statement: These results suggest a partial explanation for the negative effect of socioeconomic status on sleep among low-income adolescents. The data also suggest that developing approaches to sleep hygiene for teens may help reduce violence, aggression, and impulsivity among high-risk groups.

‘At the moment it is just a couple of eccentrics doing it’: concordance in day-to-day practice

Abstract Objectives To assess the feasibility and acceptability of concordance in pharmacy practice through examination of communication between customers and pharmacists in two community pharmacies in consultations for over-the-counter medicines. Method A qualitative pilot study involving data drawn from six sources: audiotaped training session with all the pharmacists involved, observational field work in the pharmacies, audiotaped consultations with pharmacists and customers, debriefing interviews with pharmacists after the consultation, and semi-structured interviews with customers a few days after their consultation. Setting Two community pharmacies that concentrate their services on medicine advice and dispensing, one in a deprived inner-city area, the other in a more affluent suburban area of London. Key findings The pharmacists developed a personal understanding of concordance which informed their practice. Customers reported a high level of satisfaction with services they received from the respective pharmacists. Their accounts of the consultations verified the pharmacists' patient-centredness in their day-to-day practice. Conclusion The implementation of a concordance model was possible through the development of a personalised, patient-centred model which drew on the model of concordance but was adapted in accordance with both structural constraints as well as the personal style of the pharmacists involved.

Hidden Spaces and Urban Health: Exploring the Tactics of Rural Migrants Navigating the City of Gold

Urban health practitioners working in African cities require an in-depth understanding of the context within which they work in order to plan and implement effective urban public health programmes. This paper provides insights into the complexities of the urban African environment and its residents by describing and analysing the tactics employed by a population of rural migrants as they enter and navigate the City of Gold: Johannesburg. This population resides within inner-city areas that are broadly disconnected from local government initiatives, that I term here as ‘hidden spaces’. Reflecting on personal experiences and involvement in participatory photography and film projects within these ‘hidden spaces’, the paper considers the concept of ‘being hidden’ as something that can be both a deliberate tactic employed by particular urban populations to evade the state, and as a result of marginalisation where the state bypasses groups in need of intervention.

Does Initial Point of Care Influence Neuro-ICU Outcomes?

Most of the conditions that eventually get treated in theNeuro-ICUsettingrequireinitialdiagnosisandmanagementin the Emergency Department. As hospitals increasinglydevelop networks and other inter-hospital lines of referral,this initial evaluation and treatment often takes place in acenter that does not have local expertise in NeurocriticalCare, advanced neuroimaging, or a Neurosurgeon. If, bychance or by geographic necessity, a patient is brought byEMS to such a ‘‘non-Neurocritical Care’’ ED, does thisadversely affect outcomes?This is a big question, and it potentially applies to a hostof conditions, including ischemic stroke, intracerebralhemorrhage (ICH), subarachnoid hemorrhage (SAH), andneurotrauma. The answer to this question might alter theways in which initial EMS triage and initial ED care areorganized as regional approaches to emergency care arefurther developed in the future.In this issue of Neurocritical Care, Naval and Car-huapoma examine the impact of initial point of care onclinical outcomes among patients with ICH treated in theNeuro-ICU at Johns Hopkins Hospital. Although this arelatively small retrospective study of 125 patients, there isa strong suggestion from these data that initial treatment inthe ED at Hopkins was associated with better outcomes.The authors show the outcomes at hospital discharge wereimproved in the Hopkins ED group across multiplefavorable levels of the modified Rankin Scale, and theassociation between Hopkins ED treatment and good out-come remained after controlling for ICH and IVH volumes,age, and GCS in a logistic regression model.Studies can often raise more questions than they answer,and the current paper by Naval and Carhuapoma is noexception. Many of the new questions raised by this studyarise from one central question: what does treatment in theHopkins ED (vs. another ED) really mean? Is this simply ademonstration of the excellent emergency room care pro-vided at a world-famous hospital in a busy inner-city area(as compared to other, less notable facilities)? Or is it morespecifically a demonstration of the added value of Neuro-intensivist or Neurosurgical intervention at an earlier pointin the care of critically ill patients with ICH? Perhaps theeffect seen here is that of inferior care at the outside EDscompared to standard care at the Hopkins ED (as comparedto standard care at the outside EDs compared to superiorcare at the Hopkins ED). Examples of possible inferior caremight include delayed triage, delayed diagnosis, or delayedor inadequate treatment or blood pressure or coagulopathy.Yet another explanation might be that the association seenhere is purely based on the longer time between ED arrivaland ICU admission that is by definition built into triage atone facility and ICU treatment at another. Of course, thereal answer is likely to be multifactorial, resulting fromsome combination of these and other explanations.If being brought to a Neurocritical Care center from thebeginning is in fact better than being brought to a non-Neurocritical Care center, would it make sense to bypassnon-Neurocritical Care centers during EMS transport, atthe potential cost of delaying initial evaluation and treat-ment? Would better medical informatics networks andapplications such as remote imaging access and telemedi-cine [1–3] improve outcomes for these patients and alsoavoid the risks of prolonged transport prior to initialevaluation?To what extent does the lack of familiarity with specificmedical interventions drive the association between

Urban consolidation centres for medium-size touristic cities in the Westpomeranian Region of Poland

Among the many problems arising in cities, freight delivery is one of the most important ones. Increasing demands of the recipients (due to e-commerce development) leads to pressure and intensification of transporting freight through inner-city areas. This generates many unwanted results such as congestion, escalation of waste and environmental devastation, increased noise levels, greater than before, such as the risk of car accidents. An important alternative for traditional freight delivery are Urban Consolidation Centres. Utilizing UCC gives a chance to eliminate the harmful effects due to transporting freight by large-size vehicles through the city areas. This paper is focused on analysis of perspectives of urban consolidation centres development in Westpomeranian Region of Poland, concentrating on medium-size cities. For cities like Świnoujście and Kołobrzeg implementation of urban consolidation centres is important for efficiency of freight delivery especially during holiday periods.

Mapping same-sex couple family households in Australia

Please click here to download the map associated with this article. The map (1:1,218,987) accompanying this report is the first to depict the distribution of same-sex couple family households across Australia. The map and the report contribute to emerging scholarship combining critical geographies of sexualities with quantitative techniques and GIS in order to advance the political claims of sexual minorities. The data were collected through the 2006 Census and obtained via consultation with the Australian Bureau of Statistics. These data included the number of same-sex couple family households for all Statistical Divisions across Australia and for Statistical Sub-Divisions within metropolitan capital cities. Geographical concentrations of same-sex couple family households were determined by calculating the proportion of couple family households that were same-sex in each Statistical Division and Statistical Sub-Division, since the Census defines cohabiting same-sex couples as a subset of couple family households. To visualise where the proportions fell above and below the national average, and thus where concentrations were found, these ratios were converted to location quotients using the Australian average as the denominator. The map combines different scales—Statistical Divisions and Statistical Sub-Divisions—to illustrate distributional patterns between inner-city and suburban areas, as well as between urban and regional localities. While high concentrations are found in inner-cities, there are also significant suburban and regional concentrations, thus contesting assumptions about same-sex couples' inner-city residential choices. Moreover, since same-sex couples were found in most Statistical Divisions, areas below the national average cannot be considered devoid of these families, with implications for constitutive identity politics and the operationalisation of equal rights legislation.

Rethinking Sustainable Sanitation for the Urban Domain

Climate change, diminishing natural resources and rural-urban demographic trends will have profound impacts on future urban infrastructure delivery in both developed and developing countries. These challenges will however, leverage new opportunities for circular urban economies in which productive sanitation will play an important role in both the North and South. In the developed world, the challenge is to initiate a transition from disposal oriented, water-based infrastructure regimes towards more sustainable, re-use oriented, and productive sanitation. Decentralized approaches to “productive sanitation“ (including the production of biogas, fertilizer or water for irrigation) with a source-separation focus (segregation of flow streams with different properties) will allow for considerable cost and resource savings and enable life-cycle economies. In the developing world, the sanitation challenge is about leapfrogging over-engineered sanitation services and technologies, especially for urban areas which are currently without sanitation services, to overcome the huge service backlog. This paper gives an initial overview of the current state of urban sanitation with a North- South perspective, followed by a discussion of the new role of sustainable sanitation systems for cities of the future. Planning innovations for urban sanitation, initial lessons learned and current challenges faced are addressed. Context specific challenges and opportunities are illustrated in a variety of urban settings, from non-tenured, low-income settlements to middle- and high-income inner-city areas.

Using group support to complement a task-based weight management programme in multi-ethnic localities of high deprivation

Objective Two pilot studies were undertaken to assess the efficacy and potential reach of a weight management programme in two inner-city areas of East London. Methods The programme provides a 6 weekly group sessions combining a task-based cognitive-behavioural intervention with interactive group support to increase client engagement and retention. Treatment outcome was assessed at end of treatment and at 2 and 3 months by objective markers including pedometer readings, improvements in knowledge of healthy eating, and weight change. Results A total of 162 people (mean BMI 35 kg/m 2) participated. Forty-one started the first pilot and 21 (51%) completed it, losing on average 3.0 kg. In the second pilot 121 participants started the course and 75 (62%) completed it, losing on average 2.6 kg. A total of 62 and 39 participants completed 2- and 3-month follow-up, with average weight loss of 3.8 and 4.5 kg. There were significant increases in mean daily pedometer readings and improvements in objectively assessed knowledge of caloric intake. Conclusions A task-based lifestyle-modification programme complemented by social support proved attractive to inner-city residents and generated significant short-term effects comparable to those achieved by intensive interventions with more traditional target groups.

Modifiable Risk Factors for Asthma Morbidity in Bronx Versus Other Inner-City Children

Background: Bronx children have higher asthma prevalence and asthma morbidity than other US children. Objective: To compare risk factors for asthma morbidity present in Bronx children with those of children from other US inner-city areas. Methods: Cross-sectional, multi-state study of 1772 children ages 5–11 yrs. old with persistent asthma. Parental responses to the Child Asthma Risk Assessment Tool for 265 Bronx children are compared with those of 1507 children from 7 other sites (1 Northeast, 2 South, 2 Midwest, 2 West). Results: Bronx children were significantly more likely to be sensitized to reported aeroallergens in their homes than were children from the other sites (86% vs. 58%; p <.001). More Bronx parents reported household cockroaches (65% v 20%; p <.001), mice (42% v 11%; p <.001), and rats (7% v 3%; p <.001); using a gas stove to heat the home (20% v 9%; p <.001); and visible mold (48% v 25%; p <.001). Bronx parents were more likely to report pessimistic beliefs about controlling asthma (63% v 26%; p <.001) and high parental stress (48% v 37%; p <.01). Conclusions: Compared with other inner-city children with asthma, Bronx children are more likely to be exposed to household aeroallergens to which they are sensitized and have poor housing conditions. Their parents are more likely to report low expectations for asthma control and high levels of psychological stress. Interventions that address these identified needs may help to reduce the disproportionate burden of asthma morbidity experienced by Bronx children.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterHarriet P. Lefley Ph.D.Harriet P. Lefley Ph.D.Search for more papers by this authorPublished Online:1 Nov 2009https://doi.org/10.1176/ps.2009.60.11.1557AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail An Early Example of Culturally Competent ServicesTo the Editor: In their article in the August issue, Hernandez and colleagues ( 1 ) stated that "cultural competence occurs when there is compatibility among four important factors: community context, cultural characteristics of local populations, organizational infrastructure, and direct service support." In their otherwise comprehensive literature review, it is astonishing that they failed to find, in their own state, an early research-based model that exemplified all of these characteristics. In the 1970s and 1980s the University of Miami-Jackson Memorial Community Mental Health Center (CMHC) developed a model based on prior community research and community outreach techniques similar to those in the applied example used by Hernandez and colleagues, the African-American Family Services of Minneapolis. The Miami CMHC served a multiethnic inner-city catchment area with five ethnic community teams that were based on the demographic characteristics of the center's neighborhoods and an assessment of their needs. The teams, African American, Bahamian, Cuban, Haitian, and Puerto Rican, were composed of clinical and social scientist staff matched to the ethnicity and language of the neighborhoods. In addition to providing outreach and helping the communities access needed resources, the center offered crisis, inpatient, consultation, and referral services and developed nine neighborhood mini-clinics that served outpatient and aftercare clients in their own localities. Extensive case management was also provided, because research had demonstrated that environmental interventions can improve therapeutic outcome ( 2 ). At a time when dropout rates as high as 75% were reported for African-American and Hispanic clients, this CMHC had a mean dropout rate of 4%, with a high of 12%. With respect to keeping appointments, normative evaluation data indicated no-show rates ranging from 40% to 56% for African-American and Hispanic clients. This CMHC had a mean no-show rate of 9.7% ( 3 ). The program went on to develop a national cross-cultural training institute for mental health professionals, which trained nearly 200 clinical and administrative staff and produced its own research data on organizational changes in culturally competent care ( 4 ). The program eventually became freestanding as New Horizons CMHC; however, despite its success, it has had to vastly reduce its services. We may develop many ideal models, but unfortunately, programs rich in cultural competence cannot persist without adequate funding and zeitgeist support. Dr. Lefley is professor in the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine.

“Do you see what I see?” – Correlates of multidimensional measures of neighborhood types and perceived physical activity–related neighborhood barriers and facilitators for urban youth

Objectives To classify types of neighborhood environment and to examine the gender-specific cross-sectional associations between these neighborhood types and adolescents' perceptions of physical activity–related neighborhood barriers and facilitators. Methods This cross-sectional study was conducted with a sample of 350 high school students in Baltimore, Maryland, in 2006. Participants completed the Neighborhood Environment Walkability Scale (NEWS). Objectively GIS-measured attributes of urban form came from various sources. Classification of built environment/neighborhood types was achieved by factor analysis and cluster analysis. Results Four neighborhood types were identified: (1) arterial development; (2) inner-city area; (3) suburban residential; and (4) central business district. Girls who lived in suburban residential areas were less likely than their central business district counterparts to perceive the protective effects of crosswalks and pedestrian traffic signals. Girls living in inner-city neighborhoods were more likely than their central business district counterparts to perceive the traffic as being slow. Boys' perceptions of their neighborhood did not vary by neighborhood pattern. Conclusions Girls appear to be more sensitive to their environment and perceive more physical activity–related built environment barriers compared to boys. Efforts to overcome physical activity barriers salient for adolescent girls should be tailored to the type of neighborhood.

Earl Marshal School: towards an inclusive education

For five years in the early 1990s, as the Conservative government attempted to drive through the new educational policies heralded by its Education Reform Act of 1988, a comprehensive school in Sheffield was the site of a bold experiment in progressive education. Located in a working-class, inner-city area, Earl Marshal School was ethnically highly diverse, with students from Pakistani, Somali, Yemeni and Caribbean families; white students made up less than 20 per cent of the student roll. With Chris Searle as headteacher from 1990 to 1995, these students, aged 11 to 16, were exposed to a very different kind of schooling from that envisaged by the government — with its newly introduced national curriculum, competitive league tables between schools and authoritarian system of inspections carried out through the Office for Standards in Education (OFSTED). Instead, Searle refused to exclude students for misbehaviour; did not sheepishly follow the national curriculum; was not over-impressed by OFSTED; sought student democracy; and involved the local community in the affairs of the school. Inevitably, he drew fire from OFSTED, from other headteachers, from the local education authority (LEA) and even from David Blunkett, the Sheffield MP who from 1994 was Labour’s shadow secretary of state for education. In the end, they were able to unseat him, depriving Sheffield of the benefits of his ideas. The headteacher who opposed the permanent exclusion of students was himself, as he puts it, ‘permanently excluded’ from the job that he loved and lived for.

Who needs enemies with friends like these? The importance of place for young people living in known gang areas

Despite a growing concern about gangs in Britain, academic research that focuses on gangs remains scarce. Drawing on data from the ESRC-funded ethnographic research YOGEC (Youth Gangs in an English City) project, this paper explores the negotiation of space and place by young people living in inner-city areas affected by gangs. Using a combination of fieldwork observations and focus group and interview data, this paper charts the experiences of non-gang-involved young people living in known gang areas. These young people's restricted use of space, arising as a result of gang rivalries and the policing of inner-city areas, results in exclusion, marginalization and victimization. We illustrate how young people are identified as ‘high risk’, and how they continually negotiate a range of risks bound up with the territory that they inhabit and subsequent spatial boundaries that are formed. In doing so, we provide an understanding of the lives of young people who reside in places and spaces inhabited by gangs.

Public health, the APHA, and urban renewal.

Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.

In this issue of Informatics in Primary Care: ethnicity, learning and diabetes

The quality of routinely collected data in UK primary care is high and provides great opportunities for research and quality improvement. Its strengths and weaknesses are well known, and extensively described within the pages of this journal and elsewhere. Recording of ethnicity data has been a relatively recent addition to routine coding; but good progress has been made particularly in some inner-city areas. This allows routinely collecteddata tobeused tohelpdescribe ethnic differences in disease management and ensure equity in service provision, in a way that would not have previously been possible. This is despite complex and overlapping hierarchies for data recording. The study by Hull et al, is important because it suggest that there is now better agreement betweenGP and hospital ethnicity data than with census data. This finding if repeated more widely suggests that there may be a greater role for GP data than suggested in the Department of Health’s Equity Rights Group editorial. The quality of census data unsurprisingly falls as it gets older – we are now eight years since the last census (2001) – however, this will inevitably be repeated with each 10 yearly cycle of data collection. However, GP data will perhaps better reflect the inevitable and repeated waves ofmigration andmovement that take place across this country. Using technology for learning

Community-Level Correlates of Hospitalizations for Persons With Schizophrenia

Community-Level Correlates of Hospitalizations for Persons With Schizophrenia

Experimental study of photocatalytic concrete products for air purification

Air quality in inner-city areas is a topic which receives much attention nowadays but in the coming years, the overall interest on this topic will become even bigger. One major concern is caused by the reduction of the limiting values given by the European Council Directive 1999/30/EC [Relating to limit values for sulphur dioxide, nitrogen dioxide and oxides of nitrogen, particulate matter and lead in ambient air. Official Journal of the European Communities 1999, L 163/41–60] and increasing traffic rates especially for diesel powered passenger cars and freight vehicles. A promising approach for solving the problem of nitrogen oxides (NO x ) is the photochemical conversion of nitrogen oxides to low concentrated nitrates due to heterogeneous photocatalytic oxidation (PCO) using titanium dioxide (TiO 2) as photocatalyst. A variety of products containing TiO 2 are already available on the European market and their working mechanism under laboratory conditions is proven. However, there is still a lack of transforming the experimental results obtained under laboratory conditions to practical applications considering real world conditions. This paper presents the research conducted on photocatalytic concrete products with respect to the evaluation of air-purifying properties. The degradation process of nitric oxide (NO) under laboratory conditions is studied using a test setup for measuring the performance of photocatalytic active concrete products. The test setup uses the UV-A induced degradation of NO and is oriented on the ISO standard ISO 22197-1:2007. Besides the introduction of the test setup, a uniform measuring procedure is presented to the reader which allows for an evaluation and direct comparison of the performance of photocatalytic active concrete products. This kind of direct comparison was not possible so far. Furthermore, the results of a comparative study on varying photocatalytic concrete products of the European market will be discussed.

Post-industrial Trajectories of Mediterranean European Cities: The Case of Post-Olympics Athens

This paper deals with clusters of post-industrial urban economies and their impacts on the spatial restructuring and the relandscaping of the contemporary inner city. It investigates such impacts by studying recent economic, spatial and landscape transformations of Athens, a large Mediterranean city in the geographical and economic periphery of Europe. The first part of the paper reviews earlier research on clusters of post-industrial urban economies and their spatial impacts, while attempting to present the topic in an international context. The second part focuses on a case study of Athens, Greece. It examines the planned clusters of athletics, culture and leisure that were developed for the 2004 Olympics; and, the spontaneous clusters of both culture, leisure and creative activities, and technology-intensive and knowledge-rich activities and advanced financial intermediary services that have gradually developed in Athens' inner-city areas during the past decade. The paper documents land use shifts and landscape transformations while highlighting the processes of formation of these spontaneous clusters and the urban policies involved; it also discusses urban governance issues in relation to the management of Athens' clusters, both planned and spontaneous. Finally, it draws conclusions about differences in post-industrial trajectories among large cities in the core of Europe and large Mediterranean cities in the developing periphery of Europe.

Association Between Staff Factors and Levels of Conflict and Containment on Acute Psychiatric Wards in England

Association Between Staff Factors and Levels of Conflict and Containment on Acute Psychiatric Wards in England

Association Between Staff Factors and Levels of Conflict and Containment on Acute Psychiatric Wards in England

Conflict (for example, aggression, substance use, and absconding) threatens the safety of patients and staff, and containment use (for example, coerced medication, special observation, and manual restraint) arouses strong feelings and is controversial. Previous work suggests that three staff factors have an impact on rates of these events: the positive appreciation of patients by staff, the staff's management of their own emotional reactions to patient behavior, and the provision of an effective structure. The aim of this study was to test this theory. A multivariate cross-sectional design was utilized. Data were collected for a six-month period on 136 acute psychiatric wards in 26 National Health Service Trusts in England. Multiple regression was conducted to determine the factors most strongly associated with total conflict and containment rates. Provision of an effective structure of rules and routines for patients was the staff feature most strongly and consistently associated with lower conflict and containment rates, with other elements of the theory less well supported by the data. Other patient and ward factors were also significantly associated with differences in conflict and containment rates between wards, in particular the proportion of patients formally detained under mental health legislation, the quality of the physical environment, and staff and patient race-ethnicity. Conflict and containment are reliable and meaningful concepts. Staff factors are relevant in the determination of conflict and containment rates on wards, but the most important of these is the provision of an effective, well-organized structure of rules and daily routines. There are a number of ways in which conflict on wards might be reduced, including a greater emphasis on the production of effective structure and order on the ward and work in the community to reduce the numbers of compulsory admissions.