Non-urban Communities Research Articles

Feasibility of telephone-based cognitive behavioral therapy targeting major depression among urban dwelling African-American people with co-occurring HIV

Given the burden of depression among those with HIV, and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care. This single site, uncontrolled, pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income, urban-dwelling, HIV-infected African-American people with major depression. The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview. The primary outcome was the Hamilton Depression Rating Scale (HAM-D) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR). Feasibility and satisfaction were also assessed. Assessments occurred at baseline, midpoint and at study conclusion (14 weeks). Fifteen people were screened for the study. Six HIV-infected, low-income, African-American people individuals (five females and one male) were eligible and participated in the study. All patients finished the study. On average, participants completed nine sessions. The sessions lasted for an average of 48 min (SD = 11.5). Compared to mean HAM-D score at baseline (HAM-D = 22.8 (SD = 3.1), the mean HAM-D score was significantly reduced at study conclusion (HAM-D = 9.8 (SD = 7.4); (t (5) = 4.6, p = 0.006); (Cohen d = 1.9)). Compared to the mean QIDS-SR score at baseline (QIDS-SR = 15.5 (SD = 4.2) the mean QIDS score was significantly reduced at study conclusion (QIDS = 7.0 (SD = 5.4);(t (5) = 3.2, p = 0.02); (Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 (SD = 0.3) with of a maximum score of 6. Telephone-based CBT can be delivered to low-income, urban-dwelling ethnic minority HIV-infected people resulting in significant reductions in depression symptoms with high satisfaction. The efficacy of this intervention will be assessed in a planned randomized control trial.

Seasonally dynamic fungal communities in the Quercus macrocarpa phyllosphere differ between urban and nonurban environments

*The fungal richness, diversity and community composition in the Quercus macrocarpa phyllosphere were compared across a growing season in trees located in six stands within and outside a small urban center using 454-sequencing and DNA tagging. The approaches did not differentiate between endophytic and epiphytic fungal communities. *Fungi accumulated in the phyllosphere rapidly and communities were temporally dynamic, with more than a third of the analyzed operational taxonomic units (OTUs) and half of the BLAST-inferred genera showing distinct seasonal patterns. The seasonal patterns could be explained by fungal life cycles or environmental tolerances. *The communities were hyperdiverse and differed between the urban and nonurban stands, albeit not consistently across the growing season. Foliar macronutrients (nitrogen (N), potassium (K) and sulfur (S)), micronutrients (boron (B), manganese (Mn) and selenium (Se)) and trace elements (cadmium (Cd), lead (Pb) and zinc (Zn)) were enriched in the urban trees, probably as a result of anthropogenic activities. Because of correlations with the experimental layout, these chemical elements should not be considered as community drivers without further empirical studies. *We suggest that a combination of mechanisms leads to differences between urban and nonurban communities. Among those are stand isolation and size, nutrient and pollutant accumulation plus stand management, including fertilization and litter removal.

Use of Videophone Technology to Address Medication Adherence Issues in Persons with HIV.

Adherence to HAART medication regimens is vital to maintaining suppression of HIV, but persons with HIV face many challenges to adhering consistently to HIV medication regimens. This is particularly true for persons who live in geographically-isolated areas or who have significant levels of cognitive compromise. A videophone-based version of Reynolds' HAART CARE (HC) telephone intervention for medication adherence was pilot-tested with 23 persons living with HIV residing in both urban and non-urban communities. The purpose of the pilot study was to evaluate the feasibility and acceptance of an adherence improvement intervention administered via videophones. Furthermore, the feasibility and acceptability of conducting HIV pill counts through videophones were assessed. The videophone version of HC produced significant increases in self-reported rates of medication adherence and was generally well-received by interventionists and participants. Pill counts conducted via videophone were also well-accepted by participants. Self-reported adherence levels were higher than videophone-based pill count adherence levels. Challenges to the use of videophones included the requirement that only analog landlines be used, poor quality of video and audio transmissions, and high cost for equipment. Methods to overcome these challenges are discussed.

A Profile of Patients Seen by Fly-in Clinical Psychologists at a Non-Urban Facility and Implications for Training and Future Services

With the serious mental health services deficits in non-urban communities, there is a need to evolve alternative approaches to facilitate access to care. Considering clinical psychology services are largely concentrated in the metropolitan areas, we describe a relatively unusual approach to providing services in an outlying area. The majority of patients attended to in this service are children and adolescents, and most patients have less than secondary-school education. The commonest diagnoses are mental retardation, mood and anxiety disorders, with the last two conditions mainly found in scholars and the unemployed. Fractured families are almost the norm, with four out of five children living with only one or no parents. Over half the patients are from families receiving a state grant. The majority of patients travel great distances to get to the clinical psychologists. The findings point to the need for clinical psychologists to seriously consider developing newer models for providing care, and the need for working outside of traditional approaches.

Reflections on Lupus and the Environment in an Urban African American Community

Exposure to environmental hazards is hypothesized to play an important role in the development of autoimmune diseases such as lupus. The Buffalo Lupus Project examined the relationship between a high incidence of disease and exposure to a toxic waste site in a poor, urban minority neighborhood in Buffalo, New York, U.S.A. The purpose of this study is to explore patients' experiences and concerns with their living environment and their perceptions of environmental effects on their health and disease status in an urban African American community with a high burden of lupus and other autoimmune diseases. To this end, we conducted two focus groups with a total of 13 community participants diagnosed with lupus. Participants were recruited through mail invitations and a semi-structured interview guide was used to gather information. Data analysis followed a theory-driven immersion-crystallization approach. Findings shed light on the following issues: 1) Environmental impact on illness; 2) Exposure to environmental hazards; 3) Community awareness about lupus; 4) Environmental determinants of lupus; and 5) Strategies for environmental action. The participants' experiences highlighted areas for improvement in environmental conditions as well as strategies for raising awareness of lupus and other autoimmune diseases in at-risk urban minority communities.

Outlook for ecotourism in India

SUMMARY Ecotourism has a vital role to play in sustainable development in India and in creating a framework for the inclusion of the marginalised non-urban communities, excluded from the economic growth currently being witnessed. This requires a shift in attitudes from regulation and control to empowerment, from patronage to partnership, and from linear government-led structures to alliances with diverse stakeholders. It can be achieved by a well articulated partnership policy that cascades into a viable business plan with clear mission statements and strict monitoring and evaluation criteria. While ecotourism projects need to be financially independent to remain sustainable without grants and subsidies, the primary pillars of community involvement and enhancement of the environment are paramount in measuring the success. While learning from experiences elsewhere, it is important to internalise indigenous knowledge and to adapt methodologies in a site-specific context. Transparent measurement and evaluati...

Church ladies, good girls, and locas: Stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of “ loca” (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of “good girls” and “church ladies”. Therefore, in spite of their association with the “ loca”, the women also identify with faith and religion (“church ladies”) and uphold more traditional gender norms (“good girls”) that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.

Obesity and related risk factors among low socio-economic status minority students in Chicago

To assess overweight and related risk factors among urban low socio-economic status (SES) African-American adolescents in an attempt to study the underlying causes of ethnicity and gender disparities in overweight. Cross-sectional data collected on anthropometric measures, diet, physical activity and family characteristics from 498 students in grades 5-7 in four Chicago public schools were analysed to study the risk factors for overweight using stepwise regression analysis. Only 37.2% of the students lived with two parents. Nearly 90% had a television (TV) in their bedroom, and had cable TV and a video game system at home. Overall. 21.8% (17.7% boys versus 25.1% girls) were overweight (body mass index (BMI) >/= 95th percentile); and 39.8% had a BMI >/= 85th percentile. Compared with national recommendations, they had inadequate physical activity and less than desirable eating patterns. Only 66.1% reported having at least 20 min vigorous exercise or 30 min of light exercise in >/= 5 days over the past 7 days; 62.1% spent >3 h days- 1 watching TV/playing video games/computer, while 33.1% spent >/= 5 h days- 1. Their vegetable and fruit consumption was low, and they consumed too many fried foods and soft drinks: 55.1% consumed fried food twice or more daily and 19.5% four times or more daily; 70.3% consumed soft drinks twice or more daily and 22.0% four times or more daily on average. Gender, physical activity and pocket money were significant predictors of overweight (P < 0.05). Several factors in the students' behaviours, school and family environments may increase overweight risk among this population. There is a great need for health promotion programmes with a focus on healthy weight and lifestyle, and targeting urban low-SES minority communities.

Do Migrating Seniors Affect Business Establishment and Job Growth? An Empirical Look at Southeastern Nonmetropolitan Count ies, 2000 - 2004

Migrating seniors are choosing to live in nonmetropolitan areas. Many nonmetropolitan communities are, in turn, focusing on recruiting retirees as an economic development strategy. This paper applies a regional growth model to measure the impact of migrating seniors (between 1995 and 2000) on employment and business establishment growth in the southeastern United States from 2000 to 2004. This region is a popular senior destination due to low taxes, mild climate, inexpensive housing, and proximity to friends and families. The economic impacts of senior migration are spatially heterogeneous across the region, suggesting alternative policy implications for urban and nonurban communities.

Voices of Urban and Rural Community College Minority Faculty: Satisfaction and Opinions

Due to limited knowledge about faculty at community colleges, not much attention has been given to their job satisfaction and opinions. In particular, there is a gap in the literature relative to community college minority faculty's satisfaction in rural and urban areas. Thus, the purpose of this study was to explore minority faculty's satisfaction and opinions regarding faculty issues such as benefits, job satisfaction overall, and faculty workload. Descriptive statistics were used to analyze the data along with analysis of variance to determine if there are significant mean differences among the various geographical settings. The National Study of Postsecondary Faculty 1999 database was utilized for this study. The findings of this research revealed more similarities than differences between urban and rural minority community college faculty about their satisfaction and opinions.

Controlling Suburban and Small-Town Hoods

We currently lack systematic observational data concerning street-level interactions between police and juveniles in nonurban jurisdictions. This study uses systematic social observation (SSO) methods to examine the nature and character of police encounters with juveniles age 13 to 17 years in 20 suburban and small-town jurisdictions in terms of (a) the types of problems nonurban officers confronted while interacting with juveniles, (b) the actions taken by officers to resolve these problems, and (c) the discretionary decision making of officers in arrest situations involving juveniles. The findings suggest similarities and differences between nonurban officers and previously studied urban officers in terms of how they interact with juveniles. A discussion regarding how these findings may be interpreted is offered, highlighting the general need for more research concerning street-level interactions between police and juveniles, and the importance of including samples of nonurban communities in studies of police–juvenile encounters.

Asthma patient education opportunities in predominantly minority urban communities

Disenfranchised ethnic minority communities in the urban United States experience a high burden of asthma. Conventional office-based patient education often is insufficient to promote proper asthma management and coping practices responsive to minority patients' environments. This paper explores existing and alternative asthma information and education sources in three urban minority communities in western New York State to help design other practical educational interventions. Four focus groups (n = 59) and four town hall meetings (n = 109) were conducted in one Hispanic and two black communities. Focus groups included adult asthmatics or caretakers of asthmatics, and town meetings were open to all residents. A critical theory perspective informed the study. Asthma information and education sources, perceptions of asthma and ways of coping were elicited through semi-structured interviews. Data analysis followed a theory-driven immersion-crystallization approach. Several asthma education and information resources from the health care system, media, public institutions and communities were identified. Intervention recommendations highlighted asthma workshops that recognize participants as teachers and learners, offer social support, promote advocacy, are culturally appropriate and community-based and include health care professionals. Community-based, group health education couched on people's experiences and societal conditions offers unique opportunities for patient asthma care empowerment in minority urban communities.

Creating alliances to improve cancer prevention and detection among urban medically underserved minority groups

The East Harlem Partnership for Cancer Awareness (EHPCA) was formed in 1999 to reduce disparities in cancer screening and prevention among medically underserved minorities residing in a large urban community (East Harlem, New York City) by increasing awareness of cancer risk, prevention, and treatment, and promoting greater participation in breast, cervical, colorectal, and prostate cancer screening and early detection. The Partnership augments a 20-year collaboration between an academic medical center, a public hospital, and 2 community health centers. Needs assessments were conducted to inform program development. Cancer education, outreach, and screening programs were developed based on the PRECEED-PROCEED model for health education and health promotion programming. Needs assessments revealed that although the majority of the population (86%) was insured and had a source of primary care, cancer screening guidelines for breast, cervical, prostate, and colorectal cancers were not being followed. Outreach strategies, targeted curricula, educational sessions, and screening programs have been developed and implemented to improve knowledge levels and increase screening participation. The EHPCA is a model of a successful partnership among the public and private sectors to reduce disparities in cancer screening and prevention in a diverse, medically underserved, urban minority community. Future efforts to reduce cancer screening disparities in this population will include patient navigation and improved access to standard-of-care screening such as colonoscopy. Cancer 2006. (c) 2006 American Cancer Society.

Geographical patterns of human diet derived from stable-isotope analysis of fingernails

Carbon and nitrogen isotope ratios of human fingernails were measured in 490 individuals in the western US and 273 individuals in southeastern Brazil living in urban areas, and 53 individuals living in a moderately isolated area in the central Amazon region of Brazil and consuming mostly locally grown foods. In addition, we measured the carbon and nitrogen isotope ratios of common food items to assess the extent to which these isotopic signatures remain distinct for people eating both omnivorous and vegetarian diets and living in different parts of the world, and the extent to which dietary information can be interpreted from these analyses. Fingernail delta13C values (mean +/- standard deviation) were -15.4 +/- 1.0 and -18.8 +/- 0.8 per thousand and delta15N values were 10.4 +/- 0.7 and 9.4 +/- 0.6 per thousand for southeastern Brazil and western US populations, respectively. Despite opportunities for a "global supermarket" effect to swamp out carbon and nitrogen isotope ratios in these two urbanized regions of the world, differences in the fingernail isotope ratios between southeastern Brazil and western US populations persisted, and appeared to be more associated with regional agricultural and animal production practices. Omnivores and vegetarians from Brazil and the US were isotopically distinct, both within and between regions. In a comparison of fingernails of individuals from an urban city and isolated communities in the Amazonian region, the urban region was similar to southeastern Brazil, whereas individuals from isolated nonurban communities showed distinctive isotopic values consistent with their diets and with the isotopic values of local foods. Although there is a tendency for a "global supermarket" diet, carbon and nitrogen isotopes of human fingernails hold dietary information directly related to both food sources and dietary practices in a region.

Risk Factors for Asthma and Asthma Severity in Nonurban Children in Connecticut

To examine asthma diagnosis, asthma severity, and the presence of established asthma risk factors in children who reside in nonurban communities. A cross-sectional study was conducted of 19,076 children (6 months to 18 years of age) who lived in 146 nonurban communities in the greater Hartford, CT, region and who were enrolled in a disease-management program (Easy Breathing II; Michelle Cloutier, MD; Hartford, CT) designed to improve asthma diagnosis and treatment. The overall frequency of physician-confirmed asthma in children seeking health care was 18%. Asthma frequency was related to low socioeconomic status (SES), non-Caucasian ethnicity, male gender, age > or = 5 years, and exposure to tobacco smoke, dust, or cockroaches in the multivariate analysis. When controlling for SES, African-American children were 1.33 times more likely (95% confidence interval [CI], 1.15 to 1.53) and Hispanic children were 1.60 times as likely (95% CI, 1.38 to 1.85) as Caucasian children to have asthma. In contrast, asthma severity was related to dust exposure, a family history of asthma, non-Caucasian ethnicity, and age < or = 4 years in the multivariate analysis. African-American children (odds ratio, 1.31; 95% CI, 1.03 to 1.67) had more severe asthma diagnosed as compared to Caucasian children. Hispanic ethnicity was not associated with an increase in asthma severity. Risk factors for asthma in nonurban children are similar to risk factors in urban children. Ethnicity is a risk factor for asthma regardless of SES. Even in nonurban environments, African-American and Hispanic children have more asthma, and African-American children have more severe disease than their Caucasian counterparts.

A National Program for Injury Prevention in Children and Adolescents: The Injury Free Coalition for Kids

Injury is the leading cause of death and a major source of preventable disability in children. Mechanisms of injury are rooted in a complex web of social, economic, environmental, criminal, and behavioral factors that necessitate a multifaceted, systematic injury prevention approach. This article describes the injury burden and the way physicians, community coalitions, and a private foundation teamed to impact the problem first in an urban minority community and then through a national program. Through our injury prevention work in a resource-limited neighborhood, a national model evolved that provides a systematic framework through which education and other interventions are implemented. Interventions are aimed at changing the community and home environments physically (safe play areas and elimination of community and home hazards) and socially (education and supervised extracurricular activities with mentors). This program, based on physician-community partnerships and private foundation financial support, expanded to 40 sites in 37 cities, representing all 10 US trauma regions. Each site is a local adaptation of the Injury Free Coalition model also referred to as the ABC's of injury prevention: A, "analyze injury data through local injury surveillance"; B, "build a local coalition"; C, "communicate the problem and raise awareness that injuries are a preventable public health problem"; D, "develop interventions and injury prevention activities to create safer environments and activities for children"; and E, "evaluate the interventions with ongoing surveillance." It is feasible to develop a comprehensive injury prevention program of national scope using a voluntary coalition of trauma centers, private foundation financial and technical support, and a local injury prevention model with a well-established record of reducing and sustaining lower injury rates for inner-city children and adolescents.

Characteristics of Urban and Nonurban Youth Enrolled in a Statewide System-of-Care Initiative Serving Children and Families

Central goals of system-of-care initiatives for children and families have been to decrease the use of restrictive services while increasing the use of community-based resources. However, the menu of appropriate community services must in part be based on characteristics of children and families presenting within a particular community and may differ by urban and nonurban residence. The present study aimed to compare characteristics of child and adolescent clients from urban and nonurban communities in an attempt to begin to inform the development of appropriate community programming. Using intake data from all referrals to the 23 systems of care in Connecticut from July 1, 2001, to June 30, 2002, comparisons were made between youth from urban and nonurban areas. Analyses demonstrated lower rates of bipolar disorder, hospital and foster-home placement and higher levels of caregiverreported intrapersonal strength and general child functioning among urban compared to nonurban youth. That these differences could not be attributed to correlates of urban residence, such as income, ethnicity, child poverty, high school dropout rates, and crowding, suggests the possibility that as yet unexamined variables might mitigate these risk factors.The continued examination of group differences meant to inform this important issue is warranted.

Fear of (and Fascination with) a Black Planet: The Relocation of Rap by White Non-Urban Youth

For many youth residing in non-urban communities, music plays a central role in perceptions of absent or marginal populations. Often lacking other resources to inform their understandings of race, rap fans residing in these sites understand the performances of Tupac Shakur, Snoop Dogg and other artists as authentic representations of African-American and -Canadian identities. Based on interviews conducted for a wider study on the affectivity of popular music on non-urban youth, this paper explores interpretations of rap music by youth residing in a culturally homogeneous research site, as well as their relocated performances of (what they perceive to be) the black urban male experience. Furthermore, this paper examines the tensions that exist between these youth and their peers, many of whom characterize rap culture as incongruent with the dominant attitudes and practices of their locality.

Sustained benefit of a community and professional intervention to increase acute stroke therapy.

The ultimate test of an educational intervention is the sustainability of the effect after the intervention ceases. The TLL Temple Foundation Stroke Project was a quasi-experimental study aimed at increasing Food and Drug Administration-approved acute stroke therapy in a nonurban community in east Texas. During the intensive community and professional intervention (phase 2), significantly more patients with acute stroke received intravenous tissue plasminogen activator (tPA) compared with the preintervention period (phase 1). In the comparison community, no change was noted. We present the results of tPA treatment in the 6 months after the intervention ended (phase 3). Two hundred thirty-eight patients had a validated stroke during phase 3. Among patients who experienced an ischemic stroke, 11.2% in the intervention group received intravenous tPA compared with 2.2% in phase 1 (P =.007). In the comparison group, 1.4% received intravenous tPA in phase 3 compared with 0.7% in phase 1 (P>.99). Among eligible candidates for treatment, 69.2% were treated in phase 3 in the intervention community compared with 13.6% in phase 1 (P =.002). In the comparison group, 20.0% were treated in phase 3 compared with 6.7% in phase 1 (P =.45). There was 1 protocol violation among the 9 patients treated in the intervention community in phase 3. There was a sustained benefit of the intervention in increasing tPA treatments in the intervention community even after cessation of the educational effort. Treatments in the control community remained few through all 3 phases of the study. A carefully planned multilevel intervention can improve community stroke treatments even in a nonurban community.

Sex and acute stroke presentation

Study objectives: We determine whether a sex difference exists for acute stroke emergency department presentation. Methods: The TLL Temple Foundation Stroke Project is a prospective observational study of acute stroke management that identified 1,189 validated strokes in nonurban community EDs from February 1998 to March 2000. Structured interview of the patient and the person with the patient at symptom onset identified the symptom or symptoms that prompted the patient to seek medical attention. Interview data were available for 1,124 (94%) patients. A physician blinded to sex classified the reported symptoms into 14 categories. Results: Nontraditional stroke symptoms were reported by 28% of women and 19% of men (odds ratio 1.62; 95% confidence interval 1.2 to 2.2). Nontraditional stroke symptoms, pain (men 8%, women 12%) and change in level of consciousness (men 12%, women 17%), were more often reported by women. Traditional stroke symptoms, imbalance (men 20%, women 15%) and hemiparesis (men 24%, women 19%), were reported more frequently by men. Trends were also found for women to present with nonneurologic symptoms (men 17%, women 21%) and men to present with gait abnormalities (men 11%, women 8%). There was no sex difference in the mean number of symptoms reported by an individual patient. Conclusion: This study suggests that a sex difference exists in reporting of acute stroke symptoms. Women with validated strokes present more frequently with nontraditional stroke symptoms than men. Recognition of this difference might yield faster evaluation and management of female patients with acute stroke eligible for acute therapies. [Ann Emerg Med. 2002;40:453-460.]