Poor Urban Communities Research Articles

Hispanics/Latinos in the Bronx Have Improved Survival in Non-Small Cell Lung Cancer Compared with Non-Hispanic Whites.

Hispanics/Latinos are a growing yet understudied population in the United States (US). Despite lower socioeconomic status, Hispanics/Latinos tend to have similar or better health outcomes than Non-Hispanic Whites (NHWs). This phenomenon has not been conclusively studied for lung cancer. Using a cohort of patients at Montefiore Medical Center (MMC) in the Bronx, NY, we examined factors related to lung cancer survival by race/ethnicity with an emphasis on Hispanics/Latinos. Subjects were diagnosed with non-small cell lung cancer (NSCLC) between 2004 and 2017. Demographic and clinical data were obtained from MMC's clinical systems and tumor-related information from MMC/Einstein's Cancer Registry. Survival was assessed using Cox proportional hazards modeling adjusted for clinical and sociodemographic factors including smoking. Factors related to survival within each major racial/ethnic group were examined. Hispanics/Latinos experienced decreased risk of death relative to NHWs [hazard ratio (HR) = 0.70, 95% confidence interval (95%CI) 0.57-0.86] overall and by sex (males: HR = 0.78, 95%CI 0.59-1.03, females: HR = 0.61, 95%CI 0.44-0.86). Decreased risk among Hispanics/Latinos relative to NHWs was evident in never-smokers (HR = 0.55, 95%CI 0.29-1.01), ever-smokers (HR = 0.72, 95%CI 0.57-0.90), younger subjects (HR = 0.73, 95%CI 0.54-0.99), and older subjects (HR = 0.72, 95%CI 0.53-0.97). Surgery was associated with improved survival in Hispanics/Latinos (HR = 0.60, 95%CI 0.43-0.85), and smoking with worse survival (HR = 1.56, 95%CI 1.02-2.39). Survival did not differ between Non-Hispanic Blacks and NHWs. In a poor urban community, Hispanics/Latinos experience improved survival from NSCLC compared to NHWs, which is not entirely explained by smoking. Future research should investigate the drivers of this benefit and differences in survival by Hispanic/Latino origin.

From victimhood to hubs of (trans)formation and local agency: Re-imagining poor urban communities

This article was written from the perspective of a black African who has been unfairly subjected to colonialism, apartheid and neo-colonialism. This African is learning to simultaneously blame others for mistakes committed against him and interrogate his own agency in being an answer to his own prayers. He has observed that communities of poverty are usually seen as undesirable. As a consequence of this, most of its residents prefer to move away, if they have the option of doing so. This article explored the concept of thin places as a vehicle to nurture agency amongst people living in communities of poverty such as Soshanguve. It uses the narrative approach of storytelling to recount particular past events and present ones as a tool to cultivate a ‘can-do attitude’ in ordinary people. The goal is to raise agents of hope who will bring good news to their neighbours and anybody else, using biblical principles as a critical tool in their toolkit. Communities of poverty are usually seen as undesirable. As a consequence, most of its residents prefer to move out, if they have the choice to do so. This article reflects on the efforts of a missional team, InnerCHANGE, to help residents of the township of Soshanguve migrate from a victim mentality to become agents of their own hope. It uses a theology of place that alludes to concepts of thin places which challenges ordinary people to become participants in the flourishing of lives around them. A reflection on agency influenced by the Black Consciousness Movement and other African scholars gave context, meaning and relevance to such a theology of place. Stories of agency from Africa are remembered and retold to inspire ordinary people. Some of the latter have taken to heart these inspirational stories and have been transformed into agents. This article calls such people transformation agents. A conclusion was made that the Church needs to continue playing its prophetic role in society. Such a role could entail reminding people of existing assets they may have such as stories told around them of people who defied the normal victim mentality seen in poor communities and actively built thin places around them.Intradisciplinary and/or interdisciplinary implications: This article was based on the field of missiology. It engaged historical facts (history) in a way that could nurture and develop agency in ordinary people. It challenges a general apathy towards community involvement found within the body of Christ located in South African communities of poverty.

Urban poverty alleviation strategies in Yogyakarta, Indonesia: Contrasting opportunities for community development

A multidimensional understanding of poverty includes the access of poor groups to decision‐making processes based on their needs and aspirations. However, the realisation of this ‘right to make decisions’ faces multiple obstacles. Over the last 20 years in Indonesia, in a context of a more democratic political environment and policy decentralisation, poverty alleviation policies have followed institutional arrangements to provide communities with opportunities for greater participation in development projects. Poverty data show a clear improvement in the living conditions of urban poor citizens in Indonesia; however, it is unclear whether poor communities have become stronger and more independent from public grants and better able to make their own decisions. This research analysed two urban poor communities in Yogyakarta, Indonesia, and found that some communities working on participatory poverty alleviation strategies still face obstacles to becoming more independent and making their own decisions because they remain part of an historical legacy of top‐down approaches to poverty, highly dependent on government support and working only within ‘invited spaces’. Conversely, those communities with more limited access to government funding have been more innovative in their strategies and have created ‘invented spaces’ for collective action that allows them to be more independent and empowered.

Intra-household cooperation and inter-generational communication in the extended family: a field experiment in a poor urban community in Africa

There is a dearth of studies on cooperation within the extended inter-generational family, a common living arrangement in Africa. This study employs a communication treatment and a 10-item Family Communication Scale (FCS) of the Family Adaptability and Cohesion Evaluation Scales (FACES IV) to explain cooperation in a Voluntary Contribution Mechanism (VCM) beyond the laboratory. The study applies the Random Effect regression analysis. The results show that inter-generational cooperation is heterogeneous, limited and subject to decay, with stronger cooperation up the generational hierarchy. The framed field experiment presents evidence of the positive impact on cooperation of face-to-face communication and of positive perceptions of family communication. More specifically, communication mitigates contribution decay and enhances cooperation, especially between parents and grandparents and their children and grandchildren. Inter-generational transfers and the associated investment in family-type public goods can be augmented by social developmental policies such as parenting skills training that enhance family communication and in turn, intra-household cooperation.

Knowledge and Screening Practices for Cervical Cancer Among Urban Poor Communities in Ibadan, Nigeria

PURPOSE Prevalence of cervical cancer remains high in sub-Saharan Africa, including Nigeria. Literature has documented knowledge of cervical cancer as important in promoting the adoption of preventive strategies, including screening, but most research has focused on women and health organization settings. This study assessed knowledge and screening practices of cervical cancer among male and female adults in urban poor communities in Ibadan, Oyo State, Nigeria. METHODS A cross-sectional study was carried out in two urban poor community settings in Ibadan. Data were collected from 250 randomly selected consenting respondents in each of the two communities (N = 500). Data were collected with an electronic device using the electronic data capture tool (Open Data Kit) database. Descriptive statistics were summarized using frequencies and percentages for categorical variables, and mean and standard deviation were used for continuous variables. Knowledge was scored on a scale of 0 to 39 points (0 to 18, low knowledge; 19 to 23, fair knowledge; 24 to 39, high knowledge). Associations between variables were tested using χ2. RESULTS Mean age of respondents was 35.36 years (± 12.24). The majority of respondents were female (70.6%), and more than half (52.6%) had completed secondary school education. The majority had never heard of the Papanicolaou test (93.6%) or cervical cancer screening (91.2%), and only 10% had ever heard of the human papillomavirus vaccine for the prevention of cervical cancer. The majority had low knowledge of cervical cancer (77.2%); knowledge included detection, symptoms, and risk factors for cervical cancer. Only 7.4% of females had ever heard of the Papanicolaou test, and few women (4%) had ever been screened for cervical cancer using the Papanicolaou test. Only one woman (0.2%) had been screened for cervical cancer using visual inspection with acetic acid, and four (0.8%) had ever taken human papillomavirus vaccine for protection against cervical cancer. There was a significant association between knowledge of cervical cancer and employment status of respondents (χ2 = 11.19; P < .05). CONCLUSION Health promotion interventions and strategies for awareness creation about cervical cancer and screening practices should be used in alleviating low knowledge and screening practices in urban poor communities.

A Geographic Account of Economic, Health, and Educational Disparities in Hartford’s Sheff Region

In the current study, I use geographic techniques to examine the distribution of key housing, economic, health, and educational indicators in metropolitan Hartford. I focus in particular on factors that bear upon the lives of children in this area, also known as the Sheff region—a reference to the long-standing Sheff v. O’Neill school desegregation lawsuit. The results reveal substantial disparities in the geographic distribution of important resources and outcomes across the racially and economically stratified region. Despite earnest school desegregation efforts, the opportunities, access, and resources available to children in municipalities across the metro Hartford region remain starkly different. Children of color living in central Connecticut’s poor urban communities are disproportionately affected by a highly fragmented sociopolitical geography. Recommendations are made for more comprehensive, cross-sector policy interventions as well as regional collaboratives.

Co-Production as a Driver of Urban Governance Transformation? The Case of the Oplan LIKAS Programme in Metro Manila, Philippines

ABSTRACTSocial movement-initiated co-production has been increasingly described as an approach that enables urban poor communities in the South to gain wider access to urban governance. However, with a predominant focus on project-level interventions, the case studies in which movements truly affect governance matters in a metro scale are rare. One of the examples involving such an achievement is the activism of civil society organisations and urban poor groups in Metro Manila, Philippines, which have succeeded to have a major impact on the housing and resettlement programme; the Oplan LIKAS. This article analyses how the civil society was able to gain such a position and the way it utilised it. The documentation of the challenges experienced by the civil society reflects the nature of co-productive engagement in the South and shows that it may easily reach its limits in an exclusionary governance setting.

Explanatory models of stroke in Ghana: perspectives of stroke survivors and their caregivers

ABSTRACT Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra. Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness. Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke. Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.

Mental health of children exposed to intimate partner violence against their mother: A longitudinal study from Brazil.

Exposure to intimate partner violence (IPV) is an important adverse childhood experience, but there are few longitudinal studies in low and middle-income countries. To investigate the consequences of exposure to IPV for a child's mental health. 614 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Women were interviewed in pregnancy, postpartum and six to nine years after delivery, and asked about their experience of IPV, and the exposure of their child to violence. The Strengths and Difficulties Questionnaire (SDQ) was completed by child's mother and teacher. Ten types of child experience of IPV and the age of onset of exposure were compared with the child's behavioral profile at school age. The mothers reported that 372/614 (60.6%) children had been exposed to IPV. The commonest types of child exposure to IPV were "prenatally", "overheard", "eyewitnessed", and 10.0% of children were physically or verbally involved in the IPV. Mothers reported high SDQ Total Difficulties scores in 71.7% of all children exposed to IPV and teachers in 59.8%. Multivariate logistic regression analysis demonstrated the strongest association with behavioral difficulties was with exposure to IPV in the age group 1-2 years (OR 2.5 [95% CI: 1.3-4.8]). Young children are sensitive to the age of first exposure to IPV and to the type of IPV. Interventions to reduce IPV should be targeted on vulnerable women from poor urban communities during their pregnancies and in the first two years of their child's life.

Worlding aspirations and resilient futures: Framings of risk and contemporary city‐making in Metro Cebu, the Philippines

In the Philippines, calls for creating ‘global’, ‘sustainable’ and ‘resilient’ cities are placing urban poor communities in increasingly precarious positions. These communities have long been the targets of urban development and ‘modernisation’ efforts; more recently the erasure of informal settlements from Philippine cities is being bolstered at the behest of climate change adaptation and disaster risk management (DRM) agendas. In Metro Cebu, flood management has been at the heart of DRM and broader urban development discussions, and is serving as justification for the demolition and displacement of informal settler communities in areas classed as ‘danger zones’. Using Kusno's (2010) interpretation of the ‘exemplary centre’ as a point of departure, this paper interrogates the relationship between DRM, worlding aspirations (Roy and Ong, 2011) and market‐oriented urbanisation in Cebu, and considers the socio‐spatial implications of these intersecting processes for urban poor communities. Through analysing the contradictions inherent in framings of certain bodies and spaces as being ‘of risk’ or ‘at risk’ over others, I argue that the epistemologies of modernity, disaster risk and resilience endorsed and propagated by the state are facilitating processes of displacement and dispossession that serve elite commercial interests under the auspices of disaster resilience and pro‐poor development.

Is Bangkok becoming more resilient to flooding? A framing analysis of Bangkok's flood resilience policy combining insights from both insiders and outsiders

The rapidly urbanizing cities in Southeast Asia experience increasing flood impacts due to the consequences of climate change. In these cities, policy efforts to build flood resilience are gaining momentum. The aim of this paper is to understand and assess flood resilience policy development, particularly in cities in developing countries. Bangkok is one of the cities that participates in the 100 Resilient Cities Programme (100RC) - the international policy platform for building resilient cities. In 2017, the Bangkok Metropolitan Administration (BMA) launched the ‘Bangkok Resilience Strategy’ to translate the resilience concept to its urban context. A framing perspective is adopted to reconstruct the strategy, process and anticipated outcome of Bangkok's flood resilience policy. We studied data obtained from ‘insiders’ (involved policy makers, experts and consultants) and ‘outsiders’ (local communities, civil society organizations and news media). Findings indicate that the economic growth frame is prevailing in the development of Bangkok's flood resilience policy, prioritizing structural flood protection with little attention for flood adaptation measures and related social impacts among vulnerable communities. The role of local communities and civil society in the formulation of Bangkok's flood resilience policy is limited. This paper therefore recommends cities in developing countries and cities in the 100RC Programme to organize a more inclusive resilience building process for addressing social problems regarding urban poor communities along with increasing flood safety and protection.

Climate change and flood risk: vulnerability assessment in an urban poor community in Mexico:

The impacts of climate change tend to be unevenly distributed, affecting mostly urban poor communities. This research analyses the case of El Colli, a community with high levels of marginalization ...

Climate change and flood risk: vulnerability assessment in an urban poor community in Mexico

The impacts of climate change tend to be unevenly distributed, affecting mostly urban poor communities. This research analyses the case of El Colli, a community with high levels of marginalization and urban poverty in an area characterized by informal settlements in the Metropolitan Area of Guadalajara (state of Jalisco, Mexico). The main objective was to analyse the vulnerability to climate change in El Colli, focusing on the flood risk it is exposed to and using a mixed-methods design with various research tools. The findings show the specific aspects of vulnerability in a context of urban poverty, in which basic municipal services are scarce, government action is inadequate and residents show a high acceptance of risk. Based on the data, we state the need to incorporate local urban challenges into the debate on climate change, particularly those affecting informal settlements.

Aggressive Policing and the Educational Performance of Minority Youth

An increasing number of minority youth experience contact with the criminal justice system. But how does the expansion of police presence in poor urban communities affect educational outcomes? Previous research points at multiple mechanisms with opposing effects. This article presents the first causal evidence of the impact of aggressive policing on minority youths’ educational performance. Under Operation Impact, the New York Police Department (NYPD) saturated high-crime areas with additional police officers with the mission to engage in aggressive, order-maintenance policing. To estimate the effect of this policing program, we use administrative data from more than 250,000 adolescents age 9 to 15 and a difference-in-differences approach based on variation in the timing of police surges across neighborhoods. We find that exposure to police surges significantly reduced test scores for African American boys, consistent with their greater exposure to policing. The size of the effect increases with age, but there is no discernible effect for African American girls and Hispanic students. Aggressive policing can thus lower educational performance for some minority groups. These findings provide evidence that the consequences of policing extend into key domains of social life, with implications for the educational trajectories of minority youth and social inequality more broadly.

Vulnerability of informal settlements in the context of rapid urbanization and climate change

Rapid urbanization and climate change together increase the vulnerability of poor urban communities to natural hazards, undermining urban resilience. It is therefore critical to identify and deepen our understanding of the main variables, and the complex interactions between them, producing and shaping the vulnerability of poor urban communities to natural hazards. Identifying factors that challenge or support the efforts of these communities in responding to hazards is also helpful in policymaking for urban resilience. To develop this understanding, it is necessary to conduct detailed research at the local scale. This paper aims to contribute to this knowledge by applying participatory modelling techniques to a particular case study of an informal settlement in Durban, South Africa. The aim is to elucidate how this detailed empirical research can contribute to broader theoretical knowledge on urban vulnerability and resilience in the face of climate change and rapid urbanization.

Experience and Future Perceived Risk of Floods and Diarrheal Disease in Urban Poor Communities in Accra, Ghana.

Diarrheal disease is a critical health condition in urban areas of developing countries due to increasing urbanization and its associated problems of sanitation and poor access to good drinking water. Increasing floods in cities have been linked to the risk of diarrheal disease. There are few studies that specifically link flooding with diarrhea diseases. This may be due to the fact that secondary data mainly hospital recorded cases, and not individual cases at the household level are used. Furthermore, of the few papers that consider the flood-diarrheal diseases nexus, none have considered risk perceptions in general, and more specifically, whether households that have experienced floods which resulted in a reported case of diarrhea, have higher perceived risks of future occurrences of the two phenomena compared to households that had different experiences. Yet, this is critical for the development of interventions that seek to increase protective behaviors and reduce the risk of contracting diarrhea. We surveyed 401 households in some selected urban poor communities in Accra, the capital of Ghana. Results show that households that experienced floods which resulted in a reported case of diarrhea, have higher perceived risk of future occurrence of the two phenomena compared to other households. We recommend public education that reduces the risk of exposure to flood and diarrhea through flood mitigation measures, including the construction of drains in communities and educating communities on good sanitation.

Do prepaid water meters improve the quality of water service delivery? The case of Nakuru, Kenya

Conventional water metering has a tendency of being unreliable, inaccurate, and a source of dispute and disquiet among customers, and hence it is considered to be one primary reason why water service providers perform poorly and have very low revenue collection figures. The result of this poor performance spirals into poor management, ineffective maintenance, inaccurate billing and high non-revenue water. This study explored what a prepaid metering project in Nakuru, Kenya achieved, and to see whether or not prepayment can be considered to be an innovative way of addressing these concerns, especially how to provide better service, when providing water to the urban poor. In addition, the study investigated micro financing as tools for supporting efforts by water service providers serving the poor and whether they are an effective way of financing projects. Communal prepaid meters were installed in an existing conventional network and data on commonly used performance evaluation parameters collected through interviews, field visits, and existing literature. The results portrayed prepaid metering with positive improvements to the conventional metering. It was found that there is an opportunity in microfinance for win-win partnerships among financial institutions, water service providers and low-income customers to help them in increasing access to water services. Communal prepaid meters are now bankable and viable options for serving urban poor communities.

The Human Microbiome and Child Growth - First 1000 Days and Beyond.

The assembly of microbial communities within the gastrointestinal tract during early life plays a critical role in immune, endocrine, metabolic, and other host developmental pathways. Environmental insults during this period, such as food insecurity and infections, can disrupt this optimal microbial succession, which may contribute to lifelong and intergenerational deficits in growth and development. Here, we review the human microbiome in the first 1000 days - referring to the period from conception to 2 years of age - and using a developmental model, we examine the role of early microbial succession in growth and development. We propose that an 'undernourished' microbiome is intergenerational, thereby perpetuating growth impairments into successive generations. We also identify and discuss the intertwining host-microbe-environment interactions occurring prenatally and during early infancy, which may impair the trajectories of healthy growth and development, and explore their potential as novel microbial targets for intervention.

A Community-Based Clinical Breast Examination Program: Is it Feasible?

Purpose Breast cancer presents in advanced stages in low- and middle-income countries where screening mammography is not available. In Malaysia, almost 60% of women, particularly in those the low socioeconomic group, present with stage III and IV breast cancer. We evaluated the feasibility of a community-based early detection program using clinical breast examination (CBE) carried out by the Breast Cancer Welfare Association, a nongovernmental organization. Methods Using a mobile clinic that was equipped to carry out CBE, a team of six health professionals trained in CBE techniques reached out to urban poor communities on the outskirts of the city and the rural population at the invitation of community leaders. At these events, breast self-awareness was taught to the community, with particular regard to the signs and symptoms of breast cancer and to breast self-examination. CBE was carried out in those women who agreed to be examined. Women who were found to have breast lumps were referred to the nearest public hospital and were observed for compliance. Women with anxiety were counseled. Results In 2016 to 2017, CBE was performed for 7,503 women, and 295 (3.9%) were found to have a palpable breast lump. These women were referred to the nearest hospital for additional assessment. Of these women, 156 (52.9%) consulted the doctor and sought additional examination. A total of 153 patients had no malignant findings, whereas three were found to have breast cancer. The mean age for women found to have a palpable breast lump was younger than 40 years—35 years in 2016 and 33 years in 2017—whereas the median age among the 295 women was 33 years in 2016 and 31 years in 2017 (range, 17 to 67 years). Conclusion A community outreach program using CBE as a method of early detection is feasible in Malaysia. Additional study is required to determine why 47% of those who were found to have a breast lump did not seek additional assessment. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Community and individual sense of trust and psychological distress among the urban poor in Accra, Ghana.

BackgroundMental health disorders present significant health challenges in populations in sub Saharan Africa especially in deprived urban poor contexts. Some studies have suggested that in collectivistic societies such as most African societies people can draw on social capital to attenuate the effect of community stressors on their mental health. Global studies suggest the effect of social capital on mental disorders such as psychological distress is mixed, and emerging studies on the psychosocial characteristics of collectivistic societies suggest that mistrust and suspicion sometimes deprive people of the benefit of social capital. In this study, we argue that trust which is often measured as a component of social capital has a more direct effect on reducing community stressors in such deprived communities.MethodsData from the Urban Health and Poverty Survey (EDULINK Wave III) survey were used. The survey was conducted in 2013 in three urban poor communities in Accra: Agbogbloshie, James Town and Ussher Town. Psychological distress was measured with a symptomatic wellbeing scale. Participants’ perceptions of their neighbours’ willingness to trust, protect and assist others was used to measure community sense of trust. Participants’ willingness to ask for and receive help from neighbours was used to measure personal sense of trust. Demographic factors were controlled for. The data were analyzed using descriptive and multivariate regressions.ResultsThe mean level of psychological distress among the residents was 25.5 (SD 5.5). Personal sense of trust was 8.2 (SD 2.0), and that of community sense of trust was 7.5 (SD 2.8). While community level trust was not significant, personal sense of trust significantly reduced psychological distress (B = -.2016728, t = -2.59, p < 0.010). The other factors associated with psychological distress in this model were perceived economic standing, education and locality of residence.ConclusionThis study presents evidence that more trusting individuals are significantly less likely to be psychologically distressed within deprived urban communities in Accra. Positive intra and inter individual level variables such as personal level trust and perceived relative economic standing significantly attenuated the effect of psychological distress in communities with high level neighbourhood disorder in Accra.