Multilevel Models

The government provided an opportunity for social science to verify the existence of neighborhood effects, but how can we study those effects without the powers of the state behind us Fortunately, the statistical sophistication of behavioral scientists has improved since the time of Mayer and Jencks' critique. It is now widely recognized that multilevel models can sort out the differences between compositional and contextual effects. The statistical logic of multilevel modeling was discussed in...

Intervention Studies

In intervention studies, the investigator controls the exposure status of study participants. The randomized clinical trial, which has the central elements of randomization to control and comparison arms, is generally used to evaluate the efficacy of therapeutic regimens, including drug therapies. A key strength of the randomized clinical trial is control of selection bias and confounding through randomization. The design has potential application to occupational and environmental exposures in...

Competencies for Urban Clinicians

Physicians, nurses, dentists, psychologists, and other urban clinicians should be able to describe how different types and levels of exposure to urban living conditions affect well-being. Depending on their discipline and specialty area, they should also be able to explain how urban living influences the clinical course and management of common illnesses (e.g., asthma, depression, hypertension, diabetes, influenza), characterize significant disparities in health within urban populations, and...

Centers or Institutes on Urban Health

Other universities have chosen to create institutes or centers on urban health. These organizations usually include researchers and sometimes practitioners from several disciplines, conduct research and service projects within urban settings, and often offer continuing education, academic courses, and fieldwork opportunities. Unlike academic departments, they usually do not offer degrees or academic tenure to their faculty. Often, they rely heavily on grants and contracts for financial support,...

Barriers To Health Care

Many of the health problems that affect LGBT people disproportionately result from or are exacerbated by prejudice, discrimination and stigma (Brotman, et al., 2002 Cahill, et al., 2002 Dean, et al., 2000 Diaz and Ayala, 2001 Meyer, 2001). In addition, such forces clearly play a role in LGBT people's willingness and ability to access health services as well as the quality of services they receive. These impediments can be rooted in the biases of providers, institutionalized in agency policies...

Addressing Selectivity Bias

In what follows, we outline how selectivity biases can stem from the choices made by respondents whether in terms of migration, residential mobility, or group participation and discuss the statistical tools available to assess the importance of this bias and protect inference against it. Cross-sectional designs provide only a few such tools, whereas longitudinal data much expand the possibilities. The essence of the problem can be seen in a highly simplified depiction of locational choice. Let...

Minority Groups And The Urban Environment

As stated throughout this chapter, minorities are more likely to live in urban cities, where features of the urban environment either enhance or negatively affect health. Individuals' characteristics have been seen as the panacea to produce and promote positive health outcomes. However, individuals live and interact with their peers in urban areas under circumstances that provide an enhancing or damaging milieu for health. Therefore, it is important to understand how features of the social...

Special Populations Of Urban Lgbt People

In addition to a city's social environment, physical environment, and provision of health services, the composition, diversity and density of urban populations also play a role in the health of urban LGBT residents because they include sub-populations of LGBT people facing special health needs or barriers to care. For instance, census data suggest that individuals in same-sex couples are as racially diverse as the general U.S. population (Rubenstein, et al., 2003), and more than a quarter of...

Welfare Economic Theory

Other critics have raised questions about welfare economic theory as a basis for cost effectiveness analysis. While a full review of theory is available elsewhere, I restrict my comments here to considerations that are important for applying CEA to urban health. Welfare theory is a branch of economics that examines the desirability of alternative allocation of resources (Garber and Phelps, 1997 Brouwer and Koopmanschap, 2000). (It is not at all about welfare, financial assistance to...

Eleven Principles Of The Who Health Cities Project

The following section considers those basic principles underlying the building of healthy cities. It briefly presents the eleven principles that the World Health Organization has repeatedly presented in documentation about the WHO Healthy Cities project to characterise healthy cities (Goldstein, 2000 Tsouros, 1990). Each paragraph explains how these principles can be interpreted to construct healthy cities. The 11 principles of a healthy city are shown in Table 1. 1. The meeting of basic needs...

Monetized Measures of Poverty

Researchers investigating the determinants of urban health in the U.S. or Europe often take for granted the availability of income data for households and aggregated data on median incomes, rates of poverty, and the like for census tracts and other geographic entities. In developing countries, however, data such as these are seldom available in general, and are almost never available from censuses. In part this is because wage and salary work is far from being the dominant form of employment in...

Chronic Diseases

Common chronic diseases, including hypertension, diabetes, chronic obstructive pulmonary disease (COPD), seizures, and musculoskeletal disorders, are often undiagnosed or inadequately treated in homeless adults. Relatively little research has focused on these medical conditions in the homeless population. The prevalence of hypertension was higher among homeless clinic patients than among non-homeless patients at an inner-city primary care clinic (65 vs. 52 ) (Szerlip and Szerlip, 2002). The...

References

Advisory Council for the Elimination of Tuberculosis. (1992b). Prevention and control of tuberculosis among homeless persons. Recommendations of the Advisory Council for the Elimination of Tuberculosis. Morbidity & Mortality Weekly Report, Recommendations & Reports 4 13-23. Advisory Council for the Elimination of Tuberculosis (1992a). Prevention and control of tuberculosis among homeless persons. Recommendations of the Advisory Council for the Elimination of Tuberculosis. Morbidity &...

Specification of Research Question

Clear specification of a research question is the necessary first step in all etiologic and interventional epidemiologic research and is often one of the hardest. More specifically, the greatest challenge in the epidemiologic study of urban health is in adequate specification of research questions that address how and why urban living may affect health. There are three primary reasons why this task may be particularly challenging in urban health. First, much of what may be considered urban...

Community Organizing In Urban Neighborhoods

This particular intervention has been designed to enhance the urban core of American grid cities which tend to have been planned without any provisions of significant public gathering places. Community organizing in urban neighborhoods can reverse alienation and foster a sense of responsibility that counteracts urban blight it encourages residents to take initiative against social disorder and physical deterioration (Wilson, 1996). Neighborhood stewardship manifested in physical improvements of...

Potential Strategies For Improving The Health Of People In Cities Of Nepal

The process of rapid urban growth is inevitable in Nepal but it should be harnessed in a planned way to ensure a safe urban environment as well as the health and well being of urban citizens. Therefore, health concerns should be the heart of urban planning and urban environmental management practices. Environmentally friendly urban planning and healthy city programs should be the key to planned development and management of urban growth. The Health Impact Assessment of urban policies, programs,...

Case Control Studies

The case-control design has been used extensively to characterize occupational and environmental causes of cancer, but much less frequently for other diseases, and it has had limited application specifically to urban environmental health problems. The design has proved particularly useful for cancer, as there is often a lengthy period from the time of first exposure until excess risk is manifest. The cases and controls themselves are the principal source of information on exposure. Some...

Demography Of Lgbt People

The nature, composition and size of the gay community have been the subject of much debate. Indeed, whether or not LGBT people constitute a community at all is often questioned. And if such a community exists, how ought it be defined Is this a community that can be defined geographically or by its institutions and organizations Or is this an imagined community that exists, not in any spatial location, but in the sense of a shared affinity and common purpose Woolwine, 2000 Are its members...

Framing The Problem 21 Life in the Grid City

Most American towns and cities have been laid out with a grid pattern comprised of streets and side streets crossing at right angles Figure 1 . Such a simple network of orthogonal streets that intersect in a regular manner creates rectangular or square city blocks. The rationale of city planning to shape the urban environment with this pattern of vertical and horizontal streets lies in increased connectivity the possible routes between any given two points is maximized. Short of diagonal...

Residential Segregation And Gentrification

A major problem of urban cities is the residential segregation of minority groups, which leads to economic constraints, lack of social and material resources, and diminished social capital. Residential segregation results, in part, from two of the most dominant demographic trends in almost all cities in the U.S., suburbanization i.e., white flight and metropolitan deconcentration Browne, 2000 Immergluck, 2001 Massey and Denton, 1988 . Metropolitan deconcentration reflects the process of...

The Costs of Longitudinal Approaches

None of the advantages from longitudinal research comes without cost, especially if long durations of observation are needed to monitor the health outcomes of interest. Consider studies of seasonal variations in health, the effects of climate or ecological change, mortality and morbidity due to diseases with long latency periods, and the impact of behavioral interventions whose effects are slow to develop. In rich countries such as the U.S., the extra costs have not precluded longitudinal...