A Demographic and Behavioral Profile of Homeless Youth in New York City: Implications for AIDS Outreach and Prevention

Rapid changes in the world market economy have served to destabilize many local institutions, widening the gap between the rich and the poor and undermining viability of key social and economic institutions such as family and household. Among those most deeply affected by this displacement are children and adolescents, many of whom are forced to leave family institutions before they have acquired the skills and maturity needed to become economically self-sufficient. Fending for themselves amid the vagaries of the underworld of virtually every major city in the world, these youths are at exceptional risk for a wide range of poor health outcomes and premature death. While perhaps a familiar sight in many non-Western countries, this phenomenon also has emerged in the industrialized world, a fact that accounts for the rise in exposure to violence and disease among street-involved youth and young adults in nations such as the United States. There are as yet few empirical data available about the nature of these youth populations or the constellation of behaviors that place them at increased risk for disease outcomes. In this report we construct a demographic and behavioral profile of the homeless youth population in New York City, particularly as behavioral patterns relate to risk associated with HIV infection.     

One Tragedy in Reference to Another: September 11 and the Obligations of Museum Commemoration

Yahrzeit: September 11 Observed. Museum of Jewish Heritage—A Living Memorial to the Holocaust, New York. August 29, 2002—January 5, 2003.
. Shared Experience: 04.19.95-09.11.01. Oklahoma City National Memorial Center Museum, Oklahoma City. April 19, 2002—September 1, 2003.
. Day of Reflection and Remembrance. United States Holocaust Memorial Museum, Washington, D.C. September 11, 2002.     

Psychological Resilience after Hurricane Sandy: The Influence of Individual- and Community-Level Factors on Mental Health after a Large-Scale Natural Disaster

Several individual-level factors are known to promote psychological resilience in the aftermath of disasters. Far less is known about the role of community-level factors in shaping postdisaster mental health. The purpose of this study was to explore the influence of both individual- and community-level factors on resilience after Hurricane Sandy. A representative sample of household residents (N = 418) from 293 New York City census tracts that were most heavily affected by the storm completed telephone interviews approximately 13–16 months postdisaster. Multilevel multivariable models explored the independent and interactive contributions of individual- and community-level factors to posttraumatic stress and depression symptoms. At the individual-level, having experienced or witnessed any lifetime traumatic event was significantly associated with higher depression and posttraumatic stress, whereas demographic characteristics (e.g., older age, non-Hispanic Black race) and more disaster-related stressors were significantly associated with higher posttraumatic stress only. At the community-level, living in an area with higher social capital was significantly associated with higher posttraumatic stress. Additionally, higher community economic development was associated with lower risk of depression only among participants who did not experience any disaster-related stressors. These results provide evidence that individual- and community-level resources and exposure operate in tandem to shape postdisaster resilience.     

The Invisible Suffering: Sexual Coercion,Interpersonal Violence,and Mental Health - A Cross-Sectional Study among University Students in South-Western Uganda

Background

Despite a history of conflicts and widespread human rights violation in sub-Saharan Africa, little is known about the prevalence of interpersonal violence among the population in this region. Evidence from high-income countries suggests that exposure to violence has mental health consequences and violence also has associations with experiences of sexual coercion.

Aims

This study sought to investigate the prevalence of physical and perceived threats of violence among university students in Uganda and to assess the possible relationship between such violence, sexual coercion, and symptoms of anxiety, depression, and psychoticism, respectively.

Method

In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic factors, social capital, importance of religion, mental health, experience of violence and sexual coercion, and sexual behaviour factors. Logistic regression analysis was applied as the main analytical tool.

Results

Of those who responded, 28% reported perceived threats/threats of violence and 10% exposure to actual physical violence over the previous 12 months, with no significant gender differences in exposure history. Exposure to violence was significantly associated with the experience of sexual coercion among both males and females. Sexual coercion and threats/threats of violence were both significantly associated with poor mental health in males and females, but only males showed a strong association between exposure to physical violence and poor mental health.

Conclusion

The current study suggests that in terms of general exposure, both males and females in the study population are equally exposed to sexual coercion and interpersonal violence, and both male and female students show generally similar mental health effects of exposure to such violence. The prevalence of interpersonal violence found in our study population may have long-term negative health implications. Our findings may serve as a baseline for interventions and continuing research aimed at preventing interpersonal violence.     

Competing Constructivisms: The Negotiation of PTSD and Related Stigma Among Post-9/11 Veterans in New York City

Posttraumatic stress disorder (PTSD) stands as a form of psychopathology that straddles moral and psychiatric domains. Grounded in discrete instances of trauma, PTSD represents an etiological outlier in an era of increased attention to the genetics of mental illness and a prime location for social constructivist analyses of mental illness. This examination of PTSD narratives—as voiced in qualitative interviews and focus groups with 50 veterans of the recent Iraq and Afghanistan wars living in New York City—attends to the processes through which veterans conceive and navigate PTSD symptoms and diagnoses. In so doing we highlight the social constructivist positions undertaken by veterans themselves as they varyingly challenge and internalize symptomology in dialogue with psychiatric definitions and the stigma associated with PTSD. Findings demonstrate the rejection of classic psychopathological etiology—in brain disease, for example—by many veterans as well as the complex balancing of benefit and stigma that veterans undertake when making decisions about presenting to psychiatric clinicians. Drawing on veterans’ accounts, we argue for greater cultural specificity in characterizing the diagnosis-seeking behavior of trauma survivors and a greater appreciation for the contradictions and compromise related to both acceptance and rejection of a mental health diagnosis.     

“You're Really Gonna Kick Us All Out?” Sustaining Safe Spaces for Community-Based HIV Prevention and Control among Black Men Who Have Sex with Men

Black men who have sex with men (BMSM) experience among the highest rates of HIV infection in the United States. We conducted a community-based ethnography in New York City to identify the structural and environmental factors that influence BMSMs vulnerability to HIV and their engagement with HIV prevention services. Methods included participant observation at community-based organizations (CBOs) in New York City, in-depth interviews with 31 BMSM, and 17 key informant interviews. Our conceptual framework shows how creating and sustaining safe spaces could be a critical environmental approach to reduce vulnerability to HIV among BMSM. Participant observation, in-depth and key informant interviews revealed that fear and mistrust characterized men’s relation to social and public institutions, such as churches, schools, and the police. This fear and mistrust created HIV vulnerability among the BMSM in our sample by challenging engagement with services. Our findings suggest that to be successful, HIV prevention efforts must address these structural and environmental vulnerabilities. Among the CBOs that we studied, “safe spaces” emerged as an important tool for addressing these environmental vulnerabilities. CBOs used safe spaces to provide social support, to address stigma, to prepare men for the workforce, and to foster a sense of community among BMSM. In addition, safe spaces were used for HIV and STI testing and treatment campaigns. Our ethnographic findings suggest that safe spaces represent a promising but so far under-utilized part of HIV prevention infrastructure. Safe spaces seem integral to high impact comprehensive HIV prevention efforts, and may be considered more appropriately as part of HIV capacity-building rather than being nested within program-specific funding structures.     

What Madness Prompts, Reason Writes: New York City September 11–October 2, 2001

This personal narrative describes the use of ethnographic data collection as a means for its author, a New York City resident, to take stock of local reaction and response to the events of September 11 by documenting arid analyzing the writing New Yorkers posted in public spaces during the three weeks following the attacks on the World Trade Center.     

Obesity,Social Class,and Mental Illness

The relationship between obesity and mental health was investigated, using data obtained from 1,660 persons selected as representative of 110,000 inhabitants of a residential area of New York City. In addition to confirming the previously noted relationship between obesity and age, preliminary analysis revealed a striking relationship between obesity and socioeconomic status of origin. The prevalence of obesity was 7 times higher among women reared in the lowest social class category as compared with those reared in the highest category. Scores made by the obese respondents on 9 mental health indices were compared with scores made by individuals of average weight. The obese respondents made more pathological scores on 8 of the 9 measures and on 3 of these the difference was statistically significant (“immaturity,” “rigidity,” and “suspiciousness”).     

Investigating Exposure to Violence and Mental Health in a Diverse Urban Community Sample: Data from the South East London Community Health (SELCoH) Survey

Background

General population surveys have seldom examined violence as a multidimensional concept and in relation to an array of mental disorders.

Methods

Data from the South East London Community Health Study was used to examine the prevalence, overlap and distribution of proximal witnessed, victimised and perpetrated violence and their association with current mental disorders. We further investigated the cumulative effect of lifetime exposure to violence on current mental disorders. Unadjusted and adjusted (for confounders and violence) models were examined.

Results

In the last twelve months, 7.4% reported witnessing violence, 6.3% victimisation and 3.2% perpetration of violence. There was a significant overlap across violence types, with some shared correlates across the groups such as being younger and male. Witnessing violence in the past year was associated with current common mental disorders (CMD) and post-traumatic stress disorder (PTSD) symptoms. Proximal perpetration was associated with current CMD, PTSD symptoms and past 12 months drug use; whereas proximal victimisation was associated with lifetime and past 12 months drug use. Lifetime exposure to two or more types of violence was associated with increased risk for all mental health outcomes, suggesting a cumulative effect.

Conclusion

Exposure to violence needs to be examined in a multi-faceted manner: i) as discrete distal and proximal events, which may have distinct patterns of association with mental health and ii) as a concept with different but overlapping dimensions, thus also accounting for possible cumulative effects.     

纽约弹性城市建设经验及其对上海的启示

面临气候变化带来的全球性环境、社会、经济灾难,许多国家、地区都制定了应对方案并采取行动。与上海市有着同样区位优势的纽约市,作为全球城市在有关气候变化的城市治理方面一直处于国际领先地位,引领全球城市开展弹性城市建设。在总结纽约弹性城市建设发展历程基础上,分析纽约市弹性城市建设所面临的挑战和机遇,未来100年总目标及其包含4个分目标,以及实现这4个分目标的具体措施。最后,对比纽约市与上海市的相似性,从弹性城市项目建设、投融资、区域合作、政府治理这4个方面为上海市弹性城市建设带来启示。     

A partial explanation of superior birth weights among foreign-born women

This study of 766 black women reexamined the issue of advantage in birthweight and length of gestation in foreign-born women and confirms the reported higher birthweights among that group. Subjects were new registrants for prenatal care at a public clinic in Harlem, New York City, 1971-73, and were part of a randomized trial of nutritional supplementation during pregnancy. 3 nativity groups were represented: New York City, southern United States, and foreign countries. Despite the standard selection of all subjects for high risk for low birthweight, foreign-born women had only 3.8% of births under 2500 grams in contrast to 15.6% among the southern women, and 18% among New York City natives. 6 sets of variables were examined in relation to birthweight outcome. An average birthweight advantage of 218 grams for the foreign-born was found to be associated with higher childhood social status and more positive health behaviors.     

Interactions between Handler Well-Being and Canine Health and Behavior in Search and Rescue Teams

ABSTRACT

This study reports on three years of prospective, longitudinal data on the psychological well-being of the human handlers and the health and behavior of the search and rescue dogs deployed in New York City and Washington, DC in the aftermath of the terrorist attacks on September 11, 2001. Eighty-five human handlers (63 deployed and 22 controls) and ninetyfour dogs (66 deployed, 28 controls) were assessed at multiple time points including 6 months, 1 year, 2 years, and 3 years after the 9/11 attacks. Humans were assessed for psychological health by structured clinical interview and self-report. Dogs were assessed for physical health and behavior by veterinary records and handler report. For humans, deployment after 9/11 did indeed represent a relatively short-term risk factor for developing symptoms of depression and posttraumatic stress disorder (PTSD). By and large, however, the sample showed remarkable resilience as a whole, and overall rates of DSM-IV diagnoses were quite low. By year 3, 9/11 deployment no longer conferred any special risk. On the other hand, long-term employment in an emergency profession did emerge as a significant risk factor for symptoms of PTSD by year 3. With respect to the interaction between handler emotional well-being and canine health and behavior, we found that physical illness and/or death in the dog was prospectively associated with greater symptoms of depression in the handler. We also found that symptoms of depression and PTSD in the handlers prospectively predicted behavioral problems in the dogs over time. Separation anxiety, attachment/attention seeking, chasing, and excitability emerged in the dogs at 1 year. Behavioral problems escalated to aggression towards other dogs at year 2 and separation anxiety, aggression towards other dogs, and aggression towards strangers at year 3. Like any relationship, the partnership between a handler and his or her working dog can confer both protection—when the relationship is going well and both members are healthy—and vulnerability—when either member is physically ill or psychologically or behaviorally distressed.     

Mental health problems of homeless children and families: longitudinal study

Objective: To establish the mental health needs of homeless children and families before and after rehousing. Design: Cross sectional, longitudinal study. Setting: City of Birmingham. Subjects: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. Main outcome measures: Children’s mental health problems and level of communication; mothers’ mental health problems and social support one year after rehousing. Results: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P=0.04; children 39% v 11%, P=0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. Conclusions: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.

Key messages

• Homeless children and their mothers have a high level of mental health problems
• Homeless families experience many risk factors, such as domestic violence, abuse, and family and social disruption
• In two fifths of children and a quarter of mothers, mental health problems persisted after rehousing
• In contrast with a comparison group of families of low socioeconomic status, a substantial proportion of homeless families remained residentially and socially unstable

     

A Century of Tuberculosis Epidemiology in the Northern and Southern Hemisphere: The Differential Impact of Control Interventions

Background

Cape Town has one of the highest TB burdens of any city in the world. In 1900 the City of Cape Town, New York City and London had high mortality of tuberculosis (TB). Throughout the 20th century contemporaneous public health measures including screening, diagnosis and treatment were implemented in all three settings. Mandatory notification of TB and vital status enabled comparison of disease burden trajectories.

Methods

TB mortality, notification and case fatality rates were calculated from 1912 to 2012 using annual TB notifications, TB death certifications and population estimates. Notification rates were stratified by age and in Cape Town by HIV status (from 2009 onwards).

Results

Pre-chemotherapy, TB mortality and notification rates declined steadily in New York and London but remained high in Cape Town. Following introduction of combination chemotherapy, mean annual case fatality dropped from 45–60% to below 10% in all three settings. Mortality and notification rates subsequently declined, although Cape Town notifications did not decline as far as those in New York or London and returned to pre-chemotherapy levels by 1980. The proportional contribution of childhood TB diminished in New York and London but remained high in Cape Town. The advent of the Cape Town HIV-epidemic in the 1990s was associated with a further two-fold increase in incidence. In 2012, notification rates among HIV-negatives remained at pre-chemotherapy levels.

Conclusions

TB control was achieved in New York and London but failed in Cape Town. The TB disease burden trajectories started diverging before the availability of combination chemotherapy in 1952 and further diverged following the HIV epidemic in 1990. Chemotherapy impacted case fatality but not transmission, evidenced by on-going high childhood TB rates. Currently endemic TB results from high on-going transmission, which has been exacerbated by the HIV epidemic. TB control will require reducing transmission, which is inexorably linked to prevailing socio-economic factors.     

The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort.

OBJECTIVES--To report outcome of targeting community mental health services to people with schizophrenia in an inner London district who had been shown, one year after discharge, to have high levels of psychotic symptomatology and social disability but very low levels of supported housing and structured day activity. DESIGN--Repeat interview survey of symptoms, disability, and receipt of care four years after index discharge. SETTING--Inner London health district with considerable social deprivation and a mental hospital in the process of closure. SUBJECTS--51 patients originally aged 20-65 years who satisfied the research diagnostic criteria for schizophrenia. MAIN OUTCOME MEASURES--Contact with services during the three months before interview, levels of symptoms (from present state examination), global social disability rating. RESULTS--65% (33/51) of the study group had been readmitted at least once in the three years between surveys. Recent contacts with community psychiatric nurses and rates of hospital admission increased (8 at one year v 24 at four years, p < 0.01; 5 v 13, p < 0.06). Conversely, fewer patients were in contact with social workers (17 v 7, p < 0.03). Proportions in supported housing, day care, or sheltered work did not change. Unemployment rates remained very high. A considerable reduction (almost a halving) in psychiatric symptoms was observed, but there was no significant change in mean levels of social disability. CONCLUSIONS--The policy of targeting the long term mentally ill resulted in significant increases in professional psychiatric input to the cohort but failed to improve access to social workers or suitable accommodation. Improvements in social functioning did not follow from reductions in the proportions of patients with psychotic mental states. Social interventions are likely to be crucial to achieving the Health of the Nation target of improving social functioning for the seriously mentally ill, as improving mental state seems in itself to be insufficient.     

Luis Hidalgo and his Sculpture in Wax

Early America in Miniatures: The 18th Century: Sterling Publishing Co., Inc. New York City 10016 $10.95 cloth. Reviewed by Marie Woodruff

Designs From Plant Forms: Universe Books New York City 10016 $4.95 paper. Reviewed by John W. Wadsworth

It's Easy to Carve: Doubleday &; Co., Inc. Garden City, New York $5.95 cloth. Reviewed by Frank D. Torre

Printmaking: A Beginning Handbook: Prentice-Hall Inc. Englewood Cliffs, New Jersey 07632 $9.95 paper $18.95 cloth. Reviewed by William C. Maxwell

The Golden Book of Hand &; Needle Arts … selected from The Family Creative Workshop Western Publishing Co., Inc. New York City 10022 $5.95 paper $10.95 cloth

Contemporary Crafts Market Place 1977–1978 … compiled by the American Crafts Council R. R. Bowker Co. New York City 10036 $15.95 paper     

Factors influencing mutual gaze in captive female Japanese monkeys (<Emphasis Type="Italic">Macaca fuscata</Emphasis>)

Mutual gaze occurs when two animals simultaneously look at each other, and therefore signals reciprocal visual attention. We studied the occurrence of mutual gaze among adult female Japanese monkeys (Macaca fuscata) housed at the Central Park Zoo in New York City (USA). We found that the frequency of mutual gaze varied according to one aspect of social context (proximity), and that monkeys’ age-rank was negatively correlated with the frequency of mutual gaze. The behavioral contexts in which mutual gaze was observed did not include aggression, and social rank did not predict frequency of mutual gaze. Mutual gaze therefore varies according to some aspects of social context and is generally predicted by factors that influence other social behaviors (e.g., age).     

Dog bites in New York City

The purpose of this review is to characterize the public health problem of dog bites in New York City. Dog bites represent a major source of morbidity, mortality, disability, and health care cost in the United States. The most severe injuries are frequently referred to the plastic surgeon. The authors have recently treated several severe cases of unprovoked dog attacks in children. To characterize the dog bite problem in New York City, data were obtained for 1998 from the New York City Department of Health. During that year, 6568 bites were reported by the mandated physician reporters in the five boroughs of New York City. The upper extremities, lower extremities, and face were predominantly affected. The peak incidence occurred during the summer months and in children ages 7 to 9 years old. Preventive measures are discussed.