Academy???s Latest Journal of Urban Health Includes Important New Findings on Pressing Health Concerns

NEW YORK CITY, Aug. 28???Research examining a spectrum of pressing urban issues???including homeless women???s reluctance to use faith-based services, young gay men???s ignorance about cutting-edge HIV treatments, and kids??? perceived lack of safety in schools???can be found in the September issue of the Journal of Urban Health: Bulletin of The New York Academy of Medicine. Some intriguing studies in this issue include:

-Homeless women with no religious affiliation are only half as likely to use faith-based shelters and meal programs as Christian women, according to a new study by Kevin Heslin and colleagues. Additionally, African-American women and Latinas are less likely than white women to use faith-based providers.

The findings suggest that faith-based social service programs like those being promoted by the Bush Administration are not acceptable to all homeless individuals, said Heslin, Ph.D., an Assistant Professor of Medicine at the Charles R. Drew University of Medicine and Science in Los Angeles. Non-religious homeless women may avoid those providers because they fear they???ll be pressured to participate in worship or other religious activities. As a result, these clients would be less likely to benefit from the government???s increased funding of faith-based programs, researchers said. ???Homeless individuals need shelter and food regardless of their religious affiliation or race/ethnicity,??? Heslin said. ???These findings underscore concerns about the constitutionality of the faith-based initiative.???

The researchers analyzed data from the UCLA Homeless Women???s Health Study, a survey of 974 homeless women conducted at 78 shelters and meal programs in Los Angeles County. Approximately 12 percent of homeless women have no religious affiliation, the authors said.

-A substantial minority of youths feel unsafe in their daily lives, and the school environment appears to play a major role in instigating those fears, according to a study of more than 10,000 10- to 18-year-olds and their parents. Youths who reported feeling unsafe were also more likely to perceive their schools as disorderly environments, according to co-authors Tod Mijanovich and Beth Weitzman of the Center for Health and Public Service Research in New York University???s Robert F. Wagner Graduate School of Public Service. This news is especially disturbing considering that schools are viewed as safe-havens for after-school activities and other purposes, the authors said. ???Disorderly schools can be found anywhere: rich suburbs as well as inner cities, private as well as public schools,??? said Mijanovich, a research scientist. ???Unless school disorderliness can be addressed, it may be very difficult, academically and psychologically, for children to find themselves for longer periods of time in environments they perceive as unsafe.???

The authors analyzed a random-dial telephone survey of 7,716 adults and 2,768 youths conducted in 1998-99 among urban and suburban residents of Baltimore, Detroit, Oakland (California), Philadelphia, and Richmond (Virginia). Fifteen percent of kids age 10-18 report feeling unsafe at school, which amounts to ???a significant public health problem,??? the authors said. Perceived disorder was almost twice as prevalent in public schools (33 percent) as in private schools (18 percent), but urban and suburban youths expressed nearly equal levels of concern about feeling unsafe at school, according to the study. Nearly 31 percent of all students said their schoolmates ???get away with anything.??? How to fix the school climate and make adolescents feel safer? By promoting teacher-student communication and trust, and enforcing rules fairly and consistently, the authors suggest.

-Parents in disadvantaged urban neighborhoods who consistently supervise and monitor their children through adolescence make a visible difference in keeping them out of trouble and away from drugs, according to a six-year study of more than 1,000 urban youths led by Jacqueline J. Lloyd, Ph.D., Assistant Professor at the University of Maryland School of Social Work. The researchers followed a pool of predominantly African-American students attending a single urban public school system in a mid-Atlantic state from 1989 through 1994, beginning at age 8-9 and ending at age 13-14. Youths who were more strictly supervised and monitored by parents beginning at age 8-9 were less likely to socialize with delinquent and drug-using peers, even when living in a high-risk urban environment, Lloyd and colleagues found. Better behavior continued right through the teen years when parents continued to impose high levels of supervision. While previous studies have found connections between parental monitoring and youthful deviance, they have mostly focused on white youths studied at a single point in time, Lloyd said.

Parents should be heartened to know that they can learn supervision and monitoring skills that will guide their children???s behavior, Lloyd said. ???Parents can calibrate these skills to help prevent and reduce a child???s levels of engagement with delinquent and drug using peers, even when the child is growing up and going to school in disadvantaged urban neighborhoods,??? she said.

-Many young, minority New York City men who have sex with men are unaware of the life-sustaining HIV medication therapy known as HAART, according to a study led by Beryl Koblin, Ph.D., of the New York Blood Center in New York City. A survey of 15- to 22-year-old men who have sex with men (MSM) found that those who are young, minority, HIV-negative and/or from New Jersey were least likely to be aware of HAART, or highly active antiretroviral therapy. The findings are particularly disturbing since young men are more likely to have unprotected sex and are therefore at higher risk for HIV infection that demands treatment. More than 35 percent of those surveyed reported having unprotected receptive anal sex in the last six months, for example.

HAART has transformed HIV/AIDS from a death sentence into a frequently manageable illness since entering widespread clinical use in 1996. This is the first study to examine HAART awareness among young and ethnically diverse MSM, the authors said. Most previous surveys have involved white MSM in their 30s. This survey, conducted among 816 men in New York City and Seattle in 1997-98, showed that only 35 percent of the New York City men had heard of HAART, compared to 61.6 percent of men in Seattle. The next generation of at-risk MSM should be made aware of this advanced HIV therapy through counseling venues and educational campaigns, the authors said. ???These discussions need to happen in a wide range of settings to reach the variety of subcultures within young populations,??? the authors wrote.

Copies of the studies are available upon request. The Journal of Urban Health is published quarterly by The New York Academy of Medicine. The Academy is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on urban populations, especially the disadvantaged.

Posted on August 29, 2003

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