Special Feature on the Built Environment???s Connection to Mental and Physical Health in Latest Issue of Academy???s Journal of Urban Health

NEW YORK CITY, Jan. 28???-A four-article feature exploring the mental and physical health repercussions of poor community design is among the research appearing in the latest issue of the Journal of Urban Health: Bulletin of the New York Academy of Medicine. In addition, a special supplement to the Journal examines the individual and societal factors that lead drug-using populations to acquire and transmit HIV/AIDS.

Elevated risk of cardiovascular disease, obesity and depression are very real health consequences of substandard living environments, the authors explain. ???People cannot be healthy in unhealthy environments,??? Academy President Dr. Jeremiah A. Barondess and colleagues write in an accompanying editorial.

Women with young children who live in poor-quality high-rise housing appear to suffer greater psychological distress, for example, explains Gary W. Evans, Ph.D., in ???The Built Environment and Mental Health??? (p. 536). Similarly, loud exterior noise sources like airports lead to elevated stress levels in the general population, and insufficient daylight causes depressive symptoms. ???Exposure to poor environmental conditions is not randomly distributed, and tends to concentrate among the poor and ethnic minorities,??? writes Evans, a professor in the Departments of Design and Environmental Analysis and Human Development at Cornell University.

Socioeconomically disadvantaged neighborhoods are plagued by higher rates of coronary heart disease and cardiovascular mortality, Ana V. Diez Roux points out in ???Residential Environments and Cardiovascular Risk??? (p. 569). A dearth of accessible recreational facilities and green spaces, unsafe surroundings, and a lack of wholesome, affordable food choices may all contribute to elevated heart disease risk in lower income neighborhoods, said Diez Roux, M.D., Ph.D., M.P.H., Associate Director of the Center for Social Epidemiology and Population Health at the University of Michigan. ???Health depends not only on the biological characteristics of individuals but also on the environments where people live, and these environments are in turn shaped by???economic and social policies,??? Diez Roux writes.

In a special 10-article supplement addressing how HIV is acquired and transmitted among drug-using populations, researchers from the Academy and other institutions examine the spread of HIV among drug users and how to prevent it. An important first step is to better understand why drug use risk behavior???like sharing dirty needles, or having unprotected sex ??? is higher among certain populations, write Sandro Galea, M.D., M.P.H., Dr. P.H., and colleagues from the Academy???s Center for Urban Epidemiologic Studies.

???Most approaches to HIV prevention in U.S. urban areas???where most new AIDS cases occur???have focused on individual risk behavior such as needle sharing,??? said Galea, lead author of ???Contextual Determinants of Drug Use Risk Behavior: A Theoretic Framework??? (p. iii50). ???However, such risk behaviors occur in the context of communities, where a lack of available resources, and marginalization of drug-users by residents and health care or social service providers, can influence individual behaviors.??? Efforts to achieve positive health outcomes need to consider not only what to do with the clients, but must address provider and community level issues, he said.

The December issue of the Journal also contains a special three-article feature on the use of behavioral and social sciences by health departments in major cities including New York. Behavior-change approaches to health include education campaigns encouraging prenatal care (to reduce infant mortality) and use of condoms (to reduce HIV infections).

???About half of all deaths in the U.S. can be attributed to social and behavioral factors such as use of tobacco or alcohol and diet and activity patterns, yet the nation devotes only about five percent of health expenditures to reducing these risks,??? writes Marybeth Shinn, Ph.D., a psychology professor at New York University. Shinn and colleagues authored the article, ???Use of Social and Behavioral Sciences by Public Health Departments in Major Cities??? (p.616).

This issue of the Journal also includes a variety of intriguing studies that make the following significant urban health findings: