We used an environmental justice screening tool (CalEnviroScreen 1.1) to compare the distribution of environmental hazards and vulnerable populations across California communities.
CalEnviroScreen ...1.1 combines 17 indicators created from 2004 to 2013 publicly available data into a relative cumulative impact score. We compared cumulative impact scores across California zip codes on the basis of their location, urban or rural character, and racial/ethnic makeup. We used a concentration index to evaluate which indicators were most unequally distributed with respect to race/ethnicity and poverty.
The unadjusted odds of living in one of the 10% most affected zip codes were 6.2, 5.8, 1.9, 1.8, and 1.6 times greater for Hispanics, African Americans, Native Americans, Asian/Pacific Islanders, and other or multiracial individuals, respectively, than for non-Hispanic Whites. Environmental hazards were more regressively distributed with respect to race/ethnicity than poverty, with pesticide use and toxic chemical releases being the most unequal.
Environmental health hazards disproportionately burden communities of color in California. Efforts to reduce disparities in pollution burden can use simple screening tools to prioritize areas for action.
Abstract Background Colorectal cancer is the second most prevalent cause of death from malignancies globally. The present study was conducted targeting the influence of an educational intervention ...based on the health belief model (HBM) on colorectal cancer screening behaviors in people 50 years old and older. Methods All 134 samples were included in this quasi-experimental study from Fasa City Health Service Center, equal halves were random into experimental group and control group. The data collection tool was a questionnaire that contained questions on demographic variables, knowledge, and HBM constructs (perceived sensitivity, perceived intensity, perceived benefits, perceived barriers, self-efficacy, and screening behaviors). Both groups answered the questionnaire before and two months following the intervention. There were six 90-minute instruction sessions for the intervention group. SPSS 22 and descriptive and analytical tests (independent t-test, paired t-test, and Chi-square test) were used for data analysis ( P < 0.05). Results 59 women and 75 men took part in this study. A majority of participants were married and had at least high school diploma. The findings indicated that the mean scores for knowledge, each of the HBM’s constructs, and cancer screening behaviors did not differ significantly from one another before the intervention between the test group and the control group. However, post the intervention, the intervention group exhibited a significant rise in all mentioned dimensions. Conclusion In light of the outcomes, the application of the HBM on colorectal cancer screening behaviors in people 50 years and older was successful. This approach might serve as a helpful foundation for planning, carrying out, and overseeing colorectal cancer screening programs.
Water pollution is one of the major threats to public health in Pakistan. Drinking water quality is poorly managed and monitored. Pakistan ranks at number 80 among 122 nations regarding drinking ...water quality. Drinking water sources, both surface and groundwater are contaminated with coliforms, toxic metals and pesticides throughout the country. Various drinking water quality parameters set by WHO are frequently violated. Human activities like improper disposal of municipal and industrial effluents and indiscriminate applications of agrochemicals in agriculture are the main factors contributing to the deterioration of water quality. Microbial and chemical pollutants are the main factors responsible exclusively or in combination for various public health problems. This review discusses a detailed layout of drinking water quality in Pakistan with special emphasis on major pollutants, sources of pollution and the consequent health problems. The data presented in this review are extracted from various studies published in national and international journals. Also reports released by the government and non-governmental organizations are included.
This study examines the association between objectively measured access to green space, frequency of green space use, physical activity, and the probability of being overweight or obese in the city ...of Bristol, England. Data from the 2005 Bristol Quality of Life in your Neighbourhood survey for 6821 adults were combined with a comprehensive GIS database of neighbourhood and green space characteristics. A range of green space accessibility measures were computed. Associations between accessibility and the odds of respondents achieving a recommended 30min or more of moderate activity five times a week, or being overweight or obese, were examined using logistic regression. Results showed that the reported frequency of green space use declined with increasing distance. The study also found that respondents living closest to the type of green space classified as a Formal park were more likely to achieve the physical activity recommendation and less likely to be overweight or obese. The association with physical activity, but not with overweight or obesity, remained after adjustment for respondent characteristics, area deprivation, and a range of characteristics of the neighbourhood environment. The findings suggest that the provision of good access to green spaces in urban areas may help promote population physical activity.
Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban–rural differences in psychiatric disorders.
Objective: Reviews of urban–rural differences in psychiatric disorders conclude ...that urban rates may be marginally higher and, specifically, somewhat higher for depression. However, pooled results are not available.
Method: A meta‐analysis of urban–rural differences in prevalence was conducted on data taken from 20 population survey studies published since 1985. Pooled urban–rural odds ratios (OR) were calculated for the total prevalence of psychiatric disorders, and specifically for mood, anxiety and substance use disorders.
Results: Significant pooled urban–rural OR were found for the total prevalence of psychiatric disorders, and for mood disorders and anxiety disorders. No significant association with urbanization was found for substance use disorders. Adjustment for various confounders had a limited impact on the urban–rural OR.
Conclusion: Urbanization may be taken into account in the allocation of mental health services.
Objectives. To estimate the population lacking at least basic water and sanitation access in the urban United States.
Methods. We compared national estimates of water and sanitation access from the ...World Health Organization/United Nations Children’s Fund Joint Monitoring Program with estimates from the US Department of Housing and Urban Development on homelessness and the American Community Survey on household water and sanitation facilities.
Results. We estimated that at least 930 000 persons in US cities lacked sustained access to at least basic sanitation and 610 000 to at least basic water access, as defined by the United Nations.
Conclusions. After accounting for those experiencing homelessness and substandard housing, our estimate of people lacking at least basic water equaled current estimates (n = 610 000)—without considering water quality—and greatly exceeded estimates of sanitation access (n = 28 000).
Public Health Implications. Methods to estimate water and sanitation access in the United States should include people experiencing homelessness and other low-income groups, and specific policies are needed to reduce disparities in urban sanitation. We recommend similar estimation efforts for other high-income countries currently reported as having near universal sanitation access.
Background The share of people over 80 years in the European Union is estimated to increase two-and-a-half-fold from 2000 to 2100. A substantial share of older persons experiences fear of falling. ...This fear is partly associated with a fall in the recent past. Because of the associations between fear of falling, avoiding physical activity, and the potential impact of those on health, an association between fear of falling and low health-related quality of life, is suggested. This study examined the association of fear of falling with physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons in five European countries. Methods A cross-sectional study was conducted using baseline data of community-dwelling persons of 70 years and older participating in the Urban Health Centers Europe project in five European countries: United Kingdom, Greece, Croatia, the Netherlands and Spain. This study assessed fear of falling with the Short Falls Efficacy Scale-International and HRQoL with the 12-Item Short-Form Health Survey. The association between low, moderate or high fear of falling and HRQoL was examined using adjusted multivariable linear regression models. Results Data of 2189 persons were analyzed (mean age 79.6 years; 60.6% females). Among the participants, 1096 (50.1%) experienced low fear of falling; 648 (29.6%) moderate fear of falling and 445 (20.3%) high fear of falling. Compared to those who reported low fear of falling in multivariate analysis, participants who reported moderate or high fear of falling experienced lower physical HRQoL (beta = -6.10, P < 0.001 and beta = -13.15, P < 0.001, respectively). In addition, participants who reported moderate or high fear of falling also experienced lower mental HRQoL than those who reported low fear of falling (beta = -2.31, P < 0.001 and beta = -8.80, P < 0.001, respectively). Conclusions This study observed a negative association between fear of falling and physical and mental HRQoL in a population of older European persons. These findings emphasize the relevance for health professionals to assess and address fear of falling. In addition, attention should be given to programs that promote physical activity, reduce fear of falling, and maintain or increase physical strength among older adults; this may contribute to physical and mental HRQoL. Keywords: Fear of falling, Health-related quality of life, Community-dwelling older adults
Objectives
To determine the effect of home‐based primary care (HBPC) on Medicare costs and mortality in frail elders.
Design
Case–control concurrent study using Medicare administrative data.
Setting
...HBPC practice in Washington, District of Columbia.
Participants
HBPC cases (n = 722) and controls (n = 2,161) matched for sex, age bands, race, Medicare buy‐in status (whether Medicaid covers Part B premiums), long‐term nursing home status, cognitive impairment, and frailty. Cases were eligible if enrolled in MedStar Washington Hospital Center's HBPC program during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland, and Pennsylvania.
Intervention
HBPC clinical service.
Measurements
Medicare costs, utilization events, mortality.
Results
Mean age was 83.7 for cases and 82.0 for controls (P < .001). A majority of both groups was female (77%) and African American (90%). During a mean 2‐year follow‐up, in univariate analysis, cases had lower Medicare ($44,455 vs $50,977, P = .01), hospital ($17,805 vs $22,096, P = .003), and skilled nursing facility care ($4,821 vs $6,098, P = .001) costs, and higher home health ($6,579 vs $4,169; P < .001) and hospice ($3,144 vs. $1,505; P = .005) costs. Cases had 23% fewer subspecialist visits (P = .001) and 105% more generalist visits (P < .001). In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary (P = .003) over 2 years of follow‐up. There was no difference between cases and controls in mortality (40% vs 36%, hazard ratio = 1.06, P = .44) or in average time to death (16.2 vs 16.8 months, P = .30).
Conclusion
HBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.
To determine how relevant the items on the activities-specific balance confidence (ABC) scale are to patients living in an urban setting and to evaluate additional items relevant to urban populations ...but not included in the current version of the scale.
Cross-sectional clinical survey.
Urban, tertiary vestibular rehabilitation clinic.
Vestibular rehabilitation clinic outpatients (N=103).
N/A.
Relevance of 16 day-to-day tasks on the ABC scale on a scale of 0 (not performed) to 10 (performed regularly); median relevancy score (MRS) for most relevant items.
One hundred three participants (73.7% female, mean age 61.5± years) with vestibular disorders completed the survey. The items with the highest MRS were walking around a house (MRS=10), reaching for a shelved item eye level (MRS=9), taking the stairs (MRS=7), bending over and picking up a slipper (MRS=7), and stepping onto or off an escalator while holding the railing (MRS=7). Lowest MRS items to someone living in an urban environment included walking across a parking lot to the mall (MRS=0) and walking outside the house to a car parked in the driveway (MRS=0). The most common functional activities not addressed by ABC score included navigating the subway/public transit (35.9%) and walking through crowds (32.0%).
This study revealed insights about important activities of daily living for those in an urban setting. Results show that the ABC scale should be modified to better reflect the specific activities of urban dwellers.
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