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Padilla M, Varas-Diaz N, Rodríguez-Madera S, Vertovec J, Rivera-Custodio J, Rivera-Bustelo K, Mercado-Rios C, Matiz-Reyes A, Santiago-Santiago A, González-Font Y, Ramos-Pibernus A, Grove K. "They think we wear loincloths": Spatial stigma, coloniality, and physician migration in Puerto Rico. Med Anthropol Q 2024; 38:224-239. [PMID: 38642372 DOI: 10.1111/maq.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/10/2024] [Indexed: 04/22/2024]
Abstract
Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island's presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history.
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Affiliation(s)
- Mark Padilla
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | - Nelson Varas-Diaz
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | | | - John Vertovec
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
- Research Department, Behavioral Science Research Institute, Coral Gables, Florida, USA
| | - Joshua Rivera-Custodio
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kariela Rivera-Bustelo
- Social Sciences Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Claudia Mercado-Rios
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Armando Matiz-Reyes
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | | | - Yoymar González-Font
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Alixida Ramos-Pibernus
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kevin Grove
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
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2
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Schwartz GL, Wang G, Kim MH, Glymour MM, White JS, Collin D, Hamad R. Individual and regional differences in the effects of school racial segregation on Black students' health. SSM Popul Health 2024; 26:101681. [PMID: 38840850 PMCID: PMC11152755 DOI: 10.1016/j.ssmph.2024.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/03/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background School racial segregation in the US has risen steadily since the 1990s, propelled by Supreme Court decisions rolling back the legacy of Brown v. Board. Quasi-experimental research has shown this resegregation harms Black students' health. However, whether individual or family characteristics (e.g., higher family incomes) are protective against segregation's health harms-or whether segregation is more damaging in regions of the US with fewer public sector investments-remains unclear. We leverage the quasi-random timing of school districts being released from Brown-era integration plans to examine heterogeneity in the association between resegregation and Black students' health. Methods & findings We took an instrumental variables approach, using the timing of integration order releases as an instrument for school segregation and analyzing a pre-specified list of theoretically-motivated modifiers in the Panel Study of Income Dynamics. In sensitivity analyses, we fit OLS models that directly adjusted for relevant covariates. Results suggest resegregation may have been particularly harmful in the South, where districts resegregated more quickly after order releases. We find little evidence that the effects of school segregation differed across family income, gender, or age. Conclusion The end of court-ordered integration threatens the health of Black communities-especially in the US South. Modestly higher incomes do not appear protective against school segregation's harms. Research using larger samples and alternative measures of school segregation-e.g., between districts, instead of within districts-may further our understanding of segregation's health effects, especially in Northern states.
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Affiliation(s)
- Gabriel L. Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
- Urban Health Collaborative & Department of Health Management & Policy, Drexel University Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19147, USA
| | - Guangyi Wang
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
| | - Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Daniel Collin
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94158, USA
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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3
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Littleton T, Freisthler B. Affordable Housing and Neighborhood Child Maltreatment Reports. CHILD MALTREATMENT 2023:10775595231218177. [PMID: 37994644 DOI: 10.1177/10775595231218177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Reports of child maltreatment vary by neighborhood characteristics, yet the influence of housing affordability is less understood. The current study examines the relationship between reports of suspected child maltreatment and the spatial distribution of affordable housing across 2,341 census tracts in Los Angeles County, California. Bayesian conditionally autoregressive model results indicate that neighborhoods where residents paid a greater share of their income in rent had fewer reports of suspected child maltreatment, while neighborhoods with a higher number of subsidized rental units had more reports. These findings suggest that higher cost neighborhoods provide supportive resources and amenities to families which may reduce risk of child maltreatment. Subsidized housing units are more likely to be located in high poverty, under resourced neighborhoods, thus undermining the benefits of these programs to families. These findings have implications for equitable housing policy that promotes inclusive communities as a primary prevention strategy for child maltreatment.
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Akbari H, Mohammadi M, Hosseini A. Disease-Related Stigma, Stigmatizers, Causes, and Consequences: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2042-2054. [PMID: 37899929 PMCID: PMC10612557 DOI: 10.18502/ijph.v52i10.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/14/2023] [Indexed: 10/31/2023]
Abstract
Background Stigma is a sociological concept that is important in medicine and health because it threatens health as much as the disease itself. We aimed to explore the causes, stigmatizers, consequences and coping strategies related to the stigma of diseases by systematically analyzing relevant literature. Methods This systematic review examined 65 articles on Disease-Related Stigma by searching Noormags, Magiran, SID, Google Scholar, and PubMed databases. The articles were published in Persian and English between 2001 and 2022 and conducted in Iran. We used a three-step systematic review process to select articles that met the research criteria. Results Conflict in society, lack of knowledge, specific characteristics of the disease, and the contagious nature of disease are the main causes of stigma, leading to stigmatization by different groups such as significant others, generalized others, institutional others, and macro others. Patients experiencing stigma face various psychological, physical, and social complications, and they may use concealment as a coping strategy, which can pose a potential threat to society's general health. Conclusion By knowing the causes and stigmatizers of disease-related, it is possible to reduce stigma with less cost and time.
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Affiliation(s)
- Hossein Akbari
- Department of Social Sciences, Faculty of Literature and Humanities, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mahla Mohammadi
- Department of Social Sciences, Faculty of Literature and Humanities, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Abolfazl Hosseini
- Department of Social Sciences, Faculty of Literature and Humanities, Ferdowsi University of Mashhad, Mashhad, Iran
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5
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Chavanne D, Ahluwalia JS, Goodyear K. The effects of race and class on community-level stigmatization of opioid use and policy preferences. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104147. [PMID: 37639913 DOI: 10.1016/j.drugpo.2023.104147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND With opioid use and overdose rates continuing to plague minority communities in the U.S., we explored whether a geographic community's racial composition and social class affect how opioid use in the community is stigmatized and what policy preferences arise in response. METHODS We use case vignettes in a randomized, between-subjects study (N = 1478) with a nation-wide survey. The vignettes describe a community where opioids are harmfully used, varying whether the community was (1) wealthy or poor, (2) predominantly Black or White and (3) facing prevalent use of painkillers or heroin. We tested how these variables affect public stigmatization of opioid use (measured with ratings of responsibility, dangerousness, sympathy, concern, anger, and disappointment) preferred levels of social distance from communities with opioid use (measured with responses to questions about living, working, and interacting in the community), and policy preferences for responding to opioid use (measured with levels of support for providing a safe-consumption site in the community, treating drug use in the community punitively, treating drug use in the community as an illness, and funding drug treatment in the community through income redistribution). RESULTS Compared to wealthy communities with opioid use, poor communities with opioid use were less stigmatized in terms of responsibility, sympathy, concern, anger, and disappointment; they were also met with less support for punitiveness, more support for treating drug use as an illness, and preferences for greater social distance. Compared to White communities with opioid use, Black communities with opioid use were less stigmatized in terms of responsibility, and they were met with stronger preferences to not live and work there and with reduced support for using income redistribution to provide drug treatment for people in the community. Poor-Black communities with opioid use were also perceived to be more dangerous than both poor-White and wealthy-Black communities with opioid use. CONCLUSION These results point to class- and race-based territorial stigma affecting how communities with opioid use are judged and whether policies for providing communities with treatment are supported.
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Affiliation(s)
- David Chavanne
- Department of Economics, Connecticut College, New London, CT, USA.
| | - Jasjit S Ahluwalia
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA; Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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6
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Pearson AL, Zhou Y, Buxton RT, Horton TH, Pfeiffer KA, Beyer KM. The effects of contemporary redlining on the mental health of Black residents. SSM Popul Health 2023; 23:101462. [PMID: 37456619 PMCID: PMC10339054 DOI: 10.1016/j.ssmph.2023.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Understanding how structural racism, including institutionalized practices such as redlining, influence persistent inequities in health and neighborhood conditions is still emerging in urban health research. Such research often focuses on historical practices, giving the impression that such practices are a thing of the past. However, mortgage lending bias can be readily detected in contemporary datasets and is an active form of structural racism with implications for health and wellbeing. The objective of the current study was to test for associations among multiple measures of mental health and a measure of contemporary redlining. We linked a redlining index constructed using Home Mortgage Disclosure Act data (2007-2013) to 2021 health data for Black/African American participants in the Study of Active Neighborhoods in Detroit (n = 220 with address data). We used multilevel regression models to examine the relationship between redlining and a suite of mental health outcomes (perceived stress, anxiety, depressive symptoms, and satisfaction with life), accounting for covariates including racial composition of the neighborhood. We considered three mediating factors: perceived neighborhood cohesion, aesthetics, and discrimination. Although all participants lived in redlined neighborhoods compared to the complete Detroit Metropolitan area, participants with very low income, low levels of experienced discrimination, and lower perceptions of neighborhood aesthetics resided in highly redlined neighborhoods (score ≥5). We observed that higher resident-reported neighborhood aesthetics were found in neighborhoods with lower redlining scores and were associated with higher levels of satisfaction with life. We found that lower levels of redlining were significantly associated with higher levels of perceived discrimination, which was significantly, positively associated with anxiety, depressive symptoms, and perceived stress scores. Our findings highlight that contemporary redlining practices may influence the aesthetics of the built environment because these neighborhoods experience less investment, with implications for residents' satisfaction with life. However, areas with lower redlining may be areas where Black/African American people experience increased perceived discrimination.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Michigan State University, East Lansing, MI, 48824, USA
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, Ottawa, K1S 5B6, Canada
| | - Teresa H. Horton
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Kirsten M.M. Beyer
- Institute for Health & Equity, Medical College Wisconsin, Milwaukee, WI, 53226, USA
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Aladel A, Dakhakhni B, Almuhtadi Y, Alsheweir A, Aljammaz S. Effect of Weight Self-Stigma on Quality of Life and Dietary Habits among Adult Students in Riyadh, Saudi Arabia. Healthcare (Basel) 2023; 11:1754. [PMID: 37372872 DOI: 10.3390/healthcare11121754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Weight self-stigma (WSS) is a personal experience of negative self-evaluations, perceived discrimination, and shame about body weight. Studies suggested that WSS could negatively affect quality of life, eating behavior, and psychological outcomes. WSS has been linked with a number of obesogenic health outcomes that complicate weight loss interventions. Thus, this study aimed to examine the effect of WSS on the quality of life and dietary habits among adult students. A sample of 385 students from Riyadh universities participated in this cross-sectional study and completed three online questionnaires: the WSS questionnaire, the WHO quality of life questionnaire, and a dietary habit questionnaire. The average age of participants was 24 ± 6.74, and the majority were female (78.4%). Results demonstrated a negative association between all QOL domains and WSS (p < 0.001). Moreover, higher BMI is associated with increased self-devaluation and fear of enacted stigma (p < 0.001). There was also a negative link between both quality and quantity of food with WSS (p < 0.01). No significant difference was seen in study outcomes concerning gender. The findings of this study suggest the importance of increasing awareness about the negative impact of WSS and developing social policies to prevent or decrease it. Additionally, multidisciplinary teams, especially dietitians, should be more aware of WSS when dealing with overweight and obese individuals.
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Affiliation(s)
- Alanoud Aladel
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Badeeah Dakhakhni
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Yara Almuhtadi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Azzah Alsheweir
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sadeem Aljammaz
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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8
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Abstract
The substantial literature on interactions between places/spaces and well-being/health often differentiate between physical and social aspects of geographical location. This paper sidesteps this dualism, instead considering places as sociomaterial assemblages of human and non-human materialities. It uses this posthuman and 'new materialist' perspective to explore how place-assemblages affect human capacities, in terms of both health and social dis/advantage. Based on secondary analysis of interview data on human/place interactions, it analyses the physical, sociocultural, psychological and emotional effects of place-assemblages, assessing how these produce opportunities for, and constraints upon human bodies. It than assesses how these emergent capacities affect both social dis/advantage and well-being. This analysis of how place-assemblages contribute positively or negatively to health and dis/advantage offers possibilities for further research and for social and public health policy.
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Affiliation(s)
- Nick J. Fox
- Nick J. Fox, University of
Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
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9
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Vorobyova A, Braley MS, Burgess H, Grieve S, Lyndon S, Wesseling T, Parashar S. Depressive symptoms among people living with HIV in permanent supportive housing: Findings from a community-based participatory study in Vancouver, Canada. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3778-3791. [PMID: 35579573 DOI: 10.1002/jcop.22871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
Permanent supportive housing (PSH) is an intervention addressing housing needs among marginally housed individuals. Little is known about whether and how PSH influences depressive symptoms among people living with HIV (PLHIV). This article shares results from a community-based study that, in 2016-2017, interviewed 24 residents of a PSH facility designated for PLHIV in Vancouver, Canada. The themes of taking control; social connectedness; conviviality; and relationships and supports described how the PSH environment affected depressive symptoms among the residents.
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Affiliation(s)
- Anna Vorobyova
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - McKenzie S Braley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Heather Burgess
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sean Grieve
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Sharyle Lyndon
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tim Wesseling
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Surita Parashar
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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10
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Schwartz GL, Wang G, Kershaw KN, McGowan C, Kim MH, Hamad R. The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans. Health Place 2022; 77:102904. [PMID: 36063651 PMCID: PMC10166594 DOI: 10.1016/j.healthplace.2022.102904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/10/2023]
Abstract
Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.
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Affiliation(s)
- Gabriel L Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States.
| | - Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N Kershaw
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
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11
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Shortt NK, Ross C. Children's perceptions of environment and health in two Scottish neighbourhoods. Soc Sci Med 2021; 283:114186. [PMID: 34246858 PMCID: PMC8350146 DOI: 10.1016/j.socscimed.2021.114186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/02/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
This article explores children's understanding of the role that neighbourhood plays in their health and well-being. Whilst evidence exists on the relationship between the environment and children's health, we have little knowledge of this from the perspective of children themselves. Children's experiences are all too frequently researched through the eyes of adults. Following a Rights of the Child framework, respecting children's views and giving them due weight, this paper reports from a project that worked with children from two relatively deprived urban neighbourhoods in Scotland. Using this framework, the children themselves were the researchers who designed the themes, decided upon the methods, conducted the research and analysed the resulting data. Using focus groups, visual mapping and community walks the children explored their local neighbourhoods and the findings reveal features of the environment that the children perceive as important for their health and well-being. The children selected three themes to explore in the research: safety, littering, and family and friends, through which they elicit their experiences, feelings and attitudes towards the environment and their well-being. The paper reveals that not only do the children have a deep understanding of the link between environment and health, but that they also understand how aspects of disadvantage, including place-based stigma, can limit their social participation and inclusion in society. We conclude with recommendations made by the children themselves, ranging from access to affordable activities, improved open spaces, 'support not stigma' and the need to be heard in local decision making.
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Affiliation(s)
- Niamh K Shortt
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Scotland, EH8 9XP, United Kingdom.
| | - Chris Ross
- Children in Scotland, Edinburgh, Scotland, EH12 5EZ, United Kingdom.
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12
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Halliday E, Popay J, Anderson de Cuevas R, Wheeler P. The elephant in the room? Why spatial stigma does not receive the public health attention it deserves. J Public Health (Oxf) 2021; 42:38-43. [PMID: 30576532 DOI: 10.1093/pubmed/fdy214] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/10/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
In the context of health inequalities, spatial stigma refers to the ways that areas experiencing socioeconomic inequalities become negatively portrayed and labelled in public, official and policy discourses. With respect to the body of research on social determinants of health and health inequalities, and attention accorded to this issue in policy or practice, spatial stigma remains significantly under-represented compared with other possible causal factors. We suggest three explanations contributing to this neglect. First, the lack of research into spatial stigma originates from a more limited public health focus on the symbolic meanings of places for health, compared to their physical and social dimensions. Second, lay involvement and evidence of lived experiences of health inequalities continues to be under-represented in public health decision-making. Finally, it is the case that public health organizations may also be contributing to negative area portrayals in their communications of health inequalities. There are growing examples of social action being taken by groups of residents to resist this stigma through the promotion of more positive portrayals of areas and communities. Greater public health attention to this issue as well is likely to result in health gains and aid the development of more effective health inequalities strategies.
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Affiliation(s)
- Emma Halliday
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jennie Popay
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Paula Wheeler
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.,Collaboration for Leadership in Applied Health Research and Care North West Coast, UK
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13
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Pérez M. ‘Min Al-Mukhayyam’ (‘From the Camp’). ANTHROPOLOGY OF THE MIDDLE EAST 2021. [DOI: 10.3167/ame.2021.160102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article examines the implications of long-term encampment and exile for the meaning of Palestinian identity amongst refugees. It shows how the conditions of Palestinian camps in Jordan function as a key marker of social difference between refugees of the camps and the city. Whereas camp refugees see the hardships of camp life as conditions to be confronted, urban refugees take them as constitutive features of a socially distinct refugee. As I argue, the distinctions between camp and city refugees illustrate how the refugee category and the humanitarian camp exceed the ideology and function of humanitarianism. They demonstrate how, in protracted refugee situations, the refugee label and the historical context of the camp can become socially significant and contested features of identity.
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14
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Evidence that loneliness can be reduced by a whole-of-community intervention to increase neighbourhood identification. Soc Sci Med 2021; 277:113909. [PMID: 33866082 DOI: 10.1016/j.socscimed.2021.113909] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
RATIONALE Social identification with the people in one's neighbourhood has a wide variety of benefits for individual and community health and wellbeing. In particular, previous research shows that residents' social identification with their neighbourhood is protective of mental health. However, researchers are only just beginning to design and evaluate interventions that directly target social identification on health grounds. OBJECTIVE This longitudinal study evaluated a whole-of-community intervention at scale (Neighbour Day, 2019), in which Australian residents were encouraged to build social connections in their local community. Neighbour Day is a campaign that seeks to raise public awareness of the importance of connecting with neighbours and had a reach of approximately 300,000 people in 2019. METHODS Participants were 437 hosts of neighbourhood events held across 276 diverse suburbs across Australia. Participants were surveyed at three-time points; before and after Neighbour Day, as well as at six-month follow up. RESULTS Hosting a Neighbour Day event led to a significant increase in neighbourhood social identification, which was sustained six months later. This increase in social identification predicted increased social cohesion, reduced loneliness and improved wellbeing. CONCLUSIONS This study provides evidence that neighbourhood identification is an effective target mechanism to curb loneliness and social fragmentation in the community. Implications are discussed with a focus on how social identity-building interventions can be effectively implemented in community settings to benefit public health.
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'It is surprising how much nonsense you hear': How residents experience and react to living in a stigmatised place. A narrative synthesis of the qualitative evidence. Health Place 2021; 68:102525. [PMID: 33571896 DOI: 10.1016/j.healthplace.2021.102525] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 12/29/2022]
Abstract
There are significant geographical inequalities in health. Spatial stigma - negative representations of particular localities - could be an important mechanism through which place influences population health. To explore this, we undertook a narrative synthesis of studies reporting residents' perspectives of living in stigmatised localities. Qualitative research (38 studies) was reviewed to identify how spatial stigma manifested in residents' lives, their strategies to cope with stigma and the health consequences. The review found residents internalised stigma, but also resisted it differently. Although relatively few studies purposefully investigated health, living somewhere stigmatised had psychological effects and constrained life opportunities that have implications for health.
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16
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Scott D. Stigma in place: Black gay men's experiences of the rural South. Health Place 2021; 68:102515. [PMID: 33515909 DOI: 10.1016/j.healthplace.2021.102515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Black gay men (MSM) in the rural United States South are inequitably burdened by stigmatization and the HIV epidemic. Drawing from twelve oral history interviews with middle-aged and older Black gay narrators from rural North Carolina, this research explores the impact of sexual marginalization and the HIV epidemic on lived experiences of the rural South. Despite describing increasingly empowered views of HIV and sexual health, narrators expressed persistent difficulty managing social determinants of HIV vulnerability-sexual stigma and disconnection from LGBTQ collectivity. Narrators reported better managing sexual marginalization over their lifetimes in urban settings and places outside of the South such as New York (NY). This research suggests stressful structural and interpersonal experiences of stigma may define lived experiences of particular settings.
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Affiliation(s)
- Darius Scott
- Department of Geography, Dartmouth College Hanover, New Hampshire, 03755, USA.
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17
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My neighborhood has a good reputation: Associations between spatial stigma and health. Health Place 2020; 64:102392. [PMID: 32838899 DOI: 10.1016/j.healthplace.2020.102392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022]
Abstract
Health researchers increasingly recognize the influence of spatial stigma, or negative reputation of place, as a social determinant of health. Drawing from a New Haven-based cohort study (n = 251), we assessed the relationships between spatial stigma, self-rated health, and psychological distress using generalized estimating equation models. Adjusting for neighborhood-level poverty and racial composition, those who perceived living in spatially stigmatized neighborhoods were significantly more likely to report severe psychological distress compared to those that did not perceive their neighborhoods to be stigmatized (B = 1.09, CI: 0.31, 1.87). Our findings contribute to a growing body of literature that suggests that socially constructed meanings of place may influence health.
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18
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Denney JT, Brewer M, Kimbro RT. Food insecurity in households with young children: A test of contextual congruence. Soc Sci Med 2020; 263:113275. [PMID: 32823047 PMCID: PMC7413049 DOI: 10.1016/j.socscimed.2020.113275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/03/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Abstract
Household food insecurity, an inability to provide adequate nutrition for a healthy, active lifestyle, affects nearly 1 in 7 households with children in the United States. Though rates of food insecurity declined to pre-recession levels just prior to the COVID-19 pandemic, they are now once again increasing. As a result, in one of the wealthiest countries in the world, millions of young children continue to grow up in households that struggle daily with a problem that is often associated with the developing world. The result is both immediate and long-term health and development deficits for children. We propose that the degree of demographic and socioeconomic congruence between the households of young children and their neighborhood of residence lends unique insights to food insecurity. We examine this using the ECLS-K 2010-2011 for children in families with incomes below 400 percent of the federal poverty line (N = 8600). Results show that congruence between household and neighborhood education and race/ethnicity associates with the likelihood of experiencing food insecurity. For example, households with non-Hispanic black children living in neighborhoods with high proportions of non-Hispanic blacks have significantly lower probabilities of food insecurity than similar households living in neighborhoods with smaller black populations. Similarly, more highly educated families experience lower probability of food insecurity in high education neighborhoods than when they reside in low education neighborhoods. Focusing on neighborhood risk factors as absolute and independent contributors limits our understanding of how families experience food insecurity as well as any policy efforts to address it.
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Affiliation(s)
- Justin T Denney
- Washington State University, 100 Dairy Rd., Department of Sociology, Pullman, WA, 99164, USA.
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19
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Vincens N, Stafström M, Ferreira E, Emmelin M. Constructing social identity through multiple "us and them": a grounded theory study of how contextual factors are manifested in the lives of residents of a vulnerable district in Brazil. Int J Equity Health 2020; 19:83. [PMID: 32503531 PMCID: PMC7275441 DOI: 10.1186/s12939-020-01196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
The association between contextual factors and health inequalities is well documented, also in Brazil. However, questions about how contextual factors actually affect health and well-being persist. The aim of this qualitative study was to explore how contextual factors—i.e., social stratification and neighborhood opportunity structures—are manifested in the lives of the residents of a vulnerable district in Brazil. We used a Constructivist Grounded Theory approach based on 12 in-depth interviews. The core category constructing social identity through multiple “us and them” is supported by eight main categories that characterize different pairs of “us and them”, based on internal and external aspects of the social processes involved. Our findings strengthen and support the links between contextual factors and health inequalities, highlighting the relevance of downward social comparison, territorial segregation and stigmatization and erosion of social capital in the construction of social identities and the manifestation of social hierarchies and neighborhood structures in the Brazilian context. Ultimately, these create shame and stress but also pride and empowerment, which are recognized determinants of health inequities.
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Affiliation(s)
- Natalia Vincens
- Division of Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. .,Occupational and Environmental Health, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. .,CAPES Foundation, Ministry of Education of Brazil, Brasilia, DF, Brazil.
| | - Martin Stafström
- Division of Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Efigênia Ferreira
- Department of Social and Preventive Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Emmelin
- Division of Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
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20
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Romadhon DI. A critical comparative ethnographic study of courtesy stigma in two leprosy-impacted communities in Indonesia. Glob Public Health 2020; 15:1030-1039. [PMID: 31971879 DOI: 10.1080/17441692.2020.1718734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Leprosy stigma is more neglected than the disease itself since global interventions towards leprosy are focused on the medicalisation of individual-sufferers and statistical counting of documented cases and less prioritising the impact of leprosy stigma towards society. This paper examines the impact of courtesy stigma on society through comparative ethnographic method conducted in two sites in East Java Province, Indonesia. Investigation in the first site, Mandangin Island, found that the island suffers underdevelopment of public facilities such as clinics and clean water and migration and medical knowledge bottlenecks. In the second site, Sumberglagah village, leprosy patients and the community they live with are also socially separated from the locals and they are engaged in controversial businesses exploiting the public fear of leprosy. This study finds that leprosy stigma in two leprosy-impacted communities in East Java, Indonesia, does not only isolate individuals but also a whole community from a bigger society regardless of whether all of the community members have leprosy. This study also detects problems related to leprosy education within the two impacted communities. It is suggested that efforts to address the problems require holistic approaches and commitments from various actors in the area in complement to existing global health missions.
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21
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Visceral Encounters: A Political Ecology of Urban Land, Food, and Housing in Dubuque, Iowa. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8040122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Through a praxis of co-authorship between a university scholar and two community gardeners/organizers/activists, this article showcases the ways in which knowledge, practices, and relationalities emergent in community gardens in Dubuque, Iowa USA directly engage with the politics of food, land, and housing. The authors engage in co-authorship across university and community boundaries to ontologically reframe knowledge production and draw critical attention to the everyday livelihoods and political ecologies experienced within marginalized communities. We use extended conversations and interviews to analyze the food, land, and housing issues that emerge in the context of uneven racial relations and neighborhood revitalization. We then organize our analysis using a Political Ecology of the Body (PEB) framework to consider how people’s bodily, emotional, and social lives impact their relationalities with food, gardening, and neighborhood spaces. Our findings show that community gardening efforts are transforming the Washington and North End neighborhoods—even if these changes appear to outsiders to be small-scale or difficult to measure—while also calling attention to the anti-oppression and anti-racism work that remains to be done. Our co-authorship demonstrates how community gardeners and university partners can work together to contest histories of marginalization and foster more socially just relations.
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22
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'It's like being in Tattooville': An ethnographic study of territorial stigma and health in a post-industrial town in the North East of England. Health Place 2018; 54:229-235. [PMID: 30388457 DOI: 10.1016/j.healthplace.2018.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2022]
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23
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Shankardass K, Robertson C, Shaughnessy K, Sykora M, Feick R. A unified ecological framework for studying effects of digital places on well-being. Soc Sci Med 2018; 227:119-127. [PMID: 30287115 DOI: 10.1016/j.socscimed.2018.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/13/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
Abstract
Social media has greatly expanded opportunities to study place and well-being through the availability of human expressions tagged with physical location. Such research often uses social media content to study how specific places in the offline world influence well-being without acknowledging that digital platforms (e.g., Twitter, Facebook, Youtube, Yelp) are designed in unique ways that structure certain types of interactions in online and offline worlds, which can influence place-making and well-being. To expand our understanding of the mechanisms that influence social media expressions about well-being, we describe an ecological framework of person-place interactions that asks, "at what broad levels of interaction with digital platforms and physical environments do effects on well-being manifest?" The person is at the centre of the ecological framework to recognize how people define and organize both digital and physical communities and interactions. The relevance of interactions in physical environments depends on the built and natural characteristics encountered across modes of activity (e.g., domestic, work, study). Here, social interactions are stratified into the meso-social (e.g., local social norms) and micro-social (e.g., personal conversations) levels. The relevance of interactions in digital platforms is contingent on specific hardware and software elements. Social interactions at the meso-social level include platform norms and passive use of social media, such as observing the expressions of others, whereas interactions at the micro-level include more active uses, like direct messaging. Digital platforms are accessed in a physical location, and physical locations are partly experienced through online interactions; therefore, interactions between these environments are also acknowledged. We conclude by discussing the strengths and limitations of applying the framework to studies of place and well-being.
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Affiliation(s)
- Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Ave W, Waterloo, Ontario, Canada, N2L 3C5.
| | - Colin Robertson
- Department of Geography and Environmental Studies, Wilfrid Laurier University, 75 University Ave W, Waterloo, Ontario, N2L 3C5, Canada.
| | - Krystelle Shaughnessy
- Department of Psychology, Faculty of Social Sciences, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada.
| | - Martin Sykora
- Centre for Information Management, School of Business and Economics, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK.
| | - Rob Feick
- School of Planning, University of Waterloo, Ring Rd, Waterloo, Ontario, N2L 3G1, Canada.
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24
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Felner JK, Dudley TD, Ramirez-Valles J. "Anywhere but here": Querying spatial stigma as a social determinant of health among youth of color accessing LGBTQ services in Chicago's Boystown. Soc Sci Med 2018; 213:181-189. [PMID: 30099259 DOI: 10.1016/j.socscimed.2018.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022]
Abstract
The link between stigma and negative health outcomes is established, yet available research infrequently considers the complex intersection of place, race, and class-based stigma and how this stigma shapes opportunities and health among marginalized groups. Furthermore, scholarship on the relationship between stigma and health often fails to include the voices of the stigmatized themselves. This exclusion renders their lived-experiences hidden and their insight devalued, producing findings with limited validity to promote health equity and social change. In this article, we explore intersecting place, race, and class-based stigmas, or spatial stigma, as a social determinant of health among youth of color (YoC) accessing LGBTQ-specific services in the Chicago's White, middle-class gay enclave, Boystown. Qualitative data were collected within the context of a youth participatory action research study with 11 youth researchers (ages 18-24). Data sources included critical autoethnography, focus groups with current and former LGBTQ service patrons, and individual interviews with LGBTQ service providers. Emergent thematic patterns illuminate how the stigmatization of YoC based on place, race, and class (i.e., being from poor and low-income, racialized South and West sides communities) impacts their opportunities in the neighborhood and access to health-supporting resources. These findings may be useful for practitioners and policy makers who aim to promote health equity among marginalized young people and add to the growing body of literature on health effects of spatial stigma among marginalized communities.
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Affiliation(s)
- Jennifer K Felner
- San Diego State University, Institute for Behavioral and Community Health, Center for Research on Sexuality and Sexual Health, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123, USA.
| | - Terry D Dudley
- Howard Brown Health Center, 4025 N. Sheridan Road Chicago, IL, 60613, USA
| | - Jesus Ramirez-Valles
- San Francisco State University, Health Equity Institute, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
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25
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Keene DE, Smoyer AB, Blankenship KM. Stigma, housing and identity after prison. THE SOCIOLOGICAL REVIEW 2018; 66:799-815. [PMID: 32855574 PMCID: PMC7449251 DOI: 10.1177/0038026118777447] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Existing research suggests that individuals who are released from prison face considerable challenges in obtaining access to safe, stable, and affordable places to live and call home. This article draws on repeated qualitative interviews (conducted every 6 months over a period of 3 years) with 44 formerly incarcerated individuals, to understand how these individuals experience the search for a home after their prison release. The interviews show that the quest for a home is central to participants' reintegration projects as they seek to establish themselves as 'decent' and economically self-sufficient citizens, and shed stigmatized identities associated with incarceration, poverty, homelessness, and place. Interviews also suggest that their quest for a home is an arduous one as they encounter numerous barriers to housing arising from both structural and interpersonal forms of incarceration stigma. Somewhat paradoxically, the challenges that they face in accessing housing seem to hinder their ability to shed the stigmatized identities associated with their incarceration. Ultimately, the narratives presented here show how stigma can restrict access to a valuable material and symbolic resource (housing), resulting in ongoing stigmatization, and contributing to the enduring and discrediting mark of incarceration. In this way, the study illustrates how stigma that is enacted by both individuals and the state, that is embodied in place, and that is internalized and managed by stigmatized individuals themselves, can work to reproduce power and serve as justification for inequality.
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Casualties of context? Risk of cognitive, behavioral and physical health difficulties among children living in high-incarceration neighborhoods. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0942-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Vincens N, Emmelin M, Stafström M. The interplay of contextual layers: A multilevel analysis of income distribution, neighborhood infrastructure, socioeconomic position and self-rated health in Brazil. Health Place 2018; 52:155-162. [PMID: 29894906 DOI: 10.1016/j.healthplace.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/15/2022]
Abstract
Our hypothesis is that neighborhood infrastructure modifies the association between state-level income distribution and self-rated health. In our findings neighborhood infrastructure amplifies the association between income equality and self-rated health, yet with a differential impact on health according to sex, race and education level favoring individuals at higher socioeconomic positions. Most of the individual health variation attributed to context happens at neighborhood level, based on random effects analyses. Our findings contribute to a further understanding of health inequalities in Brazil. The demonstrated synergism between state, neighborhood and individual level determinants of health supports inter-sectoral policies and interventions in a clearly multileveled way.
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Affiliation(s)
- Natalia Vincens
- Lund University, Social Medicine and Global Health, Malmö, Sweden; CAPES Foundation, Ministry of Education of Brazil, Brasilia, DF, Brazil.
| | - Maria Emmelin
- Lund University, Social Medicine and Global Health, Malmö, Sweden
| | - Martin Stafström
- Lund University, Social Medicine and Global Health, Malmö, Sweden
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28
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Haley DF, Linton S, Luo R, Hunter-Jones J, Adimora AA, Wingood GM, Bonney L, Ross Z, Cooper HL. Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care. J Health Care Poor Underserved 2018; 28:315-328. [PMID: 28239005 DOI: 10.1353/hpu.2017.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. METHODS We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. RESULTS Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). CONCLUSION These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.
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Ruff RR, Ng J, Jean-Louis G, Elbel B, Chaix B, Duncan DT. Neighborhood Stigma and Sleep: Findings from a Pilot Study of Low-Income Housing Residents in New York City. Behav Med 2018; 44:48-53. [PMID: 27492685 DOI: 10.1080/08964289.2016.1203754] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The primary objective of this study was to investigate the relationship between neighborhood stigma and sleep in a sample of low-income housing residents in New York City. Data were derived from the NYC Low-Income Housing, Neighborhoods, and Health Study (N = 120). Adults living in low-income housing completed a survey consisting of measures of neighborhood stigma, sleep quality, and sleep duration. Neighborhood stigma and sleep were self-reported. Associations between neighborhood stigma and sleep health were analyzed using generalized linear models with cluster variance estimation. Multivariable models adjusted for age, gender, race/ethnicity, income, education, employment status, obesity, the census block percentage of non-Hispanic black residents, and the census block percentage median household income. Results indicate that a reported negative media perception of the neighborhood was negatively associated with sleep quality and duration (p < 0.01). However, additional research is needed to explore neighborhood stigma as it relates to sleep.
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Affiliation(s)
- Ryan Richard Ruff
- a New York University College of Dentistry and New York University College of Global Public Health
| | - Jeannie Ng
- b New York University College of Global Public Health
| | | | - Brian Elbel
- d New York University School of Medicine and New York University Wagner Graduate School of Public Service
| | - Basile Chaix
- e Sorbonne Universités and Pierre Louis Institute of Epidemiology and Public Health
| | - Dustin T Duncan
- f New York University School of Medicine, New York University College of Global Public Health, and New York University Center for Data Science
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30
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Cain DN, Mirzayi C, Rendina HJ, Ventuneac A, Grov C, Parsons JT. Mediating Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health Among Gay and Bisexual Men. LGBT Health 2017; 4:352-359. [PMID: 28792886 DOI: 10.1089/lgbt.2017.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Depression negatively impacts the health and well-being of gay and bisexual men (GBM). However, little is known about the contexts in which rural GBM live relative to those living in urban areas and their overall mental health. The aim of this study was to examine associations between population density and depressive symptoms and the role of internalized homonegativity and social support as potential mediators. METHODS A nationally representative sample of 1071 GBM (mean age = 40.24) was enrolled. Participants provided their zip codes, which were categorized according to population density and rank-normalized. RESULTS In a path analysis model adjusted for race/ethnicity, college education, age, and relationship status, higher population density was significantly associated with increased social support (B = 0.11, P = 0.002) and decreased internalized homonegativity (B = -0.06, P < 0.001). In turn, lower social support (B = -2.93, P < 0.001) and greater internalized homonegativity (B = 4.93, P < 0.001) were significantly associated with greater depressive symptoms. The indirect effects of population density on depression through social support (B = -0.33, P < 0.001) and internalized homonegativity (B = -0.31, P < 0.001) were statistically significant, suggesting evidence for mediation of the effects. CONCLUSIONS These results indicate that living in less inhabited areas acts on depressive symptoms through mechanisms of lower social support and higher internalized homonegativity. These findings suggest that social contexts in which GBM live can affect mental health outcomes and indicate the need for further support and inclusion of GBM, especially in less inhabited areas.
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Affiliation(s)
- Demetria N Cain
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,2 Community Health Sciences Doctoral Program, Community Health Sciences, University of Illinois at Chicago School of Public Health , Chicago, Illinois
| | - Chloe Mirzayi
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,3 Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy , New York, New York
| | - H Jonathon Rendina
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,4 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.,5 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York
| | - Ana Ventuneac
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,6 Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Christian Grov
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,3 Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy , New York, New York
| | - Jeffrey T Parsons
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,4 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.,5 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York
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31
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Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol 2017; 46:839-849. [PMID: 28115577 PMCID: PMC5837605 DOI: 10.1093/ije/dyw346] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/30/2022] Open
Abstract
Background Growing evidence indicates that immigration policy and enforcement adversely affect the well-being of Latino immigrants, but fewer studies examine 'spillover effects' on USA-born Latinos. Immigration enforcement is often diffuse, covert and difficult to measure. By contrast, the federal immigration raid in Postville, Iowa, in 2008 was, at the time, the largest single-site federal immigration raid in US history. Methods We employed a quasi-experimental design, examining ethnicity-specific patterns in birth outcomes before and after the Postville raid. We analysed Iowa birth-certificate data to compare risk of term and preterm low birthweight (LBW), by ethnicity and nativity, in the 37 weeks following the raid to the same 37-week period the previous year ( n = 52 344). We model risk of adverse birth outcomes using modified Poisson regression and model distribution of birthweight using quantile regression. Results Infants born to Latina mothers had a 24% greater risk of LBW after the raid when compared with the same period 1 year earlier [risk ratio (95% confidence interval) = 1.24 (0.98, 1.57)]. No such change was observed among infants born to non-Latina White mothers. Increased risk of LBW was observed for USA-born and immigrant Latina mothers. The association between raid timing and LBW was stronger among term than preterm births. Changes in birthweight after the raid primarily reflected decreased birthweight below the 5th percentile of the distribution, not a shift in mean birthweight. Conclusions Our findings highlight the implications of racialized stressors not only for the health of Latino immigrants, but also for USA-born co-ethnics.
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Affiliation(s)
- Nicole L Novak
- Department of Epidemiology, University of Michigan School of Public Health,
Ann Arbor, MI, USA
| | - Arline T Geronimus
- Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI, USA
- Population Studies Center, Institute for Social Research, University of
Michigan, Ann Arbor, MI, USA
| | - Aresha M Martinez-Cardoso
- Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI, USA
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Bozinoff N, Small W, Long C, DeBeck K, Fast D. Still "at risk": An examination of how street-involved young people understand, experience, and engage with "harm reduction" in Vancouver's inner city. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 45:33-39. [PMID: 28578217 DOI: 10.1016/j.drugpo.2017.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/17/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. To better understand this in the context of the intensive public health response, we examined how young people, who are involved in the 'street drug scene', understood, experienced and engaged with harm reduction. METHODS Twelve semi-structured interviews were conducted in 2013 with 13 young people (ages 17-28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants' understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed. RESULTS Young peoples' ideas about harm reduction were diverse and expansive. They articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples' broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempting to gain access to drug treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver's Downtown Eastside) strongly determined access to services. CONCLUSIONS In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples' multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing infrastructure in improving their broader life chances.
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Affiliation(s)
- Nikki Bozinoff
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Cathy Long
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Public Policy, Simon Fraser University, Harbour Centre, 515 West Hastings Street, Vancouver, BC V6 B 5K3, Canada
| | - Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Abstract
Precarious employment is on the rise in Canada, increasing by nearly 50% in the last two decades. However, little is known about the mechanisms by which it can impact upon geographical mobility. Employment-related geographical mobility refers to mobility to, from and between workplaces, as well as mobility as part of work. We report on a qualitative study conducted among 27 immigrant men and women in Toronto that investigates the relationship between precarious employment and daily commutes while exploring the ways in which gender, class and migration structure this relationship.
Interview data reveal that participants were largely unable to work where they lived or live where they worked. Their precarious jobs were characterized by conditions that resulted in long, complex, unfamiliar, unsafe and expensive commutes. These commuting difficulties, in turn, resulted in participants having to refuse or quit jobs, including desirable jobs, or being unable to engage in labour market strategies that could improve their employment conditions (e.g. taking courses, volunteering, etc.). Participants’ commuting difficulties were amplified by the delays, infrequency, unavailability and high cost of public transportation. These dynamics disproportionately and/or differentially impacted certain groups of workers.
Precarious work has led to workers having to absorb an ever-growing share of the costs associated with their employment, underscored in our study as time, effort and money spent travelling to and from work. We discuss the forces that underlie the spatial patterning of work and workers in Toronto, namely the growing income gap and the increased polarization among neighbourhoods that has resulted in low-income immigrants increasingly moving from the centre to the edges of the city. We propose policy recommendations for public transportation, employment, housing and child care that can help alleviate some of the difficulties described.
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Affiliation(s)
- Stéphanie Premji
- Assistant Professor, School of Labour Studies, Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
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Smith-Morris C. Epidemiological placism in public health emergencies: Ebola in two Dallas neighborhoods. Soc Sci Med 2017; 179:106-114. [PMID: 28260635 DOI: 10.1016/j.socscimed.2017.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/11/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
Super-diverse cities face distinctive challenges during infectious disease outbreaks. For refugee and immigrant groups from epidemic source locations, identities of place blend with epidemiological logics in convoluted ways during these crises. This research investigated the relationships of place and stigma during the Dallas Ebola crisis. Ethnographic results illustrate how Africanness, more than neighborhood stigma, informed Dallas residents' experience of stigma. The problems of place-based stigma, the imprecision of epidemiological placism, and the cohesion of stigma to semiotically powerful levels of place - rather than to realistic risk categories - are discussed. Taking its authority from epidemiology, placism is an important source of potential stigma with critical implications for the success of public health messaging.
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Affiliation(s)
- Carolyn Smith-Morris
- Department of Anthropology, Southern Methodist University, 3225 Daniel Boulevard, Heroy Building #415, Dallas, TX 75275, United States.
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Cooper HLF, Arriola KJ, Haardörfer R, McBride CM. Population-Attributable Risk Percentages for Racialized Risk Environments. Am J Public Health 2016; 106:1789-92. [PMID: 27552263 DOI: 10.2105/ajph.2016.303385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Research about relationships between place characteristics and racial/ethnic inequities in health has largely ignored conceptual advances about race and place within the discipline of geography. Research has also almost exclusively quantified these relationships using effect estimates (e.g., odds ratios), statistics that fail to adequately capture the full impact of place characteristics on inequities and thus undermine our ability to translate research into action. We draw on geography to further develop the concept of "racialized risk environments," and we argue for the routine calculation of race/ethnicity-specific population-attributable risk percentages.
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Affiliation(s)
- Hannah L F Cooper
- All of the authors are with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Kimberly Jacob Arriola
- All of the authors are with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Regine Haardörfer
- All of the authors are with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
| | - Colleen M McBride
- All of the authors are with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA
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Collins AB, Parashar S, Closson K, Turje RB, Strike C, McNeil R. Navigating identity, territorial stigma, and HIV care services in Vancouver, Canada: A qualitative study. Health Place 2016; 40:169-77. [PMID: 27341275 DOI: 10.1016/j.healthplace.2016.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/20/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022]
Abstract
This study examines the influence of territorial stigma on access to HIV care and other support services. Qualitative interviews were conducted with thirty people living with HIV (PLHIV) who use drugs recruited from the Dr. Peter Centre (DPC), an HIV care facility located in Vancouver, Canada's West End neighbourhood that operates under a harm reduction approach. Findings demonstrated that territorial stigma can undermine access to critical support services and resources in spatially stigmatized neighbourhoods among PLHIV who use drugs who have relocated elsewhere. Furthermore, PLHIV moving from spatially stigmatized neighbourhoods - in this case, Vancouver's Downtown Eastside - to access HIV care services experienced tension with different groups at the DPC (e.g., men who have sex with me, people who use drugs), as these groups sought to define who constituted a'normative' client. Collectively, these findings demonstrate the urgent need to consider the siting of HIV care services as the epidemic evolves.
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Affiliation(s)
| | | | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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‘It’s not that bad’: Stigma, health, and place in a post-industrial community. Health Place 2016; 38:1-7. [DOI: 10.1016/j.healthplace.2015.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022]
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Graham LF, Padilla MB, Lopez WD, Stern AM, Peterson J, Keene DE. Spatial Stigma and Health in Postindustrial Detroit. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 36:105-13. [DOI: 10.1177/0272684x15627800] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An emerging body of research suggests that those who reside in socially and economically marginalized places may be marked by a stigma of place, referred to as spatial stigma, which influences their sense of self, their daily experiences, and their relations with outsiders. Researchers conducted 60 semistructured interviews at partnering community-based organizations during summer 2011 with African American and Latina/o, structurally disadvantaged youth of diverse gender and sexual identities who were between 18 and 26 years of age residing in Detroit, Michigan. The disadvantaged structural conditions and dilapidated built environment were common themes in participants’ narratives. Beyond these descriptions, participants’ framings and expressions of their experiences in and perceptions of these spaces alluded to reputational qualities of their city and particular areas of their city that appear related to spatial stigma. Young Detroit residents articulated the ways that they experience and navigate the symbolic degradation of their city.
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Affiliation(s)
- Louis F. Graham
- Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USA
| | - Mark B. Padilla
- Global and Sociocultural Studies, Florida International University, Miami, FL, USA
| | - William D. Lopez
- Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alexandra M. Stern
- Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Danya E. Keene
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Keene DE. "We Need to Have a Meeting": Public Housing Demolition and Collective Agency in Atlanta, Georgia. HOUSING POLICY DEBATE 2015; 26:210-230. [PMID: 29321697 PMCID: PMC5758049 DOI: 10.1080/10511482.2015.1043837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The last two decades have witnessed widespread demolition of public housing and a large-scale relocation of public housing residents. Much of the current literature has examined the impact of demolition on relocated residents, focusing primarily on individual outcomes such as employment, housing quality, and health. This article examines the potential collective consequences of relocation by using data from 40 in-depth interviews conducted with relocated public housing residents in Atlanta, Georgia, to examine experiences of civic engagement and tenant activism before and after relocation. Participants describe frequent experiences of civic engagement and tenant activism in their public housing communities prior to demolition and also discuss how these collective actions often translated into meaningful gains for their communities. Participants also describe challenges associated with reestablishing these sources of collective agency in their new, post demolition, private-market rental communities where opportunities for civic engagement and tenant activism were perceived to be limited, where stigma was a barrier to social interaction, and where they experienced significant residential instability.
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Abstract
Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent Annual Review articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of "resurgence." Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV/AIDS, and race/ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced/received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds the scientific foundation for efforts to reduce intolerance.
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41
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McNeil R, Cooper H, Small W, Kerr T. Area restrictions, risk, harm, and health care access among people who use drugs in Vancouver, Canada: A spatially oriented qualitative study. Health Place 2015; 35:70-8. [PMID: 26241893 DOI: 10.1016/j.healthplace.2015.07.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 12/16/2022]
Abstract
Area restrictions prohibiting people from entering drug scenes or areas where they were arrested are a common socio-legal mechanism employed to regulate the spatial practices of people who use drugs (PWUD). To explore how socio-spatial patterns stemming from area restrictions shape risk, harm, and health care access, qualitative interviews and mapping exercises were conducted with 24 PWUD with area restrictions in Vancouver, Canada. Area restrictions disrupted access to health and social resources (e.g., HIV care) concentrated in drug scenes, while territorial stigma prevented PWUD from accessing supports in other neighborhoods. Rather than preventing involvement in drug-related activities, area restrictions displaced these activities to other locations and increased vulnerability to diverse risks and harms (e.g., unsafe drug use practices, violence). Given the harms stemming from area restrictions there is an urgent need to reconsider this socio-legal strategy.
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Affiliation(s)
- Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Hannah Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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42
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Geronimus AT, Pearson JA, Linnenbringer E, Schulz AJ, Reyes AG, Epel ES, Lin J, Blackburn EH. Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:199-224. [PMID: 25930147 PMCID: PMC4621968 DOI: 10.1177/0022146515582100] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Residents of distressed urban areas suffer early aging-related disease and excess mortality. Using a community-based participatory research approach in a collaboration between social researchers and cellular biologists, we collected a unique data set of 239 black, white, or Mexican adults from a stratified, multistage probability sample of three Detroit neighborhoods. We drew venous blood and measured telomere length (TL), an indicator of stress-mediated biological aging, linking respondents' TL to their community survey responses. We regressed TL on socioeconomic, psychosocial, neighborhood, and behavioral stressors, hypothesizing and finding an interaction between poverty and racial-ethnic group. Poor whites had shorter TL than nonpoor whites; poor and nonpoor blacks had equivalent TL; and poor Mexicans had longer TL than nonpoor Mexicans. Findings suggest unobserved heterogeneity bias is an important threat to the validity of estimates of TL differences by race-ethnicity. They point to health impacts of social identity as contingent, the products of structurally rooted biopsychosocial processes.
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Affiliation(s)
- Arline T Geronimus
- Stanford University, Stanford, CA, USA University of Michigan, Ann Arbor, MI, USA
| | | | - Erin Linnenbringer
- University of Michigan, Ann Arbor, MI, USA Washington University, St. Louis, MO, USA
| | | | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | - Elissa S Epel
- University of California San Francisco, San Francisco, CA, USA
| | - Jue Lin
- University of California San Francisco, San Francisco, CA, USA
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Singleton JL, Raunig M, Brunsteter H, Desmond M, Rao D. Identity, Physical Space, and Stigma Among African American Men Living with HIV in Chicago and Seattle. J Racial Ethn Health Disparities 2015; 2:548-55. [PMID: 26863561 DOI: 10.1007/s40615-015-0103-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/04/2015] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
African American men have the highest rates of HIV in the USA, and research has shown that stigma, mistrust of health care, and other psychosocial factors interfere with optimal engagement in care with this population. In order to further understand reducing stigma and other psychosocial issues among African American men, we conducted qualitative interviews and focus groups with African American men in two metropolitan areas in the USA: Chicago and Seattle. We examined transcripts for relationships across variables of stigma, anonymity, self-identity, and space within the context of HIV. Our analysis pointed to similarities between experiences of stigma across the two cities and illustrated the relationships between space, isolation, and preferred anonymity related to living with HIV. The men in our study often preferred that their HIV-linked identities remain invisible and anonymous, associated with perceived and created isolation from physical community spaces. This article suggests that our health care and housing institutions may influence preferences for anonymity. We make recommendations in key areas to create safer spaces for African American men living with HIV and reduce feelings of stigma and isolation.
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Affiliation(s)
- Judith L Singleton
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- School of Urban Public Health, Hunter College, City University of New York (CUNY), New York, NY, USA
| | - Manuela Raunig
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Halley Brunsteter
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Michelle Desmond
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Box 359931, 325 9th Ave, Seattle, WA, 98104, USA.
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Hatzenbuehler ML, Keyes K, Hamilton A, Uddin M, Galea S. The Collateral Damage of Mass Incarceration: Risk of Psychiatric Morbidity Among Nonincarcerated Residents of High-Incarceration Neighborhoods. Am J Public Health 2015; 105:138-143. [PMID: 25393200 DOI: 10.2105/ajph.2014.302184] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We examined whether residence in neighborhoods with high levels of incarceration is associated with psychiatric morbidity among nonincarcerated community members. Methods. We linked zip code-linked information on neighborhood prison admissions rates to individual-level data on mental health from the Detroit Neighborhood Health Study (2008-2012), a prospective probability sample of predominantly Black individuals. Results. Controlling for individual- and neighborhood-level risk factors, individuals living in neighborhoods with high prison admission rates were more likely to meet criteria for a current (odds ratio [OR] = 2.9; 95% confidence interval [CI] = 1.7, 5.5) and lifetime (OR = 2.5; 95% CI = 1.4, 4.6) major depressive disorder across the 3 waves of follow-up as well as current (OR = 2.1; 95% CI = 1.0, 4.2) and lifetime (OR = 2.3; 95% CI = 1.2, 4.5) generalized anxiety disorder than were individuals living in neighborhoods with low prison admission rates. These relationships between neighborhood-level incarceration and mental health were comparable for individuals with and without a personal history of incarceration. Conclusions. Incarceration may exert collateral damage on the mental health of individuals living in high-incarceration neighborhoods, suggesting that the public mental health impact of mass incarceration extends beyond those who are incarcerated.
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Affiliation(s)
- Mark L Hatzenbuehler
- Mark L. Hatzenbuehler is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Katherine Keyes, Ava Hamilton, and Sandro Galea are with the Department of Epidemiology, Mailman School of Public Health. Monica Uddin is with the Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
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45
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Wutich A, Ruth A, Brewis A, Boone C. Stigmatized Neighborhoods, Social Bonding, and Health. Med Anthropol Q 2014; 28:556-77. [DOI: 10.1111/maq.12124] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Amber Wutich
- School of Human Evolution and Social Change; Arizona State University
| | - Alissa Ruth
- School of Human Evolution and Social Change; Arizona State University
| | - Alexandra Brewis
- School of Human Evolution and Social Change; Arizona State University
| | - Christopher Boone
- School of Sustainability and School of Human Evolution and Social Change; Arizona State University
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48
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Keene DE, Ruel E. "Everyone called me grandma": Public housing demolition and relocation among older adults in Atlanta. CITIES (LONDON, ENGLAND) 2013; 35:10.1016/j.cities.2012.10.011. [PMID: 24187415 PMCID: PMC3811152 DOI: 10.1016/j.cities.2012.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Over the last few decades public and political dissatisfaction with public housing projects and an increasing emphasis on poverty deconcentration has led to the demolition of public housing in cities across the country. A significant body of literature has examined experiences of relocation from public housing and their implications for the well-being of individuals and communities. While much of this literature has focused on young or middle-aged adults and children, older adults have also been affected by demolition and relocation. The displacement of older adults raises a new set of age and life-course specific concerns for the well-being of this population. In this paper, we analyze the relocation narratives of 25 former public housing residents in Atlanta, Georgia. Our analysis focuses on the loss of geographically rooted communities of kinship, support and belonging that many participants, particularly those who have aged in place, attribute to their former developments. Participants describe many material and psychosocial benefits associated with living in communities that were "like families" and where they often held important roles as respected elders. While some were satisfied with their moves, others describe the dispersal of these "families" as a deeply felt loss. While some were able to draw on support from children and grandchildren in their new homes, others describe experiences of profound isolation after relocation.
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49
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The ‘blemish of place’: Stigma, geography and health inequalities. A commentary on Tabuchi, Fukuhara & Iso. Soc Sci Med 2012; 75:1921-4. [DOI: 10.1016/j.socscimed.2012.07.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/25/2012] [Indexed: 11/20/2022]
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50
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Tobin KE, Hester L, Davey-Rothwell MA, Latkin CA. An examination of spatial concentrations of sex exchange and sex exchange norms among drug users in Baltimore, Maryland. ACTA ACUST UNITED AC 2012; 102:1058-1066. [PMID: 23626374 DOI: 10.1080/00045608.2012.674902] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Baltimore, Maryland consistently ranks highest nationally in rates of sexually transmitted diseases and HIV infection. Prior studies have identified geographic areas where STI and HIV infection in the city is most prevalent. It is well established that sex exchange behavior is associated with HIV and STIs, yet it is not well understood how sex exchangers are spatially distributed within the high-risk areas. We sought to examine the spatial distribution of individuals who report sex exchange compared to those who do not exchange. Additionally we examined the spatial context of perceived norms about sex exchange. Data for the study came from a baseline sample of predominately injection drug users (n=842). Of these, 21% reported sex exchange in the prior 90 days. All valid baseline residential addresses of participants living within Baltimore city boundaries were geocoded. The Multi-Distance Spatial Cluster Analysis (Ripley's K-function) was used to separately calculate the K-functions for the addresses of participants reporting sex exchange or non-sex exchange, relative to the recruited population. Evidence of spatial clustering of sex exchangers was observed and norms aligned with these clusters. Of particular interest was the high density of sex exchangers in one specific housing complex of East Baltimore, which happens to be the oldest in Baltimore. These findings can inform targeted efforts for screening and testing for HIV and STIs and placement of both individual and structural level interventions that focus on increasing access to risk reduction materials and changing norms about risk behaviors.
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Affiliation(s)
- Karin Elizabeth Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Second floor, Baltimore, Maryland 21205, 410-502-5368, 410-502-5385 (fax)
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